Who's afraid of community consultation?

Consulting local communities and other stakeholders as part of developing new plans and projects can be a difficult process. But it needn’t be so.

Communities are not scary, incomprehensible and unpredictable aliens from outer space! They are just like you and me. They have the same aspirations and dreams and the same worries and anxieties for their families and neighbourhoods that we all have.

Here are twenty top tips to help you make community consultation a rewarding, involving and engaging experience.

Do:

• Know your audience.
• Make sure you know why you are consulting, engaging or involving.
• Make sure you let everyone else know why you are consulting, engaging or involving.
• Be truthful even if that means saying “I don’t know”.
• Then find out what you don't know and get back to them with an answer.
• Be yourself.
• Plan for how things might go wrong.
• Smile, make eye contact and be warm.
• Recognise that consultation and involvement generates uncertainty and unpredictability – for you and them.
• Listen, listen and listen.

Don’t:

• Ever promise what you can’t deliver.
• Start consulting without getting agreement on a clear plan of action.
• Assume that everyone in the team knows what they’re supposed to be doing.
• Be disrespectful to people or their views.
• Lose your cool.
• Walk away leaving people feeling dissatisfied or aggrieved.
• Finish the consultation without letting people know what the next steps are.
• Get scared. Each consultation is unique and we all make mistakes.
• Take comments at face value. If you have the chance, ask people why they’ve said what they have and what evidence they have to support it.
• Forget to say “Thank you”.

Further Information: A Ladder of Citizen Participation - Sherry R Arnstein

Cost Benefit Analysis of HIA

The UK Department of Health has published a cost benefit analsysis of HIA. From the abstract:

"The report sets out the findings of the cost benefit evaluation of Health Impact Assessment. York Health Economics Consortium followed 16 HIAs looking at the process, impact, outcomes and costs and benefits of HIA. The findings show the benefits outweigh the costs, although it was a small sample. The report will be subject to further consideration and comments are welcome."

Many of the issues identified in the report will be familiar to HIA practitioners. What is perhaps most interesting is the large variation in the amounts spent on conducting the HIAs - ranging from £1,107 to £65,240.

Where does HIA fit best within the policy and planning cycle?

I’d like to stimulate some debate about where people see HIA best fitting within the planning cycle (following on from the interesting recent blog discussion on HIA as a scientific tool).

In New South Wales, HIA is seen as adding most value as a prospective tool at a specific point in the planning cycle; after a draft proposal has been developed but before implementation.

However, recently we’ve been approached to use HIA as a tool to assist with planning for health earlier in the cycle. This raises a number of issues:

First, should or can HIA be a substitute for good needs assessment and problem identification? Or can HIA become a useful needs assessment / problem identification tool? Work with communities on regeneration projects in Victoria has indicated this may be the case.

Second, developing a draft proposal takes time and effort. How can HIA be integrated with this time and effort while planning decisions are being made rather than afterward as a check on those decisions? Would this be a better way of ensuring health impacts are considered? At a recent training course Ben and I attended in Thailand, it was suggested that HIA can stretch itself earlier in the planning cycle to assist with developing different options and their potential impacts before the proposal is drafted.

Third, what are some other approaches and methods the HIA can use or add to earlier on in the planning cycle? For example, at a recent meeting we had with Urban Planners, it was suggested that as Health professionals we need to understand how private sector developers plan and develop proposals (i.e. through market analysis).

Finally, while I am open to HIA being used earlier in the planning cycle, I would take more convincing concerning the use of HIA as a retrospective tool that replaces evaluation.

What do others think?

Will the HIA wiki replace existing HIA websites?

There's an interesting debate taking place over at the HIA Wiki at the moment about the future of HIA websites around the world. Take a look at the discussion and take a few moments to add your point of view.

New Zealand inlcudes commitment to HIA in childhood obesity prevention strategy

New Zealand Prime Minister Helen Clark yesterday announced that policy HIA will be included as part of a portfolio of initiatives aimed at childhood obesity prevention

We are here today to launch Mission-On, a new $67 million government-wide package of initiatives to help New Zealand's children and young people become healthier, so they can lead active and successful lives.

...Finally, policy makers will be required to carry out health impact assessments when developing new policy and legislation.

Read speech in full

It will be interesting to see how this commitment to HIA develops in practice. The New Zealand Public Health Advisory Committee has developed guidelines on policy HIA which will be readily applicable.

Media Coverage of the Mission-On launch
Helen Clarks' Speech (Scoop)
Opposition Response (Stuff)
Unhealthy Foods Get Chop from Tuck Shops (NZ Herald)
Launch of $67 Million Campaign to Fight Obesity (Radio New Zealand
Campaign Pressures Schools Over Junk Food (Bay of Plenty Times)

Health in All Policies: New publication from the Finnish Ministry of Social Affairs and Health

The mark the Finnish presidency of the European Union (as we've mentioned before) the Finnish Ministry of Social Affairs and Health has published a book entitled Health in All Policies: Prospects and potentials [PDF 1.9 Mb]. The publication presents a number of examples of "health in All policies" in sectors such as education, the environment, water and sanitation, planning, labour, housing, traffic, agriculture and nutrition.

The book has five sections:

• Health in All Policies: The wider context
• Sectoral Experiences
• Governance
• Health Impact Assessment
• Conclusions and the Way Forward

HIA: What's new on the web?

The London Health Observatory has released a Guide to Reviewing Published Evidence for Use in Health Impact Assessment. The guide has been through quite a rigorous testing and peer-review process and a revised edition, incorporating user-feedback, is planned for 2008. I haven't had a chance to use if yet and I'd be interested to hear about your experiences using it.

The European Public Health Alliance has an interesting page comparing the health impact assessments that have been done on US and European food and agricultural policies.

Mary Mahoney, from the Deakin University HIA Unit, recently spoke about a retrospective HIA that she has undertaken on drought relief in rural Victoria in Australia. The ABC has a page with details on the conference and Mary's HIA, along with an MP3 file of their interview with Mary (MP3, 1.6 Mb).

