Health & environmental impact assessment an integrated approach British Medical Association Earthscan 256 pages 14.95

All developers will in future be legally required to assess the impact of their activities on health, as well as on the environment, says the British Medical Association, in this comprehensive report. Written by a multi-disciplinary committee, its aims include 'challenging the way people think about impact assessment... and how this might be enhanced'.

As the authors point out, although Article 129 of the Maastricht Treaty requires the EU Commission to check policy proposals for their impact on health, there is no systematic way of doing so. The report describes a number of ways in which health impact assessments can be incorporated more explicitly into existing UK procedures for environmental impact assessment.

Various case studies are described, to show how existing EIAs frequently fail to assess the impact of new initiatives on health. The privatisation of the water industry, for example, has led to increased disconnections among poorer households, with all of the attendant health risks.

The studies end with a plea for health economists to broaden their horizons to include health promotion.

The book concludes with a series of recommendations intended to ensure that broader health considerations are fully considered at the planning stage of all future policies.

This is a valuable and timely contribution to a subject of rapidly growing importance, especially in view of the government's commitment, in the recent public health green papes, to assess the impact of its own policies on health. It therefore provides a useful checklist against which to measure the progress of their implementation.

This authoritative report is written for a broad audience, including doctors, environmental health officers, town planners, and local councillors. However, it would have had considerably greater impact if the implications of multi-disciplinary public health had been fully accepted by the BMA.

As the authors remind us, health, unlike medicine, is the responsibility of a great many professions and sectors; public health is, in fact, widely defined as, 'the promotion of health through the organised efforts of society'. It is therefore all the more irritating to have to wade through five pages of self-laudatory remarks about the BMA before we come to the report itself.

The BMA's cause is not helped either by a recommendation that the Environment Agency should appoint a medical officer with responsibility for health at each regional level - presumably the BMA has no time for non-medically qualified epidemiologists?

In contrast to the BMA's monopolistic approach (much against the spirit of the report), the Chartered Institute of Environmental Health arranged for its landmark Agendas for Change report on the future of environmental health to be produced by an independent, multi-disciplinary working party. The result was a publication which all of us can 'own' - whereas the BMA book reads in places like an in-house report to its members, even though at least half of the authors were not medically qualified.

Other shortcomings include the failure to mention the potential conflicts between health and environmental impact assessments - for example, over the imposition of VAT on fuel or the introduction of water meters. In both cases, the concept of environmental equity needs to be invoked to prevent sacrificing the health of the poor today in order to conserve resources for everyone tomorrow.

The numerous references to a person called the 'chief medical officer' (presumably the English version, but we have to guess), and the failure to recognise that the Our Healthier Nation green paper refers only to England, will substantially reduce its influence in other parts of the UK.

This is a major contribution to public health, even though it would have been better published as a report from an inter-disciplinary committee, supported by, but not part of, the BMA.

May the BMA be persuaded to initiate many more reports of this kind, on a truly inter-disciplinary, multi-sectoral and UK-basis.