healthimpactassessment benharris-roxas-150610073811-lva1-app6892-1
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Centre for Primary Health Care and Equity
Health Impact AssessmentÉvaluation d’impact sur la santé
Ben Harris-Roxas BSW MPASR PhD
Conjoint Lecturer, University of New South Wales, Sydney
Convenor, HIA Global Working Group, IUHPE
Consultant, ZEST Health Strategies
• Sections
1. Health impact assessment
2. Evolution and forms
3. HIA practice
4. Evaluation of HIA
5. Lessons learned
6. Resources
A combination of procedures, methods and tools by which a policy, program or project may be assessed for its potential and often unanticipated effects on the health of the population and the distribution of these impacts within the population.
Gothenburg Consensus Paper
European Centre for Health Policy (1999) Gothenburg Consensus Paper on Health Impact Assessment: main concepts and suggested approach, WHO Europe: Brussels (adapted by Mahoney & Morgan).
Key Aspects of HIA
• Prospective (ex ante assessment)
• Combination of methods
• Looks at intended and unintended impacts
• Distribution of impacts
• Evidence-informed recommendations
http://hiaconnect.edu.au/wp-content/uploads/2012/05/Health_Impact_Assessment_A_Practical_Guide.pdf
Distribution of Impacts
• Age
• Gender
• Socioeconomic status
• Location
• Ethnicity and culture
• Existing levels of health and disability
If you implement the
proposal
These will be the impacts
If you make these changes
These will be the gains
Assessment Recommendations
1950s 1960s 1970s 1980s 1990s 2000sEnvironmental Disasters
Regulatory Environmental Impact Assessment
Environmental Health
Health EquityHIA
1956 Clean Air Act (UK)
1969 Santa Barbara Channel (USA)
1969 US National Environmental Policy Act (USA)
1978 Love Canal (USA)
1984 Bhopal (India)
1986 Ottawa Charter
1990 Concepts & Principles of Equity in Health
1997 Jakarta Declaration
1999 Gothenburg Consensus Paper on HIA
2008 WHO Commission on the Social Determinants of Health
Social View of Health
1972 Lake Pedder Dam controversy (Australia)
1974 Environmental Protection (Impact of Proposals) Act (Australia)
2005 Health included in IFC Performance Standards
1994 Framework for Environmental and Health IA (Australia)
2007 1st Asia-Pacific HIA Conference (Australia)
1978 Seveso (Italy)
1990 Environmental Protection Act (UK)
1980 The Black Report (UK)
1972 The Indian Wildlife (Protection) Act
1974 Lalonde Report (Canada)
1998 Merseyside Guidelines for HIA
1978 WHO Seminar on Environmental Health Impact Assessment (Greece)
2004 Equity Focused HIA Framework (Australia)
1978 Declaration of Alma Ata
1992 Asian Development Bank HIA Guidelines
1959 Minamata Bay (Japan) 1980 International
Association for Impact Assessment formed
1969 Cuyahoga River Fire (USA)
1962 Silent Spring
2007 HIA’s use included in Thailand’s Constitution
1998 The Solid Facts
1979 Three Mile Island (USA)
2005 Guide to HIA in the Oil and Gas Sector
1986 Chernobyl (Ukraine)
1989 Exxon Valdez Oil Spill (USA)
2009 Montara West Atlas Oil Spill (Australia)
2010Marmot Review
Harris-Roxas B, Harris E (2011) Differing Forms, Differing Purposes: A Typology of Health Impact Assessment, Environmental Impact Assessment Review, 31(4): 396-403. doi:10.1016/j.eiar.2010.03.003
1999 Erika sinking in Bay of Biscay (France)
2010 Deepwater Horizon (USA)
Mandated
Decision Support
Advocacy
Community ledHarris-Roxas B, Harris E (2011) Differing Forms, Differing Purposes: A Typology of Health Impact Assessment, Environmental Impact Assessment Review, 31(4): 396-403. doi:10.1016/j.eiar.2010.03.003
Source: Harris E, Baum F, Harris-Roxas B, Kemp L, Spickett J, Keleher H, HarrisM, Morgan R, Dannenberg A, Sukkumnoed D, Wendel A. The effectiveness of health impact assessments conducted in Australia and New Zealand; Australian Research Council Discovery Project Grants; 2010-2011. [DP1096211]
Source: Winkler M et al. (2013) Untapped potential of health impact assessment, Bull World Health Organ 2013;91:298–305. doi:10.2471/BLT.12.112318
Source: Harris-Roxas B, Harris P. Learning by Doing: The value of case studies of health impact assessment. NSW Public Health Bulletin, 2007:161-163.
Types of Health Impacts
Source: The Rise of HIAs in the United States http://www.pewhealth.org/reports-analysis/data-visualizations/the-rise-of-hias-in-the-united-states-85899464695
Fredsgaard MW, Cave B, Bond A (2009) A Review Package for Health Impact Assessment Reports of Development Projects, Ben Cave Associates: Leeds.
Bhatia R, Farhang L, Heller J, Lee M, Orenstein M, Richardson M and Wernham A. Minimum Elements and Practice Standards for Health Impact Assessment, Version 3. September, 2014.
