Health in All Policies - Health Impact Assessment and other approaches Margaret Douglas August 2017 Scottish Health and Inequalities Impact Assessment Network

Outline Background to Health in All Policies HIA approach and steps SHIIAN – current role, future directions?

How do we influence these decisions? What policy decisions or plans have had a large impact on people’s health in your area in last 3 years? How do we influence these decisions? Beyond delivery of ‘projects’? Without just ‘throwing tomatoes’ (And other pitfalls...)

Health in All Policies ‘Shared governance for health and wellbeing’ ‘Government objectives are best achieved when all sectors include health and wellbeing as a key component of policy development ... Need for new social contract between all sectors to advance human development, sustainability and equity [and] health outcomes’

Health in All Policies - tools Inter-ministerial and interdepartmental committees Cross sector action teams Integrated budgets and accounting Cross cutting information and evaluation systems Joined up workforce development Community consultations and citizens juries Partnerships platforms Health Lens Analysis Impact Assessments Legislative frameworks

‘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 Gothenburg consensus paper 1999

HIA steps Screening Scoping Appraisal Recommendations Reporting Monitoring

Why use HIA for HiAP? Established, recognised approach Uses different sources of evidence – research, stakeholder views, data Good way to involve people meaningfully in decisions – fit with community empowerment Comprehensive scoping of health issues Report can be critiqued Flexible in scale and methods

Disadvantages of HIA Scepticism about assessment burdens (Perceived) skills gaps ‘Health imperialism’

HIA in Scotland – brief history

2008: ‘Integrated impact assessment processes for public policies and programmes should be developed and implemented at national and local levels’ 1998 Green paper: 6 mentions of Health Impact Assessment 1999: ‘The Public Health Strategy Group will promote the widespread use of Health Impact Assessment when formulating Government policies’

HIA in Scotland (Some) policy support… but not a requirement No dedicated staff or other resource No HIA consultancies Environmental consultancies have no health professionals > 1000 people in various public health roles, mostly in Boards

Scottish Health and Inequalities Impact Assessment Network Running since 2001 Coordinator one day per week Now part of Scottish Public Health Network Aim to promote and support HIA and inclusion of health in other impact assessments Evidence based guides to HIA of specific sectors General HIA guidance Training Support and advice to colleagues

Recent work Support to Health Impact Assessment of Unconventional Gas – led by HPS Revised HIA Guidance HIA of 50,000 affordable homes Updating HIA Transport guide Bespoke training Support to colleagues

Pragmatic approach Aim is better policies – not better assessment Proportionate resources and methods Do a scoping workshop, other evidence only if it will inform decision Integration of assessments, especially EQIA Build into mainstream roles and other processes

How best to ensure health is considered? Interest in social determinants, HiAP supported in PH review How much support is there for HiAP in Scotland and how to capitalise on it? Should we promote HIA, or another formal approach, or just aim to be ‘at the table’? What should SHIIAN do to support it?

Outline Background to Health in All Policies HIA approach and steps SHIIAN – current role, future directions?