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.



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