31 August 2012

Plenary 3: Making Sense of Increasingly Diverse Approaches

In this third plenary we wanted to cover the different models of practice of HIA and look at how they could be classified. We also wanted to look at the research that can contribute to the advancement of HIA methodology and practice.

Fit for More than One Purpose: Typologies, Theory and Evaluation in HIA

Ben Harris-Roxas, Harris-Roxas Health


  • We were trialling the use of HIA in 2004 and we got a lot of criticism from EIA practitioners because they felt that they were covering health, even they were not really doing so.
  • We saw that they were focused on Protecting Health rather than Promoting Health and Tackling Health Inequalities.

Types of HIA

  • Mandated: required by the policy and planning process
  • Decision-support voluntary undertaken to help inform the policy and planning process
  • Advocacy: Undertaken by NGOs not proponent or decisionmakers with a generally overt political agenda
  • Community-led: Undertaken or commissioned by local communities, raised own funds, to examine concerns they have about health and influence decisionmakers

Often HIAs don't fit neatly into these categories but they overlap and merge rom one into another.


An evaluation study we undertook found that in Australia and New Zealand found that there are two other aims of HIA:

  • Improve governance and decision-making
  • Learning - And then in turn technical, conceptual and socil

  • HIA is fit for more than one purpose and it is important to examine the purpose and types of learning.


Investigating HIA from Politic-Administrative Perspective: a theoretical perspective

Monica O'Mullane, Slovak

  • Will talk about my experience in Ireland.
  • Examined 4 HIAs
  • Great momentum in Ireland for HIA in the early 2000s in the South and North, incorporated into health strategies

  • Case studies were on physical environment and housing and one each from Northern Ireland and the Republic of Ireland
  • Traffic and Transport Plan, Air Quality Action Plan
  • Travellers accommodation programme, Dove Estate housing development

  • All 4 HIAs were Decision Support HIAs
  • The Traveller accommodation programme HIA was a Advocacy and Community led HIA, it sought to reframe and challenge and oppose government policy

In my research framework I developed the idea of Utilisation

  • Instrumental use
  • Conceptual use
  • Persuasive use - political use

  • HIA is influenced by tier of government
  • Involvement of key partners
  • Conceptualisation of health
  • Role of the policymakers and community

HIA in Wales: a social science perspective

Eva Elliott, Cardiff University and Wales Health Impact Assessment Support Unit

  • Wales has had a strong tradition of examining and tackling health inequalities and HIa was seen as a vehicle to look at health inequalities
  • Social science can provide a sociological understanding of how impacts can affect people's lives and we can also use it to look at how HIA is practiced
  • HIA can provide civic intelligence by bringing together scientific and community and policy understanding.

Types of HIA in Wales

  • All types have been undertaken, danger that it is everywhere therefore nowhere
  • Emphasis on citizen participation where possible
  • Move from decision support to mandated HIAs has moved from capacity building to quality review of HIAs
  • Mandated HIAs can be a vehicle for excluding citizen concerns: through scientific exclusivism, bureaucratic proceduralism, by not happening.

Case study of a waste incinerator HIA

  • Should have been a mandated HIA, but was a mixture of community and advocacy with elements of decision-making support
  • Plans for an incinerator had been rejected by planning department but the company appealed
  • WHIASU supported the community in developing the HIA in an 8 week window to ensure it was considered at appeal
  • HIA can provide a space for residents to think about the possible benefits and mitigation opportunities
  • Much bett at thinking about cumulative impacts
  • Main issues were the lack of trust between citizens and public agencies and sense of being dumped on
  • Means that people should be more systematically engaged in the policymaking process
  • Lack of control in the process is a determinant in itself
  • Company submitted new plans that we submitted earlier than the appeal and the HIA work was stopped and interim HIA was not considered and company granted operating license in November 2010

More needs to be done

  • More discussion needed on mandated HIAs
  • Need to question the purposes of mandated HIAs who conducts theme on behalf of whom
  • Need to question the science and develop the evidence base, examples from popular epidemiology/citizen science
  • We need regulation for engagement





Q: mention this issue of self evident truths and how a planner had a different understanding and can you say how you came towards a more closer understandings?

A: what I learned was that planners thought of health and health care, they came to a closer understanding by looking at the Whitehead and Dalgren rainbow diagram and discussions around it.


Q: We say that consultants are hired to get to a predetermined outcome and that if we use HIA with communities to oppose a development then are we not doing the same things and how does the practitioner navigate this?

A: Can understand your point, when communities come to us we say this is not the same as lobbying and that HIA is a space for different kinds of evidence and issues, we shouldn't underestimate the ability of communities to und stand the issues, there core concern was being excluded from the process, in other cases where communities wanted to present evidence in a one sided way we said to them that using that in the HIA would not be listened to.


Q: What are the resource implications of WHIASU?

A: This is difficult to say as its a partnership between the University and the Wales Public Health Unit so the funding is shared and we don't see the money directly, at the moment we have 3 full time staff, plus part time director level management, for a population of 4 million plus we can access other resources in the public health units


Q: when we are generating knowledge and giving weight knowledge and whose knowledge is weighted more - community versus science and the gaps in scientific?

A: There is a fundamental tension, working with indigenous groups have unique issues from communities in general, many are concerned about collective impacts and spiritual health, to western audiences this can be easily dismissed but they are central to the function of these indigenous communities, in such cases we have developed contextual definitions of health that included these things, aim to be transparent and lok at this explicitly.