Rhodus J, Fulk F, Autrey B, O’Shea S, Roth A (2013) A Review of Health Impact Assessments in the U.S.: Current State-of-Science, Best Practices, and Areas for Improvement, Office of Research and Development, National Exposure Research Laboratory, U.S. Environmental Protection Agency: Cincinnati. http://www.epa.gov/research/healthscience/docs/review-hia.pdf
–Essential components for HIA reports
1. A documented and transparent process.
2. A clear statement of the HIA's goals and purpose.
3. A rigorous, documented approach to gathering and assessing evidence.
4. Clear predictions of impacts.
5. Recommendations for enhancement and mitigation.
Harris-Roxas B, Harris P, Wise M, Haigh F, Ng Chok H, Harris E (2013) Health Impact Assessment in Australia in Past Achievement, Current Understanding and Future Progress in Health Impact Assessment (Ed Kemm J), Oxford University Press: Oxford, 223-243.
O'Mullane M, Harris-Roxas B. Health Impact Assessment, Journal of Environmental Assessment Policy and Management, 17(1):11, 2015. doi:10.1142/S1464333215500052
Harris-Roxas B, Harris E (2013) The Impact and Effectiveness of Health Impact Assessment: A conceptual framework, Environmental Impact Assessment Review, 42: 51-59. doi:10.1016/j.eiar.2012.09.003
Harris-Roxas B, Haigh F, Travaglia J, Kemp L. Evaluating the impact of equity focused health impact assessment on health service planning: Three case studies, BMC Health Services Research, 14:371. doi:10.1186/1472-6963-14-371 www.biomedcentral.com/1472-6963/14/371
–The factors that influence the impact and effectiveness of HIAs
1. Informing implementation
2. Consolidating understanding of health and health equity
3. Enabling discussion of alternatives
4. Clearer articulation of the values that inform health planning and implementation
5. Time
6. The role of individuals
7. Conceptualisations of the purpose of EFHIA
Harris-Roxas B, Haigh F, Travaglia J, Kemp L. Evaluating the impact of equity focused health impact assessment on health service planning: Three case studies, BMC Health Services Research, 14:371. doi:10.1186/1472-6963-14-371 www.biomedcentral.com/1472-6963/14/371
–Common criticisms
• HIA is expensive and time-consuming
• Health is already addressed through planning and policy development
• HIA could create duplication and inefficiencies
• Government response
• “Health impact assessments have been promoted as a means of assessing the health impacts of policies, plans and projects using quantitative, quantitative and participatory techniques. While we think that they may be a useful tool, we believe that they have the potential to be expensive and time-consuming, and we believe that this needs to be taken into account in any further consideration of these.”
• [Senate] Committee view
• …There are already mechanisms in place to ensure that important issues are considered across government when necessary, such as the requirements for inter-departmental consultation in the preparation of cabinet submissions, the requirement for Regulatory Impact Statements in conjunction with the introduction of legislation, and statements of compatibility with human rights.
• Community Affairs References Committee (2013) Australia's domestic response to the World Health Organization's (WHO) Commission on Social Determinants of Health report "Closing the gap within a generation": Submissions
received by the Committee, Australian Senate: Canberra.
• …but there is limited evidence to support these claims empirically.
• For example, I was involved in an equity focused HIA that was completed in 5 days.
• Harris-Roxas B, Harris P, Harris E, Kemp L (2011) A Rapid Equity Focused Health Impact Assessment of a Policy Implementation Plan: An Australian case study and impact evaluation, International Journal for Equity in Health,
10(6). doi:10.1186/1475-9276-10-6
Maturity Model Level
5. Optimised
High functioning
4. ManagedSpecific, Measurable Accurate Responsive, Timely (SMART)
3. Defined
Structured approach
2. Repeatable
Processes in place
1. Ad-hoc
Limited system in place
0. Not defined
No level of activity
Level Workforce Tools and resourcesOrganisational development
Governance Partnerships Leadership InvestmentData and technical
systems
Optimised
High functioning service coordination
Sustainable highly skilled workforce
Practical HIA tools are widely used
Sustainable organisational development
High functioning HIA governance and regulatory
mechanisms
Strong HIA partnerships exist
Strong leadership to provide support across
different settingsOngoing investment in HIA
Relevant and intuitive data systems exist to collect consistent information
ManagedSpecific, Measurable Accurate Responsive,
Timely (SMART)
Skilled workforce provide proactive support
HIA resources are commonly used
Strong organisational development exist
Strong HIA governance and regulatory mechanisms
Responsive and adaptable HIA partnerships exist
Recognised leadership Diversified HIA investmentData systems routinely
used to collect information
Defined
A structured approach
Skilled workforceRelevant HIA resources
are customised and adapted
Defined organisational development
Defined HIA governance and regulatory mechanisms
Defined partnership processes
Defined roles and responsibilities
Sustained HIA investmentRelevant data and
technical systems exist
Repeatable
Processes in place
Reactive support providedRelevant HIA resources
existStructured organisational
development
Repeatable HIA governance and regulatory
mechanisms
Structured partnership and governance processes
Identified leaders who may be called upon again
Some investment in HIA Data systems built
Ad-hoc some level of system in place
Ad-hoc workforce identifiedHIA resources identified as
neededSome organisational
developmentAd hoc governance and regulatory mechanisms
Informal processesA form of leadership in
placeIdentified need for investment in HIA
A system in place
Not defined No identified workforce No relevant resources No supportNo governance and
regulatory mechanismsNo processes No support provided No investment
No Systems
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