A practical introduction to health equity impact assessment

1
A practical introduction to health equity impact
assessment
Stephen James, Public Health Directorate Ealing
Primary Care Trust
Title pages
2
Aims of session

• Introduction to health equity impact assessment.
• Practical experience of assessing the impact of a
  policy or service.
• Share experience and ask questions.

Title pages
3
Outline of session

• Part 1 Background and context
• Part 2 Concepts health, equity,
  equality, impact assessment
• Part 3 Methods and practice
• Part 4 Practical exercise
• Part 5 Next steps and evaluation

Title pages
4
Background and context
Part 1
Part 1 Background and context
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Health equity impact assessmentPolicy Context

• Equalities and Human Rights Legislation
• Independent Inquiry into Inequalities in Health.
  Acheson, 1998.
• Tackling Health Inequalities a Programme for
  Action, 2003
• Environmental impact assessment.

Part 1 Background and context
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Health equity impact assessmentIndependent
Inquiry into Inequalities in Health

• All policies likely to have an impact on health
  should be evaluated in terms of their impact on
  health inequalities.

Part 1 Background and context
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Concepts and definitionshealth, equity,
equality, impact assessment
Part 2
Part 2 Concepts and definitions
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HealthDefinition

• Health is a state of complete physical, mental
  and social well-being and not merely the absence
  of disease
• (WHO, 1947)

Part 2 Concepts and definitions
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Part 2 Concepts and definitions
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• Equality
• What differences exist?
• Equity
• What is fair?
• E.g. equal treatment for equal need.
• Equitable (but unequal)
• Breast screening for over-50s.
• Counselling for haemoglobin disorders.
• Unequitable (but equal)
• Health education leaflets.
• Talking therapies.

Part 2 Concepts and definitions
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Inequality and inequity unavoidable or
unacceptable?

• Natural, biological variation
• Health damaging behaviour freely chosen
• Transient health advantages (where others can
  catch up)
• Health damaging behaviour where choice is limited
• Unhealthy living and working conditions
• Inadequate access to essential services
• Health-related social mobility

Part 2 Concepts and definitions
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Health impact assessment
The estimation of the effects of a specified
action on the health of a defined
population. (Scott Samuel, 1998)
Health equity impact assessment

• .. and on diverse groups within that population.

Part 2 Concepts and definitions
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Health equity impact assessmentKey principles

• a social model of health and well-being
• an explicit focus on equity and social justice
• a multi-disciplinary, participatory approach
• the use of qualitative as well as quantitative
  evidence
• explicit values and openness to public scrutiny

Part 2 Concepts and definitions
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Health equity impact assessmentMethods and
practice
Part 3
Part 3 Methods and practice
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Health equity impact assessmentAims

• Policies, services and functions
• Assess different impact on different groups (if
  any)
• Positive and negative
• Maximise positive and minimise negative

Part 2 Methods and practice
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Health and equity impact assessmentSteps

• Scanning assessment for relevance and rapid
  assessment of policies and functions
• Identify priorities
• Fuller assessment
• Action planning
• Review

Part 3 Methods and practice
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Example Palliative careMonitoring
informationStakeholder groupLiterature
reviewPatient and public involvement reference
groupPatient pathway analysisReport and
recommendations
Part 3 Methods and practice
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Example Consent PolicyThere is a potential
risk that some patients cannot get access to
interventions that they need because the consent
that they give cannot be recognised as valid for
some reason or other. There is a need for robust
prior information. Particular groups affected
include non-English language speakers, people
with visual impairment (access to written
information), people with learning disabilities,
and young people. We need to use information from
formal and informal complaints, listen to
feedback from staff, and promote communication
aids such as the interpreting service.
Part 3 Methods and practice
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Example Five A DayThis healthy eating project
aims to benefit 7-11 year olds in Southall and
Acton, and there is a need to extend this to
Northolt. There are high levels of diabetes and
coronary heart disease in South Asian communities
and the project should aim to meet the cultural
needs of this group. Census and other data can be
used to measure access, although school
populations differ from ward populations.
Part 3 Methods and practice
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Part 3 Methods and practice
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Data can be .....

• Quantitative
• e.g. based on existing routine and ad hoc data
  sources
• Qualitative
• e.g. based on interviews and focus groups
  (workshops) with key stakeholders

Part 3 Methods and practice
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A multi-disciplinary, participatory approach
Health professionalsPatients and carersThe
publicLocal authority partnersVoluntary and
community sectorsPress and media
Part 3 Methods and practice
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Conduct health and equity impact assessment when
-
changes are planned in policies or services.new
policies are proposed.concerns are expressed or
complaints received about access.monitoring or
other data indicate problems of access.there is
routine review of policies and services.
Part 3 Methods and practice
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Health equity impact assessment exercise
Part 4
Part 4 Exercise
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Outline of exercise

• Select policy, function, service
• Scanning and rapid assessment
• Review as a group
• Next steps

Part 4 Exercise
Part 4
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Part 4 Exercise
Part 4
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Part 4 Exercise
Part 4