SPATIAL PLANNING AND HEALTH

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SPATIAL PLANNING AND HEALTH Assessing the Health
Consequences November 10th 2008 Jayne
Parry Professor of Policy Public
Health University of Birmingham
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LEARNING OUTCOMES

• Understand that the term health is slippery!
• Recognise the role of non-health factors in
  causing good and bad health
• Be able to describe the 5 steps of an HIA process
• Not be afraid to point out the problems

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OVERVIEW

• Overview of HIAs history and role in England
• What is health?
• Doing an HIA The Theory
• Reflections on the process
• Some thoughts..

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Are you healthy? How do you know? What makes you
healthy?
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What some other folk have said
having confidence in yourself and what you do
(man in urban area, lone parent content in all
aspects of life (older Black woman, urban
area) healthy living (Asian woman, urban
area)   eating properly (unemployed person,
urban area) its loving and being loved, isnt
it? (younger unemployed man, rural area)
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What some other folk have said
body, mind, spirit at one with the rest of the
world(woman staff member, Primary Care Group in
a rural area )   Its feeling at ease with your
its an internal equilibrium, isnt it( member
of an urban regional group) Believing in God,
Jesus (unemployed person, urban area)   having
a bath without the children screaming at you
(young father in a rural area)   being settled,
yourself, able to sleep, feel safe(woman in a
new town refuge)
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What some other folk have said
doing your knitting being able to read well
(older women in residential accommodation, urban
area)   not being a possession, being able
to breathe (woman living in a battered womens
refuge) well-being iswhen the family is
happy too( Asian woman in an urban area)   they
link it, dont they, with health fitness
(woman in rural voluntary sector organisation)  
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What some other folk have said
satisfied with their life (member urban
primary care group)   if youre really old and
you cant get out and youre lonely, I mean that
must be the worst thing, you know because you
feel trapped in your situation. (Woman worker in
voluntary and community sector, rural
area)   its made a big difference to me to see
both my grandson and my son this week(older
woman in residential accommodation, urban area)
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What some other folk have said
a mental and physical state where no impediment
exists related to health, preventing full
functioning as related to my expectation of full
functioning capability   But arent we being
unrealistic here, because there is no way anyone
in the world can achieve this so it is even
pointless talking about this. (member of an
urban secondary care focus group)   I dont
think you can ever get a hundred percent, to be
honest (disabled woman, urban area)  
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What some other folk have said
In practice, the definition of health has
always been the territory of those who define its
opposite Blaxter M (2004) In Health.
Polity Press, Cambridge (p10)  
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What is health?
Dahlgren Whitehead (1991)
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Health Impact Assessment is
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
Gothenburg Consensus Paper, 1999
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SHAs also have responsibility for strategic
capital and other investment. A HIA can help
ensure that the potential of such investment to
reducing health inequalities is maximised
Tackling Health Inequalities a programme for
action (2003) Para 5.18
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The government will build health into all future
legislation by including health as a component in
regulatory assessment
Choosing Health (2004) Chapter 8 Para 4
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The Secretary of State for Health should be
given the role of ensuring the Cabinet assesses
the impact on future health of the population of
any major policy development
Derek Wanless Securing Good Health for the Whole
Population, Final Report (2004) Recommendation 9.8
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The Department will improve the support it gives
to commissioners to reduce health inequalities
including considering how health impact
assessments can be used more systematically and
consistently
Health Inequalities Progress and Next Steps
(2008) Executive Summary Recommendation 31
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The Department will lead work across government
to ensure that cross-government mandatory impact
assessment, which includes health impact
assessment, is strengthened by emphasising the
importance of considering health inequalities so
that the impact of cross-government policies on
health inequalities are further understood and
taken into account in policy -making
Health Inequalities Progress and Next Steps
(2008) Chapter 6 Meeting the Future
Challenges Point 6.22
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An HIA should encourage and/or persuade those who
make decisions to consider and take into account
any effects on health their decision may have.
Enhance the positive impacts of any decision,
and reduce (or eliminate) the negative impacts of
any decision Consider differential effects on
population sub-groups
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Roots of Health Impact Assessment
Environmental Impact Assessment Policy
Appraisal Healthy Public Policy Public
Participation
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Stages in an HIA
SCREENING SCOPING APPRAISAL RECOMMENDATIONS MO
NITORING EVALUATION
Evidence from the local area and elsewhere using
both quantitative and qualitiative
methods Construct impact pathways Identify
impacts Prioritise impacts
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Scoping
Setting the terms of reference for the work and
developing a rough plan of what the HIA might
look like.
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Scoping
Setting the terms of reference for the work and
developing a rough plan of what the HIA might
look like. Who should do this? Who should be
invited to join the Steering Group?
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Whither the decision-makers?
Better to have him inside the tent pissing out,
than outside pissing in. Lynden B. Johnson,
of J. Edgar Hoover
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Types of HIA
Mini HIA
Desk-top
Rapid appraisal
In-depth
Comprehensive
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Scoping
What is the proposal being assessed? Who are the
stakeholders? What causal pathways are we
considering? What resources have we
available? What assessment methods are we going
to use? How much participation should we/can we
do?
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Appraisal
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A plea to all doing an assessment of health
consequences
Please make your assumptions explicit
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New road will be a dual carriageway with heavy
traffic-flows and with a substantial number of
lorries and trucks travelling at night
Mental health may be reduced
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New road will be a dual carriageway with heavy
traffic-flows and with a substantial number of
lorries and trucks travelling at night
Noise levels for residents living near the dual
carriageway may increase
This may cause disturbance and a disruption of
sleep
Mental health may be reduced
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RESEARCH PAPERS
MODELS
LAY KNOWLEDGE
OPINION
LITERATURE REVIEWS
EVIDENCE
EXPERT KNOWLEDGE
LOCAL DATA
GREY LITERATURE
EXPERIENTIAL KNOWLEDGE
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New road will be a dual carriageway with heavy
traffic-flows and with a substantial number of
lorries and trucks travelling at night
Noise levels for residents living near the dual
carriageway may increase
This may cause disturbance and a disruption of
sleep
Mental health may be reduced
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New road will be a dual carriageway with heavy
traffic-flows and with a substantial number of
lorries and trucks travelling at night
Parents worry that children will get run over as
they play near the road
This may cause anxiety
Mental health may be reduced
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New road will be a dual carriageway with heavy
traffic-flows and with a substantial number of
lorries and trucks travelling at night
Older adults concerned that will be unable to
cross road easily to get to shopping precinct
This may cause anxiety and loss of socialising
opportunities
Mental health may be reduced
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DOES HIA WORK?
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Everyone was for policy analysis, but few had
come to expect much from it James Schlesinger
(1969) Testimony before the US Senate
subcommittee on National Security and
International Security
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There is nothing a government hates more than to
be well-informed, for it makes the process of
arriving at decisions much more
difficult John Maynard Keynes
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SCHOOLS OF THOUGHT
Epidemiology Quantitative Technical Impartial Tool
for authority Voluntary Integrated
Sociology Qualitiative Participative Advocate Weap
on against authority Regulatory Distinct
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AGAINST HIA?
Adds to complexity of the process Not
cost-effective Not practical Not intellectually
coherent Undertaken by health imperialists who
do not understand the wider framework of
policy-making
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if the HIA is undertaken in a context where it
otherwise would not have been then it will have
put health on the agenda and therefore cannot
have failed.