Health Impact Assessment: Current practice internationally

Mirko Winkler led a team that undertook a survey of 122 HIA practitioners across 29 countries. The findings highlight that:

• HIA is being used worldwide
• Capacity is concentrated at the beginner and intermediate levels, though a higher proportion of respondents from Europe reported having more than ten years of HIA experience
• there is a need for more advanced capacity building and training offerings internationally
• strengthening the policies and legal frameworks under which HIAs are undertaken remains relevant.

Twenty-four percent of respondents were from the Asia Pacific, and practices across our region are reflected in the overall results.

Health Impact Assessment: A practical guide that I wrote with Patrick Harris, Elizabeth Harris, and Lynn Kemp (Harris et al. 2007) was identified as the fifth most-used HIA guidance internationally, after WHO guides, Martin Birley’s book on HIA (Birley, 2011), and the IAIA Best Practice Principles (Quigley et al. 2006).

In general respondents were split on whether HIA’s use is continuing to increase or has stagnated, a debate that has relevance across the Asia Pacific region. Of particular important to our region, the paper emphasises that:

Finally, there is an increasing recognition of the role that biodiversity and ecosystem services play in the relationship “healthy planet, healthy people”, and the role that impact assessments play. In an outlook for the future, and additionally to providing a framework for safeguarding health in sustainable development, HIA has the potential to be contributory to the operationalisation of “planetary health”

References

Quigley, R., L. den Broeder, P Furu, A Bond, B Cave, and R Bos. “Health Impact Assessment International Best Practice Principles.” Fargo, North Dakota: International Association for Impact Assessment, 2006.

Winkler, Mirko S., Peter Furu, Francesca Viliani, Ben Cave, Mark Divall, Geetha Ramesh, Ben Harris-Roxas, and Astrid M. Knoblauch. “Current Global Health Impact Assessment Practice.” International Journal of Environmental Research and Public Health 17, no. 9 (April 25, 2020): 2988. https://doi.org/10.3390/ijerph17092988.

Harris, P., B. Harris-Roxas, E. Harris, and L. Kemp. “Health Impact Assessment: A Practical Guide.” Sydney: UNSW Centre for Primary Health Care and Equity and NSW Health, 2007.

Martin Birley. Health Impact Assessment: Principles and Practice. London: Routledge, 2011.

Health impact assessment for health promotion, education and learning

Special issue on HIA for
health promotion, education
and learning

A new issue of Global Health Promotion on Health impact assessment for health promotion, education and learning has been published. All articles are freely available as open access for a limited time.

It includes articles on diverse topics such as climate change, e-waste, local government and evaluation. Several of the articles are in French.

The issue was developed as an activity of the International Union For Health Promotion and Education's Global Working Group on HIA, and guest edited by Ben Harris-Roxas and Monica O'Mullane.

Special issue table of contents http://journals.sagepub.com/toc/pedb/24/2 

Editorial in English http://journals.sagepub.com/d…/full/10.1177/1757975917704614

Editorial in French http://journals.sagepub.com/d…/full/10.1177/1757975917712410

Editorial in Spanish http://journals.sagepub.com/d…/full/10.1177/1757975917712806

Lessons about health impact assessment: Learning by Doing

VicHealth team presenting on their
equity focused health impact assessment

Last week I attended the final day of a Learning by Doing health impact assessment (HIA) training program. Learning by Doing is a structured six-day training program run by the Centre for Health Equity Training, Research and Evaluation (CHETRE), where I work. The training is broken up into distinct stages. People learn about HIA, go away and do the steps they've learned about, then come back to reflect and learn about the next steps in the process.

The final day is always great because the different groups who have been doing their HIAs present their work and their findings. There were five HIAs conducted in this round of Learning by Doing, which included the South Western Sydney Local Health District, the NSW Department of Family and Community Services, VicHealth, Liverpool City Council, the Think+Do Tank and community representatives.

