Plenary 5Chair: Owen Metcalf

Health Impact Assessment: Making the Difference

Steve Cropper

Director, Research Institute for Public Policy and Management, Keele University

Health Impact Assessment: Making the Difference

Community Involvement in Health Impact Assessment:

what’s the case?

Steve Cropper

Centre for Health Planning and Management

Research Institute for Public Policy and Management

Keele University

HIA

• A means of ensuring that the health effects of any policies, programmes and projects are considered in the process of decision making

– Improve understanding – estimation of benefits and risks/harm arising– Identify potential actions to avoid negative effects and enhance positive

effects– Inform and influence decisions

• A ‘framework’into which evidence about impact can be placed and assessed

Evidence

• Incomplete outcome sets• Uncertainty about the significance/value

placed on the outcomes identified• Incomplete understanding of pathways/ from

‘interventions’ to outcomes – theories of change

• Contest

Status of HIA• ‘Point in time’ decision technology

– Propositional assessment

• ‘Means of adding to knowledge combining normative claims & evidentiary base

• Moral stance’ – questions about values– Risk society - limits to technocracy– Holistic conception of health

• Contribution to reparatory and democratising processes

Status of ‘community’ in HIA

• Source of ‘evidence’ • Lay or ordinary knowledge• ‘’Local’ knowledge

• Guide and advisor

• Participant in decision

• Commissioner and conduit

Influence& Control

Informing value base of decision

Au M. Rein

Lay or Ordinary Knowledge

• Knowledge that does not owe its origin, testing, degree of verification, truth status or currency to distinctive science techniques, but rather to common sense, casual empiricism, or thoughtful speculation and analysis.

Lindblom and Cohen (1979: 11)

Local Knowledge

• Cultural rather than ‘simple truth’ & ‘plain fact’– Not just using eyes and ears, but using them

judiciously, intelligently, perceptively– A basis for making one’s way

• Addressing everyday problems in an everyday way (Geertz)

– Principles interpreted in lived context– Stories of contrast – here and there; then and now; us

and them– Ad hoc, but full of propositional knowledge too

The Pool

….it brought life into that bit of the area because it was lit up..the whole place had an aura about it... But now you go up there, you’ve nae light, the building is dim the weans have smashed whatever lights hanging about, it’s dreary, it’s frightening, that’s how the shops are shutting because naebody is there at night whereas when the baths were opened at night it lit the whole area up”

Quote in Thomson, Kearns & Petticrew (2003)

1 close swimmingpool ... open

swimming pool

2 sense of personalsafety in public

spaces

3 closure of otheramenities

4 changingappearance of the

area

5 attractiveness ofthe area

6 nae light ...area lit up

7 loss of life inthe area ... lifebrought into the

area

8 weans smashwhatever lights

9 shops are shutting

10 naebody is thereat night

11 nae reason foranybody to go up

there

12 emphasise scaleof under-investment

13 symbolic of widerarea decline

14 positiverelatinship betweenhealth and context

independent ofparticipation ref 14

-

How can/do the views of local people add to understanding?

• Validate AND add to the set of impacts understood to arise from the policy/ programme/project

• Inform understanding of the significance of these impacts to and within the community

• Provide pathways knowledge – how will policy take effect

• Incorporation within/fusion with other evidence

Two knowledge dynamics

HIA

CurrentDecision

HIA

HIA

Evidence Base

Future decisions

What does HIA ‘give back’: cautions

• The prospectus – a chance to inform and influence - – community expectations: relationships to current, near

and far decisions

• Respect and admission of uncertainty: exposure - policy/programme (and ‘levers’ available to decisions makers) not always clear, defined –

• Community ‘capacity’– boundaries and legitimacy –

Participation – political virtue

“How can citizens so disillusioned … become engaged in debate about future guiding values? Is it possible to use institutional design processes to break out of Putnam’s vicious circle of distrust, disengagement and weak democracy?”

