1. The contents and the main objectives of the plan or programme and its link with other plans or programmes.

This issue is fully addressed in Table A4.2 of the Manual.

2. The relevant aspects of the current state of the environment, including health, and the likely evolution thereof should the plan or programme not be implemented.

3. The characteristics of the environment, including health, in areas likely to be significantly affected.

4. The environmental, including health, problems which are relevant to the plan or programme.

These three items may overlap but relate to different aspects of health conditions in areas covered by the plan or programme and on which it is likely to have significant effects.

In paragraph 2, the relevant aspects might describe overall trends in the state of health in the area.

In paragraph 3, relevant general trends in health might be described, with specific reference to areas with high values for well-being (public spaces, areas for exercise, etc.), areas with localized health problems or health inequalities, and densely populated areas.

In paragraph 4, health problems might be mapped. When a more comprehensive approach to addressing health issues in the SEA is chosen, determinants of health might be identified and might include factors such as lifestyle, social or community influences, living and working conditions or general socio-economic, cultural or environmental factors.

5. The environmental, including health, objectives established at international, national and other levels which are relevant to the plan or programme, and the ways in which these objectives and other environmental, including health, considerations have been taken into account during its preparation.

Health objectives might include international or regional (e.g. from WHO or WHO/Euro), national and more local o bjectives that are relevant to the plan or programme’s likely significant effects or to issues that it raises.

6. The likely significant environmental, including health, effects*/ as defined in article 2, paragraph 7.

*/ These effects should include secondary, cumulative, synergistic, short-, medium- and long-term, permanent and temporary, positive and negative effects.

Health should be considered in the context of the other components listed in article 2, paragraph 7, such as exposure to traffic noise or air pollutants. A description of the relationship between these components might be important, as it might reveal other and more significant effects than by a study of the components individually.

More comprehensive approaches to addressing health might assess the positive and negative effects of a plan or programme on relevant health determinants, and might draw conclusions on whether the plan or programme would create favourable conditions for a healthy population, with health being defined to include well-being, not merely the absence of disease.

7. Measures to prevent, reduce or mitigate any significant adverse effects on the environment, including health, which may result from the implementation of the plan or programme.

Environmental mitigation measures proposed in the environmental report might themselves have adverse health effects and vice versa. Any such effects should be considered.

8. An outline of the reasons for selecting the alternatives dealt with and a description of how the assessment was undertaken including difficulties encountered in providing the information to be included such as technical deficiencies or lack of knowledge.

This issue is fully addressed in Table A4.2 of the Manual.

9. Measures envisaged for monitoring environmental, including health, effects of the implementation of the plan or programme.

Monitoring issues specific to health may include:

• Monitoring short- and longer-term effects . Changes to the physical environment may have short-term consequences, for instance changes in transport and land use may see an immediate impact on accident rates. Other ecosystem changes such as air quality and climate change may have much longer-term impact timeframes.
• Monitoring impacts on health inequalities (differences in health status). If the scoping and environmental reporting stage has addressed health inequalities, it may be important to include these indicators in the monitoring stage. This will be of benefit to environment and health practitioners as well as supporting the provision of information to the public concerned.

The feasibility of any m onitoring of health effects will be influenced by the availability of data, which may be obtained through:

• Use of existing national, regional or local data . Environmental and health authorities will most likely have an existing environmental and health monitoring programme.
• Use of health indicators . It may sometimes be useful to continue the use of the health indicators chosen during the scoping and environmental reporting stages to monitor the health impacts of the plan or programme. This allows for consistency of analysis throughout the SEA. However, adjustments to existing monitoring systems in order to incorporate new health indicators may be quite demanding. Therefore, the feasibility of the establishment of any new monitoring system should be carefully reviewed prior to its approval.

10. The likely significant transboundary environmental, including health, effects.

This issue is fully addressed in Table A4.2 of the Manual.

11. A non-technical summary of the information provided.

This issue is fully addressed in Table A4.2 of the Manual.