A: One thing I find problematic is that we place too much difference between science and community knowledge (that community knowledge is about feelings/emotion) rather they can be early warning sentinels for scientists. PLOTS, Public Laboratory for Open Science is an example of interesting science and citizen participation.


Q: I didn't see discussion of the role of the judiciary in allowing people to get their voice heard in the policy making and planning process, have you considered this in your evaluation and have administrative systems taken account of this e.f. Going to European Court?

A: often not many ways for communities to sue in these contexts. In mandated HIAs they do set precedent of what is considered the range of scope of what a HIA is which makes it then more difficult later to be flexible and change the scope so that often the judicial scope is narrow.



Parallel Session 2: Role of HIA in the Environmental Review Process: tool for community engagement and agency engagement in decision making

Baltimore Washington Rail Intermodal Facility HIA:

Lessons learned in capacity building and community participation

Ruth Lindberg, Program Manager, National Center for Healthy Housing, USA


Project Context:

  • Panama Canal Authority widening canal
  • ...
Intermodal facility:

  • Allow double stacked containers with the aim of moving more goods by rail than road

Community context

  • 4 proposed candidate sites, do nothing option and potentially another additional candidate sites
  • Two sites - rural area, small town, sense of community, peacefulness, people try to support each other
  • One rural area had 11 correctional community and a waste treatment facility.

Key health topics:

  • Air quality
  • Noise
  • Employment
  • Neighbourhood resources
  • Water quality


  • Key issue was health equity and how do you avoid burden already vulnerable communities.
  • Communities have been pitted against each oth with each saying that the other communities are likely to be better places to put the facility.
  • A lot of community distrust, don't feel they are getting truthful responses from government, don't feel involved in the process.


Policy Context

  • 4 key agency decision-makers
  • Voluntary or Regulatory as part of EIA
  • NEPA has a health reference but found decision-makers say that it is already being coved or that health is not part of the Act and hence not needed.
  • Asked to do an integrated EIA and HIA but this was not taken up by decision-makers
  • We conducted HIA separately from the EIA

Challenges of engaging agency officials in HIA

  • No funding
  • No legislative authority
  • No capacity


  • Positive - We were in control of the HIA and the data that was used.
  • Negative - that it might be disregarded and not seen as part of the process.
  • Community still distrustful of using data from government agencies

Approaches used to engage:

  • Training
  • Community forums
  • Media outreach
  • Use existing meetings on other issues
  • Engaged local leaders
  • Legislators
  • Meetings set up out of work hours

Lessons learned

  • Set and maintain realistic expectations of HIA influence
  • Transparency is critical
  • Budget time and resources for engagement
  • Engage early and often
  • Be prepared for unexpected challenges and setbacks
  • Policy change, rumours, lack of information

Lake Merritt HIA

Pilar Lorenzana-Campo, Program Director, Change Lab Solutions, Oakland, California, USA

Public health people, planners and lawyers


  • Funded by federal transport agency and this for increasing community participation not to do a HIA
  • HIA was used as an approach to engaging community
  • Had Health Impact Partners, Environmental Justice and oth advocacy and community groups.


  • Too many priorities - many community needs, access for transportation, affordable housing, jobs and services, parks and recreation and public safety.
  • Had to deal with funding and timeline constraints.


  • We did not collect any data ourselves but got data from other agencies, but that meant that some things we could not analyse because we did not have that data.
  • Used strength of relationship between aspects and health to filter and prioritise issues.
  • We developed a clear policy target - affordable housing
Affordable housing strategies:

  • Ensure that existing regional target is maintained 30% affordable.
  • Plan and develop family housing
  • Provide a development incentive to build affordable housing

  • Push back from decision-makers, but was mitigated by us identifying the positive impacts of the project.
  • Congratulating them on the positives helped to develop trust and an improved relationship.
  • Decision-makers came back and asked to look at other documents and had opportunity to provide input into developing policies.

Good stuff
  • Building capacity around health and built environment
  • A new dynamic in the conversation
  • Incorporation of some recommendations into draft plan
  • Use of HIA in other projects



Q: How did you Do the health assessment on affordable housing?

A: Tried to see where the affordable housing Was and what type of affordable housing there was - restricted and unrestricted, a lot more unrestricted, these units were at risk, this had an implication of forcing people to move. Current incentives are only for 12% rather than the target of 30%, an example is building height by allowing higher levels in return for affordable housing.


Q: how do you use HIA without using HIA?

A: in the intermodal facility how did you get funding to do it, we applied for funding through Health Impact Project, Pew Charitable Trust, had strong relationships with local partners. Ho

E that this will be a successful project for how the Transportation Department in terms of engaging communities.


Q: There is an equity in relation to the 4 sites you mentioned for the intermodal facility? How can you justify siting for example the community with all the correctional facilities?

A: Still struggling with this issue, I don't think we will be recommending any one site, we hope to provide the positives and negatives in each area and to inform decision-makers who will make the decision. Interesting that the site being dismissed has a lot of greenery while the site added had a lot of negative health indicators probably because more concerns expressed and more vocal local politician in the site that was being dismissed.