Is HIA a Science?

About six months ago, I re-read the Merseyside Guidelines, the leading guidance on HIA in the UK. It's the guidance that every practioner in the UK, and I'm one of them, has read or says they've read. Okay, so first time round I read them quite quickly and I liked what I read. What I hadn't done three years ago, when I was a novice HIA practitioner still learning the ropes, was to read them critically. That's what I did second time around. Imagine my shock, as a signed up champion of science, when on re-reading them I found, at the back, this definition of HIA:

"Is health impact assessment a science?
It is important to emphasise that HIA is not strictly a science.
Having said this, it most certainly draws on a scientific knowledge base.
Scientific evidence on health impacts of specific determinants forms the backbone of this creative, interdisciplinary form of enquiry.
But each HIA is uniquely located in time, space and local conditions though its evidence base can be evaluated, and the rigour with which procedures and methods were implemented can (and should) be assessed.
Uncertainties encountered during the undertaking of HIAs will frequently dictate the need to make assumptions, which may result in challenges to the HIA’s validity: such assumptions are acceptable as long as they are stated explicitly, so that the reader is free to agree or disagree. ”

I agree with every part of this quote except the phrase "HIA is not strictly a science" because for me it describes perfectly what it means to apply scientific knowledge to the real world outside the lab.

For me, both HIA and science in all its myriad forms are "interdisciplinary forms of enquiry"; to misquote John Donne 'No science is an island entire unto itself every science is a piece of the continent, a part of the main'.

HIA for me is:

1. a systematic endeavour;
2. it uses knowledge and methods from other scientific disciplines e.g. epidemiology, sociology, toxicology and biology;
3. it aims for rigour,
4. it actively avoids bias and confounding;
5. the findings of one HIA have some applicability to communities of a similar social and cultural mix as that studied by the HIA; and
6. its results are subject to revision when new evidence or information comes to light that contradicts and refutes previous knowledge.

For me, this quote illustrates a misreading of science as about numbers and quantitative findings and about universal laws that transcend time and space. That works for the physical world (most of the time) but doesn't work so well for our social and cultural worlds where general laws and theories need to take account of local context. In fact even the universal laws of physics have to take account of local context. Science is about systematic enquiry where the resulting knowledge is always provional and subject to revision.

What's even more interesting is that environmental impact assessment practitioners don't have any qualms about calling EIA a science. Neither do economists or sociologists.

But public health professionals and HIA practitioners, in my experience, seem to have a problem with saying that HIA is a public health science? Or maybe I've got it wrong?

Health Impacts of the Built Environment

The Institute for Public Health in Ireland has released a review on the health impacts of the built environment, complementing their earlier reviews of the health impacts of employment and transport. The review provides a useful basis for understanding the range of health impacts that may arise in relation to the built environment, though the lack of contextually-specific detail may make it more useful as a document that guides scoping.

The review includes the version of the determinants of health diagram developed by Goran Dahlgren and Margaret Whitehead that has been adapted by Barton and Grant to include a planning perspective. What I think is missing from the model is the important role health services still play in determining health outcomes, though their absence may be understandable given the audience for whom the diagram was adapted (land use planners, social planners, local government, etc).

I'm reminded of McKee's (2002) observation that McKeown's influence on public health was to popularise the view that improvements in mortality were mostly due to improvements in living conditions (McKeown 1979). Mackenbach and his colleagues refuted this, at least in part, by demonstrating the decline in deaths from conditions that could be altered through health care represented a major part of overall improvement in life expectancy in The Netherlands between 1950 and 1984 (Mackenbach et al 1988).

I think there's still an important role for health services in contributing to a reduction in health inequalities and ensuring population health gains. What do you think?

References
Mackenbach J, Looman C, Kunst A, Habbema D, van der Maas (1988) Post-1950 mortality trends and medical care: gains in life expectancy due to declines in mortality from conditions amenable to medical interven-tion in The Netherlands. Social Science and Medicine 27:889-894.

McKee M (2002) What can Health Services Contribute to the Reduction of Inequalities in Health?, Scandanavian Journal of Public Health, 30(Supplement 59) p 54-58.

McKeown T (1979) The role of medicine: dream, mirage or nemesis? Oxford: Blackwell.

Monitoring and Evaluation

An excellent introduction to monitoring and evaluation has been released by the World Bank:

Monitoring and Evaluation Report

This is a useful resource for anyone considering monitoring and evaluation approaches, tools and strategies as part of their HIA (or broader work). The booklet covers performance indicators, the logical framework approach, theory surveys, rapid appraisal methods, participatory methods, public expenditure tracking surveys, cost-benefit and cost-effectiveness analysis, and impact evaluation. Each has a section to itself that covers what each is, what each is used for, advantages, disadvantages, costs, skills and time required, and links to other websites and resources. Using the booklet would certainly help people to quickly and concisely scope the most appropriate approach to the monitoring and evaluation stage of their HIA (the least well covered stage in the HIA guidance literature).

7th International HIA Conference Proceedings are Now Online

Information from the 7th International Health Impact Assessment Conference held in Cardiff in April is now available on the Welsh Health Impact Assessment Support Unit website, including conference reports and presentations. (Thanks Salim!)

Health Impact Assessment Wikis

Wikis are website that allow any user to update and edit the information they contain. The biggest and best known wiki is Wikipedia, an ambitious free web-based encyclopedia project with over 1.2 billion articles in English.

Of interest to HIA practtioners are the HIA Wiki, which was started by Salim Vohra, and the HIA page on Wikipedia. You can use these not only as a source information but also as a vehicle for updating others on HIA-related developments.

A number of people have expressed concerns about wikis' unmoderated nature. I think that when using a wiki it's important to view the page history to assess if what you're reading is the result of informed and constructive contributions. The other thing to keep in mind is that even with traditional mediums such as books and journals the editorial and peer-review processes aren't rock-solid guarantees of quality. Critical appraisal has always been important.