Some of the stand-out lessons from the Learning by Doing sites were:

• A lot of the value of HIA lies in highlighting and clarifying assumptions made during planning.
• A planned engagement approach is useful as part of all HIAs.
• Conceptual learning remains an important outcome of HIAs, in particular learning about health equity.
• Involving consumers in HIAs has multiple practical benefits, such as identifying alternatives and providing an understanding of  context and history.
• Scoping remains as critical as always - being rigorous but not biting off more than you can chew (it also reminded me of this paper about scoping in EIA).
• Not all barriers can be overcome; you need to be realistic about what you can achieve within the limits of an HIA.

For more on CHETRE's work on health impact assessment go to HIA Connect. The Learning by Doing approach is described in greater detail in the chapter below:

Harris E, Harris-Roxas B, Harris P, Kemp L. “Learning by Doing”: Building Workforce Capacity to undertake HIA - An Australian case study, in O’Mullane M (ed) Integrating Health Impact Assessment into the Policy Process: Lessons and Experiences from around the World, Oxford University Press: Oxford, 2013, p 99-108. ISBN 9 7801 9963 9960 Google Books link

Cross-posted from my personal blog

Trading away Health: Reflections on an HIA of a trade agreement”

Guest post by Fiona Haigh:

The HIA team at CHETRE has been working with a group of Australian academics and non-government organisations to carry out a health impact assessment (HIA) on the Trans Pacific Partnership Agreement (TPP) negotiations. The report has attracted a lot of attention and in general has been a different experience from the typical HIAs that we are involved in. We thought it would be interesting to share with the HIA community a few reflections on our experience.

We weren’t commissioned to do this HIA- a small group of us thought it would be a good and interesting thing to do and we somehow managed with some support from CHETRE and the Public Health Association of Australia keep it going. The support from CHETRE enabled us to bring in Katie Hirono to do a lot of the work on it and we were supported by a group of experts and advocacy groups who contributed their expertise and advice. There were some technical challenges to do with trying to do an HIA on something that is being kept secret. We had to base our assessment on leaked documents on wikileaks and advice from academics working in the area and policy experts. We also faced the challenge of trying to predict likely future public health policies that could be impacted on by the trade agreement (since it won’t affect current policies). We approached this by working with policy experts to identify likely future public health policies in our scoped areas of focus that would be impacted on by the TPP.

We also walked the talk of taking a participatory approach, which meant sharing power with the technical advisory group and the advocacy groups that we worked with throughout the process. We feel that this has worked really well- it meant that we focused on issues they identified as important and we have produced a report that they have been able to immediately use for their advocacy. Without them I’m pretty sure this report would not be having the impact it has had so far. The report is being talked about on the front pages of major newspapers, there have been multiple radio interviews, a social media campaign led by CHOICE (the main consumer advocacy group in Australia), lots of tweets and perhaps most satisfying of all we’ve been labeled scaremongers in a press release from the minister for trade and investment - we must be doing something right!

Minimum Elements and Practice Standards for Health Impact Assessment Version 3

From the SOPHIA HIA Practice Standards Working Group:

The HIA Practice Standards Working Group is happy to report that Minimum Elements and Practice Standards for Health Impact Assessment, Version 3 has now been finalized and released. The group establish a structured process through which public comments on Version 2 of the standards could be submitted. We received extensive feedback – 137 individual comments by our count. The comments were thoughtful and insightful. Each comment was considered and, for each, we came to consensus on what changes to the standards to make, if any. Version 3 includes a more detailed description of the purpose and scope of the standards, a very significantly re-worked set of minimum elements, as well as significant changes to the practice standards.

The document can be downloaded here.

The Impact and Effectiveness of Equity Focused Health Impact Assessment in Health Service Planning

This free ebook looks at the use of equity focused health impact assessment (EFHIA) on health service plans. It examines:

1. What are the direct and indirect impacts of EFHIAs conducted on health sector plans?
2. Does EFHIA improve the consideration of equity in the development and implementation of health sector plans?
3. How does EFHIA improve the consideration of equity in health planning?

Download PDF (3.5 Mb)

For Acrobat and PDF readers

Download EPUB (910Kb)

For iBooks and most e-readers

Download MOBI (1.2Mb)

For Kindles and Kindle apps

Download from Amazon

For Whispernet transfer N.B. Costs US $0.99

About the ebook

This ebook describes the use and evolution of health impact assessment (HIA) and EFHIA internationally and in Australia, how it has been used in relation to health service plans, examines its effectiveness and impacts on decision-making and implementation and examines several EFHIAs using case study and interpretive description methodologies.