Plenary 2: Canada Experience - Institutionalisation of HIA: addressing political and administrative issues

Institutionalization of HIA in Quebec

Alain Poirier, Ministry of Health and Social Services, Quebec, Canada

  • Largest Canadian province
  • 8 million people
  • French is the official language
  • Federated structure with power sharing between federal and provincial government
  • Health and social services are integrated in the same department

Structure of health and social services system overview

  • 1980s HIA a facet of environmental assessment
  • 1990-2000s a greater push with the development of a Public Health Act (2001)
  • Two ways of covering HiAP, political one is Section 54 of the Act, Minister should be consulted on any significant public health impact

Institutionalization in HIA

Decharut Sukkumnoed, Thailand Healthy Public Policy Foundation


  • 1997 health system reform led to several significant change sin health system and beyond. A new definition of health that included social and spiritual health alongside physical and mental health.
  • Focus moved from I'll health to good health.
  • A National Act was introduced that stated that HIA was one of the main tools for healthy public policy.
  • It took over 3 years for the legislation to be passed from the point where the draft act was completed and the legislation was implemented, National Health Act 2007.
  • Section 11 of Act that people have the right to request for assessing and participating in the assessment of the impact on health of a public policy...they will have the right to express his/her opinion.
  • Explicit mention of an environmental and health impact asessment needing to be undertaken for any project which may seriously affect a community's environmental quality, natural resources or health.

HIA in the USA

Aaron Wernham, US Health Impact Project


  • America is not getting good value for its health dollar
  • Social determinants is starting to be a part of the dialogue
  • Push - More and more calls and a push with government instead in working across sectors.
  • National Prevention Council, brings teeth 14 different agencies
  • Pull - a lot of community advocacy - housing tenants, native American communities
  • First HIAs in 2000, funded by charitable foundations mainly
  • Done by community advocacy, public health, transportation agencies and private sector

Alain Poirier is back for the second part about how we go about doing institutionalisation of HIA:

  • Intergovernmental mechanism to assess health impact
  • Developed this concept of knowledge transfer
  • Monitoring and asessment of HIA practices

Executing the strategy requires:

  • Strengthening MSSS capacity - dedicated resources - funding and staff, internal government procedures
  • Creating a network of sponsors to apply the Section 54 PHA, most ministries represented
  • Producing and distributing HIA tools
  • $1.7 million budget
  • Set up and maintain a research programme
  • Ministries are using the HIA grid and are going through this exercise when reviewing new policies
  • Do review this at Secretariat General Level
We undertake

  • Strategic HIAs
  • Public health reports and science advisory reports
  • Participating in inter ministerial collaborations and other government projects
  • Ministries use their own tols and their own language
  • An evaluation found that 50% had prior involvement of MSSS and 80% took account of MSSS issues
  • Change in the way departments are working and relationships are becoming formalised
  • Need to keep going to consolidate intersectional cooperation at all levels of government



Decharut Sukkumnoed back again:

  • Combination of two main ideas: HIA as a legal requirement and HIA as a social learning proces
  • Both ideas found their way into the Act
  • Several entry points for HIA: mandatory regulatory HIA, HIA initiated by government agencies on a policy/planning process
  • Requested by local community
  • ...
Structure of organisations: in a collaborative and a contested political and social environment

  • National HIA coordination Center
  • HIA Division, DEpartment of Health
  • HIA university consortium
  • HIA private consultant club
  • Community HIA network
  • Advocacy HIA NGOs


Mandatory HIA is possibly necessary but not sufficient

  • Positive and negative experiences
  • Thai word for health means both happiness and state so it makes it easy to move beyond physical health/illness.
Learning HIA is nice but does not always work

  • Postive and negative experiences

Lessons learnt
  • Need to focus on the learning process for different stakeholders
  • Apply HIA at different levels
  • Need better understanding of policy process and creative policy interactions
  • Trying to move from push strategy to pull - instead of giving the policymakers the proposal in hopes they will take it but gaining public attention and encouraging policymakers community dialogue
  • Need to keep a collaborative and contesting environment
  • Apply HIA early in development process
  • Need to develop inactive HIA learning tools
  • Need to expand the scope of thinking for innovative solutions to healthy public policy
  • Communicating more effectively
  • More pull than push

Aaron Wernham is back for the second part:
  • US no where near a national institutionalised framework
  • There are examples at state level - Massachusetts Healthy Transportation Compact, no funding, collaborating on a first pilot, between transportation and health departments; Washington State governor can request a health impact review that addresses social determinants of health; some funding provided but now withdrawn now HIAs stopped
  • National Environmental Policy Act 1969 - health is in the Act but little health analysis is conducted, recent advocacy by Alaska Native tribes and community based groups, Alaska California Oregon and others have integrated HIA information system into EIA
  • Many other laws are asking for health analysis
  • How many existing legislative levers are out the that we are not using?

Alaska example:
  • Started as a community driven need for HIA
  • Alaska has a programme run from the Health Department and it is institutionalised
  • Role of community now less clear
NGOs are a major driver of HIA practice in the US particular in the absence of government grant funding.

Things most important in the US driving HIA use:

  • Community pull to have HIAs done
  • Public health leadership
  • Charitable foundation funding
  • Federal funding more recently as well as cross sectoral working
  • ...
Key challenges

  • Stable funding and staffing - fee for service HIAs undertaken by Departments of Health
  • Legal requirement versus incentives - legislation very unlikely and incentives is likely to be important

Does Institutionalization mean part of government or private sector that does not always serve the needs of the most vulnerable?
Is this better than before when health was not considered?

