ASSESSMENT IN HIAs Elizabeth J. Fuller, DrPH , MSPH Georgia Health Policy Center

1. ASSESSMENT IN HIAsElizabeth J. Fuller, DrPH, MSPHGeorgia Health Policy Center

2. Assessment: Purpose • The purpose of assessment is to characterize the potential health effects of alternative decisions based on available evidence. • Assessment builds upon work done in the scoping phase, which identifies plausible mechanisms of health effects and the approaches for evaluating those effects. • The scoping and assessment phases are often iterative.

3. Assessment: Purpose The health impact assessment process is use to rate and rank potential impacts in order to help prioritize mitigation

4. Assessment: Two phases of work • The assessment phase includes two tasks: • 1. Creating a profile of the population affected, which includes information on the demographics, baseline health status, and social, economic and environmental conditions that are important to health. This can include collection of original data. • 2. Analyzing and characterizing the health effects of the policy or proposal under consideration

5. Assessment: Common types of evidence Existing population demographic data and health statistics, such as census data, vital statistics, agency reports Environmental measures, to assess hazardous agents or conditions Maps, to reveal “hot spots” or spatial differences Empirical research Qualitative Methods, such as focus groups, key informant interviews etc..

6. Assessment: Characterizing the effects • After the assessment team has analyzed information and evidence , they will next need to synthesize their findings into an overall characterization of the expected health effects. • Four important and commonly described characteristics of health effects are: • likelihood • severity • magnitude • distribution • There are others, which are referenced in the HIA guides and the assessment worksheet.

7. Assessment: Characterizing the effects • There is no gold standard for health effects characterizations in HIA and these characterizations are not testable or falsifiable. • In practice, the meaning of each of these characteristics can be subject to varied interpretation both among members of the assessment team and among stakeholders and decision-makers.

8. Assessment: Characterizing the effects Consequently, discussion and debate on the meaning and sufficiency of the characteristics and the evidence required to make a particular characterization should be considered a necessary and useful part of a transparent HIA process.

9. Equity thread • An HIA should consider the distribution of health impacts across populations, paying special attention to vulnerable populations. • In the assessment phase, this means: • looking at the baseline data by subgroup • characterizing the effects by subgroup

10. Stakeholder engagement thread Access to data and necessary information is one of the key ways in which stakeholders can contribute to the HIA. Stakeholders should also be given opportunity to reflect and comment on the effect characterization process

11. Communications thread Remember that HIA is an independent/transparent process, and be clear about the limitations of your data and/or characterization of effects. HIA is not an advocacy process, however the findings can be used for advocacy.

12. Evaluations thread In your process evaluation, be sure to document any barriers you faced and successes you had in data collection, including decisions about collecting original data. Document the process of categorizing the effects, including stakeholder and decision-maker feedback