Please take a look at both wikis. I'd be interested in your impressions of them.

Should population health studies be called HIAs?

I was reading through a report in today's Courier Mail (Brisbane, Australia) about an industrial estate in Queensland that's causing a bit of controversy. The local community has been concerned about the health impacts of a chemical fire that occurred in one of the estate's factories nine months ago, and the ongoing risks the industrial estate poses for their health.

In the article the Premier is reported as saying that a HIA will be undertaken as part of his plan for the site. The article isn't entirely clear about what the HIA will be done on - the impact of the fire nine months ago or the possible health impacts of relocating the four businesses identified by the government as being unsuitable for the industrial area. I get the impression that it's the former because it's described as "a full health impact assessment and full scientific study conducted with independent consultants".

This made me wonder, should this sort of activity be called HIA?

My gut response is that it shouldn't. It doesn't follow the steps of HIA and it doesn't necessarily involve looking at the determinants of health (instead often focusing on measuring health outcomes). This issue has come up in the past, with people calling a variety of population health-related research activities health impact assessment (see Kemm 2003, PDF 38Kb - particularly the discussion of retrospective and concurrent HIA).

What do you think about these sort of studies being called HIAs?

References
Kemm J. Perspectives on Health Impact Assessment, Bulletin of the World Health Organization 81(6):387. Available from http://www.who.int/entity/bulletin/volumes/81/6/kemm.pdf

New HIA Guidance from Ireland

The Institute for Public Health in Ireland has produced an interesting set of guidance on HIA. I like the way there are a number of case studies included in the appendices, helping to ground the guidance in the real-world experience of HIA.

What's your take on the publication?

Advancing HIA during the Finnish EU Presidency

I came across an interesting interview with Pekka Puska, head of the Finnish National Public Health Unit about the "health in all policies" goal they're working towards during the Finnish EU Presidency.

Tapani Kauppinen and Kirsi Nelimarkka (pictured with their poster on human impact assessment) mentioned at the IAIA Conference that STAKES is also going to be undertaking work to progress HIA at the policy level during the presidency.

It will be interesting to see how things progress.

The 7th International Health Impact Assessment Conference

By Patrick Harris

I grew up in the U.K. during the 1980’s and 90’s, Cardiff, the capital of Wales, had a reputation for being a rough, dead-end place, decimated by high unemployment caused by the closing of coal and other industries. While the rest of Wales was renowned for its natural beauty, Cardiff was to be avoided at all costs, glimpsed from the motorway if seen at all. So when I heard that the 7th International HIA conference was to be held in Cardiff, and that I was going, I was more than a little nervous. As it turned out however, these dark thoughts were entirely misplaced. As soon as we arrived, the taxi driver taking us to the hotel, past gleaming new buildings, told us with pride how Cardiff had put its rough past behind it, reinventing itself as one of the UK’s premier cities to live in and visit.

He wasn’t wrong, and while there I recognised that Cardiff was in fact the perfect place to have the latest HIA conference. The capital city embodies Wales’ regeneration as a healthy place to live, based on the legacy on health left by an industrial past. As the 2nd Minister for Health said at the conference dinner, re-iterated by speakers at the conference, the Welsh government is taking a ‘twin-track’ approach to health. One track refers to clinical services, the other to an agenda to improve health and reduce health inequalities. HIA is recognised as an important tool within this broader agenda.

The conference itself brought up some very interesting areas for those interested in HIA in Australia and NSW to consider. One was evaluating the effectiveness of HIA. The first keynote speaker, Professor Sally Macintyre from the Medical Research Council in Glasgow, threw down the evaluation and effectiveness gauntlet from the word go. While some delegates were concerned over Professor Macintyre’s familiarity with HIA, her presentation did reasonably suggest that for HIA to become better recognised as an effective tool, there needs to be a stronger loop between the assessment step and the monitoring and evaluation step. Interestingly this was reflected in the ‘capacity building’ session I presented in. Out of the four speakers only Professor Andrew Danenberg, reporting on developments in the U.S. via HIA case studies, referred to the impact of those HIAs on proposal development and decision making. Evaluation of HIA effectiveness is an area we can improve on in Australia (and are working on). However this is reflective of where HIA needs to improve internationally.

In recognition of this shortfall, the U.K. department of health has commissioned a cost benefit analysis of HIA. While the final report is yet to be released, Jacqueline O’Reilly of the York Health Economics Consortium, who are undertaking the analysis, presented on its methodology. The project builds on the process-impact-outcome framework, covering rapid and comprehensive HIAs across a broad range of subject areas as they are being conducted. Cost is based on time-sheets and wage rates of those involved and the stages in HIA. Benefits are threefold. Process benefits include community engagement and increased partnership working, the impact benefit (the primary benefit) is the impact benefit on informing and influencing the decision-making process, and the outcome benefit is the impact on public health. While the proof of the pudding will be in the final report, the project is a good example of how HIA can be evaluated. The report hopefully should help HIA move forward from the paralysing debate on the problems of conclusive causation. Let’s follow this example and just get on with it!

Another regular that reared its head during the conference was where HIA sits in relation to other assessment processes, with Environmental Impact Assessment (EIA) the most talked about example. From the ensuing debates it became clear that a number of people see the future of HIA as part of EIA, although I noted many of these people worked for EIA consultancies. Others see HIA as a stand alone process, noticeably health professionals. I myself came away thinking that both are important, HIA as separate on some proposals, and on others within EIA as long as the HIA component is done effectively. The debate also raises other questions: Is this is a golden opportunity for health to work intersectorally? Would this require further legislation that incorporates both a health protection and health promotion focus? Further discussion on this is warranted in NSW, particularly on planning and urban development issues.