How do we avoid the risks?










Q: Is there enforcement of legislation and how does this work?

Q: Funding and resources is challenge?

Q: Need to have consistency, is this seen as health becoming stronger than they want it to?

Q: No discussion on health equity?



A: If the law is not respected within Quebec government it is a challenge given the secrecy and confidentiality of policy development, at regional level regional director of public health can ask for another sector to collaborate and look at an issue.

A: In Thailand, legislation provides the firm ground for communities to ask for a HIA, does make a difference in getting HIAs more routinely undertaken but real success is acting on the HIA. EIA is linked to EIA but analytically there are issues because the health analyses are only on physical health.

A: In the US, about law not being enforced you can argue the NEPAL already had health in it and it has not been enforced and Health agencies have not made a fuss, it is very important that a good law is a starting point but you need the organisational structure and sme work sound it to implement and action the law. EIA is seen as a legislative hurdle, bureaucracy, red tape and barrier to getting anything built.

A: The equity issue is about where is the community in the institutionalisation process, that is the key issue.


Q: Talked about tools developed for partner organisations, what is changing between the,?

A: In Quebec, we have the same tool, but we reviewed and developed material that identified what aspects of their work impacted on health. Developed a screening grid with tailored questions relevant to that MInistry


Q: In Thailand what is the criteria that determines whether a project will have a negative impact?

A: Government has developed criteria but these are used to lobby both for and against doing a HIA through the legal system. there is more use of legal and technical tactics to avoid doing HIAs.


Q: What are your experiences of working at multi level government and intersectional action on HIA?

A: In Quebec, we don't talk about HIA but talk about intersectoral action around health in various policies, there is coordination of plans at the various levels of government.

A: In US, HIA has been a way for getting intersectoral working going in practical and concrete way that can influence actual decisions particularly at local level - public health and planners, federal government are starting to this through the Prevention Council and the prevention agenda.

A: In Thailand, HIA is not the main relationship between health and non health sector, it is a tool for communities to get their voice heard in government policy and decision making.




Workshop: Education, training and materials for building capacity in national and international settings


Introduction, Martin Birley

  • Long history of training courses and guides
  • Standards discussed at successive conferences
  • Do we need to standardise around education and training and in guides and textbooks?

Building a HIA program in the US, Arthur Wendel

  • Base at Healthy Community Design Initiative, our interest in HIA is therefore on the role of HIA in creating healthy community design
  • high healthcare expenditure in the US
  • Lots of government departments having policies that support HIA and integration into their work and processes
  • Lot of HIA stakeholders involved in education and training - public sector, academic, Profesional associations and non-profit organisations
  • Aim to train people to do HIAs, 18 HIAS a year, 600 professionals reached per year, engage with oth sustainability efforts, developing a range of materials
  • Lot of diferent types (type of decision or policy/project area) and depth of training needed and audience - stakeholders, practitioners and trainers

HIA Knowledge and Capacity Building, Hilary Dreaves

  • My theme is about moving beyond training and how we create engagement across sectors.
  • We run a range of courses and activities at IMPACT - introductory and comprehensive, leadership in HIA, HIA policy and screening seminar and tailore made solutions
  • HIA Knowledge Exchange: Mastres level, participative, facilitation, synchronous groups
  • Current economic climate has meant that training and education money is not around and we are using action learning and organisational development as a way of developing HIA awareness, knowledge and skills
Education, training and matials for building capacity, Andrew Dannenburg

  • Early experiences were apprenticeship and learning by doing.
  • Formal courses are short courses (substantial interaction with teachers)' online courses (little or no interaction with teachers), university courses (provide depth of skills, encourages collaboration between students from other courses e.g. planning, can produce a completed HIA at the end of the course but small number of students)
  • Each has strengths and weaknesses
  • 8 university currently offer HIA modules in the US
  • Content is background information about HIAs, introduction to HIA methods, critical reviews of completed HIAs, exercises in steps of conducting HIAs, active engagement in a local HIA project
  • Lots of existing material out there

Questions for discussion, Salim Vohra

To be added



Q: How do you teach commissioning of HIA?

A: Not easy, it's informal, word of mouth, rather than a formal training, need to support the, in scoping what they want, managing expectations,


Q: You have a synchronous online course on HIA at Liverpool, how did you go about developing that?

A: This is a pilot even at the University, we have quality standards of the university apply to the online course, use Blackboard, having student tracking which shows their access, there are management issues especially of getting people to do the course training...


Q: Have found a gap between the course and practice, what a the strategies to close that gap? Know the theory and practice of how to do a HIA but get caught out on the content expertise e.g. transport, energy and food?

Q: Also there need to be learning on project management skills?

A: One bridge is to present a critique of HIAs and we do have a little project management through group work.

A: In practice need to bring in people with those skills/expertise, there is an important role for learning by doing


Q: Interested in your experience or perspective on follow up consultation and to develop communities of practice?

A: First time local authorities engage in HIA it does not go well, they learn a lot about analytics and topic area, the support of the State Department and Local Department as skills develop and they gain experience they want to do more HIAs.


Q: Wondering about ctification and accreditation of HIA professionals, EIA community has it, why don't we do it and what do we need to do move it forward?

