1. ihia.org.uk Health impact assessment: appraising potential consequences of policies and interventions Alex Scott-Samuel IMPACT International Health Impact Assessment Consortium, University of Liverpool

2. ihia.org.uk What is HIA? A combination of procedures, methods and tools by which a policy, programme 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 Source: WHO Gothenburg consensus paper, 1999

3. ihia.org.uk Important characteristics of HIA Prospective Decision support tool, not evaluation method Trade-off between brevity and rigour

4. ihia.org.uk Uses of HIA creation of healthy public policies / projects social and economic development health advocacy advocacy for disadvantaged groups personal development partnership building

5. ihia.org.uk Early origins: 1970-1990 environmental impact assessment healthy public policy

6. ihia.org.uk Some types of impact assessment health environmental social economic gender disability human rights integrated

7. ihia.org.uk Two perspectives of HIA Source: National Assembly for Wales (1999) Developing health impact assessment in Wales. Broad perspective Tight perspective View of healthHolistic Definition and observation Disciplinary roots Sociology, epidemiology Epidemiology, toxicology EthosDemocraticTechnocratic QuantificationIn general terms Towards exact measurement Types of evidence Key informant data Measurements PrecisionLowHigh

8. ihia.org.uk Ron Labonte. Inequalities in Health in the City of Toronto. 1991

9. ihia.org.uk Levels of impact

10. ihia.org.uk Health and the built environment Activity - foster incidental and recreational activity Nutrition - provide / promote safe, affordable, healthy food Housing - safe, affordable, acceptable housing Transportation - safe, reliable, accessible, affordable transportation Environmental quality - safe, clean water, soil, air and building materials Aesthetics / ambience - well-maintained, appealing, clean environments Source:www.preventioninstitute.org

11. ihia.org.uk The Merseyside approach to HIA - 1 Screening Steering group Scoping / terms of reference Select assessor Policy analysis Profiling of communities Collect data from stakeholders and key informants Identify health determinants affected

12. ihia.org.uk The Merseyside approach to HIA - 2 Assess new and published evidence Establish priority impacts Recommend and justify options for action Appraise assessment Negotiate favoured options Implement and monitor Evaluate and document

13. ihia.org.uk Health inequality Unfair or unjust differences in health determinants or outcomes within or between defined populations

14. ihia.org.uk Equity …from each according to his abilities, to each according to his needs… Karl Marx, Critique of the Gotha Programme (1875) Distributional justice

15. ihia.org.uk Health inequality in HIA inequality a screening (selection) criterion vulnerable groups identified in profiling and policy analysis distributional impacts (as well as population impacts) identified recommendations take account of impact inequalities monitoring and evaluation based on inequality indicators and outcomes

16. ihia.org.uk Equity in HIA public involvement in HIA steering groups ‘lay’ people as stakeholders and key informants equitable valuation of lay evidence and of evidence on lay priorities ‘bias to the poor’ in recommendations choice of paradigm (expertist vs participatory)

17. ihia.org.uk Some IMPACT HIA projects Foresight Vehicle Initiative Castlefields regeneration Policy HIA for the EU – European Employment Strategy Capacity building in Liverpool ‘Making it Better’ – healthcare reconfiguration

18. ihia.org.uk Methodological controversies science and politics value-free and value-laden holism and reductionism qualitative and quantitative expertism and participation duration and depth equity and inequality

19. ihia.org.uk Gaps in current practice poor monitoring and evaluation limited application - especially re public policy macroeconomic policy human rights foreign policy trade social and gender policy

20. ihia.org.uk Gaps in current theory distributional effects poorly operatioalised political determinants of health insufficiently acknowledged, eg power, ideology, class, interest groups, institutions participatory research feminist research

21. ihia.org.uk The future of HIA Causal drivers promotes healthy public policy promotes sustainable development promotes organisation development reduces health inequalities Contextual drivers equity public participation

22. ihia.org.uk The future of HIA whether takes off in USA healthy public policy relatively unpopular disparities agenda NB there’s gold in them thar HIAs acceptable to all US politicians? likely to thrive in EC good global prospects - human rights, TNCs etc

23. ihia.org.uk Capacity building a limiting factor training advocacy policy development organisation development

24. ihia.org.uk impact@liverpool.ac.uk 0151 794 5004