Health impact assessment explained

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Health impact assessment explained

• Kevin Elliston
• Consultant in Public Health
• Plymouth teaching Primary Care Trust
• October 2006

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Starting point for Impact Assessments
Proposals Policy, programme, Strategy, Plan or
other development
HIA
Health of a population
HNA
Organisation Services Systems
HEA
IIA
Sustainability and well being
SA
Source HDA 2004
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Health Impact Assessment (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 WHO, European
Centre for Health Policy. Gothenburg Consensus
Paper, Health Impact Assessment- main concepts
and suggested approach. Brussels, 1999.
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Why use HIA?

• We have to think about the effects policies have
  on health, and in particular, how they can alter
  the health of all people in the population.
  Non-health sector proposals, where health is not
  the main objective, may have major effects on the
  health and well-being of people, particularly
  vulnerable groups.

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HIA explained

• HIA is an approach that gets people to think
  about what they are doing, and how it may alter
  peoples health. It promotes health and in the
  long term contributes to the health of local
  people
• Imagine someone was planning to build a new
  motorway. An HIA would answer How would this new
  development affect peoples health?

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An HIA would ask.

• Would the new road increase or decrease noise,
  air or light pollution?
• How would the road affect local businesses and
  jobs?
• Would the new road reduce or increase the stress
  for local people?
• How would a new road change the local
  infrastructure needs - and would this be good or
  bad for local people?

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The purpose/function of HIA is to

• Inform and influence the decision maker
• Help address inequalities in health.
• Promote joined-up working.
• Place public health on the agenda
• Reduce conflict between stakeholders
• Encourage sustainable development

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HIA does this by

• Using a broad understanding of health.
• Using a participatory approach that considers
  which stakeholders need to be involved
• Helping involve local people in decisions and
  responding to their concerns about health.
• Considering different types of evidence - from
  local views to scientific information.
• Assessing how the proposal will affect all
  members of the community particularly the most
  vulnerable.
• Assisting with sustainable development by
  considering short and long term impacts.

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Many factors impact on your health

• the social and economic environment
• the physical environment
• and the persons individual characteristics and
  behaviours.
• For example, income and social status - higher
  income and social status are linked to better
  health. The greater the gap between the richest
  and poorest people, the greater the differences
  in health.
• For example, education low education levels are
  linked with poor health, more stress and lower
  self-confidence.

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What international policies support HIA?

• Article 152 of the Amsterdam Treaty - the
  European Union (EU) should examine the possible
  impact of major policies on health.
• The new Strategic Environmental Assessment
  protocol - places a special emphasis on the
  consideration of human health for Europe
• 1997 Organisation of African Unity Harare
  Declaration on Malaria Prevention and Control in
  the Context of African Economic Recovery and
  Development - included calls for EIA and HIA of
  all new developments in Africa.
• Health21 The health for all policy framework -
  outlines strategies to ensure the use of health
  impact assessment in Europe.

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What international policies support HIA?

• The Strategic Environmental Directive -adopted by
  the European Commission to ensure that
  environmental consequences of certain plans and
  programmes are identified and assessed during
  their preparation and before their adoption.
• Environmental impact assessment - a statutory
  requirement in many countries. Similar to HIA,
  EIA explores the effect of policies, programmes
  and projects on the environment.

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When is an HIA undertaken?

• Before implementation (prospective) - to allow
  steps to be taken to change a proposal at the
  planning stage.

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Steps in HIA

• Identifying if an HIA should occur (screening) -
  systematically deciding if an HIA necessary.
• Identifying what to do and how to do it (scoping)
  - reviewing the issue in more detail, setting the
  boundaries for the HIA, and considering how the
  HIA appraisal stage should be undertaken
• Identifying health hazards and considering
  evidence of impact - considering a range of
  evidence between the determinants of health and
  key elements of the proposal.

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Steps in HIA

• Developing recommendations to reduce hazards
  and/or improve of health - set of recommended
  changes/policy review questions to the proposal
  to the decision makers.
• Evaluation and monitoring
• whether the HIA has influenced the decision
  making process (and the subsequent proposal)
• monitoring the implementation of the proposal to
  ensure that any recommendations that
  decision-makers agreed to, actually occur
• longer term monitoring of the health of
  populations is sometimes a component of larger
  proposals.

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Academic/ User utility
Influence decisions
Can be resource intensive
Participation Wide views
Not always robust
Not statutory
Supports consultation
Adds to evidence
HIA
Done by experts
Encourages Partnership working
Highly recommended
Can be ignored
Flexible tool
Not widely under- stood
No agreed approach
Raises expectations
Qualitative Quantitative
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The Plymouth experience

• HIAs focusing on inequalities in health
  regeneration related projects
• Morice Town Home Zone
• Local Improvement Finance Trust
• East End Renewal Community Village
• East End Eastern Corridor Road link
• Close links with City Council
• Endorsed by Health Overview Scrutiny Cttee
• We are still learning!

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Eastern Corridor East End HIA

• Access to health, education, employment
• Social networks
• Recreation
• Danger
• RTAs

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HIA tools and guidance
Many different toolkits are available, as are
basic guides to carrying out HIA. Find all these
at www.who.int/hia
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Tools for HIA?

• Examples of HIA are available on www.who.int/hia
  
• The site also provides information
• About HIA
• Tools and methods to do HIA
• How HIA contributes to policy making
• The evidence used in HIA
• HIA related links and networks.

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Some examples of where HIA has been used.

• Building a new road near residential areas.
• The local village school policy to implement
  safer routes to school.
• Building an out-of-town shopping centre.
• Increasing runway passenger capacity at an
  airport.
• Changing the fuel used in a cement kiln.
• Assessing the common agricultural policy.