A: Internationally it is difficult because ther are liability issues and the time and effort to do this in the long term.

A: In the US it's too early

A: Mental Wellbeing IA are being accredited...


Q: Talking to HIA practitioners have said that they dont need training but other people need it?

A: There needs to be different types and content for training tailored to different audiences. We need to be able to find different types of courses/materials quickly.


What are the ways forward? What can we take forward?

  • External examiners system to ensure that all the courses we at the same standard, though there is an issue that it can be too rigid.
  • Any certification needs to validate that people have learned stuff.
  • Having a quality assurance framework when developing a course and have a range of certified and non-certified courses.


Plenary 1: Q&A

Q: It would be great if at Helsinki 2013 that the representatives of Ministries of Health who are invited that they should bring along someone from another Ministry?

A: We are looking at this.


Q: There are many different types of HIA? Did not hear much about data or is it just about being a process for engagement?

A: Data is important in HIA and lack of data is a big challenge in many HIAs especially looking at impacts on us populations where baseline data for these groups is not available. This is why community engagement is such an important step.

A: one of the lessons we learnt is who defines the evidence and whose data is it, we found that while it might be robust and credible for health e had to go through a lengthy process of what was meaningful for oh departments/sectors. The other thing we are looking at rolling out is to make sure that the planning function and the data used is not just health data, we have to look at other data sets and sources on determinants used by other agencies. Not an easy of straightforward issue.


Q: from what I've understood is that approaches need a flexibility and freedom where Heath does not necessarily get the credit back, how do we create that latitude and economy?

A: it is a challenge, we took the view that we wanted to engage with other sectors and we tried to make sure that our mandate was constantly renewed and reviewed and recommitting the legitimacy. Not relying on a single politician, legislation or agency.


Key messages:


  • How to create accountability for all sectors
  • Shared values on health across society
  • Continuing dialogue

  • Health tries to bring others sectors into the health agenda rate than Health supporting other sectors. We have to go onto their territory to help them achieve their goals.


  • Mutual respectful relationships and mechanisms to nurture those relationships between agencies
  • ...
  • Public and policymakers understanding of the bidirectional interplay between health and all ther other societal goals



Plenary Session 1: Australia - HiAP and HIA

Danny Broderick, Department of Public Health, South Australia


  • This is one approach to HIA from within a Government setting. There are other approaches. We have grown out of our conditions.
  • We've stolen stuff from Quebec to inform our approach in South Australia. Looking at their legislation (10 years before we got ours) and giving it an SA twist and the comradeship that Quebec gave us.
  • How much of this was planned? Just enough, often we were making it up as we went along.

  • 1.5 million people mostly in Adelaide
  • Public health care system budget $4 billion a year (30% of State Budget)

In the beginning we wre doing HIAs but the kind of response we were getting was mixed. This was because:

  • No clear mandate
  • Came in late into the process
  • Little change to change things
  • Perceived to be remote and judgemental
  • Seen as the bearer of bad news
  • For us we found that there were no self evident truths (as we thought)

Ilona Kickbusch helped to kick start us in a new direction through the Thinker in Residence Scheme.

  • See did not saying and doing very much different for what we were doing
  • But because she came with her own authority and charisma from another country she helped to raise the agenda and set health in the context of the social and economic agenda.
  • Complimented government on what was already being achieved and the strategi clan you have can achieve what you require, it did not need explicit health goals, not what other sectors could do for health but rather what we as Health can do for other sectors.
  • We used HiAP as the approach, we developed a proof of concept with willing departments and got our first mandate from the State Cabinet. Did not ask for a seperate structure but bonded with existing structures. Created a group of Chief Executives from other departments and the CE for Health was explicitly not part of that group.
  • Had to start by listening and be prepared to stop and collaborate.
  • The perfect is the enemy of the good - previously we were trying to have health at the top of all agenda this time we wanted to have it somewhere.
  • Health is a resource for living and not an end in itself.
  • Had humility and respect

Where did HIA fit in?

  • Used it flexibly where they fit in the context of the overall process, the strategic dimension
  • Did a number of Health Lens Analyses


  • We did not have a mandate but took a leap of faith and built our mandate
  • We built the framework in the hope that people would come
  • Now we have a South Australian Public Health Act 2011 as legislation is the strongest expression of a mandate

  • Mandate needs to be built and renewed ov time
  • Ned to adapt and reinvent and be agile
  • Needs to be useful and seen to be
  • Working on subsidiarity to permeate it across the whole system rather than in one unit within Public Health
Two thought to leave you with:

  • HiAP, what's in a name, what is it, don't like to use it as a noun "Hiap" it's a health jargon phrase, Is it a process, a goal of government or a slogan - for us it has been a process and hope that it will at some point in time become a goal of government.
  • My problem with "All" in HiAP, we are tapping into an egalitarian value, equity for all, but outside of health it has TOTALITARIAN implications...so I'd like to suggest SHiP...p SOME HEALTH in POLICIES...please


30 August 2012

Plenary Session 1: USA - HiAP and HIA


LInda Rudolph, Consultant in HiAP and H earthy Communities


LIke to discuss our experience in California and some of the issues we've faced.


