The use of Health Impact Assessment in Europe Health Impact Assessment-systems in Europe

1
The use of Health Impact Assessment in Europe
Health Impact Assessment-systems in Europe

• Julia Blau
• Research officer
• The European Observatory on Health Systems and
  Policies
• WHO European Center for Health Policy

2
The Effectiveness of HIA project
22 teams from 19 countries
Three year project 15 Aug 2004 14 Aug 2007
The overall aim of the project is to map the
use of HIA, evaluate its effectiveness and
identify the determinants for its successful
implementation.
Co-funded European Commission, Public Health
Work Programme (Grant agreement 2003101)
3
The mapping exercise
4
Overview

• Overview on the results
• Frequency and use of HIA
• Settings of HIA
• Sectors
• Levels
• Elements of HIA
• Stages
• Types
• HIA systems
• Means of endorsement
• Objectives in the policy documents and in
  practice
• Health intelligence
• Financing and costs

5
An overview on the results

• HIA is a reality in Europe but unevenly developed
  across countries
• All countries implement various elements of HIA
  but adapt it to the country context
• HIA takes place across various sectors and at all
  levels, but predominantly at the local level
• Countries in their policies, regulations or other
  means of endorsement, have a different set of
  objectives for HIA.

6
Frequency of HIAs

• The number of all reported HIAs is 470
• The exact number is unknown for Austria, Belgium,
  Finland, Germany, Hungary, Italy, Poland, the
  Netherlands, Spain, Sweden, Switzerland
• The project has abstracted 158 HIAs
• National level 1 reference region 1 reference
  locality
• Covering the period from 1990 to 2005

7
Use of HIA (in the sample)

• HIA is used in all countries but strong
  differences remain

8
Settings of HIA Sectors

• Fullfilling its intersectoral promise

9
Settings of HIA Levels

• Strong at the local level
• National level 54
• Reference regions 23
• Reference localities 81

10
Elements of HIA Stages

• Not all HIAs follow all the stages

11
Elements of HIA Types

• Mini and standard are the most commonly used
  types of HIA

12
HIA systems Means of HIA endorsement

• There is no legal obligation in most countries
  for HIA unlike environmental impact assessment
  (EIA)
• Most countries have at least a policy, a
  regulation or another means of endorsement for HIA

13
HIA objectives in the policy documents

• Objectives related to decision makers rank high
  at all levels

14
HIA in practice Participation

• 102 out of 158 fact sheets reported
  participation

15
HIA in practice Equity

• 71 out of 158 fact sheets reported a
  stratification of the population

• 15 out of 19 countries reported a stratification
  of the population

16
HIA-systems Some aspect of health intelligence

• Collecting and gathering health intelligence for
  HIA varies across countries

17
HIA systems Financing HIA

• Funding for HIA is scarce

18
HIA-systems Cost of an HIA

• The cost of an HIA can vary quite a lot

19
Summary and outlook

• HIA is a reality in Europe but unevenly developed
  across countries
• Most countries have at least a policy, a
  regulation or another means of endorsement for
  HIA, however funding for HIA is scarce
• Equity and participation play a substantial role
  in the practice of HIA
• Further development needs to built on better
  regulation, in particular on establishing sound
  financing and evaluation

20

• More information can be found on the European
  Observatory website
• http//www.euro.who.int/observatory/