iom chia comprehensive health impact assessment tool box 2008

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Centre for Health Impact Assessment .

Comprehensive

Health Impact Assessment

Toolbox

IOM CHIA2 Toolbox


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The IOM is a major independent centre of scientific excellence in the fields of occupational andenvironmental health, hygiene and safety. We were founded as a charity in 1969 by the UK coalindustry in conjunction with the University of Edinburgh and became fully independent in 1990. Our

mission is to benefit those at work and in the community by providing quality research, consultancyand training in health, hygiene and safety and by maintaining our independent, impartial position asan international centre of excellence. The IOM has more than seventy scientific and technical staffbased in Edinburgh, Chesterfield, London, and Stafford. Consultancy work is undertaken throughIOM Consulting Limited which is a wholly owned subsidiary.

Dr Salim Vohra is the Director of the IOMs Centre for Health Impact Assessment based in London.

The vision of IOM CHIA is to be a Centre of Excellence in:

Health impact assessment theory and practice

Healthy public policy Evidence-based analysis and evaluation of the impacts

of policies and programmes on health

Researching the wider determinants of health and

wellbeing

Tackling environmental and health inequalities

Healthy urban planning and development

Urban and rural regeneration and health


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Institute of Occupational Medicine CHIA2Toolbox (2008)

Contents

Page1. Screening 12. Scoping (scope and terms of reference) 33. Methodology 54. Baseline Assessment 85. Policy Context (and policy evidence) 106. Appraisal Rapid 127. Health Appraisal Detailed 158. Consultation Plan 199. Evaluating The Evidence 2110. Key Conclusions 2211. Mitigation And Enhancement 2512. Monitoring And Evaluation 2613. Recommendations 2714. HIA Evaluation 29

Developed by Salim Vohra (2005-08)


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Introduction

This toolbox has been

developed to help health

organisations, local

authorities, private sector

businesses and

communities understandwhat health impact

assessments on plans,

programmes and projects

are all about.

"Health is a state of completephysical, mental and socialwellbeing and not merely theabsence of disease orinfirmity

Health is therefore a resource

for everyday life, not theobjective of living; it is apositive concept, emphasizingsocial and personal resources,

as well as physical capacities."

World Health Organisation,

1947 and 1984.

It follows the eight core

steps that generally make

up a health impactassessment process:

Screening

Scoping

Baseline and community profile

Stakeholder involvement

Evidence and analysis

Mitigation and enhancement

Health impact statement(HIA reporting)

Follow-up

(monitoring & evaluation)

What is health

impact

assessment

(HIA)

HIA is a public healthscience.

It is a systematic approach

to identifying the differential

health impacts of proposed

plans and projects so that

positive health impacts are

maximised and negative

health impacts are

minimised within a givenpopulation. It aims to work

within an explicit

democratic, equitable,

sustainable and ethical useof evidence framework and

uses a range of structured

and evaluated sources ofevidence that includes

public and other

stakeholders' perceptions

and experiences as well aspublic health,

epidemiological,

toxicological and medical

knowledge.

Whereas health needs

assessment starts fromanalysing the health needs

of a population and then

develops plans and

projects to meet those

needs; health impact

assessment appraises plans,

programmes and projects

in terms of their healthimpacts on a population.

Why this

toolbox

This toolbox highlights all thekey issues and questions

that need to be answered

by a health impact

assessment. Its our "almostevery question youever

need toask in a HIA

toolbox.

We use this toolbox with

clients and communities as

a prompt and a systematic

way of ensuring that all the

important health and

wellbeing issues are

addressed when we carryout a HIA. It helps us to

ensure that clients andcommunities understand

what we are doing andhow we are doing it every

step at every of a HIA.

HIA is not a linear process

but an iterative, dynamic

and non-linear one with

issues from later stagessometimes feeding into

earlier ones.

How we have

used this

toolbox

We use this toolbox in four

ways:

To work through the

health and wellbeing

concerns of local

communities.

To carry out a rapid or

comprehensive HIA.

To develop shorter

health impact screening

tools for specific local

proposals for particularclients.

As a tool for training

people in HIA practice.

HEALTH IMPACT ASSESSMENT

HEALTH NEEDS ASSESSMENT

Population Proposal


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Page 1

1. Screening

Assess whether an proposal (plan, policy programme, project or service) should have a health

impact assessment undertaken by answering as honestly as you can the following questions.

