Health impact assessment (HIA)

A tool to promote healthy public policies

Overview

• Why HIA?

• Theory of HIA: – Definition and roots

– Basic principles and objectives

• HIA in practice: – The steps

– HIA, a diverse practice

– Issues and supporting the practice

Why use this tool?

• Concern and shared responsibility towards health: HIA is a way to act on the determinants of health

• ‘‘Good governance’’ : – Need for solid information

– Democratization of the process: public involvement and intersectoral action

Formulation d’alternatives

HIA in the development of a policy

Agenda settingby the government

Perception of public and private problems

Implementation

Evaluation

(Re) Emergence of a problem

Adoption of a policy

Adapted from Knoepfel, Larrue and Varone ( 2001)

HIAFormulation of alternatives

The most common definition

HIA is…‘‘a combination of procedures, methods and tools by which a policy, program 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.’’

World Health Organization, Gothenburg Consensus, 1999

Two roots and their influence

• Environmental impact assessment (EIA)– Methodological rigour (science)

– Expert-driven

• Health promotion– Social determinants of health and equity (distributive

effects)

– Community participation/ Public involvement (empowerment)

– To put into practice the Ottawa Charter strategy: healthy public policies and a healthy environment

Basic principles…

Reduction of social inequities in health

Rigour and neutrality of the analysis

Involvement of stakeholders and intersectoral parties/ decision-makers

Collective responsibility towards the population

Democracy, sustainable development, equity, participation, ethical use of evidence

(Gothenburg Consensus)

…and objectives

• To structure action to promote healthy public policies

• To give insight, in the context of decision-making on policies outside the health sector, as to their potential unintended negative effects on health and to propose ways to mitigate or avoid them

• To support intersectoral actions

• To promote public involvement/ participation

• To reduce health inequities

The HIA Steps

Screening

Scoping

Appraisal

Recommendations

Evaluation

PP

RR

OO

PP

OO

SS

AA

LL

A diverse practice

• Based on research of evidence regarding links between a policy and determinants of health

• Based on public involvement/ participation

• Based on the relation between the public health sector and decision makers

A tool that can be adapted to all

levels of decision making LOCAL - PROVINCIAL- NATIONAL

Issues and challenges

Methodological- Management of uncertainties and multidisciplinary work- Predictive capacity- Availability of relevant data

Political and policy context - Political will, ideological and cultural context - Lack of knowledge about policy field - Capacity to fit into the policy process

Organizational - Legitimacy - Capacity building/ skills development - Resources

Supporting the practice

• Ensure access to capacity building and to the development of knowledge for HIA practitioners:

– HIA training– Use of guides to support the practice – Build capacities in intersectoral action – Build capacities for public involvement/ participation

• Ensure access to scientific and administrative data

• Ensure a relation of trust between the health sector and other sectors in which decisions that may have an impact on health are made

• Develop a workplace culture which promotes and values multidisciplinary work within the organization in charge of the HIA

Suggested readings

• Bekker, M.P.M. (2007). The politics of healthy policies. Redesigning Health Impact Assessment to integrate health in public policy. Delft: Eburon.

• Douglas, M., Conway, L., Gorman, D., Gavin, S., Hanlon, P. (2001) Developing Principles for health impact assessment. Journal of Public Health Medicine, 23,2, 148-154.

• Kemm, J. (2001). Health Impact Assessment: a tool for Healthy Public Policy. Health Promotion International, 16, 79-85.

• Lemieux, V. (2002) L’étude des politiques publiques: Les acteurs et leur pouvoir. Les Presses de l’Université Laval. Québec.

• Mahoney, M. (2001). Health Impact Assessment: Environmental management versus healthy public policy perspective - exploring the nexus between the two. In 28th National Environmental Health Conference.

• Wismar, M. et al. (2007).The effectiveness of Health impact assessment. Scope and limitations of supporting decision-making in Europe, European observatory on Health Systems and Policies.

HIA in Practice: Selected Resources

• HIA Gateway-Association of public health observatories: http://www.apho.org.uk/default.aspx?QN=P_HIA

• HIA connect (CHETRE-Centre for health equity training, research and evaluation): http://www.hiaconnect.edu.au/

• National Collaborating Centre for Healthy Public Policy (NCCHPP) - HIA section: http://www.ncchpp.ca/627/Health+Impact+Assessment.htm

• INSPQ - Public Policy and Health Portal, HIA section: http://politiquespubliques.inspq.qc.ca/en/index.html

• NCCHPP - HIA Guides and Tools: http://ccnpps.ca/docs/HIAGuidesTools2008en.pdf

• Swiss portal (in French): http://www.impactsante.ch/spip/

• World Health Organization - HIA section: http://www.who.int/hia/en/