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A practical introduction to health equity impact assessment

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Introduction to health equity impact assessment. ... Counselling for haemoglobin disorders. Unequitable (but equal) Health education leaflets. ... – PowerPoint PPT presentation

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Title: A practical introduction to health equity impact assessment


1
A practical introduction to health equity impact
assessment
Stephen James, Public Health Directorate Ealing
Primary Care Trust
Title pages
2
Aims of session
  • Introduction to health equity impact assessment.
  • Practical experience of assessing the impact of a
    policy or service.
  • Share experience and ask questions.

Title pages
3
Outline of session
  • Part 1 Background and context
  • Part 2 Concepts health, equity,
    equality, impact assessment
  • Part 3 Methods and practice
  • Part 4 Practical exercise
  • Part 5 Next steps and evaluation

Title pages
4
Background and context
Part 1
Part 1 Background and context
5
Health equity impact assessment Policy Context
  • Equalities and Human Rights Legislation
  • Independent Inquiry into Inequalities in Health.
    Acheson, 1998.
  • Tackling Health Inequalities a Programme for
    Action, 2003
  • Environmental impact assessment.

Part 1 Background and context
6
Health equity impact assessment Independent
Inquiry into Inequalities in Health
  • All policies likely to have an impact on health
    should be evaluated in terms of their impact on
    health inequalities.

Part 1 Background and context
7
Concepts and definitions health, equity,
equality, impact assessment
Part 2
Part 2 Concepts and definitions
8
Health Definition
  • Health is a state of complete physical, mental
    and social well-being and not merely the absence
    of disease
  • (WHO, 1947)

Part 2 Concepts and definitions
9
Part 2 Concepts and definitions
10
  • Equality
  • What differences exist?
  • Equity
  • What is fair?
  • E.g. equal treatment for equal need.
  • Equitable (but unequal)
  • Breast screening for over-50s.
  • Counselling for haemoglobin disorders.
  • Unequitable (but equal)
  • Health education leaflets.
  • Talking therapies.

Part 2 Concepts and definitions
11
Inequality and inequity unavoidable or
unacceptable?
  • Natural, biological variation
  • Health damaging behaviour freely chosen
  • Transient health advantages (where others can
    catch up)
  • Health damaging behaviour where choice is limited
  • Unhealthy living and working conditions
  • Inadequate access to essential services
  • Health-related social mobility

Part 2 Concepts and definitions
12
Health impact assessment
The estimation of the effects of a specified
action on the health of a defined
population. (Scott Samuel, 1998)
Health equity impact assessment
  • ….. and on diverse groups within that population.

Part 2 Concepts and definitions
13
Health equity impact assessment Key principles
  • a social model of health and well-being
  • an explicit focus on equity and social justice
  • a multi-disciplinary, participatory approach
  • the use of qualitative as well as quantitative
    evidence
  • explicit values and openness to public scrutiny

Part 2 Concepts and definitions
14
Health equity impact assessment Methods and
practice
Part 3
Part 3 Methods and practice
15
Health equity impact assessment Aims
  • Policies, services and functions
  • Assess different impact on different groups (if
    any)
  • Positive and negative
  • Maximise positive and minimise negative

Part 2 Methods and practice
16
Health and equity impact assessment Steps
  • Scanning assessment for relevance and rapid
    assessment of policies and functions
  • Identify priorities
  • Fuller assessment
  • Action planning
  • Review

Part 3 Methods and practice
17
Example Palliative care Monitoring
information Stakeholder group Literature
review Patient and public involvement reference
group Patient pathway analysis Report and
recommendations
Part 3 Methods and practice
18
Example Consent Policy There is a potential
risk that some patients cannot get access to
interventions that they need because the consent
that they give cannot be recognised as valid for
some reason or other. There is a need for robust
prior information. Particular groups affected
include non-English language speakers, people
with visual impairment (access to written
information), people with learning disabilities,
and young people. We need to use information from
formal and informal complaints, listen to
feedback from staff, and promote communication
aids such as the interpreting service.
Part 3 Methods and practice
19
Example Five A Day This healthy eating project
aims to benefit 7-11 year olds in Southall and
Acton, and there is a need to extend this to
Northolt. There are high levels of diabetes and
coronary heart disease in South Asian communities
and the project should aim to meet the cultural
needs of this group. Census and other data can be
used to measure access, although school
populations differ from ward populations.
Part 3 Methods and practice
20
Part 3 Methods and practice
21
Data can be .....
  • Quantitative
  • e.g. based on existing routine and ad hoc data
    sources
  • Qualitative
  • e.g. based on interviews and focus groups
    (workshops) with key stakeholders

Part 3 Methods and practice
22
A multi-disciplinary, participatory approach
Health professionals Patients and carers The
public Local authority partners Voluntary and
community sectors Press and media
Part 3 Methods and practice
23
Conduct health and equity impact assessment when
-
changes are planned in policies or services. new
policies are proposed. concerns are expressed or
complaints received about access. monitoring or
other data indicate problems of access. there is
routine review of policies and services.
Part 3 Methods and practice
24
Health equity impact assessment exercise
Part 4
Part 4 Exercise
25
Outline of exercise
  • Select policy, function, service
  • Scanning and rapid assessment
  • Review as a group
  • Next steps

Part 4 Exercise
Part 4
26
Part 4 Exercise
Part 4
27
Part 4 Exercise
Part 4
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