Name of Proposal:

Answers

favouring

doing a HIA

From your knowledge and/or

in your judgement

Answers

favouring not

doing a HIA

Health Impacts

Yes / not sure

Yes / not sure

Does the proposal affect health directly?

Does the proposal affect health indirectly?

No

No

Yes / not sure Are there any potentially serious negativehealth impacts that you currently know of?

No

Yes / not sureIs further investigation necessary because

more information is required on the potential

health impacts?

No

No / not sureAre the potential health impacts well known

and is it straightforward to suggest effective

ways in which beneficial effects are

maximised and harmful effects minimised?

Yes

No / not sureDo you (or others) judge the identified healthimpacts as being small in effect?

Yes

Community

Yes / not sure Is the population affected by the proposallarge?

No

Yes / not sure Are there any socially excluded, vulnerable or

disadvantaged groups likely to be affected?

No

Yes / not sure Are there community concerns about any

potential health impacts?

No

Proposal

Yes / not sure Is the size of the proposal large? No

Yes / not sure Is the cost of the proposal high? No

Yes / not sure Is the nature and extent of the disruption

caused by the proposal likely to be major?

No

Organisation

Yes Is the proposal a high priority/ important for

the organisation/ partnership?

No

For = TOTAL Against =


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Page 2

1. Screening contd

Assess what kind of HIA should be done on your proposal by answering as honestly as you

can the following questions.

Rapid Type of HIA Comprehensive

Yes Is there only limited time in which to conduct

HIA?

No

Yes Is there only limited opportunity to influence the

decision?

No

Yes Is the timeframe for the decision-making processset by external factors beyond your control?

No

Yes Are there only very limited resources available to

conduct HIA?

No

Assess who should do the HIA on your proposal by answering as honestly as you can the

following questions.

External Assessors Internal

No Do personnel in the organisation or partnershiphave the necessary skills and expertise to

conduct the HIA?

Yes

No Do personnel in the organisation or partnership

have the time to conduct the HIA?

Yes

Adapted from a screening tool developed by Erica Ison in Resources for Health Impact Assessment, 2000,


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Page 3

2. Scoping (scope and terms of reference of the HIA)

Question Answer

Who will lead on the project management of

your HIA?

Will you have a HIA steering group, if yes, who

will make up the members, what will be its terms

of reference?

Are there other professional or community

stakeholders - not included on your steering

group who should be involved in the design of

your HIA?

When do the decision-makers you are aiming to

influence make their decision and hence when

does your HIA report need to be completed by?

Why is the proposal being undertaken? What

are the proposals aim and objectives?

Why do you want to do this HIA?

What are your HIAs aim and objectives?

What geographical area will your HIA cover?

What population group will your HIA

encompass?

Will the population assessed reside within the

geographical area described above or include

workers living outside the area,travelling families, etc?


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Page 4

2. Scoping contd

Question Answer

What definition of health will you use

for your HIA?

What HIA model/approach do you want to use?

Are there any specific health impacts that you

want your HIA to focus on?

Do you know which specific population sub-

groups/ community groups will be directly

affected by the proposal under consideration?

Will your HIA give specific detailed

recommendations or will you just detail the

potential health impacts so that your steering

group and other decision-makers can then

separately think about the implications and

recommendations?

Other issues relevant to your local or

organisational setting


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Page 5

2. Scoping notepad


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Page 6

2. Scoping notepad


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Page 7

3. Methodology

Question Answer

Depending on what HIA model you chose in

scoping,will you use a quantitative, qualitative

or mixed approach?

Why?

What health evidence and research sources will

you use?

What sources wont you be able to use?

Why?

Current evidence on health needs (public

health, local authority, etc)Research review evidence on health impacts

Will you do an informal windscreen or

walkabout observation of the geographical

area and community?

Will your HIA include a formal consultation of

professional and community stakeholders?

Why?

What method/s are you thinking of using?


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Page 8

4. Baseline Assessment

Question Answer

What are the characteristics of the

local people age, gender, ethnicity?

What is the health situation like

of local people?

What is the social situation like?

What is the economic situation like?

What is the local environment like?


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Page 9

4. Baseline Assessment contd

Question Answer

What health & social care services are there in

the area/serving local people?

What voluntary sector and charity services are

there?

What retail, shopping and banking services are

there?

What culture and leisure services are there e.g.

cinemas, theatres, sports centres?

What urban/rural regeneration or other area or

health improvement programmes

are there?


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Page 10

5. Policy context (and policy evidence)

Question Answer

What international health and non-health

policies does the proposal link into?

