1 September 2012

Plenary 4: HIA in Decision-making: what we know and what we need to know

Welcome to this last plenary!

Informing decision-makers and creating change with HIA
Rob Quigley
  • Lots of HIAs in New Zealand, 51, on many different topics and mostly at local level
  • Most done because its a good idea
  • 17 have been evaluated, Ministry of Health funded mostly
  • Meta evaluation of 24 NZ HIAs
  • Does HIA work, HIA WORKS!

What does HIA achieve
  • Inform and change the proposal
  • After the proposal development process
  • Inform and change other work streams, and organisational thinking and action
  • Develops knowledge of HIA and the social determinants of health
  • Develop ....


Quotes of participants
  • I started this process wondering what health had to do with a graffiti policy ... Now I know.


HIA works when:
  • Technical knowledge and skills - determinants,
  • Soft skills - partnership working, consult with communities and stakeholders, influence decision-makers, flexible, reality testing, leadership
  • Apply our values - Gothenburg Consensus state stat values are at the heart of HIA
  • Covering difficult determinants
  • Harder to reach populations
  • Inequalities
  • Clarifying communication about policy


What is (sometimes) less important
  • Time and money
  • Quantification
  • Being an expert at the start, capacity can be built along the way, or supported via mentoring


What is really really important
  • Knowing your HIA process is sound
  • Knowing you HIA will add value - under promise and over deliver


What's the future: how do we open the door, beyond one off effective HIAs?
  • HiAP
  • Leadership (public health and political)



Effective population health practice: where does HIA fit?
Rajiv Bhatia



  • Our goals are multiple and one of the ways we used to help us achieve this is HIA, HIA can allow us to achieve all of these goals

Outcomes of HIA practice in San Francisco
  • Enabled the relevance of the public health agency and health determinants to policy
  • Participation in policy networks
  • Involvement
  • ...

From research measures to performance measures
  • Translated injury measures to injuries per mile and helped focus on 5% of roads
  • This has helped other sectors and policy to tackle this because it seemed more manageable

From policy analysis to policy development and implementation
  • No regulation on levels of indoor air pollution in houses from nearby roads
  • We developed a new law rather than waiting for it to emerge from others or national level
Need engagement across the policy cycle


Strategic uses of HIA
  • Use HIA t o identify and answer new policy questions
  • Multiple decision targets
  • ...

Factors contributing to our success
  • Built on existing priorities
  • Found ways to be helpful to other public agencies and communities
  • Brought data and scientific evidence to controversies
  • Recognised existing public health agency authority and responsibility
  • ...

What do decision makers want?
  • Value and benefit of rather constituencies
  • ...

  • HIA may serve multiple purposes at different times
  • Use of HIA has to be one part of a larger public health engagement with policy processes
  • ...


Future: open government agenda
  • Facilitating open data access to health and community indicators
  • Supporting data application development
  • Acquiring new public source data


Analysis of impact of the processes of decisions
Andre Fortier
  • In Quebec, ministers follow a consensus based approach and are collectively responsible decisions.
  • If a decision is not controversial or has issues then it can take 4-8 weeks, for those that aren't can take much much longer.
  • Assessment of impacts is integral to the decision making process, there are 16 topics that are assessed.
  • Section 54 is the act that covers the health topic and how it needs to be considered.

  • Government asks MSSS to provide advise and guidance on the issues in relation to the policy being decided on.
  • Sometimes information is not enough because of lack of data, conflicting evidence and conflicting expert opinions.
Any political decision involves an area of uncertainty and we ned to be humble and recognising our limititations in how the uncertainty can be reduced, need to continue the search for knowledge to help reduce the uncertainty and help improve public health.


Q&A
Where does HIA works

  • The intent is right
  • The team understands the political context and the role and power of new knowledge
  • A mandate that HIA should be done can be unproductive and counterproductive
  • Having legislation helps to ensure that public health units can get involved in decision making, gives them the right and authority
  • But we have to make sure that they take place early in the process so that solutions can be developed that can lead to consensus decisions.

Q: in what area have recommendations of a HIA are more easily accepted e.g. in Quebec, in your opinion? And where recommendations are not accepted and not implemented by a Government is there some other process such as the Ombudsman in Quebec?

A: Where the recommendations affect the economic feasibility or where the recommendations involve restrictions on the public. The ombudsman has a lot of latitude but you need to think about the fact that the public health system is part of government so that going out to other structures is problematic. Our role is to clarify and inform a decision and for elected officials to make the decision.

A: Where the recommendations are beyond the power or responsibilities of the decisionmaker.

A: It is important to make recommendations, coming with solutions that can't be implemented by decisionmakers are there alternatives that are feasible that achieve the same outcomes as the draft recommendations. Need to have dialogue to develop the most feasible recommendations. Often HIA can have. A laundry list of recommendations and often less is more, the ones that are most important.



Q: How do decisonmakers manage the volume of policy that they have to decide?

A: it is through provide information and analysis of draft proposals so that some policies are not taken forward because of what the assessment has found in the early policy development process.