Vivien Lowndes and David Wilson (2000)

HIA and deliberative action

• “Community development therefore has to be propositional as well as oppositional….

– to help local groups to decide what they are for, not just what they are against. …

– to identify and develop the common interests within communities. … [and]

– to link local government in to these complex grassroots communities.”

(Benington: 1997: 239-40)

Concluding Thoughts

• HIA as impure’ science– Value critical policy analysis/impact assessment

• Experiential and abstract knowledge• Fact and value• Thick description and interpretation as much as estimation

• Democratise policy/technological design and practice– HIA as start or catalyst to dialogue – beneficial in its own

right

• Insider..outsider strategies

Anthea Cooke

Director, Inukshuk Consultancy

Health Impact Assessment: Making the Difference

HIA & Community Participation – more trouble than worth?

Anthea CookeDirector – Inukshuk Consultancy, Specialist

HIA Advisor London Health Observatory

Inukshuk

Inukshuk

More trouble than worth?

• What does the theory tell us?

• More trouble….?

• Case study

• Learning the lessons….

• Challenges…

• Provides information about proposal to those affected

Inukshuk

Why do it?

• Improves quality of assessment by ensuring potential health impacts identified will match local experience

• Provides opportunities for stakeholders to express and consider concerns

• Can help manage expectations and misconceptions• Improves quality of final decision as local needs can be reflected and tailor made response

developed

• Affirms transparency of process by opening to public scrutiny

Inukshuk

More trouble?• We’ve already said what we think – no-one’s listened before?

• You’ll only get the ‘usual subjects’ – representation

• It’s only ‘their’ opinions – we know what the evidence says works

• Hierarchy of evidence

• How can we can quantify impacts from people’s opinions?• Methods for collecting and appraising community evidence are patchy and not well

documented

• **** off you middle class white consultant – we can do this work ourselves…

HIA as part of Masterplan for estate of approx 4,000 households, very disaffected community, partnership working with health broken down & health weakest aspect of a ‘failing’ NDC

• Community profile – revised the baseline• Scoped the HIA priorities with ‘stakeholder workshop’• Literature search on effectiveness of interventions• Tacked health into existing consultation rather than

separate process• Reviewed previous consultation documents• Steering group members made links with groups not previously consulted and interviews, visits & questionnaires using consistent methodology• Steering group workshop to prioritise

recommendations Inukshuk

Inukshuk

Outcomes of HIA re Community participation?

• Agreed set of priorities for NDC and partners on health

and wellbeing

• Masterplan clearer about importance of transport,

service facilities, access to food & exercise opportunities

• Kick starting of renewed partnership with health and NDC• Steering group became NDC health planning group with

improved resident participation, health and local authority

• NDC 5 year Delivery Plan (health) now based on findings

of HIA, & influenced other parts such as Employment and Crime

• Use systematic methods – not always easy when need different approaches

Inukshuk

Learning the lessons• Screening and scoping is essential – be clear whose evidence you need, why and status of

this, build on what is already known or collected

• Need to have policy makers on board from the beginning and to be able to demonstrate to people that it is worth getting involved

• Be willing to seek to give voice and value to those who are potentially affected by the proposed policy or programme

Inukshuk

Learning the lessons• Realistic timescales – this work takes time and resources

• Better to focus on smaller number of projects and to base community participation on these as it makes it more real for the community

• Open and transparent process which recognizes it is a two way learning process, integrity crucial

• Develop a sustainable partnership with the communities involved – be clear how the work will go forward

Inukshuk

Challenges to conference…• Is community participation in HIA more about community development than gathering

evidence – does it matter?

• How do we do community participation when the impacts of proposal are likely to be negative?

• How can we build credibility for qualitative evidence gathering with limited resources, time and credibility?

• Where is the funding to develop the methods?

7th International Health Impact Assessment

Conference

Health Impact Assessment: Making the Difference

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