This research shows that EFHIA has the potential to have both direct and indirect impacts on health service planning. These impacts are influenced by a broad range of factors however. The case studies in this ebook show that engagement with the EFHIA process and the extent to which EFHIA is regarded as a broader learning process are important factors that mediate the extent to which EFHIAs influence subsequent activities.

This research suggests that it is not possible to adequately describe the full range of impacts of EFHIA on decision-making and implementation without looking at perceptions about EFHIA’s effectiveness, in particular the perceptions of those involved in the EFHIA and those responsible for acting on its recommendations. These perceptions change over time, suggesting that future research on the effectiveness of HIA should look at the mechanisms by which this change occurs.

The ebook makes two theoretical contributions in the form of (i) a typology for HIAs and (ii) a conceptual framework for evaluating the impact and effectiveness of HIAs. This conceptual framework is tested for its applicability and refined.

The ebook and the accompanying publications were written to fulfil the requirements for a Doctor of Philosophy in Public Health at the University of New South Wales.

HIA of Treatment Instead of Prison

Great news in the latest Human Impact Partners' email update:

In 2012, HIP partnered with WISDOM, a statewide congregation-based network, to assess the public health impacts of increasing funding for Wisconsin’s treatment and diversion programs for non-violent drug offenders. HIP’s study has had a tremendous impact on the conversation around treatment over incarceration in Wisconsin and helped win a four-fold increase in funding for treatment alternatives. Legislators from both parties have pledged continued support for future increases. Watch our video to learn more about this HIA success story.

Find out more here

Would you do health impact assessments if you didn't have to?

Carrot and Stick by Bruce Thomson

There's an interesting article by Elsa João and Anna McLauchlan in the latest issue of Impact Assessment and Project Appraisal. They asked 187 Scottish Strategic Environmental Impact Assessment (SEA) practitioners "if SEA was not compulsory, would you do it?"

This made me wonder about this question in relation to HIA. In many, if not most settings, there is not a requirement that makes HIA's use compulsory. For most HIA practitioners this question is not a hypothetical one. We encounter it in relation to every HIA.

Some recent  research I was involved in found that only 7% of HIAs conducted in Australia and New Zealand between 2005 and 2009 were done to meet a legal or regulatory requirement.

The overwhelming majority of Scottish survey respondents said they would do SEA even if it was not compulsory. In HIA practice we rarely have to wonder, which is a luxury in some ways. Most HIAs are done freely and to learn something. The link between voluntary involvement and the ability to learn something from HIAs is not theoretical. As my colleagues and I found in this study, the extent to which participants had a degree of choice or control over their involvement in an HIA had an impact on their receptiveness to learning from the HIA process and acting on its recommendations.

Interestingly, even though the survey was looking at SEA in Scotland where its use is mandated, the themes identified through the survey resonate with those we encounter in promoting HIA's use:

• the perception that a similar process are already being done;
• a lack of resources;
• the need for a ‘leaner process’; and
• the difficulties that can arise when external conditions or many decisions have already been determined.

The article is well worth reading, here's the abstract:

Strategic environmental assessment (SEA) is undertaken in more than 60 countries worldwide. Support to the SEA process can range from formal legal requirements to voluntary ‘ad hoc’ approaches. In the cases where SEA is legally required, such as in Europe where the SEA Directive sets a framework for SEA legislation in 28 countries, practitioners may engage with SEA but in a reluctant way. This paper reports on a unique survey of 203 key people responsible for implementing the SEA legislative requirement in Scotland. The majority (53%) of the 187 practitioners who answered the hypothetical question ‘If SEA was not compulsory, would you do it?’ said ‘Yes’. However, results suggest that the responses were much nuanced. Practitioners were asked to explicate their reasoning and, irrespective of whether the answer was ‘yes’ or ‘no’, common themes were evident in accompanying remarks. This paper enables reflection on reasons for acceptance or rejection of the SEA process by discussing: the perception that a similar process to SEA is already being done, the problem with lack of resources, the call for a ‘leaner process’ and the difficulties of undertaking SEA when conditions are already determined at a higher ‘tier’.

http://www.ingentaconnect.com/content/tandf/iapa/2014/00000032/00000002/art00001

The effectiveness of HIAs conducted in Australia and New Zealand

It occurred to me that I haven't posted a link to the final report on the Australian Research Council-funded study on the effectiveness of HIAs conducted in Australia and New Zealand between 2005 and 2009. The report has lots of information in it. Download it here.

