Implementation of Health Impact Assessment Gabriel Gulis, PhD University of Southern Denmark Esbjerg, Denmark

Objective What is HIA? Is HIA implemented? If so, how? Can we define a standard HIA methodology?

Method ECHP Brussels HIA mailing list Mailed questionnaire survey

HIA Gothenburg consenzus paper: “any combination of procedures or methods by which a proposed policy or program may be judged as to the effects it may have on the health of a population”

Other impact assessments? EIA? – SEA? –Although SEA moved up EIA into level of policy making, the main scope is still on project level and environment Social impact assessment? –Social impacts are primary and the only addressed, health only at limited extent Human impact assessment? –Seems to be the most comprehensive, however not yet clear methodology and rather development, economy based Risk assessment? –The “heart” of HIA, but HIA is not limited to risk-factor (health hazard) – health outcome approach Epidemiology? –The same is true as with risk assessment, epidemiology provides basic information, data, relation, knowledge, but HIA adds for example evaluation and monitoring. Moreover, HIA shall always be decision making related Needs assessment? –Frequently input part of a HIA, a part compared to which health impacts are assessed

Implementation Definition – adoption, putting policy into practice, behavioral change, putting rules into practice Policy implementation track – Mazmanian, Sabatier (tractability of the problem (technical, diversity, target group), ability to structure (objectives, theory, financing, planning, rules…), non-statutory variables (SES, public support, attitudes..), stages ( implementing agencies, compliance, impacts…)) Diffusion of innovation – innovation, time, communication channels, social system Elements – legislation, training, infrastructure

Results 17 questionnaires returned 17 questionnaires returned UK – 7 –5 England –1 Wales –1 Scotland Finnland Czech Republic Denmark USA – Minnesota EstoniaSwedenAustraliaMalta Germany –Hamburg Slovak Republic

Legislation Germany (Hamburg), Finland, Australia and Czech republic, Slovak Republic reported HIA requested by law Czech Republic and Slovak Republic as part of health policy legislation, Australia and Finland by sectoral legislation, Germany within EIA No local level, Czech Republic and Germany on regional level, Czech Republic, Slovak Republic, Germany and Finland on national level, Australia did not report levels Germany 1990, Finland 1994 and Czech republic 2000, Australia not available and Slovak Republic not clear

Training Regular training with HIA included in university curricula exists in England, Australia, Scotland, USA- Minnesota, Czech Republic, Slovak Republic and Sweden Within medical curricula or public health curricula (Slovak Republic) In construction and land planning only in England Graduate training in England, USA-Minnesota, Czech Republic, Slovak Republic and Sweden Post-graduate training in England, Australia, Scotland, Slovak Republic and Czech republic

Infrastructure Out of Germany – Hamburg and Slovak Republic each country reported some kind of leadership infrastructure for HIA High rank governmental offices, Ministries of health, national institutes, research institutes Wales – HIA support unit at the National assembly Denmark – municipality of Nordborg

Methodology National guidelines exist out of Germany, Slovak Republic, Denmark and Malta Merseyside methodology Follow-up of use of HIA recommendations rather rarely, mostly cases in UK

Conclusions HIA –past, recent and future The Effectiveness of HIA project Other new project funded by EC Link to decision makers, politicians Capacity building Legislation – does it help if HIA is required by law?