Health Impact Assessment Zsombor Kovacsy, Ministry of Justice, Hungary Regional Strategic Workshop on Impact Assessment Riga, Latvia 2-4 February, 2005 Organized by Open Society Institute and UNDP

Definition of Health (WHO) „Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity„

Factors of health Dominantly related to the individual Primarily environmental Income and social status Education Genetic and biological character Health behavior and defence capacity against health challenges Healthy childhood Natural and built environment Employment and occupational circumstances Healthcare services Social system

Measurement of health factors 1.Objective, physiological indicators 2.Morbidity & mortality data 3.Functional, subjective scales

Cumulative incidence Number of new cases within a determinded period of time CI=n/N n: No. of new cases N: Size of population at zero time

Prevalence Proportion of cases at a given point of time P=n/N n: No. of cases N: Size of population

Decline of function Impairment: a problem affecting the anatomic structure and/or function of the body Activity restriction: a problem emerging in the realization of a physical or mental activity Participation restriction: a problem emerging in the realization of social role and/or participation in the society.

QALY Death: 0, total health:1 Usually subjective evaluation of functions Comparison of programs or procedures

Further tools DALY Capacity to benefit Burden of disease

ProcedureScopeDimension of impact Consideration of allocation Data need CBAGeneralMonetaryNoExtremely high CEASpecialPhysiological &morbidity data NoModerate CUA/QALYSpecial QALY NoHigh CUA/DALYSpecial DALY YesModerate Burden of DiseaseSpecial QALY/ DALY NoModerate Capacity to benefitSpecialYesHigh Measurement options of health impact (summary)

Some HIA protocols Human Impact Assessment (Finland) The Swedish Council Model The British Columbia Model