Practical approaches to health impact assessment 
Erica Ison, Public Health Resource Unit, University of Oxford

Notes of a presentation to the Health Impact Assessment Conference  held at Lyngford House, Taunton 19 June 2001

What is HIA?

HIA can be viewed as, and the term used to describe:

 The development and use of HIA has been lead by the Canadians, who developed the methodology in the context of the assessment of non- health policies.

  Definition

 “a combination of procedures or methods by which a policy, program or project may be judged as to the effects it may have on the health of a population”

The Gothenburg Consensus Paper, European Centre for Health Policy, WHO Regional Office for Europe

  Types of HIA

  Distinguishing characteristics

  Underpinning values

  Process

Screening: The role of this step in the process is to select those proposals that should be subjected to HIA. It is best if this step is performed with the support of a screening tool. During screening, proposals are filtered out if:

 they have a negligible impact on health;

 the impacts on health are well known and documented, as are the mechanisms to enhance the positive impacts and minimise the negative impacts.

This step enables resources to be targeted on those proposals the potential impacts of which require further  investigation, and/or on those proposals that may need modification because of the impacts they have on health.

Scoping

alternative terms: Setting the Terms of Reference

The role of this step in the process is to establish the foundations for the next three steps, by establishing the boundaries for the appraisal of the health impacts, by identifying the stakeholders, by determining the type of appraisal and the way in which it will be managed, by defining the line of accountability/reporting with the decision-makers, and by outlining the parameters and processes for monitoring and evaluation. At this stage, it is important to initiate work on a baseline profile of the community/population affected by the proposal including any relevant local circumstances, and an evidence base of the potential impacts of the proposal.

Appraisal

alternative terms: risk assessment; data collection, collation and analysis

This step is pivotal to the whole process. At this stage, it is important to do a proposal analysis, complete the profile of the affected population, identify the potential health impacts and characterise them ideally in conjunction with stakeholders and key informants and using the evidence base, and identify the ways in which the proposal can be modified to optimise health gain also with the support of the evidence base. A report and recommendations is prepared for decision-makers.

Decision-making

Decision-making must be seen as integral to the HIA process, and it is advisable for decision-makers to be involved in the whole process. If this is not possible, then it is important that they are committed to the principles of HIA, and are prepared to consider the results of appraisal and the recommendations arising from it.

Monitoring and evaluation

This involves the following:

 monitoring whether recommendations that were accepted are actually implemented;

 monitoring trends in health determinants and health outcomes;

 evaluation of the process of HIA;

 evaluation of health trends and outcomes.

  Approaches to HIA

There are two basic approaches to HIA - broad and tight perspective (see Table below) 

From: Developing Health Impact Assessment in Wales

  Models of HIA (examples)

In addition, many local agencies/partnerships are developing their own models of/tools for HIA.

  Types of appraisal

  Policy drivers for the introduction of HIA

1. Saving Lives: Our Healthier Nation (D o H, 1999)

 “Local decision-makers must think about the effect which their policies may have on health, and in particular how they can reduce health inequality. In most cases this will require a change in the way that health authorities, local authorities and other local agencies see their role. They will in future need to act much more as health champions at a local level and ensure health is on the agenda of all local organisations and agencies outside the health field. An important part of their role will be to encourage all local agencies to make local health impact assessments when planning investment in, for example, amenities, buildings or local communities and in the location of services.” (Paragraph 4.47)

2. National Service Framework for Coronary Heart Disease (NSF for CHD)

3. Research and Development Strategy for Public Health

  Context in the UK

  Restraints to the introduction of HIA at a local level

  Implementation of HIA at a local level

Majority of HIAs will be based around rapid appraisal, supported by:

Rapid appraisal: advantages of a stakeholder workshop

 - learning as individuals and teams in partnerships and organisations

 - developing a greater understanding of other viewpoints, perspectives, professions, the community, etc.  

 - contributing, and building on the contributions of others

 - reaching a consensus about priorities in terms of health impacts and how to modify proposals

General policy outcomes that can be gained using HIA

Introducing HIA into organisations/partnerships

 Gain commitment to the principles of HIA at a strategic policy level

 Integrate HIA into organisation’s/partnership’s usual planning and development cycle

 Identify suitable policy and/or strategic frameworks suitable for the initial introduction and piloting of HIA in organisation/partnership

 Develop or select a screening tool for HIA

 Build the capacity to undertake HIA

HIA and the development of public health practice - the possibilities

Advantages of using HIA on proposals

  Hallmark of HIA - Flexibility/Adaptability

  Development of a rapid appraisal tool for HIA in Four Counties

DsPH of the Four Counties (Berkshire, Buckinghamshire, Northamptonshire, and Oxfordshire) commissioned the Public Health Resource Unit to develop a rapid appraisal tool, a project that is also receiving support from the Faculty of Public Health Medicine. The tool will be launched on 8 November 2001. It has been developed in conjunction with users through a series of rapid appraisal workshops, based on the WHO model. It is hoped that a training package can be developed, but funding has yet to be secured.

Policy and strategy frameworks in which HIA can be applied at a local level (examples - see Table below)

References to Key Documents/Websites for HIA

Department of Health (1999) Health Impact Assessment.
Report of a Methodological Seminar.

    A vailable at http://www.doh.gov.uk/research/healthimpact.htm

 

Health Promotion Division (1999) Developing health impact assessment in Wales.
National Assembly for Wales.