Transcript Using Public Health Tools for change Dr Bobbie Jacobson & Dr Jenny Mindell London Health observatory Monitoring health and health care in the capital, supporting.

Using Public Health Tools for
change
Dr Bobbie Jacobson & Dr Jenny Mindell
London Health observatory
Monitoring health and
health care in the capital, supporting practitioners and
Informing decision makers.
What is Health Equity Audit (HEA)?
Health equity audit is a process by which:
• partners systematically review inequities in the
causes of ill health, and access to effective
services and their outcomes, for a defined
population
• Further action is agreed and incorporated into
policy, plans and practice.
actions taken are reviewed to assess whether
inequities have been reduced
Source: “Health Equity Audit Made Simple.”
http://www.lho.org.uk/HIL/Inequalities_In_Health/Attachments/PDF_Files/equit
yauditfinal21.1.3.pdf
What is Health Impact Assessment
(HIA)?
• “a combination of procedures, methods and tools by
which a policy, programme or project may be
judged as to its potential effects on the health of a
population, and the distribution of those effects
within the population”
WHO European Centre for Health Policy. Health Impact Assessment.
www.euro.who.int/document/PAE/Gothenburgpaper.pdf
What is Health Needs Assessment
(HNA)?
• It is a process by which a populations’ average ability
to benefit is increased in relation to risk or need.
• The overall aim is to provide information to plan
support and change in services for the better and
to improve health in other ways.
Adapted from Stevens A, Raftery J, Mant J An Introduction to
health needs assessment http://hcna.radcliffe-oxford.com/
What is Race Equality impact
assessment (REIA)?
“A way of systematically assessing and
consulting on the effects that a proposed
policy is likely to have on people
depending on their racial group”.
Public Health Tools for Change: How are they related?
HIA: helps identify
positive / negative
health effects of
proposed policy /
actions
Agree partners,
1
Priorities and topics
6
Health Equity
profile
Review progress
against local
objectives
2
HNA: analysis of
need; can contribute to
equity profile and
priorities for action
The Health equity audit cycle
5
Influence change
in investment /
delivery
3 Use evidence
4
Agree key local
objectives with
partners
to prioritise
effective actions
Race equality
impact assessment
The stages
of Health
Impact
Assessment
Screening
Scoping
Appraisal
Policy
analysis
Literature
review
Local
data
Recommendations
Influencing decisions
Local
knowledge
Similar Techniques – Different
purposes
• Use of local data to profile the area
– demography
– determinants of health
– health data
• Use of literature for evidence of (cost-)
effective interventions
– on health, determinants, and inequalities
• Information gathered from stakeholder and
community members & organisations
What are the differences in
Purpose?
• HEA
– To reduce inequities
• HIA
– To improve health consequences of a proposal and to
reduce inequalities
• HNA
– To determine average health status and ability to benefit
from services
• REIA
– To prevent adverse effects of policies on race equality
What Kinds of Health Inequality?
Spectrum of inequality
GENDER
SOCIO-ECONOMIC
GROUP
GEOGRAPHY SEXUALITY
DISABILITY
AGE
GENDER GEOGRAPHY
DISABILITY AGE ETHNICITY
Social-economic environment
e.g. jobs, housing, education, transport
Lifestyles/health behaviour
e.g. diets, smoking, social networks
Access to effective health/social care
e.g. services that result in health benefits
Health outcomes
e.g. increase/reduce mortality, morbidity, ill health, disability
7
Inequalities (differences) and
inequities (unfair differences) are:
•
•
•
•
The prime focus of HEA
An integral component of HIA
Not always a part of HNA
The prime focus of REIA
What are the differences in
process?
•
•
•
•
HEA is cyclical
HIA is linear and looks forward
HNA is linear and looks back
REIA is linear but in includes effects on
implementation – it also looks forward
Making a difference through HEA: The
Improvement in W Hertfordshire Coronary
Revascularisation Equity before and after
Introducing the CHD NSF
Making a Difference Through Health
Impact Assessment – Some Examples
• Transport proposals
– Manchester airport – rail link added, car parking reduced,
jobs & training for local people
– London mayoral transport strategy – impacts of HIA
demonstrated, eg more emphasis on walking, cycling, and
buses
– Nottingham Local Transport Plan – promotion of walking &
cycling, supported workplace parking levy
• Regeneration
LHO Further Work on HEA
• Baseline survey of HEA in London
• Further workshops and development of master classes with
APHO
• Development of benchmarking tools for PCTs/LSP
• Modelling ways of closing the gap in life expectancy
• Further analysis of inequalities in access to health and health
care – e.g. the new London Regional HES Service
• A register of audits
LHO Further Work on HIA
• Training courses (at LHO and elsewhere)
• Guide to commissioning HIA:
– Points to consider
– List of available consultants and areas covered
• Costing tool (due on web November 2004)
• Resource to aid commissioning, conducting or appraising
reviews of evidence for use in HIA
• Review of available instruments for conducting HIA
• Supporting HIA practitioners in London
• Supporting other PHOs’ HIA leads
• Possible ‘train the trainer’ courses
Resources for Health Equity Audit
• DH Health Equity Audit: A Guide for the NHS
www.doh.gov.uk/healthinequalities/hea_guide_nhs.pdf
• Health Equity Audit: A Self assessment Tool for PCTs
www.doh.gov.uk/healthinequalities/hea_guide_nhs.pdf
• Health Equity Audit Made Simple
• http://www.lho.org.uk/Health_Inequalities/Attachments/PDF_Fil
es/equityauditfinal21.1.3.pdf
• The Health Poverty Index: www.hpi.org.uk/index.php
Resources for Health Impact Asessment
• HDA’s HIA Gateway www.hiagateway.org.uk
• World Health Organisation www.who.int/hia/en
• London Health Observatory www.lho.org.uk
• The London Health Commission (LHC)
http://www.londonshealth.gov.uk/hia.htm
• IMPACT (International Health Impact Consortium, Liverpool)
www.ihia.org.uk
• HIARU (Health Impact Assessment Research Unit, Department
of Public Health and Epidemiology, Birmingham)
www.publichealth.bham.ac.uk/hiaru
• HEA: A Baseline Survey of PCTs in England
London Health Observatory
Monitoring health and
health care in the capital, supporting
practitioners and
Informing decision makers.
http://www.lho.org.uk