  • Environments shape health and these environments are shaped by other sectors and these have had inequitable impacts on vulnerable communities.
  • Initial focus was on obesity prevention and some climate change initiatives.
  • HIA was used as part of this.
  • Part of a long history of intersectional action in public health - seat belts...

HiAP came out of an Executive Order by Arnold Swarzenegger that explicitly talked about this as a policy aim. A HiAP Task Force was created. Defined as a collaboration to improve wellbeing.


First challenge was to get people working together and to generate enthusiasms and get people working together better. Met with a range of stakeholders and set up an Ad Hoc Advisory Group. We then developed a definition of Healthy Communities to guide our thinking and developed a vision of how each agency could health. The suggestions from meetings and public meetings was reduced to a set of 6 themes and 11 recommendations.


So what are my thoughts and questions on HiAP and HIA.

  • Health Imperialism can be a charge made at us when we do HiAP
  • We answered or attempted to answer the question What Is In It For Me?
  • Needed to deal with the concerns of HIA from a administrative, regulatory and legal perspective
  • We stayed away from using the term HIA and talked about tackling health equity and using a health lens and that HIA is one approach to incorporate health perspectives
  • Not possible to do HIAs on all policies
  • But we need to do HIAs and when and how more formal HIAs are the most appropriate method in HiAP
  • How do we deal with conflicting policies - should not build housing within 500m of a freeway but there is also a transportation policy to reduce vehicle miles and reducing greenhouse gases. This also had an impact on reaching affordable housing goals.
  • Active community engagement is very hard and their are agency concerns about this being an opportunity for advocacy groups to criticise government
  • Really easy for us to focus on the immediate here and now risks and not the more important long term issues around climate change and greenhouse gas emissions
  • How do we look at the health impacts of windfalls and smart energy grids a deters that does not undermine the longer term climate change interventions needed.
  • Can we use HIA to deal with complex issues and can we do this with humility...maybe.





Plenary Session 1: Finland - HiAP and HIA


Timo Stahl, Led the development of Human Impact Assessment in Finland


HiAP Not a new innovation same as healthy public publicy and intersectoral action for health. It was set up at Alma Ata and Ottawa.

But there was an implementation gap and the aim of HiAP was about how to do it not whether it should be done.

How does Quebec HIA2012 related to other global conferences?

  • Non Communicable disease is only the second issue - after HIV/AIDS - for a WHO global conference on Health Promotion.
  • NCDs single biggest cause of death in the world.
  • 90% of premature deaths from NCDs occur in developing countries.
  • Heart disease and stroke, diabetes, cancer and chronic lung disease
  • New York political declaration and Rio Declaration place an emphasis on prevention and reducing health inequalities with HIA as an explicit approach in the Rio Declaration.
HiAP Approach

  • Few definitions of the concept
  • Characterised it as approach that emphasises public policies, on citizen's health, health determinants, capacity of health systems, and integration of considerations of health, wellbeing and equity
  • Not the same as whole of government approach but similar

Key elements of HiAP
  • Democratic and transparent policy making
  • Legitimacy
  • Political literacy
  • public health literacy
  • Organisational structure for collaborating with other sectors
  • Political will


It is possible to implement HiAP even if health is not high on the political agenda.


Implementing HiAP

  • National admnistration - intersectional committees, impact assessment, policy audits, policy review and assessments, joint action...
  • Political process - specific committees, required review and oversight processes, hearings and consultations, public health reports, informal parliamentary coalitions and networks

Last few words on HIA

  • World is full of IAS economic, environment, business...142 IAs in 2004
  • How do policymakers know what IA to use?
  • Key questions - integrated in routine planning or commissioned, the investment in IA should be proportional to the health issue and policy decision
  • HIA is important but so are IA
  • Not realistic that other sectors will do HIA
  • IIA needs attention - other sectors may be more responsive to this since their areas are also assessed, IIA gives access to other sectors, if institutionalised then no selection possible, a risk that health impacts are neglected
  • Strong health component in other IAs - health sector needs to work on this and ensure it

  • Good time for concrete action
  • Need how to guidance
  • Aim is to reduce NCDs by 25% by 2025

Encourage you to follow the Helsinki conference next year in 2013, thank you.







Plenary Session 1: Health in All Policies and HIA - Introduction


Welcome to the conference and introduction to the first speaker from the Public Health Agency of Canada.


Fairness in health and Health Integration in All Policies.

Canada has been one of the leaders on moving the social determinants agenda forward. Quebec has Ben a leade within HIA and it is the only province where the Minister can ask for HIA to be done.

Publc Health Agency has supported the development of HIA and HiAP nationally and internationally.

Welcome to Canada and welcome to Quebec and I wish you a great meeting.








First Day and Breakfast for the early birds

The exhibitions stands are ready with lots of useful stuff, heading for those during the break.
The poster boards are set up I'll aim to get some phots when people are milling around later.
Hilary, Decharut and David having breakfast and a chat!

IHIA 2012 Quebec City Officially Starts!


Alain Poirier welcomes the participants at the conference. Over 365 participants from around the world from 42 countries and from health as well as environment and local and national government.

The Deputy Mayor Michelle Morin-Doyle welcomes delegates and hopes that we get a chance to see Quebec without missing any of the sessions.

Richard Masse, Chair of International Scientific Committee of the Conference and Professor at Montreal University thanks the international and local scientific committee members and all the person who contributed to setting up and supporting this conference.

