Health impact assessment: towards public policy as if people mattered

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Health impact assessment towards public
policy as if people mattered

• Alex Scott-Samuel
• IMPACT
• International Health Impact
• Assessment Consortium, University of Liverpool

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Bottom line a healthy society is a fair and just
society
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Uses of HIA

• creation of healthy public policies / projects
• reduction of health inequalities
• social and economic development
• health advocacy
• advocacy for disadvantaged groups
• personal development
• partnership building

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Background 1970-1995

• environmental impact assessment
• healthy public policy
• HIA in LDCs in 1980s
• British Columbia 1993
• Manchester Airport 1993

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HIA 1998 onwards

• 1st UK Health Impact Assessment Conference 1998
• Merseyside Guidelines for HIA
• public sector projects
• capacity building
• academic centres
• journal papers
• widely adopted by WHO, TNCs etc

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European support for HIA

• Swedish Federation of County Councils
• Health Impact Screening
• STAKES (Helsinki) meeting - January 1998
• WHO European Centre for Health Policy
• European health impact assessment e-mail
  group
• seminars / fellowships
• Gothenburg consensus conference / book
• EC involvement - DG Sanco
• Practical Guide to Services
• Policy HIA for the EU

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Important characteristics of HIA

• Prospective
• Decision support tool, not evaluation method
• Trade-off between brevity and rigour

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Some IMPACT HIA projects

• Foresight Vehicle Initiative
• Castlefields regeneration
• Policy HIA for the EU
• Capacity building in Liverpool
• Antisocial behaviour - Citysafe
• Community HIA
• Making it Better
• Mental well-being impact assessment

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Two perspectives of HIA  
Source National Assembly for Wales (1999)
Developing health impact assessment in Wales.  
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• Ron Labonte. Inequalities in Health in the City
  of Toronto. 1991

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The Merseyside approach to HIA - 1

• Screening
• Steering group
• Scoping
• Policy analysis
• Profiling of communities
• Collect data from stakeholders and key informants
• Identify health determinants affected

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The Merseyside approach to HIA - 2

• Assess new and published evidence
• Establish priority impacts
• Recommend and justify options for action
• Appraise assessment
• Negotiate favoured options
• Implement and monitor
• Evaluate and document

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Health inequality in HIA

• inequality a screening (selection) criterion
• vulnerable groups identified in profiling and
  policy analysis
• distributional impacts (as well as population
  impacts) identified
• recommendations take account of impact
  inequalities
• monitoring and evaluation based on inequality
  indicators and outcomes

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Equity in HIA

• choice of paradigm (expertist vs participatory)
• public involvement in HIA steering groups
• lay people as stakeholders and key informants
• equitable valuation of lay evidence and of
  evidence on lay priorities
• bias to the poor in recommendations

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Methodologicalcontroversies

• science and politics
• value-free and value-laden
• holism and reductionism
• qualitative and quantitative
• expertism and participation
• duration and depth
• equity and inequality

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Gaps in current practice

• limited application - especially re public policy
• macroeconomic policy
• human rights
• foreign policy
• trade
• social and gender policy

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Gaps in current theory

• distributional effects poorly operationalised
• political determinants of health insufficiently
  acknowledged, eg power, ideology, class, interest
  groups, institutions
• participatory research
• feminist research

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The future of HIA

• Causal drivers
• promotes healthy public policy
• promotes sustainable development
• promotes organisation development
• reduces health inequalities
• Contextual drivers
• equity
• public participation

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The future of HIA

• extent of adoption in USA
• healthy public policy relatively unpopular
• disparities agenda
• extent of adoption in EC/EU
• good global prospects - human rights, TNCs etc

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Capacity building

• a limiting factor
• training
• advocacy
• policy development
• organisation development

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• impact_at_liverpool.ac.uk
• 0044 151 794 5004