San Francisco Department of Public Health's annual Health Impact Assessment Practitioners' Training

We are excited to announce that registration is now open for the San Francisco Department of Public Health's annual Health Impact Assessment Practitioners' Training (July 14-17, 2014). Register early at the link http://bit.ly/1mhK7lh

What is Health Impact Assessment?
Health impact assessment (HIA) is most often defined as “a combination of procedures, methods and tools by which a policy, program or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population” (World Health Organization, 1999).  

The field of HIA and the process of getting health into decision-making continues to evolve and grow http://www.healthimpactproject.org/hia/us

How will you and your team enhance skill sets, leverage big data, meaningfully engage communities, and have collective impact? HIA is one of many tools that may be considered for health-protective policy and action.

About the SFDPH HIA Training

What:  
7th Annual Health Impact Assessment Practitioners Summer Training Course

Where:
TCE Oakland Conference Center, 1111 Broadway, 7th Floor, Oakland, CA

When:
July 14-17, 2014 (attendance all four days is mandatory)

Instructors:
HIA practitioners at the San Francisco Department of Public Health and community, academic, and local government partners

Cost:
$960 (includes the cost of course materials, breakfast and lunch; accommodations and travel not included).  We are working to raise funds to support attendance of organizations facing financial hardship. We STRONGLY encourage applications from community-based organizations who are actively planning, considering, or doing HIA to apply.

When is an HIA not an HIA?

Guest post from Karen Bauer from the Denver HIA Collaborative:

Yesterday I attended a seminar given by the Denver Regional Council of Governments entitled Prescription for a Healthy Community.  The main speakers were the Colorado Health Foundation and Urban Land Institute.  To give you some idea of the influence that these organizations have, consider that the Colorado Health Foundation is the third largest health-focused foundation in the country, with $2.2 billion in assets, and ULI is a worldwide nonprofit representing land use and real estate development.  Its membership dues are $1200 annually.    

In 2013 ULI announced that their new initiative would be building healthy places.  Along with $4.5 million funding from the Colorado Health Foundation, they chose three locations in Colorado to receive the ULI treatment.  That means that ULI developed a TAP (technical advisory panel) that spent one week in each community to meet with stakeholders.  During that week they developed a report of opportunities and recommendations, which was then presented to the community. (I requested to see these reports, as they are not online).  After that, the community has the opportunity to apply for up to $1 million from the Foundation to implement their plans. 

I took a look at the ULI website to learn more about their initiative.  You can see that they are working completely outside of the world of HIA and its years of research, capacity building and expertise.  

A number of questions come to mind:

1. Does the HIA community need to do more to gain recognition as the go-to organization for research, tools, assessments?
2. Should we need a certification to go into a community to do a health assessment?
3. Does this help or hurt our field?
4. Maybe HIA has it wrong.  Is there something to be said for a one-week process? 

I would like to hear your comments, questions, concerns about this topic.

TechPresident post on Rajiv Bhatia's work on HIA in San Francisco

WHO Urban HEART Consultation Day 1

I've been invited to participate in a WHO Consultation on Urban HEART in Kobe. This is a post on some of the issues discussed on Day 1, with some of my thoughts and reflections scattered throughout. There are also posts on Day 2 and Day 3.

Urban HEART grew out of the Commission on the Social Determinants of Health's work and dates back to 2007. Early activity on piloting and developing a tool were led by a few countries, notably Iran. The final report from the CSDOH gave further impetus and led to more piloting of Urban HEART in more cities. After piloting Urban HEART was extensively reviewed and Version 1 was published in 2010.

