Positioning subjective well-being in environmental health impact assessments

Abstract Introduction Environmental health Impact Assessments (HIAs) are essential tools to inform policy decisions about the health effects of changes in environmental exposures. Conventional health impact metrics, focusing on morbidity, disability and mortality. We aim to explore the need and feasibility of integrating well-being indicators into quantitative environmental HIAs. Methods Building on an expert workshop and current literature, we provide a background of different definitions of well-being and the existing well-being indicators. We examined the potential pathways and epidemiological evidence linking environmental exposures to well-being. We evaluated the feasibility, challenges of the integration of well-being indicators into environmental HIA and provided an exploratory example. Results We argue that including well-being in HIAs is essential as it provides a positive dimension of health and aligns with the goal of policymaking of improving citizen's well-being. We found considerable variability in definitions and measurements of well-being. While plausible pathways linking green space to well-being have been identified, evidence for noise, air pollution, and temperature is more tentative. The limited number of epidemiological studies that examined air pollution (n = 18), noise (n = 6), green space (n = 16), and temperature (n = 5) provided suggestive but methodologically heterogeneous associations with subjective well-being. We propose to conduct exploratory HIA analyses integrating well-being, especially for green space and air pollution. Two strategies emerged for the inclusion of well-being in HIA: presenting the well-being impact individually as well-being adjusted life years and considering its inclusion in indicators such as Quality-Adjusted Life Years or Disability-Adjusted Life Years. Conclusions Well-being indicators should be considered for incorporation into HIA to present a more comprehensive representation of health beyond morbidity and mortality. Key messages • Well-being indicators should be considered for incorporation into HIA to present a more comprehensive representation of health beyond morbidity and mortality. • We propose to conduct exploratory HIA analyses integrating well-being, especially for green space and air pollution.