Assessing the Costs and Benefits of HIA Jacqueline O’Reilly, YHEC Cardiff, 6 April 2006

Presentation Overview  Motivation  Evaluation of HIA  Methods

Motivation  Increasing HIA interest and activity  Emphasis on value for money  Wanless Review, NICE  Opportunity cost of undertaking HIA  Pressure on finance for front-line services  Resources could be deployed elsewhere  Do the benefits of HIA justify the costs?

Evaluation of HIA Impact evaluation Impact on decision-making process Outcome evaluation Impact on public health Process evaluation What activities were undertaken? How? By whom?

Previous Evaluations  Previous HIA evaluations  HDA  London Mayoral Strategies  Alconbury Airbase  Finningley Airport  Focus on process evaluation  Methods

Cost Benefit Analysis  Concurrent study of HIAs  Process  End-of-stage surveys  Review of documentation  Resource use and costs  Benefits

Resource Use & Cost  Direct costs  Time input from HIA team  Weekly timesheets  Wage rates from Annual Survey of Hours and Earnings  Indirect costs  External consultants, venue hire  Resource log

Benefits of HIA Impact benefits Informing and influencing decision making Outcome benefits Recommendations to maximise positive, and minimise negative, health effects Process benefits Community engagement Awareness of health and its wider determinants

Identification of Benefits of HIA Impact benefitsOutcome benefits Process benefits Interviews with decision makers and stakeholders Quantification of health effects

Valuation of Benefits  Problems  Quasi willingness-to-pay approach  How much do you value the benefits gained from HIA, relative to …?  Hypothetical, costed alternatives  Specific to PCTs and LAs  Affected by scope of HIA

Conclusions  Previous studies evaluated HIA process  Assessment using cost benefit analysis  Especially difficult to quantify benefits  Credence to HIA