What is occurring in Europe provides some useful insights. The recent Strategic Environmental Assessment (SEA) directive related to land-use planning from the European Union requires the consideration of the likely significant effects of a range of topics including population and human health into strategic spatial (which is replacing land-use) planning. In a plenary address on ‘Integration, Planning and HIA’, Ben Cave of Ben Cave Associates argued that SEA provides a golden opportunity for health to re-unite with planning, and for HIA to be a vehicle for this. Mr. Cave argued that HIA assists this intersectoral work while putting health on the planning agenda by encouraging action around shared definitions, concepts and language on health and health impacts. Later in the plenary, Hugh Barton from the University of the West of England added another bow to this debate. He argued that HIA should be part and parcel of an integrated approach to assessment, based on the concept of sustainability, the planning tool for which is a health map. Of interest was that this health map is based in the original determinants of health ‘Rainbow’ by Whitehead and Dahlgren. From a health professional’s perspective, it is encouraging that planning appears to want to engage with health around a broad concept of health, although the required driver may be broad directive such as SEA.

There were also excellent presentations on actual HIAs and the lessons learnt from these. Of relevance to all HIA practitioners was the experience of a local HIA undertaken on a proposal to erect 367 wind turbines on the island of Lewis in the Outer Hebrides. Apart from the findings of the HIA - for example that much of the island’s roads float on marshland, with implications for trucks carrying turbines reaching over120m in height! – was the process of the HIA itself. This apparently took place without any level of capacity building or support for those who conducted the HIA. Problems beset the HIA from the outset. The lesson is that without some level of expertise and support, such HIAs have the potential to be fraught with difficulties.

One other notable presentation was Mary Mahoney’s plenary on Healthy Public Policy in Victoria. Mary talked candidly about the challenges and achievements of her work on HIA in Victoria, and produced the ‘piece de resistance’ of the whole conference, a short film of cowboys ‘herding cats’. The ensuing mirth reflected how well this resonated with the work of many, including us in NSW, in the audience.

To conclude, a comparison of HIA in Australia and NSW to other countries is useful. Pleasingly our work appears to be in sync with HIA as it has been developed and is developing in other countries. However, we are also in a strong position to strengthen HIA internationally based on our current work. For example our work in NSW with planning will provide useful lessons for all. We also may be in a useful position to strengthen the evaluative component of HIA while we are embedding HIA in the system rather retrospectively or as an afterthought.

Oh and one last thought. Anyone planning on going to Wales or the UK on holiday, I recommend you spend a few days in Cardiff!

This piece first appeared in issue 15 of the HIA eNews.

HIA eNews: Issue 15 now online

• Be a Developmental Site!
• 7th International HIA Conference Report
• Health Impact Assessment in San Francisco
• Healthy PLACES Act
• HIA Connect Blog
• New Resources
• Download

Stay Up to Date: IAIA Conference Abstracts

The abstracts for the upcoming IAIA conference are now searchable online:

Abstract Listing
Even if you're not attending the conference the 28 HIA abstracts are well worth a look. Contact details are included as well if you'd like to contact people about their work.

US Healthy Places Act of 2006

More information on the Healthy Places Act of 2006 that we posted on previously is now available. The bill has been referred to the Committee on Health, Education, Labor, and Pensions. You can track its progress on GovTrack. It's probably important that we, as HIA practitioners, don't get our hopes up - most bills never make it out of committee.

You can download a copy of the bill [PDF 87Kb] if you'd like to read it int full, but the HIA related sections are:

SEC. 2. DEFINITIONS. ...
(5) HEALTH IMPACT ASSESSMENT- The term `health impact assessment' means any combination of procedures, methods, tools, and means used under section 4 to analyze the actual or potential effects of a policy, program, or project on the health of a population (including the distribution of those effects within the population).

... (Read More)

SEC. 4. HEALTH IMPACT ASSESSMENTS.

a) Definition of Eligible Entity- In this section, the term `eligible entity' means any unit of State or local government the jurisdiction of which includes individuals or populations the health of which are or will be affected by an activity or a proposed activity.

(b) Establishment- The Secretary, acting through the Director and in collaboration with the Administrator, shall--

(1) establish a program at the National Center of Environmental Health at the Centers for Disease Control and Prevention focused on advancing the field of health impact assessment, including--

(A) collecting and disseminating best practices;
(B) administering capacity building grants, in accordance with subsection (d);
(C) providing technical assistance;
(D) providing training;
(E) conducting evaluations; and
(F) awarding competitive extramural research grants;

(2) in accordance with subsection (f), develop guidance to conduct health impact assessments; and

(3) establish a grant program to allow eligible entities to conduct health impact assessments.

(c) Guidance- The Director, in collaboration with the IWG, shall--

(1) develop guidance for the assessment of the potential health effects of land use, housing, and transportation policy and plans, including--

(A) background on international efforts to bridge urban planning and public health institutions and disciplines, including a review of health impact assessment best practices internationally;
(B) evidence-based causal pathways that link urban planning, transportation, and housing policy and objectives to human health objectives;
(C) data resources and quantitative and qualitative forecasting methods to evaluate both the status of health determinants and health effects; and
(D) best practices for inclusive public involvement in planning decision-making;

(2) not later than 1 year after the date of enactment of this Act, promulgate the guidance; and

(3) present the guidance to the public at the annual conference described in section 3(e)(2).

(d) Grant Program- The Secretary, acting through the Director and in collaboration with the Administrator, shall establish a program under which the Secretary shall provide funding and technical assistance to eligible entities to prepare health impact assessments--

(1) to ensure that appropriate health factors are taken into consideration as early as practicable during any planning, review, or decision-making process; and

(2) to evaluate the effect on the health of individuals and populations, and on social and economic development, of decisions made outside of the health sector that result in modifications of a physical or social environment.

(e) Applications-

(1) IN GENERAL- To receive a grant under this section, an eligible entity shall submit to the Secretary an application in accordance with this subsection, in such time, in such manner, and containing such additional information as the Secretary may require.

