15 April 2011

2nd Day Plenary Session 1 - HIA development and institutionalizing in decision-making processes

For live streaming and videos of the plenaries go to:

Either the conference website http://www.hiainternationalconference.org

Or directly at: http://si.easp.es/eis2011/


Carlos Artundo HIA'11 Chairperson and
General Director of the Andalusian School of Public Health

welcomes delegates to the second day

The morning's plenary speakers getting ready to speak
(and setting up their head mics, 
which have worked very well and look cool too)



Alain Poirier, Canada

HIA developed from Ottawa Charter. 1980's HIA through EIA and in the 1990s Institutionalisation of HIA centrally.

Public health 2001, Minister  can provide advise to other departments on public health and shall be consulted in relation to the development of the measures...

Strategy to implement the Public Health Act
www.msss.gouv.qc.ca/article54

1. Intergovernmental working - dialogue and discussion during the development of policy (though in some cases consultation happens at the end). Development of tools with other ministries: establishment of network of ministerial representatives, practical guide, ...


Findings
a) Greater awareness and increasing integration of HIA process
b) Request for projects other than bills and regulations e.g action plans
c) ...


2. Development and transfer of knowledge - funded research on public policy conducive to health ( meet needs of intersectoral partners, synthesise existing evidence) and evaluate public policy

Challenges and pespectives
Support changes in practice for greater use of HIA, develop strategic monitoring, strengthen intersectoral action. 20% of policies advice not taken but 80% where it was.


Rajiv Bhatia, USA


10 year story of HIA in the USA.

Improving health and getting health considered in all sectors - public, private, civil. Where does HIA fit with this intersectoral action

Started with Living Wage Bill and looked at and didn;t realise until someone working internationally said that what we had done was a HIA!

Completed 18 HIAs - labor laws, land use plans, housing, transport, ...

Findings: change public understanding of health determinants, some influence on policy, developed methodological capacity t engage with other sectors, developed accountability of EIA in relation to health, enhanced intersectoral cooperation, NGO understanding of the strategic role of health evidence and identification of policy gaps.

Moved from heavy investment in HIA (90%) to a more wider intersectoral approaches (as mentioned above).

Also developed health indicators for development projects e.g. transportation.

Leading on cross-cutting issues that has no one has current responsibility allowing/enabling the Public Health Department to take the lead/responsibility e.g. pedestrian safety - used EIA to introduce mitigation, then established a citywide law and then...

Work with most city agencies and for some created new institutions and took on policy leadership.

Lessons:
HIA is a learning process - when learning done you don't need to do it.
HIA contributed to staff capacity, methods, policy gaps, accountability, organizational relationships.
...

We started with where people are at and tried to positively participate and add value to the process.

Need for HIA in land use and transportation will disappear as we move upstream.

Role of HIA:
Poorly understood health effects
Specific analytical issue raised by policymakers
...



Need guidelines and standards of practice, technical capacity, resource commitment, cross sector experience, understanding and buy-in, publicly sanctioned screening and selection process, prioritize key issues 3-4 on which to do a HIA and then legal framework...

Need a public health political constituency to progress HiAP. Public health professionals need to take the lead even when we don't feel confident.


Laetitia Kuijpers


"Link and pin" between ministries of health and other ministries.

Similar to other countries in that health needs to raise awareness and the importance of other ministries in improving health.

"Health nearby: health care and safe facilities" - new approach is that health should go back to the people and come from people.

Make health fun!

Big socio-economic inequalities and Ministry has chosen some key districts to target in terms of 4 topics - socio-economic disadvantage, problems in the living environment as experienced by inhabitants, low quality housing stock, physical problems in the living environment according to inhabitants. But no health indicators initially.

Focus on 5 topics: housing, employment, education, integration...

Partnership between local (18 municipalities) and national government (12 ministries) and housing corporations (70) and residents of the 40 districts (5,000-200,000 population) and national alliance of private parties.

Vouchers for inhabitants (grants for community projects) alongside money to local government and the housing corporations.




National government as catalyst, 'unblocker' and mediator.

Residents have a say on the charters between institutions and action plans.

Analysis of this approach is being done through the URBAN40 project.

Municipalities doing things their own way but sharing practice is an important issue across the municipalities.

Early findings:
Employment and education results improving.

Long term involvement necessary (10 years plus, charters have helped to ensure that even though new government less interested they have carried on with the projects)
Sharing knowledge and experiences
...

Follow the flow
Knock on the door
Invest in other policies (why and how we can help each other)
Show facts and figures on health
Ask other policies to help
Join other policies and ask how to help


Taru Koivisto


HiAP complementary to public health measures and health care.

HiAP evolution:
Health for all
Intesectoral action for health
Healthy public policies
Social determinants of health
Health in all policies

Legal basis - health promotion (Constitution), public health act (very soon) and health care act

Policies - Public health programmes and national action plan

Recommendation - Quality recommendation for health promotion (2006) i.e. how it should be implemented.

HIA - a tool for HiAP, described as Human Impact Assessment to incorporate health and social issues.

Intersectoral actions - consultations/public hearings, horizontal committees with legal mandate (Public Health Committee), ad hoc committees, public health reporting (legal basis and/or cooperation of other sectors), formal communication between sectors (bilateral meetings with key civil servants/bureaucrats and impact assessment (integrated/health).

Lessons:
Similar to previous speakers - long term commitment and vision, public health expertise for advocacy, data on health determinants and analyses of links between health outcomes, determinants and policies; health literacy among public, policymakers and civil servants in all sectors and intersectoral structures, processes and mechanisms.

New health care act will incorporate public health and HiAP (stronger permanent structures for health promotion in municipalities, most already do it and this is to incorporate those that are not doing it).

 Municipalities to promote health and wellbeing. Human impact assessment is included in the new Act and the requirement for health and social care institutions to be involved in impact assessment and intersectoral working in municipalities. Also required to monitor through online system. Integrated into the traditional functions of municipalities.

HIA support: regional seminars with workshops and guidance materials, National Institute for health and welfare, model for prospective impact assessment (rapid HIA, conventional HIA), HIA developed as part of structures for health promotion, Capacity building to develop regional experts in polytechnics/universities to support municipalities.