Marilyn Wise, Australia
How difficult it is to put things together - determinants, equity, climate change, trying to grapple put together disparate understandings and to try and change things not just locally but globally and society by society.
Trying to put together the complexity of life itself.
Rainer Fehr, Germany
For different target groups, HIA is not necessarily the concept of interest.
For society - health is the issue
For policymaking - health impact (or maybe) the issue
For expert community - how to estimate health impact is the issues
Integration - is the multi-layered HIA context, we need to consider integration for several reasons:
HIA can be integrated in many avenues - HI, HA and IA
Health impact issues:
Impact on (range of determinants, unified approach, synthesis) and of health (on health care system, interest of other non-health sectors e.g. education, employment)
Do we exploit our R&D on HIA and apply them to practice? Probably not as well as we could and should.
Health impact quantification - new and improved quality of science-policy interaction, unwanted patina of robust science, health impact modelling in environmental health and public health ...
From Granada workshop - Why? For whom? What to quantify? How? What scale level? etc..., uers are many including policymakers, public, persons working in policy environments...
Process of health impact quantification is as important as the numerical results as the real goal of improving 'real' health.
Family of health related HIAs - Health in SEA, ...
Crude typology for integration:
None, partial (e.g. health in another assessment) and full (separate integrated framework for assessment)
Need to 'think' about integration but not necessarily to do it always...in research, HIA conference
Izabella Rohlfs, Spain
Difference between gender and sex is not always clear - biological and social
Gender perspective implies a transformational relationship to policies in terms of power, roles and autonomy for women and men; empowers women and tackles equity between men and women.
What is gender analysis?
Reveal the differential impacts between men and women with gender and sex and the interactions between them and other determinants such as socio-economic sttaus and ethnicity.
Gender as a construct rather than sex as a variable (e.g. in epidemiology that is a factor to be accounted for).
Gender in HIA - Are women and men differently affected by a policy? Is it equitable or not?
Screening - sensitive to avoid bias, alive to gender constructions and stereotypes.
Identification of stakeholders - failure to engage women who generally participate much less.
Scoping - Are there implicit and explicit stereotypes in the terms of reference?
Identifying impacts - policy contextualisation in terms of implementation, separate analysis for men and women, gender bias in expert and professional opnion, ...sex distribution, socio-economic position, age, ethnic origin, sexuality, etc.
Gathering evidence - "None of the social positions of interest nor the variables used to represent them are..." MacIntyre, ...
Synthesising evidence - critical approach to evidence reviews and synthesis, insufficient research should not be an excuse we must look for a measurement criteria and develop new evidence. Balance between subjective and objective evidence.
Analysis - contextualisation of health impacts
Towards a better future...
Marilyn Wise, Australia
Logic pathway - healthy population > health equity > equitable determinants of health > public policy
Solving earlier problems has created new problems.
Szreter's work demonstrated the relationship between enfranchisement and the earliests purposeful public health successes. Important to remember that during industrial revolution there was more equal exposure to poor environments between rich and poor.
Evidence on its own does not enough to bring about change - necessary but not sufficient.
The more the issue is at the regulatory/population level the less likely science to influence policy and vice versa the more individual/targeted level that the intervention is.
Intersectoral work has been challenging for the health sector.
Engaging has been framed as 'empowering' or 'self-determination' without regard for the role of the 'top'.
Need to develop a structured discussion between stakeholders.
Benefits but also challenges...
And issues of institutionalisation (no natural home), what is the trigger, mandated and capacity.
What promotes use of IA?
But nothing about INEQUITY - systematic, persistent and routine on some groups compared to others.
Define equity/health equity
Differentiate between inequality and inequity
Include explicit attention to equity in each step of the process
"Fish don't see water" ?Labonte
Structured conversation to create shared meaning.
Needs political action
Sustainability may be the universal stimulus and IIA may prove to be the only logical form of IA to address the integrated systems that are responsible for 'creating' the problems and this needs to be linked to activism and political power.