health impact assessment & planning- sue wright, rtpi cpd june 2013
TRANSCRIPT
Health Impact Assessment (HIA) & Planning
Sue WrightKnowledge and Evidence Manager (Higher Level) HIAKnowledge and Intelligence Team (West Midlands)
18th June 2013RTPI (West Midlands)
What is HIA?
• Combination of procedures, methods & tools
• That systematically judges the potential, & sometimes unintended, effects of a policy, programme or project
• On both the health of a population, & the distribution of those effects within the population
• HIA identifies appropriate actions to manage those effects
Quigley, R., L. den Broeder, P. Furu, A. Bond, B. Cave and R. Bos 2006 Health Impact Assessment International Best
Practice Principles. Special Publication Series No. 5. Fargo, USA: International Association for Impact Assessment.
What is HIA?
Screening
Scoping
Appraisal
Recommendations
Monitoring and Evaluation
Consider whether to perform an HIA
Plan how the HIA is to be done
Assessment of Health impacts
Formulates recommendations for decision makers
Actions to monitor impacts and evaluate HIA
Enhance positive health impactsReduce negative health impacts/MitigationReduce health inequalities
Present health profileFactors influencing healthHow will plan change theseIs everyone equally affected?
Purpose of HIAThe purpose of a HIA is to develop evidence based recommendations which influence the decision making process. The recommendations inform decision makers of the ways in which their proposal needs to be amended to enhance the positive impacts and reduce or eliminate the negative impacts.
• Informs a decision and is a decision support tool
• Predicts the health consequences of implementing different options
But also
• Increases awareness of health and health inequalities (better informed)
• Participation and engagement of stakeholders (decisions more open)
• Fosters interagency working
HIA and Planning
• Planning has the potential to support, sustain and improve health
• HIA is a tool to assess the health consequences of decisions e.g. plans, projects and programmes
• If HIA is considered at the planning and design stage then HIA can contribute to better decision making for health
Key features of HIA
• Broad definition of health– More than just absence of disease
– More than access to healthcare/services
• Wider determinants of health– Understanding of the many factors influence health
– E.g.: transport, education, income, social networks,
housing, income (see Dahlgren & Whitehead 1991 model)
• Addresses health inequalities– Assesses differential impact on population groups
Older people
Street
Lighting
Positive health
Heart Disease
Bad HousingBlood Pressure
Teenage Pregnancy
Meningitis
Drugs
Accidents
Feeling good
HIV/AIDS
Diabetes
Smoking Food Safety
Waiting
ListsParenting
Suicide
Water Fluoridation
Exercise
Family
Are you healthy? What makes you healthy?
Health is “… a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities."[
World Health Organization. The Ottawa Charter for Health Promotion. Adopted at the First International Conference on Health Promotion, Ottawa, 21 November 1986 - WHO/HPR/HEP/95.1.
What does Health mean?
8Haglund, Svanström, KI, revision, Beth Hammarström
HEALTH & HEALTH INEQUALITIES
Prediction of health impacts
HIA makes assumptions explicit.
Show how a project may potentially affect the health of people through intermediate variables
Assumption that changes in one factor lead to other changes which in turn lead to changes in health.
Critical Guide to Health Impact Assessment (West Midlands Public Health Observatory)
Proposal/ Project
Intermediate Variables
Expected Outcomes
Build new road
Increased road speed &
traffic
Increased road
accidents
Appraisal Stage of HIA
Policy Context
Stakeholder views
Literature & reports
Local Data
Analyse &prioritise
Describe impacts Which groups?
Evidence
Community Profile
The appraisal stage of a HIA involves collecting the evidence and assessing the health impacts. This is done by:
Expert knowledge
Modelling
Cars
Emissions
Local Business
Social networks
Increase employment opportunities/reduce
emissions
Improve accessibility to
city centre
“Park & Ride” scheme in outer city
Local bus services not
viable in outer city
Winter and Farthing (1997); Barker (1995)
Unintended Health Impacts of Health related Policies
Concerns about HIA
Criticism Response
Costly Estimated to be 0.01% of master plan development and implementation1; not as costly as treatment of health impacts in the long run
Time-consuming & slows decision making
Conducting the HIA early will bring issues to the front of the decision-making process, potentially speeding approval processes, and preventing costly litigation that delays projects
Stops economic development
HIA identifies mitigations and recommendations to enhance health and reduce risks but not to say “don’t do that”
HIA not scientific
HIA pulls together disparate pieces of the best available evidence to make a broad statement about impacts
Health impacts already covered e.g. open space, cycling/walking
Unintended impacts and health inequalities not always addressed; additional health enhancing actions could be recommended (see HIA of Herne Bay)
1Cost Benefit Analysis of Health Impact Assessment. University of York Health Economics Consortium (2006).
Does HIA work?Studies Impacts Impacts
16 HIAs in England 2006
Positive influence on decision making
Benefits outweighed costs
HIA in 19 European countries 2004-07
Increased awareness of potential health impacts across sectors
Contributed to specific policy changes
76 HIAs in US 2010 Health successfully incorporated into planning processes
Gateshead 2008-present Stoke –on-Trent 2009-present
Wanted to integrate health into Council decision making
Integrate health into policies and decision making
Established HIA steering group and HIA champions in council departments
Research project on how the council makes decisions and where health is taken into account (SoT is a Healthy City)
HIA Steering Group
4 Pilot HIAs 4 Pilot HIAs supported by 2year mentoring project
HIA events/awareness raising/training.Guide to HIA published
HIA events/HIA training, also development of high level IIA tool
Partnership with HIA expert Partnership with HIA expert and academic institution
Identified health impacts of council decisions
Assessed council reports for HIA
Introduced “Place making for Health” Supplementary Planning Document Healthy Urban Planning-all development plans (specific size) have to have HIA
Integrated HIA into Health and Wellbeing Boards
Guide to health proofing master plans published
What does HIA add?Herne Bay Regeneration
Sustainability Appraisal (SA) themes
SA Focus HIA themes HIA Focus
Historic Environment
Historic character of buildingsand identity
Neighbourhood image
Reputation and pride of place – impacts on health-related behaviour e.g. relatively high rates of binge drinking and teenage pregnancy.Need for community involvement in shaping the character of the town
Employment and theEconomy
Out-commuting, need for local employment, and diversification of theeconomy
Employment,education and thelocal economy
Out-commuting, need for local employment, and diversification of the economy, protection of those displaced in the regeneration. Promote healthy workplaces in new employment areas
Transport Need to reduce congestion and address parking pressures
Traffic flow, carparking and travel
Congestion and car parking management. Safety of all road users; shared space; activetravel
Quality of Life Need for investment in business and leisure sectors
Participation; healthylifestyles
Integrate healthy lifestyle interventions with community involvement in the regeneration.Focus on healthy settings approach
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What HIA is about and other health related IAs
HIA reports from1996 to present
Resources to help do HIA
People to contact; training; events; and other websites http://www.apho.org.uk/default.aspx?RID=44538; www.hiagateway.org.uk