Professional Documents
Culture Documents
what it is, why do it, when to use it, how to do it, how to commission it
Dr Salim Vohra
Centre for Health Impact Assessment, Institute of Occupational Medicine
What is health?
health
wellbei
ng
diseas
e
Environment & health in context:
housing
a complex web of factors conditions
housing employment
tenure status
disability sexual smoking
ethnicity behaviour alcohol family working
personality
relationships Personal condition
Biological
genetic leisure circumstances
factors Lifestyle medication
factors activities income
noise soil
smell quality water
quality
public & community
social
environmental air social participation
support
health services quality contact
Environment Determinants of peer
Health & Wellbeing Social influences
pressure
Adapted from ‘Rapid Health Impact Assessment: a guide to research’ by Amanda Harris, 2002
Or put another way!
HIA is:
a combination of procedures, methods and
tools
Adapted by Salim Vohra and Dean Biddlecombe from Dahlgren, G. and Whitehead, M. (1991).
Policies and strategies to promote social equity in health. Stockholm, Institute for Future Studies.
What is Environmental Impact Assessment?
Waste
Air quality
Ecology
Noise and vibration
Town and Country Planning (Environmental Impact Assessment)
(England and Wales) Regulations 1999.
What is healthy public policy?
POPULATION PROPOSAL
National Assembly for Wales. Developing health impact assessment in Wales. 1999.
available at http://www.wales.gov.uk/polinifo/health/keypubs/healthimpact/pdf/healthimp_e.pdf
Types of HIA
in knowledge
Quantitative vs Qualitative
Stanley Fish quoted in The Wilson Quarterly, Autumn 2001, pg60 Wittgenstein's Curse, by Jay Tolson
Factors to Consider
Difficult to rank and depends on the types of
information you are looking for
UK - Merseyside
qualitative Q definite D
estimable E probable P
calculable C speculative S
+
ve -
ve
Merseyside …
stages in the process
Health impact pathways
Context
young, mobile, ethnically diverse population,
high levels of deprivation, poor housing conditions
Mechanisms
Housing company
Outcomes
residents feel more positively about building works
area renovation process
the area will become more attractive some people might have to move to
to tenants who want permanent new accommodation outside
homes and are able to pay higher programme area
rents in the private market Health outcomes
strengthen social capital mental stresses, increased pollution
positive health outcomes from & accident hazards from building
improved housing works
improve average measures of health negative health outcomes associated
but will not reduce health with continuing problems with
inequalities housing and possibly homelessness
From A practical guide: Vol 1 HIA for regeneration
for some
projectsgroups
Gathering the Evidence
Disease based … lots of ALSO … websites …
agencies … Consultant
for Communicable take note of where you
Diseases visit so that you do not get
lost and do not get
Crime … Police … victim swamped by the detail …
support
government departments
Employment … Learning are useful as are
& Skills Council, Training organisations in other
& Workforce regions …
Confederation …
Economic Development - Office of National
officer Statistics
Applied
‘Normal’ Science
(traditional notions of science)
Evidence for many health impacts that have a complex and indirect effect
on people’s health are difficult to apply directly to specific local populations
and even more difficult to use to give quantitative estimates of impact.
All types of evidence have strengths and limitations and therefore explicit
criteria for how evidence is evaluated is important in HIA.
Lay people are just ‘experts’ on their day off i.e. they have useful knowledge
and experience to provide on the health effects of initiatives.
Stakeholder Involvement & Engagement
8 Citizen control
Degrees of
7 Delegated power
Citizen Power Better
and
6 Partnership
more
5 Placation genuine
stake-
Degrees of holder
4 Consultation
Tokenism
involve
ment
3 Informing
2 Therapy
Non
Participation
1 Manipulation
Arnstein, S. (1969). A ladder of citizen participation in the USA. Journal of the American Institute of Planners 35, 216-24.
Reporting Back - writing a HIA report
“My aim is to put down on paper what I see and what I feel
in the best and simplest way.”
Ernest Hemingway
Influential stakeholders
professional groups, politicians, business
Lack of clarity
Lack of clear vision and rationale for proposed changes
For external consultant-practitioners, references from previous clients are very useful in
assessing the quality of their work but the best way is to review actual copies of previous
HIA statements that they have produced as this will provide a more detailed insight into
whether their approach meets your needs and expectations.
As for costs, a good rule of thumb is that, a rapid HIA is likely to cost between £7-
12,000,an intermediate HIA requiring a community consultation between £20-35,000 and
a comprehensive HIA with a wide stakeholder consultation between £50,000+.
A clear HIA plan and timetable can ensure that the HIA runs to deadline and is within
budget.
Getting other colleagues or another HIA practitioner to critically review the final HIA report
can throw up errors of fact, especially about local context issues, as well as identify where
judgements might be seen as unjustified because they are based on weak, controversial
or little evidence.
Finally, a good understanding of the strengths and limitations of HIA in general will ensure
that commissioners are realistic about what HIA can deliver and achieve and what it
cannot.
Scrutinisng a HIA
Key questions to ask are:
What is the scope of the HIA and the definition of health used?
Was the methodology used appropriate, explicit and logical?
What evidence and sources of evidence were included and excluded
and was the justification given explicit, reasonable and appropriate?
Was there any stakeholder involvement and were a range of
stakeholder consulted?
Was the justification for not consulting stakeholders and/ or involving
only certain stakeholders explicit, reasonable and appropriate?
Was the appraisal of impacts systematic and the reasons for judging
the significance and the extent of the positive and negative health
effects explicit, appropriate and justified?
Do the recommendations, including mitigation and enhancement
measures, follow on from the key issues emerging from the appraisal?
Is the report as a whole clear, coherent and understandable?
Does the HIA statement-report achieve the HIA’s aims and objectives?
Driving forces for change
International
Globalisation – interconnectedness and fragility of systems
Climate change
Population pressures (growth and migration)
Europe
Public concern
Sustainability
Public and environmental health
South Africa
As above
Poverty, Development, Inequalities
Overview of what’s happening
Internationally
Canada, Australia and New Zealand – Health and planning
legislation
USA - interest gathering pace
World Bank through IMF
Shell
European Union
SEA and EIA Directives
EC research on health and planning
Public health agenda - skills, capacity building,
mainstreaming
Planning agenda – HIA champions, spatial plans
www.designforhealth.net
USA
www.sfdph.org/phes/enchia/enchia_HDMT.htm
USA
www.hiaconnect.edu.au/completed_hia.htm
Australia
Africa
Netherlands
www.belfasthealthycities.com
Ireland
www.anamai.moph.go.th/6thglobal/Health%20Impact%20Assessment%20in%20Laos!.pdf
Laos
www.who.int/hia/examples/overview/whohia201/en/index.html
HIA in Thailand
www.mrcindia.org/MRC_profile/epidemiology/HIA.pdf
India
..
http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/ENVIRONMENT/EXTENVASS/0,,contentMDK:20486275~pagePK:148956~piPK:216618~theSitePK:407988,00.html
World Bank
www.ipieca.org/activities/health/health_publications.php
Private Sector