Health Impact Assessments

Introduction to HIA What is HIA? - And why do you need to know about it? Key features of HIA Health, health determinants and health inequalities Stages of HIA and screening Causal Pathways Case study Group Exercise: scenarios

Health Impact Assessment definition: “ Health Impact Assessment is a combination of procedures, methods and tools by which a policy, program 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: Gothenburg consensus paper 1999

Definition: a combination of procedures, methods & tools that systematically judges the potential, & sometimes unintended, effects of a policy, programme or project on both the health of a population, & the distribution of those effects within the population HIA identifies appropriate actions to manage those effects: reduces negative impacts, enhances positive impacts

HIA – Distinguish from: Community Development Advocacy Evaluation Needs assessment e/item.aspx?RID=44779

Roots of HIA Environmental Impact Assessment Healthy Public Policy Movement

Purpose of HIA Inform decision makers – contribute to – support – inform Predict consequences of different options Participation – Involve stakeholders – More open decisions Other – Foster interagency working – Increase awareness of health in community – Increase awareness of health in decision makers

Why do an HIA? - Reasons To inform a decision (e.g. Hinckley Point C) To demonstrate that a decision already taken is correct To stop something happening (e.g. Margam Opencast Mine, Wales) To support the case for doing something (e.g. business case for “Streetcar” HIA)

WHY DO YOU NEED TO KNOW ABOUT HIA? Public Health in Local Authorities May be asked to contribute to HIA Unintended health impacts of health policies Further information - Further training

KEY FEATURES OF HIA Broad definition of health Determinants of health Health and social inequalities Core values and principles Different techniques, methods & sources of evidence

What influences our health? Definition of Health WHO (1948) definition: “Health is a state of complete physical, social and mental wellbeing and not simply the absence of disease or infirmity” Many definitions, Ambiguous, Complex, Multi- disciplinary base

What influences our health? Health Impacts Employment Income Benefits Housing Air quality Transport Education Fear of crime Family welfare Community coherence Environment quality Climate change

Evidence in HIA; Methods and Techniques Literature reviews: academic research Surveys/Census Data/Registers Local data: PCTs Lay knowledge: interviews/workshops/focus groups Health profiles Expert informants

HIA Core Values Broad definition of health Equity Sustainability Openness Ethical use of evidence

How do you do HIA?

Screening “Should an HIA be done on this proposal?” Does the proposal affect the health of the population? Is their an opportunity to change the proposal? Is there community concern about the proposal? Do you have the resources/support to do an HIA?

Group Work Screening scenario: Northam Primary Care Centre Questions: Would this be suitable for a HIA? Who are the main groups potentially affected What determinants of health would you consider? You may need: Screening checklist List of vulnerable groups Health and well determinants checklist

Recommendations “Recommendations for decision makers” – Maximise positives – Minimise negatives – Mitigate – Any gaps in the proposal?

Monitor & Evaluate Monitor Monitor the implementation of the policy decision and its outcomes on health determinants and health status Indicators? Are recommendations being implemented? Evaluate Evaluation of the HIA process and its outcomes Impact of HIA on decision- making process Impact of the HIA on public health

Causal Pathways

North Staffordshire “Streetcar” Bus Rapid Transport Scheme HIA Contributions: Salim Vohra: Centre for Health Impact Assessment, IOM Marcus Chilaka: Consultant, University of Salford Judith Ball: Centre for Health Impact Assessment, IOM Gifty Amo-Danso: Centre for Impact Assessment, IOM Sue Wright, West Midlands Public Health Observatory

Describing an impact Causal pathways Direction, Nature and Magnitude of impacts Differential impacts in the population (age, gender etc.. and exposure, susceptibility)..in a systematic way

Conclusions from Health Impact Analysis Moderate to major ‘+’ health and wellbeing impacts at local, regional and national levels over the medium to short term Few ‘-’ health and wellbeing impacts: minor to moderate over the short term and mainly temporary Equity: the BRT scheme has the potential to narrow health inequalities and enhance equity (same ticket price as standard service; discounts available; easily accessible buses for many; improved environment along all the route; more distant jobs/services/amenities accessible)

Recommendations Planning – All electric or hybrid buses – Fully accessible + ramps – Integrate with workplace travel plans – Apply Universal Design Principles: street furniture, greening Construction – Communication plan – Assessment criteria: complaints, safety – Priority local recruitment Operation – Long term maintenance plans – Social marketing with PCT: behaviour change – User group to monitor project – Link employers to encourage use – Regular user surveys

Issues Complex urban area (route 12 miles) Strategic HIA: still in planning stage (may be 32 stops or less) No HIA of a BRT scheme found Literature (evidence) moderate to poor Health profiles/demographics for population difficult No information on current bus users

Other impact assessments EIA Environmental Impact Assessment SIA Social Impact Assessment SEA Strategic Environmental Assessment EqIA Equity Impact Assessment HIIA Health Inequalities Impact Assessment IIA Integrated Impact Assessment RIA Regulatory Impact Assessment MWIA Mental Wellbeing Impact Assessment Some of these are statutory requirements for certain proposals Health is covered in varying amounts (if at all) Definition of health varies IA methods are broadly similar Not all address differential impacts for different population groups

Group work 2 Causal diagrams, health impacts and recommendations Choose which one you want to do Scenario 1: Proposed BMX Park Scenario 2: Proposed Wind Farm development

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