Question topics covered in a rapid HIA workshop Rob Quigley, Director, Quigley and Watts Ltd

Background Information collection in the appraisal stage can use many methods One is a rapid appraisal workshop, where information is provided to stakeholders beforehand and during the workshop, and then information is collected from them. With limited time, which questions are asked? What key features are present in many tools?

Assessing the positive and negative impacts. A feature of all tools: The impact assessment matrix and the Merseyside guidelines have a separate column for each; Ison’s RAT and PHACs determinants and inequalities matrices asks if the impact is positive, negative or neutral. Some don’t mention the words ‘positive or negative’, just ‘identify the impact’ or something similar (PPP; HEAT, Health Lens).

Addressing inequalities Most tools are explicit about this, with a question something like: – ‘what are the potential effects on inequalties (Health Lens) –Are there differential impacts on particular groups (Determinants matrix; impact matrix) –Focusing on Maori (PPP); –Focusing on inequalities (inequalities matrix; HEAT) –Whom will it affect, the whole community or various groups (Ison’s RAT) –Who is most advantaged and how; who will benefit most (HEAT) –For Merseyside Guidelines, it’s in the supporting documentation only

Evidence Some don’t ask about this (Health Lens; PPP; impact matrix; HEAT; Merseyside) Others ask it in a roundabout way – identify any measurable indicators; How measurable is the impact; (determinants matrix, inequalities matrix, Explicit – what is the basis for identifying this impact: evidence base, experience base, personal experience (Isons RAT)

Mediating factors Not covered in the Health Lens, PPP, inequalities matrix, impact matrix, Included in determinants matrix (what external factors may interact with the policy being assessed?) Included in Ison’s RAT (which of the factors affecting health/determinants are key to mediating that impact) What are the determinants of this inequality (HEAT)

The principles of the Treaty of Waitangi Included in the Health Lens (How will the proposal address the principles of partnership, participation and protection) Included in HEAT (How will you address the Treaty of Waitangi in the context of the NZ Public Health and Disability Act 2000) Not in the determinants matrix, Ison’s RAT or Merseyside The sole purpose of the four PPP questions Ethnicity is included in the inequalities matrix Impact on Maori has it’s own row in the impact matrix

Scale of impact Not included in Health Lens, determinants matrix, PPP, inequalities matrix, merseyside, HEAT. Sole purpose of the impact matrix – likelihood, severity/significance, number affected, time to take effect, measurability of impact. Included in Ison’s RAT – magnitude, frequency, time of occurrence, point of occurrence, likelihood, severity/benefit

Recommendations Not covered in determinants matrix, PPP, inequalities, Merseyside. How will the unintended consequences be addressed (Health Lens) Where/how will you intervene to tackle this issue? (HEAT) Possible actions to enhance positive or diminish negative impacts (Impact matrix) Whole section in Ison’s RAT

A scenario Imagine you are running a rapid appraisal workshop with multiple stakeholders – community, policy writers, public health experts, other stakeholders. You have 4.5 hours in total, of which much of the time is taken up in introducing the policy, the evidence and describing the population affected You have about three hours left for small group or plenary session work

Questions to consider for each determinant: How is the proposed Arts Centre likely to affect this determinant of health? i.Will this impact on health directly, or will it affect health (indirectly) after affecting other factors in a pathway leading to [poor health?] ii.What is the existing evidence for the answers you have given above– e.g. past experience, facts, research & existing data sources

Possible enhancements/mitigation iii.Will the impact affect some Youth more than others? Who will benefit/suffer most? Will inequalities increase or decrease? iv.What key factors might encourage or prevent the health impact? v.What recommendations do you suggest? Who are the recommendations directed at?