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Health Impact Assessment Copyright © 2014 by The University of Kansas What is a Health Impact Assessment? A Health Impact Assessment is a combination of procedures, methods, and tools by which a policy, program [a series of projects over time], or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within that population. • An HIA is intended not to determine, but to support decision-making. • An HIA may be conducted as a desktop, rapid, or comprehensive process. • An HIA may be prospective, concurrent, or retrospective. • HIA’s guiding values are democracy, equity, sustainability, and the ethical use of evidence. • HIA takes a community or broader perspective on health, and considers the social, psychological, economic, environmental, and political determinants of health as important as specific health issues in assessing health impacts. Copyright © 2014 by The University of Kansas Why conduct a Health Impact Assessment? • HIAs make for better decisions. • HIAs promote cross-sectoral cooperation. • HIAs raise the profile of health and health issues, and make it more likely that they’ll be considered in all circumstances. • HIA champions a participatory approach that values, includes, and empowers the community. • HIAs bring the community together. • HIAs promote equity. • HIAs promote healthy behaviors and practices. Copyright © 2014 by The University of Kansas Why conduct a Health Impact Assessment? • HIAs can be used in numerous and varied situations. • Prospective HIAs provide information before the fact, leaving time to make adjustments in plans. • HIAs can promote sustainable development and environmental responsibility. • HIAs are adaptable to the needs of many different groups. • HIAs can assist policy development. • HIAs help EU and some other policy makers address policy making requirements. • HIA recognizes that other factors besides health guide decisions. • HIA is a proactive process that improves positive outcomes and decreases negative outcomes. Copyright © 2014 by The University of Kansas When should you conduct a Health Impact Assessment? If possible, HIAs should be conducted before the proposed project or policy is fully planned or implemented, so that it can take advantage of the information the HIA provides. Copyright © 2014 by The University of Kansas Who should be involved in conducting a Health Impact Assessment? HIAs should involve representatives of all stakeholders. These include: • Those who are directly affected by the proposed actions or policies. • Those who are involved in carrying out the proposed actions or policies. • Nonprofit and non-governmental organizations (NGOs) concerned with the issues and/or the populations affected. • Advocacy groups. Copyright © 2014 by The University of Kansas Who should be involved in conducting a Health Impact Assessment? • The decision-makers themselves. • Government agencies that have responsibility for the issues and/or populations in question. • Representatives of other sectors that are affected by the proposal. • Health workers at local, national or international levels. • Employers and unions. • The commissioner(s) of the HIA – those who set it in motion (and pay for it, in many cases.) • Those who actually conduct the HIA. Copyright © 2014 by The University of Kansas How do you conduct a Health Impact Assessment? Political aspects of conducting an HIA In order for HIA to become common, and particularly for it to be institutionalized, politicians and government agencies have to understand: • That health is important enough to be integral to any project or policy that can have an impact on it. • That health is not simply an individual issue, but has to be viewed in a larger – community, regional, national, or international – context, depending on the scope of the project or policy proposed. Copyright © 2014 by The University of Kansas How do you conduct a Health Impact Assessment? Political aspects of conducting an HIA • That health is more than the alleviation, elimination, or prevention of disease, injury, or medical conditions, but also includes the promotion, psychological implications, and other aspects of health. • That the social and other determinants of health are both real and crucially important to creating a healthy community and society. That health transcends any one department or ministry – i.e., that more than public health agencies need to be involved in examining the health impacts of a project or policy, and that interdepartmental and inter-sectoral collaboration is necessary in order to fully understand the health impacts of projects or policies. • That they need the best, most accurate, most nearly complete information possible in order to make good decisions that take health impacts into account. Copyright © 2014 by The University of Kansas • HIAs won’t happen with any regularity or quality control unless they’re institutionalized by a legal basis of some sort – a law, an agency regulation, a clear policy, permit requirements, etc.. • HIAs have to be paid for, either directly by government, or by developers and contractors as part of the permit process. • Government agencies have to collaborate for an HIA to be of high quality. • Government has to be willing to involve, and listen to (and heed) the concerns and advice of those who will be affected. Copyright © 2014 by The University of Kansas Practical aspects of conducting an HIA The first step is to choose people to conduct the HIA. HIA practitioners ideally are trained and experienced, or, at the very least, have the professional, interpersonal, and organizational skills needed to conduct an HIA successfully. Copyright © 2014 by The University of Kansas Conducting an HIA HIA consists of five stages: 1. 2. 3. 4. 5. Screening Scoping Assessment Reporting and recommendations Evaluation Copyright © 2014 by The University of Kansas Conducting an HIA 1. Screening is the examination of the project or policy to see if an HIA is needed. Copyright © 2014 by The University of Kansas Conducting an HIA 2. Scoping is actually the planning of the HIA – identifying ways in which the decision could affect health, the people who might be affected, how impacts should be assessed, whose expert opinion you need to get the full picture, what resources are needed to conduct the HIA, what kinds of evidence should be gathered, etc.. A general guideline for developing a plan might take these steps: Using logic, prior knowledge, and the concerns of the community, make an educated guess about the possible health impacts of the proposed project or policy. Determine the sectors, populations, groups, and individuals that need to be consulted and/or drawn into the process. Assemble a team from among them, representing all stakeholders, to plan and do the groundwork for the HIA. Become familiar with the current state of the project or policy, possible alternatives to current options, and the decisions that can and/or must be made. Assign responsibilities for all parts of the HIA. Copyright © 2014 by The University of Kansas Conducting an HIA 3. Perform the actual assessment. Review existing evidence. Familiarize yourself with the proposed project or policy. Learn what the range of options is. Conduct individual and group interviews, hold meetings, administer surveys, etc., to gather other evidence and obtain community input. Gather or compile statistics and other evidence currently unavailable which is necessary for a full picture of the situation. Gather information available from the various agencies, NGOs, think tanks, businesses, institutions, and other groups whose responsibilities or concerns are directly or indirectly relevant to the HIA or the issue, sector, geographic area, or population potentially affected. Assess the impacts of the proposed project or policy on the health of populations affected. Determine the impacts that come with different options. Copyright © 2014 by The University of Kansas Conducting an HIA Compose and deliver an understandable two-part report to all stakeholders and the public, describing the HIA process and conclusions, and making recommendations for maximizing the positive health impacts and minimizing the negative health impacts of the project or policy. 4. 5. Evaluate the HIA’s effectiveness. Continue to use the HIA conclusions and recommendations to guide the implementation of the project or policy, making adjustments and revisions as necessary to reflect changing conditions or new information. Copyright © 2014 by The University of Kansas