(2) INCLUSION-

(A) IN GENERAL- An application under this subsection shall include an assessment by the eligible entity of the probability that an applicable activity or proposed activity will have at least 1 significant, adverse health effect on an individual or population in the jurisdiction of the eligible entity, based on the criteria described in subparagraph (B).
(B) CRITERIA- The criteria referred to in subparagraph (A) include, with respect to the applicable activity or proposed activity--

(i) any substantial adverse effect on--

(I) existing air quality, ground or surface water quality or quantity, or traffic or noise levels;
(II) a significant habitat area;
(III) physical activity;
(IV) injury;
(V) mental health;
(VI) social capital;
(VII) accessibility;
(VIII) the character or quality of an important historical, archeological, architectural, or aesthetic resource (including neighborhood character) of the community of the eligible entity; or
(IX) any other natural resource;

(ii) any increase in--

(I) solid waste production; or
(II) problems relating to erosion, flooding, leaching, or drainage;

(iii) any requirement that a large quantity of vegetation or fauna be removed or destroyed;
(iv) any conflict with the plans or goals of the community of the eligible entity;
(v) any major change in the quantity or type of energy used by the community of the eligible entity;
(vi) any hazard presented to human health;
(vii) any substantial change in the use, or intensity of use, of land in the jurisdiction of the eligible entity, including agricultural, open space, and recreational uses;
(viii) the probability that the activity or proposed activity will result in an increase in tourism in the jurisdiction of the eligible entity;
(ix) any substantial, adverse aggregate impact on environmental health resulting from--

(I) changes caused by the activity or proposed activity to 2 or more elements of the environment; or
(II) 2 or more related actions carried out under the activity or proposed activity; and

(x) any other significant change of concern, as determined by the eligible entity.

(C) FACTORS FOR CONSIDERATION- In making an assessment under subparagraph (A), an eligible entity may take into consideration any reasonable, direct, indirect, or cumulative effect relating to the applicable activity or proposed activity, including the effect of any action that is--

(i) included in the long-range plan relating to the activity or proposed activity;
(ii) likely to be carried out in coordination with the activity or proposed activity;
(iii) dependent on the occurrence of the activity or proposed activity; or
(iv) likely to have a disproportionate impact on disadvantaged populations.

(f) Use of Funds-

(1) IN GENERAL- An eligible entity shall use assistance received under this section to prepare and submit to the Secretary a health impact assessment in accordance with this subsection.

(2) PURPOSES- The purposes of a health impact assessment are--

(A) to facilitate the involvement of State and local health officials in community planning and land use decisions to identify any potential health concern relating to an activity or proposed activity;

(B) to provide for an investigation of any health-related issue addressed in an environmental impact statement or policy appraisal relating to an activity or a proposed activity;

(C) to describe and compare alternatives (including no-action alternatives) to an activity or a proposed activity to provide clarification with respect to the costs and benefits of the activity or proposed activity; and

(D) to contribute to the findings of an environmental impact statement with respect to the terms and conditions of implementing an activity or a proposed activity, as necessary.

(3) REQUIREMENTS- A health impact assessment prepared under this subsection shall--

(A) describe the relevance of the applicable activity or proposed activity (including the policy of the activity) with respect to health issues;

(B) assess each health impact of the applicable activity or proposed activity;

(C) provide recommendations of the eligible entity with respect to--

(i) the mitigation of any adverse impact on health of the applicable activity or proposed activity; or
(ii) the encouragement of any positive impact of the applicable activity or proposed activity;

(D) provide for monitoring of the impacts on health of the applicable activity or proposed activity, as the eligible entity determines to be appropriate; and

(E) include a list of each comment received with respect to the health impact assessment under subsection (g).

(4) METHODOLOGY- In preparing a health impact assessment under this subsection, an eligible entity--

(A) shall follow guidelines developed by the Director, in collaboration with the IWG, that--

(i) are consistent with subsection (c);
(ii) will be established not later than 1 year after the date of enactment of this Act; and
(iii) will be made publicly available at the annual conference described in section 3(e)(2); and

(B) may establish a balance, as the eligible entity determines to be appropriate, between the use of--

(i) rigorous methods requiring special skills or increased use of resources; and
(ii) expedient, cost-effective measures.

(g) Public Participation-

(1) IN GENERAL- Before preparing and submitting to the Secretary a final health impact assessment, an eligible entity shall request and take into consideration public and agency comments, in accordance with this subsection.

(2) REQUIREMENT- Not later than 30 days after the date on which a draft health impact assessment is completed, an eligible entity shall submit the draft health impact assessment to each Federal agency, and each State and local organization, that--

(A) has jurisdiction with respect to the activity or proposed activity to which the health impact assessment applies;

(B) has special knowledge with respect to an environmental or health impact of the activity or proposed activity; or
(C) is authorized to develop or enforce any environmental standard relating to the activity or proposed activity.

(3) COMMENTS REQUESTED-

(A) REQUEST BY ELIGIBLE ENTITY- An eligible entity may request comments with respect to a health impact assessment from--

(i) affected Indian tribes;
(ii) interested or affected individuals or organizations; and
(iii) any other State or local agency, as the eligible entity determines to be appropriate.

(B) REQUEST BY OTHERS- Any interested or affected agency, organization, or individual may--

(i) request an opportunity to comment on a health impact assessment; and
(ii) submit to the appropriate eligible entity comments with respect to the health impact assessment by not later than--

(I) for a Federal, State, or local government agency or organization, the date on which a final health impact assessment is prepared; and
(II) for any other individual or organization, the date described in subclause (I) or another date, as the eligible entity may determine.

(4) RESPONSE TO COMMENTS- A final health impact assessment shall describe the response of the eligible entity to comments received within a 90-day period under this subsection, including--

(A) a description of any means by which the eligible entity, as a result of such a comment--

(i) modified an alternative recommended with respect to the applicable activity or proposed activity;
(ii) developed and evaluated any alternative not previously considered by the eligible entity;
(iii) supplemented, improved, or modified an analysis of the eligible entity; or
(iv) made any factual correction to the health impact assessment; and

(B) for any comment with respect to which the eligible entity took no action, an explanation of the reasons why no action was taken and, if appropriate, a description of the circumstances under which the eligible entity would take such an action.

