Health impact assessment: appraising potential consequences of policies and interventions

1. Health impact assessment: appraising potential consequences of policies and interventions Alex Scott-Samuel IMPACT International Health Impact Assessment Consortium, University of Liverpool ihia.org.uk

2. What is HIA? A combination of procedures, methods and tools by which a policy, programme or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population Source: WHO Gothenburg consensus paper, 1999 ihia.org.uk

3. Important characteristics of HIA • Prospective • Decision support tool, not evaluation method • Trade-off between brevity and rigour ihia.org.uk

4. Uses of HIA • creation of healthy public policies / projects • social and economic development • health advocacy • advocacy for disadvantaged groups • personal development • partnership building ihia.org.uk

5. Early origins: 1970-1990 • environmental impact assessment • healthy public policy ihia.org.uk

6. Some types of impact assessment • health • environmental • social • economic • gender • disability • human rights • integrated ihia.org.uk

7. Broad perspective Tight perspective Two perspectives of HIA View of health Holistic Definition and observation Disciplinary roots Sociology, epidemiology Epidemiology, toxicology Ethos Democratic Technocratic Quantification In general terms Towards exact measurement Types of evidence Key informant data Measurements Precision Low High Source: National Assembly for Wales (1999) Developing health impact assessment in Wales.   ihia.org.uk

8. Ron Labonte. Inequalities in Health in the City of Toronto. 1991 ihia.org.uk

9. Levels of impact ihia.org.uk

10. Health and the built environment • Activity - foster incidental and recreational activity • Nutrition - provide / promote safe, affordable, healthy food • Housing - safe, affordable, acceptable housing • Transportation - safe, reliable, accessible, affordable transportation • Environmental quality - safe, clean water, soil, air and building materials • Aesthetics / ambience - well-maintained, appealing, clean environments Source:www.preventioninstitute.org ihia.org.uk

11. The Merseyside approach to HIA - 1 • Screening • Steering group • Scoping / terms of reference • Select assessor • Policy analysis • Profiling of communities • Collect data from stakeholders and key informants • Identify health determinants affected ihia.org.uk

12. The Merseyside approach to HIA - 2 • Assess new and published evidence • Establish priority impacts • Recommend and justify options for action • Appraise assessment • Negotiate favoured options • Implement and monitor • Evaluate and document ihia.org.uk

13. Health inequality Unfair or unjust differences in health determinants or outcomes within or between defined populations ihia.org.uk

14. Equity …from each according to his abilities, to each according to his needs… Karl Marx, Critique of the Gotha Programme (1875) Distributional justice ihia.org.uk

15. Health inequality in HIA • inequality a screening (selection) criterion • vulnerable groups identified in profiling and policy analysis • distributional impacts (as well as population impacts) identified • recommendations take account of impact inequalities • monitoring and evaluation based on inequality indicators and outcomes ihia.org.uk

16. Equity in HIA • public involvement in HIA steering groups • ‘lay’ people as stakeholders and key informants • equitable valuation of lay evidence and of evidence on lay priorities • ‘bias to the poor’ in recommendations • choice of paradigm (expertist vs participatory) ihia.org.uk

17. Some IMPACT HIA projects • Foresight Vehicle Initiative • Castlefields regeneration • Policy HIA for the EU – European Employment Strategy • Capacity building in Liverpool • ‘Making it Better’ – healthcare reconfiguration ihia.org.uk

18. Methodologicalcontroversies • science and politics • value-free and value-laden • holism and reductionism • qualitative and quantitative • expertism and participation • duration and depth • equity and inequality ihia.org.uk

19. Gaps in current practice • poor monitoring and evaluation • limited application - especially re public policy • macroeconomic policy • human rights • foreign policy • trade • social and gender policy ihia.org.uk

20. Gaps in current theory • distributional effects poorly operatioalised • political determinants of health insufficiently acknowledged, eg power, ideology, class, interest groups, institutions • participatory research • feminist research ihia.org.uk

21. The future of HIA Causal drivers • promotes healthy public policy • promotes sustainable development • promotes organisation development • reduces health inequalities Contextual drivers • equity • public participation ihia.org.uk

22. The future of HIA • whether takes off in USA • healthy public policy relatively unpopular • disparities agenda • NB there’s gold in them thar HIAs • acceptable to all US politicians? • likely to thrive in EC • good global prospects - human rights, TNCs etc ihia.org.uk

23. Capacity building • a limiting factor • training • advocacy • policy development • organisation development ihia.org.uk

24. impact@liverpool.ac.uk 0151 794 5004 ihia.org.uk