How well do strategic environmental assessments in Scotland consider human health?

Objectives: Strategic environmental assessment (SEA) is a systematic approach to identifying, describing, evaluating and reporting on the environmental - and health - effects of policies, plans and strategies. SEAs have potential to improve population health because they assess 'upstream' health determinants and recommend measures to improve these. The authors studied the range of health issues considered in SEAs in Scotland, and the evidence used in their assessment. Study design: Documentary review of 62 consecutive SEA reports. Methods: Environmental reports were categorized by sector, and the health-related environmental problems, SEA objectives/criteria, differential impacts, evidence, recommended mitigation and monitoring were identified for each report. Results: Environmental reports identified many health-related issues, and set a wide range of health-related objectives/criteria, but these were inconsistent for SEAs assessing similar plans. Few identified differential impacts or mental health impacts. Mitigation focused on mitigating adverse impacts rather than enhancing positive impacts. It was unclear what health evidence was used to inform the judgements made in scoring the plans against SEA objectives. Conclusions: Many SEAs in Scotland adopt a wide perspective on health, but most fail to identify differential impacts. Health involvement in scoping of health issues and better use of health evidence may enhance their quality.