(h) Health Impact Assessment Database- The Secretary, acting through the Director and in collaboration with the Administrator, shall establish and maintain a health impact assessment database, including--

(1) a catalog of health impact assessments received under this section;
(2) an inventory of tools used by eligible entities to prepare draft and final health impact assessments; and
(3) guidance for eligible entities with respect to the selection of appropriate tools described in paragraph (2).

(i) Authorization of Appropriations- There are authorized to be appropriated to carry out this section such sums as are necessary.

Temporary Home for the HIA Gateway

The HIA Gateway has relocated to a temporary home, following NICE's decision to close it. You can now access it at:

www.hiagateway.org.uk

US Healthy PLACES Bill calls for HIAs to be undertaken

Washington DC
Originally uploaded by bport.

United States senators Barack Obama and Hilda Solis announced that they would introduce the Healthy PLACES (Priorities for Living Actively in Community Environments) Act this week as part of the American Public Health Association's Designing Healthy Communities, Raising Healthy Kids week. The bill's focus is on improving urban and environmental design in order to prevent chronic disease and promote physical activity.

The bill includes measures aimed at supporting the voluntary use of HIA:

Health Impact Assessments The bill would establish a program to support voluntary Health Impact Assessments (HIA). States and communities could conduct HIAs to assess the effect of major policy or programmatic changes on the health of the community. Source

There is, of course, a huge gap (and a lot of negotiation) between a bill being introduced to the US Congress and it being passed. The fact that HIA is being discussed at a political level at all is something of an achievement however, illustrating that it's on US decision-makers' radars in some form.

Links
Op-Ed piece by Barack Obama and Georges Benjamin about the Healthy PLACES bill
WHO Healthy Environments for Children Alliance's Framework for Action

Subscribe! Two ways to stay updated

In response to suggestions from you (i.e. the people who read this blog) I've added two easy ways for you to stay up-to-date:

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This will hopefully save you visiting this blog only to find that we haven't posted recently.

Please keep sending in your suggestions for improvement!

Update: HIA Gateway

The HIA Gateway will be unavailable while NICE are opening up their new website this week but a contact person is available for people wanting to use material on the site during the rest of this week.

NICE will establish a link between their new site and HIA Gateway URL as a temporary measure so that the site remains live to provide time for seeking an alternative provider.

NICE will set up a meeting as soon as possible to discuss the way forward for finding a new host for the HIA Gateway site.

Information courtesy of Colleen Williams from the UK Department of Health via Salim Vohra.

Related Post: HIA Gateway to Close

A blog post about a poster about a blog...

At the risk of being slightly too self-referential for my own good I thought you might be interested in the poster about this blog [PDF file, 1.95 Mb] that Patrick is very kindly taking to the UK and Ireland HIA Conference for me. As the poster says "despite having a number of regular visitors we have experienced difficulty in encouraging users to comment on the issues raised" so I'd be interested to hear your thougts on it! :)

The conference program is now available and it looks like there will be a number of really fascinating sessions. I'm very interested to see that so many people will be presenting on capacity building issues. At the last conference in 2004 it seemed as though there were only a handful of people engaged in system-oriented capacity building work - has there been a shift in the focus of HIA work internationally?

HIA Gateway to Close

Screenshot of NICE's announcement of the closure on the HIA Gateway

NICE has announced that the HIA Gateway will be closed at the end of March. The Gateway was one of the original and best HIA resources on the web; it's loss represents a considerable blow to the HIA community.

The notice on the Gateway says that NICE are seeking a new host for the information held on the Gateway. What are you suggestions and ideas?

A number of suggestions have already been made on the HIANET listserv including hosting the information on the South East Public Health Observatory or setting up a HIA wiki.

If you post your ideas and comments here I'll consolidate them and then distribute them on the HIANET and IAIA HIA listservs.

New HIA Newsletter

There's a new HIA newsletter being put out by the Institute of Public Health in Ireland. It's a fairly low-key publication at the moment but it may be worth keeping an eye on it in future.

It's good to have a companion to our own humble HIA E-News.

Health Believers in HIA (Others Less Convinced): New Zealand survey of policy-makers' attitudes

Public Health has an interesting article that reports on a survey of New Zelanad policy-makers' attitudes to the determinants of health:

Gaulda R, Bloomfield A, Kiro C,Lavis J, Ross S. Conceptions and uses of public health ideas by New Zealand government policymakers: report on a five-agency survey, Public Health 120(4): 283-289. doi:10.1016/j.puhe.2005.10.008

There are a number of interesting findings in the survey but the one that I find most compelling is the attitudes to making HIAs mandatory that are reported:


As you can see, health policy-makers are largely supportive of the ida of making HIAs madatory (76%)but policy-makers from other sectors are less convinced (38%). Support for the concept of HIAs being mandatory is further reduced when respondents from the Ministry of Social Development, probably New Zeland's largest human services ministry, are removed from the "other" catgory (only 27%).

This is quite telling becuase New Zealand has done a moderate amount of work in developing HIA and using it to assess other sectors' proposals (and it's not just government that supports its use).

I suspect that if a similar survey was done in Austalia or other countries where capacity to undetake HIA is being built there may be even less support for the idea of making HIA mandatory.

What do you think about this? I think it suggests that a softly-softly approach to involving policy-makers from non-health sectors in HIA may be more appropriate than a regulatory/mandated one.

Article Abstract

Objectives
This article describes New Zealand government policymakers' awareness of, attitudes toward and self-reported use of ideas about the determinants of health. Some comparison with an earlier Canadian study is provided.

Methods
Employees with policymaking and advisory responsibilities in government departments of health, social development, housing, education and finance were surveyed.