Which parts of these policies does the proposalfollow and which parts does it ignore?

What are the reasons for this?

What national and regional health and non-

health policies does the proposal link into?

Which parts of these policies does the proposal

follow and which parts does it ignore?What are the reasons for this?

What local health and non-health policies does

the proposal link into?

Which parts of these policies does the proposalfollow and which parts does it ignore?

What are the reasons for this?


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Page 11

Determinants of

Health & Wellbeing

Lifestyle

Environment

Economic

conditions

Availab

age

sex

genetic

effects

leisure

activities

exercise

sexual

behavioursmoking

alcohol

prescriptiondrugs

substance

misuse

Biological

factors

familyrelationsh

social

contac

discrimination

health & socialcare services

emadviceservices

voluntary &

charity groups

public

transport

shops andbanking services

job

creation

distribution of

incomes

availability oftraining

quality of

employment

availability of

employment

business

activity

research & technologicaldevelopment

land use &

planningnatural

resourcesgreen

spacewastemanagement

public &

environmental

health services

natural

hazards

civic design

smell noise

vibration

air

quality

waterquality

soilquality

Adapted from Rapid Health Impact Assessment: a guide to research by Amanda Harris, 2002


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Page 12

6. Appraisal rapid adapted from the British Columbia HIA model as described by Erica Ison in Resources for H

Yes,

No,

Not Sure

If Yes,

is the health impact

likely to be positive

or negative (+/-)?

Who or what people

or group(s) will it

potentially affect?

How is the impact likely

occur?

How do you know this?

Will the proposal affect the

creation and distribution of

income or wealth levels?

Will the proposal affect

employment opportunities?


learning opportunities?

Will the proposal createhealthier beginnings for

children?

Will the proposal affect the

number and quality of

personal connections?


crime and safety?


peoples ability to influencetheir lives and locality?

Will the proposal affectthe local environment?


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7. Health appraisal detailed adapted from the BMA and Merseyside HIA models

Themes

What are the potential

effects on ..?

Will the

change

be +/-

for

peopleshealth?

What stakeholder/s

(individuals & groups)

are likely to be

affected?

When is the impact

likely to occur

(start, during or end of

the proposal)

EVIDENCE OF IMPACT

- TYPE

(reports, reviews,surveys, experiences)

EVID

(aex

infectious diseasese.g. TB, measles, food

poisoning, salmonella, BSE,

SARS

non-infectious/

chronic diseasese.g. heart disease, cancer,

accidents & physical

injuries

mental health &

wellbeing


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7. Health appraisal detailed contd

Themes


effects on ..?

Will the

change

be +/-

for

peopleshealth?

What stakeholder/s


are likely to be

affected?

When is the impact

likely to occur


the proposal)

EVIDENCE OF IMPACT

- TYPE


EVID

(aex

housing &

accommodation

education & learning

employment &

economy

transport &

connections


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Themes


effects on ..?

Will the

change

be +/-

for

peopleshealth?

What stakeholder/s


are likely to be

affected?

When is the impact

likely to occur


the proposal)

EVIDENCE OF IMPACT

- TYPE


EVID

(aex

crime & safety

social capital &

community cohesion

health & social care

services

retail shops and other

amenities


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Themes


effects on ..?

Will the

change

be +/-

for

peopleshealth?

What stakeholder/s


are likely to be

affected?

When is the impact

likely to occur


the proposal)

EVIDENCE OF IMPACT

- TYPE


EVID

(aex

culture & leisure

lifestyle & daily

routines

energy & waste

land & spatial


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Page 19

8. Consultation plan

Stakeholder

Aim of consultation Key issues to be discussed Consultation method/s Pote

Public


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Page 20

8. Consultation plan contd

Stakeholder

Aim of consultation Key issues to be discussed Consultation method/s Pote

Professionals


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Page 21

9. Evaluating the evidence

Assess how strong the evidence of positive or negative health impacts is likely to be by

answering as honestly as you can the following questions.

Answers showing

the evidence is

more likely to be of

good quality

To your knowledge

Answers showing

the evidence is less

likely to be of good

quality

Research

Yes Does the evidence for each impact come from more

than one source?

No

Yes Is the evidence for each impact of more than one type

(i.e. both quantitative and qualitative and/or a range ofquantitative and qualitative studies/reports)?

No

Yes Has some or all the evidence for each impact been

reviewed by other research experts (peer-reviewed

and/or published)

No

No Is the evidence for each clear and consistent or are

there areas of ambiguity and differences of emphasis in

the different types and sources of evidence?

