The basics of health impact assessment (HIA): Part 1 Erica Ison Specialist Practitioner in HIA and HiAP Expert Adviser in HIA, WHO Network of European Healthy Cities, Phase IV What is the overall purpose of HIA? To improve the health of the population by: • Encouraging an awareness and understanding of health at every level of policy- and decision-making • Establishing a desire to improve health as routine during policy- and decision-making • Making policy- and decision-making “healthy” What is the intention behind HIA? • The main intention when undertaking HIA is to provide information to support decisionmaking about a particular proposal: – Potential impacts of a proposal – beneficial and harmful; differential – Suggestions about ways to maximise the benefits and minimise the harms, and ways to reduce inequalities and/or inequities • HIA offers decision-makers the possibility of changing a proposal to protect and improve health, and to reduce inequalities/inequities, thereby achieving health gain Definition of HIA “a combination of procedures, methods and tools by which a policy, a program or project may be judged as to its potential effects on the health of a population and the distribution of effects within the population” WHO Gothenburg Consensus Paper, 1999 HIA: How is the term used? • • • • • • Concept Process Models Methods Tools Approach Models of HIA Biomedical model of health Social or socio-economic focusing on illness and model of health focussing disease on prevention and health promotion Biophysical or Social or socio-economic environmental model of model of HIA HIA Environmental determinants of health Socio-economic determinants of health Quantitative evidence Qualitative evidence Measurement of variables; modelling Descriptive What are the determinants of health? Determinants of health could be referred to as the conditions of living that have an influence on health: • Social conditions • Economic conditions • Environmental conditions • Cultural conditions • Political context Dahlgren & Whitehead: determinants of health Barton and Grant HIA: judging potential effects on health Any proposal has two main types of effect on health: 1. Direct 2. Indirect, through the determinants of health Investigating the potential impacts on health and well-being Proposal Indirect Effects Direct Effects HEALTH DETERMINANTS OF HEALTH Characteristics of HIA • • • • • • Multidisciplinary Intersectoral Range of different methods Use of quantitative and qualitative evidence Focus on health inequalities Participatory Values for HIA • Sustainability – work towards sustainable development or sustainable communities • Equity • Democracy – people’s democratic right to participate in open and transparent decisionmaking processes • Ethical use of evidence Classic process of HIA 5 stages 6 stages Screening Screening Scoping Scoping Appraisal, including reporting Appraisal Reporting Supporting decision-makers Supporting decision-makers Monitoring & evaluation Monitoring & evaluation Classic process of HIA Stage of HIA Key questions to answer Screening Do we undertake an HIA on this proposal or not? Scoping What are the boundaries for the HIA study? What are the management arrangements? What are the overall governance and accountability arrangements? Appraisal What are the proposal’s effects on health, for the whole population and for vulnerable groups? How can we achieve health gain through health protection, health improvement and reducing health inequalities? Reporting How do we present the information about health impacts, and suggestions to address those impacts, in an ethically responsible way that is useful to and usable by decision-makers? Supporting decision-makers How do we support decision-makers to understand the HIA results in relation to other information about the proposal? Monitoring and evaluation Process evaluation: Did the HIA process go well? Could it be improved? Effectiveness evaluation: What effect did the HIA have on the proposal? Outcome evaluation: What effect did the amended proposal have on health?