Results
More than half of the respondents (58%) were familiar with ideas about health determinants. Eighty percent felt that health determinants should be considered in all government policy, but that more practical information on effective policy interventions is needed. Commitment to the idea that the economy should take precedence over reducing health inequalities was low.

Conclusions
There is a demand for literature on health determinants that is sector specific and which provides practical and proven information about effective interventions that influence health.

HIA Capacity Building

I recently came across IMPACT's Capacity Building for Health Impact Assessment webpage. It's a project that brings together IMPACT, Liverpool Primary Care Trusts and the Liverpool City Council to build capacity to undertake HIA. They're doing interesting work, quite similar in nature to our NSW HIA Project.

If you're interested in some of the specifics of CHETRE's approach you can access the article on the project in the NSW Public Health Bulletin or look at the presentations I gave on the project at the 2005 IAIA conference and at the 2004 UK & Ireland HIA conference. I'm sure that IMPACT will presenting on their work at the upcoming HIA conference in Cardiff.

Building system capacity to undertake HIA is one of the primary challenges facing governments interested in utilising HIA. (more) Past experience suggests that top-down or legislative approaches requiring HIA with little prior capacity building will fail.

CHETRE has taken more of a multi-pronged approach to building capacity, drawing on the NSW Capacity Building Framework:


I know that IMPACT's work draws upon this approach as well.

What HIA capacity building work are you currently engaged in? What has worked and what hasn't?

New Zealand Public Health Association call for wider use of HIA

The New Zealand Public Health Association has urged the New Zealand Parliament's Finance and Expenditure Committee to rigorously assess the wider impact of government policies.

Dr Bichan urged Government to fully assess the health impacts of various policies, saying that health impact assessment tools were available to policy-makers. By considering the impact of a policy on the health of children and families, the Government could be alerted to any unintended negative consequences of that policy, such as some groups slipping further into poverty, and experiencing poorer health.
Source

The HIA tools mentioned include the Guide to HIA: A Policy Tool for New Zealand which was release by the Public Health Advisory Committee in 2004. It's quite a well structured document and is worthwhile reading for those with an interest in using HIA on policies.

Opportunities to Present on HIA (in Australia)

The closing date for abstracts for a number of HIA-related Australian conferences are approaching:

International Society for Equity in Health Conference: Creating Healthy Societies through Inclusion and Equity
Adelaide 11-13 September 2006
Abstracts due 11 March 2006
http://www.iseqh.org
The deadlines for abstract submission for a number of Australian HIA-related conferences are approaching:

Health Promotion Symposium: Getting Evidence into Practice
Sydney 28-29 June 2006
Abstracts due 31 March 2006
For more information email hpsymposium@swahs.health.nsw.gov.au

Public Health Association of Australia Conference: Tackling the Determinants of Health
Sydney 25-27 September 2006
Abstracts due 1 April 2006
http://www.phaa.net.au/conferences/Annual06/callforpapers.htm

It's unusual to have so many opportunities to present HIA-related work in Australia so I urge you all to make the most of it.

Bungendore in the News

Bungendore, a village 35 km east of Canberra, has been in the news recently following the release of a Water Discussion Paper by Palerang Council. The discussion paper highlights some of the major challenges Bungendore faces in sustaining population growth and a sufficient water supply.

A HIA of the Bungendore's population growth planning is currently being undertaken as one of the 2005 Developmental sites. To find out more about the HIA access the article in the HIA E-News or you can take a look at the presentation on the HIA given at CHETRE's Health and Urban Development Workshop in December.

Maplecroft Global Information Maps

Maplecroft Maps has quite an interesting series of maps that cover a range of determinants of health issues:

• Poverty
• Education
• Digital Divide
• HIV/AIDS
• Malaria
• Tuberculosis
• Development Assistance
• Corruption and Transparency - salient when we consider that HIA is about influencing decisions and increasing transparency.

A you can see they're more related to health and social determinants issues than HIA per se, but I thought they might be of interest to you anyway.

Growing the Field of HIA in the USA

The American Journal of Public Health has published an a piece on Growing the Field of Health Impact Assessment in the United States. The article is based on a workshop held in October 2004 that brought together US and international practitioners, government agency representatives and academics with an interest in HIA.

The article is interesting because canvasses a number of debates around HIA's use, reminding me of many of the issues that CHETRE had to consider during Phase 1 of the NSW HIA Project.

The article's abstract is available after the jump.

Growing the Field of Health Impact Assessment in the United States: An Agenda for Research and Practice

American Journal of Public Health, 96(2): 262-270, 2006.
Authors: Andrew L. Dannenberg, MD, MPH, Rajiv Bhatia, MD, MPH, Brian L. Cole, DrPH, Carlos Dora, PhD, Jonathan E. Fielding, MD, MPH, Katherine Kraft, PhD, Diane McClymont-Peace, MS, Jennifer Mindell, MBBS, PhD, FFPH, Chinwe Onyekere, MPH, James A. Roberts, PhD, CEP, Catherine L. Ross, PhD, Candace D. Rutt, PhD, Alex Scott-Samuel, MB, ChB, MCommH and Hugh H. Tilson, MD, DrPH

Health impact assessment (HIA) methods are used to evaluate the impact on health of policies and projects in community design, transportation planning, and other areas outside traditional public health concerns. At an October 2004 workshop, domestic and international experts explored issues associated with advancing the use of HIA methods by local health departments, planning commissions, and other decisionmakers in the United States.

Workshop participants recommended conducting pilot tests of existing HIA tools, developing a database of health impacts of common projects and policies, developing resources for HIA use, building workforce capacity to conduct HIAs, and evaluating HIAs. HIA methods can influence decisionmakers to adjust policies and projects to maximize benefits and minimize harm to the public’s health.