Richard sets out the objectives and themes of the conference:

  • HIA in the policy-making process
  • Institutionalisation of HIA:addressing political and administrative issues...different ways not just a way
  • Diversity of practices:developing a common framework, maintaining flexibility
  • Evaluation, research and ethics: advancing HIA practice

Thanks to everyone who submitted proposals for oral presentations nd poster presentations.

What I'd like to see is discussion and dialogue within and across sectors - health and beyond health.


Carlos Dora, World Health Organization, he is responsible for HIA and intersectional action. Pleasure to be here in Quebec.

Carlos discusses future of HIA:

  • Why is it essential to scale up action on HIA and Health in All Policies (HiAP)
  • Why do we think HIA is a key part of the response to global health issues
  • Elements for a strategy to increase the application of HIA for HiAP
  • How this conference can be a turning point for tackling these global health issues

  • Economic crisis has made the need for making more with less even more urgent.
  • Crisis in non-communicable disease which can be solved with preventative measures taken by non-health sectors, trillions of dollars worldwide.
  • Renewed debate on sustainable development - post 2015 goals

  • HIA offers a framework for: sustainable development indicators, identifying inter-sectoral policies to tackle non-communicable diseases
  • HIA can be used at a strategic level which multiplies the reach and impact of HIA. HIA can be way for private sector and public sector to manage investment risk. Sets a standard for industry. Enhance participation...WHO guide on Health and Community Finance...work with extractive industries...Inteersting and unique issues such as mobile men with money...provides a 'bird eye view'
  • No reference to health in Rio+20 had health in it. A guide was developed Measuring Health Gains from Sustainable Development
  • Health in a 'Green Economy'...focus on mitigation of climate change, co-benefits from green and climate friendly policies...transport, construction, energy, housing...health cobenefits part of next IPCC recommendations
  • While health is in EIA and while it's not perfect it has a greater visibility than HiAP.
  • A lot of discussions have happened around methodology and doing it and now we need to do it.

How can we increase the global implementation of HIA for HiAP?

  • Wide dissemination of info on health risks and benefits of sector policies
  • Tracking system to monitor and report on sector policies health performance
  • Substantial health inputs made using existing legislation e.g. Environmental...

Lobby private sector to undertake HIAs of strategies and policies...


Develop a functional global tracking system to monitor the health impacts of policies through HIA usage


Hope we can us ethics conference to act as a springboard to realise the full potential and health gain storm HIA...hope for a QUEBEC MANIFESTO on how we can see the changes in the future by bringing the brains in this audience to develop a work plan to take things forward.



Health sector needs to do more HIAs and take a wider social determinant of health e.g how can the hospital influence the health of the local population - non patients - around it.


Q: What actions should local regional and national governments take in the next 5 years?

A: I think the 3 tasks I mentioned previously are for governments particularly the global tracking system. Energy is an important are and WHO are looking at developing a global tracking system for energy policies globally. The other tasks is communicating widely and being bolder in getting the message out even where faced with litigation and other hurdles. Using EIA and SEAs as a vehicle for health, with each country incorporating it in their own way - they are natural allies and competitors, need to use all existing mechanisms to get health onto the agenda.


Q: should it be a targeted approach where we can make headway or to have a broad approach and cover all sectors?

A: I'm in favour of the targeted approach and taking up opportunities and focusing on key sectors for a country, region, locality so that there can be visible achievements.


Q: Should economic analysis be integrated into HIA and in HiAP? Do you think we should develop skills in this area?

A: Yes and no. Yes because we have to create interactions and in other sectors. It is useful to quantify but it is not enough. Health is more important than economics because it is an important policy and societal goal. People see health as the mor eimportant issue.


Q: why don't we do HIA in the health field and in the vertical programmes for HIV and malaria? Are we ready to ask for this to happen?

A: WHO is asking for this and we hope health agencies and governments and health systems will listen an stake it up. Health systems are difficult to change to shift from treatment to prevention because the power and incentives are in curative services. This is true even in WHO. Disease focused programmes outweigh social determinants focused programmes. Need to think about what smart strategies we can use to engage health care workers - nurses, student doctors/nurses - to start some sort of change from within.




Follow HIA2012 on Twitter #eis2012

The HIA2012 conference is about to start. I'll be tweeting it - you can follow things @hiablog or the #eis2012 hashtag.

23 August 2012

Urgent update on Ghana Health Service announcement

Some applicants have encountered problems with the email address previously provided. Please use the following email address to submit your proposals:

Integrating Health into EIA: a UK perspective (free webinar)

EIA Quality Mark Webinar Series

Integrating Health into EIA practice 
Thu 30 August 2012: 12.30-1.30pm BST

The August EIA Quality Mark webinar will focus on the relationship between human health and EIA (in the UK). Whilst not specified in the current EIA Directive, the protection of human health is a key driver behind much environmental legislation and is a topic that must be given consideration in Strategic Environmental Assessment and where EIA is undertaken in a trans-boundary context (i.e. under the Espoo Convention).

This webinar will include presentations from:
-       Raoul Tufnell - Hyder Consulting's Land Development Team
-       Gillian Gibson - Managing Director - Gibson Consulting & Training

The presentations will consider:
  • What health is, its role in and relationship with EIA, and the tools available to assess health impacts,
  • Provide case studies of how health can be integrated into the EIA, including:
  • An application for a NSIP consent order (Nationally Significant Infrastructure Project)
  •  A major new residential development
  • Provide conclusions on future opportunities for appropriate further integration of health issues into EIA practice.