Yes

Front-line experts and professionalsYes Is there broad consensus among front-line experienced

experts and professionals that the impacts can/do

occur in these kinds of proposals?

No

Yes Is there broad consensus among experienced front-line

experts and professionals that the evidence for each

impact is sound?

No

Lay publics

Yes Is there broad consensus among resident and

communities who have experienced the impacts (lay

experts) that these impacts can/do occur in these kinds

of proposals?

No

Yes Is there broad consensus among the public (non-experts) that the evidence for each impact is sound? No

Assessors/Evaluators

Yes Do the assessors/evaluators of the evidence of impact

have experience and expertise in reviewing health and

social care evidence?

No

Social Context

No Is there current heightened public concern and/ or

local, regional or national political issues surrounding

some or all the impacts?

Yes

More likely = TOTAL Less likely =


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Page 22

10. Key conclusions

IMPLEMENTATION OR CONSTRUCTION PHASE

Question Answer

What are the key potential positive impacts?

What are the key potential negative impacts?

What groups are likely to be affected positively?

How?

Will this widen existing health inequalities?

What groups are likely to be affectednegatively?

How?


How strong is the evidence for the positive

effects?

Do the affected communities agree?

How strong is the evidence for the negative

effects?



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Page 23

10. Key conclusions contd

OPERATION OR WORKING PHASE (short & long term)

Question Answer


- short term

- long term


- short term

- long term


How?



How?



effects?



effects?



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Page 24

10. Key conclusions contd

END OF PROPOSAL - DECOMMISSIONING PHASE

Question Answer




How?



How?



effects?



effects?



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Page 25

11. Mitigation and enhancement

Question Answer

What are the key options to reduce (mitigate)

the potential negative impacts for each stage:

implementation/ construction phase

operation/ working phase (short & long term)

end of proposal phase

What are the key options to increase (enhance)

the positive impacts?

implementation/ construction phase

operation/ working phase (short & long term)

end of proposal phase


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Page 26

12. Monitoring and evaluation

Question Answer

What monitoring processes will you put in place

to ensure that negative health effects arereduced?

What indicators will you use?

What monitoring processes will you put in place

to ensure that positive health effects are

enhanced?

What indicators will you use?

How will you evaluate the proposal in terms of

health outputs and health outcomes?

- process evaluation

- impact evaluation

- outcome evaluation


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Page 27

13. Recommendations

Question Answer

What key recommendations emerge from your

assessment?

Should the proposal go ahead?

How should the proposal be taken forward sothat it is provides the greatest health benefits?

Which mitigation and enhancement options will

local people and/or other key stakeholders findmost acceptable?


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Page 28

The End

except for evaluating the HIA itself see next page


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Page 29

14. HIA evaluation

Question Answer

What was the proposal that was assessed?

What type of HIA did you undertake?

What HIA model/method did you use?

Why?

What were the costs (financial, human, time)

involved and could these have been better

spent elsewhere?

Did you use a wide range of evidence sources

to make the assessment and did they inform the

HIAs recommendations?

Were health inequalities assessed and if so how

were they assessed?

How were recommendations formulated and

prioritised?

What factors influenced this decision-makingprocess?

Were decision-makers involved and engaged in

the process and if so how was this done?

What were their expectations and were theyfulfilled?

Were the recommendations delivered in a form

and within a timescale that was relevant and

appropriate to decision makers?

What did the steering group, consultees and

others involved in the HIA think about the HIA

process and the

method used?


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Page 30

14. HIA evaluation contd

Question Answer

Were all or some of the recommendations

accepted and implemented by the decisionmakers?

What factors contributed to their acceptanceor rejection?

Were the aim and objectives of the HIA met?

What other impacts were associated with the

HIA?

- improved partnership working,

- raising the profile of local health needs andputting health on partner agencies agendas,

- organisational development

- new ways of working within and across theorganisations involved

Adapted from the Health Development Agency Learning from Practice Bulletin Evaluating Health Impact Assessmentby Taylor, L., Gowman, N., Quigley, R. 2003.


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For more information on health impact assessment consultancy, training and research contact us at:

Centre for Health Impact Assessment, Institute of Occupational Medicine

Research House Business Centre, Fraser Road, Perivale, Middlesex. UB6 7AQ

Tel: 020 8537 3491/2 Fax: 020 8537 3493

iom chia comprehensive health impact assessment tool box 2008

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