Access the article

Welsh coal mining HIA urges precautionary approach

A HIA recently completed by the Welsh Health Impact Assessment Support Unit has urged planners to apply the precautionary principle in denying approval to a coal mine expansion. Whilst the assessors could not be certain about magnitude or severity of negative health impacts arising from the proposed expansion of an opencast coal mine in south west Wales they have urged planning authorities to reject the proposal:

"On balance, there is sufficient uncertainty regarding the negative health impacts to apply the 'precautionary principle approach' - which would not allow mining to proceed in such close proximity to residential areas."

Further details are available on the BBC News website.

Update 2 March 2006
I think that Carolyn Lester will be speaking about this HIA at the upcoming HIA conference in Wales. One more reason to attend.

Upcoming Social Impact Assessment Training

It's not HIA-specific but the social impact assesssment training run by Rabel Burdge is still quite relevant to people with an interest in HIA. He's returning to Australia to run a series of courses in Queensland in March and in Queensland and New South Wales in August: (more information)

March 15-16
Eco-Centre building on the Griffith University campus in Nathan, Brisbane, Australia.

March 20-21
Robertson Gardens-Comfort Inn Hotel in Robertson at 281 Kessels Road, Brisbane, Australia

May 21-22
Stavanger Forum, Conference and Exhibition Center in Stavanger, Norway, in conjunction with the annual meeting of the International Association for Impact Assessment (IAIA).

June 8-9
Conference Centre at the University of British Columbia, Vancouver, BC, Canada, in conjunction with the 12th International Symposium on Society and Resource Management (ISSRM).

June 25 (one day only)
Sheraton City Centre Hotel, in St. Louis, Missouri (USA) in conjunction with the annual conference of the Community Development Society.

August 17-18
Eco-Centre building on the Griffith University campus in Nathan, Brisbane, Australia.

August 21-22
Wesley Conference Centre, 220 Pitt Street in downtown, Sydney, Australia.

November 10-11
Hyatt Regency Montreal Centre-Ville, Montreal, Quebec, Canada in conjunction with the annual meeting of the International Association for Public Participation (IAP2).

I did Rabel's course last year and found it very helpful. I've also used the course materials quite a bit subsequently. If you're interested in finding out more you can access the website or email Rabel at burdge@cc.wwu.edu

New South Wales HIA Colloquium

CHETRE hosted a colloquium on health impact assessment (HIA) at Bondi on the 9th of December 2005. The colloquium featured presentes from Thailand, Queensland, Victoria and of course New South Wales.

A number of the presentations from the day have already been uploaded to HIA Connect. We're hoping to add video files of the keynote speeches along with more of the concurrent session and workshop presentations soon. I'll let you know here when all the files have been uploaded.

You can find out more about the program and the keynote speakers on the colloquium page.

HIA in Local Government

A report on the role HIA in local government has been published by the by the HIA Unit at Deakin University.

Blau, G & Mahoney, M. 2005. The Positioning of Health Impact Assessment in Local Government, Deakin University , Melbourne.

From the executive summary:

In those countries where HIA is being applied either strategically or routinely at the local government level, it has directly improved local area planning and public policies, and has indirectly:

• encouraged key decision-makers in non-health departments to consider unanticipated health impacts of their decisions, particularly differential impacts across the municipality;
  
• facilitated intersectoral collaboration within local government;
  
• provided a systematic mechanism for evidence-based planning;
  
• encouraged ownership of local government decisions by utilising civic intelligence; and
  
• identified and made transparent trade-offs in local government decisionmaking.

Download the Report

Special Issue on HIA: NSW Public Health Bulletin

The NSW Puublic Health Bulletin has released a special issue on HIA, that was lauched at the NSW HIA Colloquium.

Articles in the special issue cover a wide range of HIA-related topics, including: (more)

Guest editorial: Health impact assessment in New South Wales
Elizabeth Harris, Peter Sainsbury and Michael Staff

An introduction to health impact assessment
Sarah Simpson

Contemporary debates in health impact assessment: what? why? when?
Elizabeth Harris

Response to ‘Contemporary debates in health impact assessment’
Michael Staff

Health impact assessment: An international perspective
Alex Scott-Samuel

Health impact assessment in Australia
Mary Mahoney

Health impact assessment in New Zealand
Barbara Langford

The art of the possible: experience and practice in health impact assessment in New South Wales
Stephen Corbett

Building an equity focus in health impact assessment
Rosemary Aldrich, Mary Mahoney, Elizabeth Harris, Sarah Simpson and Jenny Stewart-Williams

The New South wales Health Impact Assessment Project
Ben Harris-Roxas and Sarah Simpson

Constructing a database of development applications considered by public health units in New South Wales
Trish Mannes and Adam Capon

Health impact assessment case study: working with local government to obtain health benefits
Sarah Thackway, Susan Furber and Leonie Neville

Health impact assessment on an integrated chronic disease prevention campaign
Blythe O’Hara, Jenny Hughes, Paul Kehoe, Hannah Bairdm, Therese Milham and Sharon Hills

NSw Health Aboriginal Health Impact Statement
Liz Wheeler

The NSW Public Health Bulletin is a peer-reviewed, Medline listed journal and copes of the HIA issue can be downloaded for free from:
http://www.health.nsw.gov.au/public-health/phb/HTML2005/julaug05html/julyAug05.pdf

Effective report writing, the 1:3:25 rule.

One of the major hazards facing practitioners of HIA is effective report writing. It is easy to become so involved in the process of the HIA that the final report becomes something longer and less accessible than the Magna Carta! Such reports are ineffectual because the purpose of a HIA is to influence the heady world of project, program, or policy decision making. These people want clear concise recommendations supported by a clear concise and transparent rationale concerning why these recommendations have been made.

One useful strategy to consider is offered by the Canadian Health Services Research Foundation (http://www.chsrf.ca/). This is the ‘1:3:25 rule’: start with one page of main messages; follow that with a three page executive summary; and present findings in no more than 25 pages of writing. The Foundation has provided a very useful two page resource detailing how to write using the rule. This available for download as one of a series of useful resources from http://www.chsrf.ca/knowledge_transfer/resources_e.php#commnotes

Enjoy!