As usual the webinar will be chaired by IEMA, who will provide a brief EIA update at the start of the webinar on wider developments in EIA legislation, guidance and practice.

Courtesy of Olena Popovych, Atkins Global.

17 August 2012

Ghana Health Service recruits HIA and other health experts for a consultancy

The Ghana Health Service will conduct a strategic Health Impact Assessment (sHIA) of the country’s oil and gas development plan. The objectives of the sHIA are to:

  • Generate a comprehensive review of human risks associated with different development scenarios for oil and gas sector, for example in the context of chemical spills, changes in communicable disease patterns, workplace based accidents and injuries etc.;
  • Identify which interventions and response capacities would be needed to address those issues, including so as to not overwhelm existing health systems capacities;
  • Establish a population health baseline, framework for use in monitoring and reporting of health impacts (both positive and negative) generated as a result of the growth of the petroleum industry;
  • Develop Ghana’s institutional capacity for the use of HIA tools and methods for the eventual application to other sector policies, plans and projects, for example in mining, energy or agriculture.
The Ghana Health Service now invites eligible Consultants (Health Impact Assessment Specialists, Occupational Health and Safety Specialists and Chemical Safety Specialists) to indicate their interest in providing the services. Interested Consultants should provide information indicating they are qualified to perform the services (brochures, description of similar assignments, experience in similar conditions, availability of appropriate skills among staff, curriculum vitae etc) Consultants may associate to enhance their qualifications.

A consultant will be selected in accordance with the procedures set out in the Public Procurement Act, 2003 (Act 663) of the Republic of Ghana.

Interested consultants may obtain further information at the address below from 08.00hrs to 17.00 hrs GMT.

Expressions of interest must be delivered to the address below on or before 14.00 hrs GMT, on September 03, 2012              

Tel:  (233) 0302 687853
Fax:  (233) 0302 687853 (for queries only)
E-mail: procurement@ghsmail.org

Impact Assessment as a tool for Multisectoral Action for Health

The WHO Centre for Health Development recently convened a consultation on impact assessment as a tool for multisectoral action for health. The summary report is worth reading and will inform a number of upcoming conferences and events.

15 August 2012

IAIA Conference 2013 - Calgary - 13-16 May 2013

IAIA13, the 33rd annual IAIA conference, will be held from 13-16 May 2013 in Calgary, Alberta, Canada.  For more information, visit https://www.iaia.org/iaia13/

Session proposal deadline: IAIA13 session proposals are being accepted through 31 August at https://www.iaia.org/iaia13/ > Submissions > Submit Session Proposal.

Sponsorship opportunities:  IAIA is currently seeking sponsors for the IAIA13 conference.  Visit http://www.iaia.org/conferences/iaia13/sponsors.aspx to download the Sponsorship Opportunities brochure and find out the various ways your company can reach out to over 800 environmental professionals from 80+ nations.

Welcome video: Watch a brief clip of IAIA13 Program Co-Chair Miles Scott-Brown inviting you to attend the conference in Calgary.

Photo: Some of the HIAers at the IAIA 2012 Conference in Porto, Portugal.

13 August 2012

Stress Mapping and other visual tools to improve bicycling network

Mineta Transportation Institute at San Jose conducted a study on bicycling network to identify the key factors to improve bike commuting by so-called “level two” cyclists: those who will ride if car traffic is minimal.

The main determinant of biking is a low-stress, well-connected and relatively direct route.  This research has highlighted the importance of intersection approaches and street crossings in network connectivity. A major achievement has been developing criteria for crossing stress and a way of integrating intersection stress with the stress on a link.

The researcher proposes a set of criteria by which road segments can be classified into four levels of traffic stress (LTS). LTS 1 is suitable for children; LTS 2, based on Dutch bikeway design criteria, represents the traffic stress that most adults will tolerate; LTS 3 and 4 represent greater levels of stress.
The study then mapped every street in San Jose according to LTS and they found that only about five percent of shorter (under six miles) work trips in San Jose could currently be accomplished on low-stress (levels one and two) streets, but this figure would almost triple if improvements in strategically placed segments that provide low-stress connectivity across barriers were implemented. 

10 August 2012

Hypertension: widely present in developing countries

Hypertension is still the leading risk factor for cardiovascular disease and mortality and worldwide, more than 7 million deaths can be attributed directly or indirectly to the effects of hypertension. This major cause of morbidity and mortality affects between 20% and 50% of adults. The Lancet has dedicated a Series of three papers about hypertension
Hypertension is also very common in developing countries as around three quarters of people affected by hypertensions live in a developing region. Despite this high burden, the rates of awareness, treatment, and control are low and this situation might be attributed to several factors .
From  Ibrahim and  Damasceno article: “Several hypertension risk factors seem to be more common in developing countries than in developed regions. Findings from serial surveys show an increasing prevalence of hypertension in developing countries, possibly caused by urbanisation, ageing of population, changes to dietary habits, and social stress. High illiteracy rates, poor access to health facilities, bad dietary habits, poverty, and high costs of drugs contribute to poor blood pressure control. The health system in many developing countries is inadequate because of low funds, poor infrastructure, and inexperience.”