Health, environmental assessments and population health: tools for a complex process.

Place is more than physical and natural environment. The role of biophysical environment has still to be articulated in population health discourse and its relations with human health are fraught with scientific uncertainty and dissension. An environmental impact assessment (EA) evaluates the environmental effects of a proposal--a rational and technical process. Sometimes health assessments are included, usually by quantitative risk assessments which are subject to the limits of scientific knowledge and bedevilled by data limitations. The goal must be to add health to the process, yet the relevant features to include are complex. Impacts are non-specific and they interact and have spatial and temporal characteristics. To integrate environment into population health, there is a need for a physical environment-health database and inter-sectorial policy and action. There is also a need for different types of indicators to measure process, impact and effectiveness, and for new tools (stories, photography) to account for context and values.