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HIA as an intersectoral governance structure

HIA as an intersectoral governance structure. John Kemm Granada 15/4/2011. The problem. HIA or a similar process is essential if HIAP is to be a reality. HIA has the potential to support policy consistency in government Very few governments make much use of HIA in policy making.

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HIA as an intersectoral governance structure

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  1. HIA as an intersectoral governance structure John Kemm Granada 15/4/2011

  2. The problem • HIA or a similar process is essential if HIAP is to be a reality. • HIA has the potential to support policy consistency in government • Very few governments make much use of HIA in policy making.

  3. Why is HIA not used? Demand barriers Supply barriers Lack of leadership Too busy (impact assessment fatigue) Lack knowledge of health and HIA Lack of support • Health unimportant • Health not business of our department • Unaware of HIA • Don’ t believe HIA can help

  4. Ken Clarke Minister of Health 1982-85 On evaluation of NHS reforms “I do not want academics crawling all over my reforms” Cited in Robinson R Introduction to Evaluating the NHS reforms King’s Fund 1994

  5. Overcoming demand barriers • Public commitment • Recognise health is only one of many issues • Leadership from government centre - not department of health • Briefing ministers and civil servants on health • Briefing ministers and civil servants on HIA

  6. What about making HIA legally required ? • Legislation only works when generally accepted. • Danger of tokenism • Need to ensure understanding, support and capacity in place before legislation.

  7. Supply barriers Who will undertake HIA? • Civil servants in department originating policy • May not be sufficiently independent • Bodies commissioned outside government • May not sufficiently understand policy context

  8. Reducing the work load • Integrated impact assessment • Parallel impact assessment and policy development • HIA support units and easily available (?online) guidance

  9. FOR Efficient use of time Reduces bureaucratic work load Balances different policy objectives Opportunity for trading and alliances AGAINST Risk of tick-box exercise Inadequate coverage of any issue Integrated Impact Assessment

  10. Parallel HIA & Policy making Propose and finalise Options Propose Options Consider Health Impacts Assess options with HIA Revise Options Finalise Options Consider HIA HIA Make Decision Make Decision

  11. Quality assurance of HIA • Procedural checklists • Peer review • Ministerial sign-off • Public scrutiny • Judicial review • Accreditation

  12. http://www.ialibrary.berr.gov.uk/

  13. Ten Steps to increase use of HIA Make public commitment Identify senior figure to lead Require use of HIA (?legislation) Train civil servants to understand health & HIA Establish HIA support unit Ensure consultation can inform HIA Cooordinate health with other impact assessments Make considering health part of policy development Decide for each policy if HIA is required Require minister to publish HIA

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