Health impact assessment appraising potential consequences of policies

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

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 ihia. org. uk Source: WHO Gothenburg consensus paper, 1999

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

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

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

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

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

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

Levels of impact ihia. org. uk

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 ihia. org. uk Source: www. preventioninstitute. org

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

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

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

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

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

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

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

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

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

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

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

The future of HIA ihia. org. uk • 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

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

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