Urban HEART is conceptualised by WHO as a tool for assessment and response to health equity issues at the city level. Urban HEART was designed to meet four criteria:

• ease of use
• comprehensive and inclusive
• feasible and sustainable
• links evidence to action

It's a stepwise process with a lot of similarities to HIA. In contrast to HIA it doesn't need a proposal (even a general one or options) to assess. Rather it allows municipalities to identify issues for action and responses at the city level, and in that way it's more like a needs assessment or planning activity. It's useful where some willingness to act on health already exists, so Healthy Cities is a useful basis for action. Higher-order support is always required (which may be less true for HIA?).

Data that informs Urban HEART is almost always spread across agencies - no single one holds or reports on even the core indicators. This means multiple permissions and interagency liaison is often required, which reiterates the need for higher-order permission and negotiation at the earliest stages. Whilst this is undoubtedly desirable for HIAs as well it hasn't always been possible in my experience and HIAs often fly under the radar, at least in the early stages. I'm not sure that would be possible for Urban HEART but I'm not sure that's a bad thing. The under-the-radar HIAs I've been involved in have often encountered resistance when their recommendations are presented. A clear, unambiguous mandate and imprimatur as a basis for proceeding isn't a bad thing.

A survey of Consultation participants that was conducted in advance found that most participants thought Urban HEART works well overall, is easy to use and successfully links evidence to action, but is less successful at being comprehensive and organisationally sustainable.

Case studies from the City of Paranaque in the Philippines, Tehran in Iran and Indore in India provided a range of useful, practical lessons on the use of Urban HEART (and they were quite inspirational). The Inore case in particular modified the indicators in a way to suit the local context, in their case by ensuring that the indicators were all meaningful and comprehensible to anyone, from residents to national bureaucrats. The case studies also highlighted the need for Urban HEART to not be a one-off activity but as an activity that needs to be revisited/undertaken semi-regularly.

Health Impact Assessments in Australia and New Zealand 2005-2009

Overview of HIAs in Australia and New Zealand during the study period

I'm excited that several colleagues and I have published a paper on HIAs conducted in Australia and New Zealand between 2005 and 2009:

http://onlinelibrary.wiley.com/doi/10.1111/1753-6405.12102/full

This paper is essentially a census of practice. It's the first paper from an Australian Research Council-funded study of the impact and effectiveness of HIAs conducted in Australia and New Zealand. The best thing is it's an open access publication, so anyone can access the entire article for free.

The flow chart below gives an overview of how HIAs were selected for inclusion in the study. We don't think we included every HIA done - a number were not possible to find or were never publicly released - but the study represents one of the more systematic and comprehensive attempts to describe HIA practice internationally.

A total of 115 potentially eligible HIAs were identified; 55 met the study's inclusion criteria

Please let us know what you think in the comments.

HIA Step by Step - A new online course by the NCCHPP

From the Canadian National Collaborating Centre for Healthy Public Policy:

Health Impact Assessment (HIA) is used to inform decision makers about the potential effects of a project, program or policy on the health of a population. HIA of public policies applies to any project, program or policy for which the decision maker is a governmental authority, either at the local, regional, provincial or federal level.

The NCCHPP will offer a new online continuing education course on HIA of public policies starting this fall.

This 12-hour online course will take place over a period of 3 weeks and will be offered both in French and in English.

This course will allow you to become familiar with the HIA process as applied to public policies, recognize its foundations, and reflect on the favorable conditions for successful HIA implementation.

Dates of the online course:

• in French from October 15 to November 1st 2013 
• in English from October 21 to November 8, 2013

Registration deadline: October 7, 2013. Places are limited.

For more information, and to register: click here. (http://www.ncchpp.ca/274/Online_Course.ccnpps?id_article=922) 

For any question concerning this new online course, please contact us at the following address: ncchpp_training@inspq.qc.ca or by phone at 514-864-1600 ext. 3637.

Cross-country analysis of the institutionalization of HIA

Cross-country analysis of the institutionalization of Health Impact Assessment.
Discussion Paper Series 8 (Policy & Practice). Geneva, World Health Organization, 2013
Available online PDF [45p.] at:http://bit.ly/18yCf5y

This report presents the findings of a cross-country study that describes and compares the institutionalization of HIA in nine (mainly middle- and high-income) countries and the European Union. It aims to provide greater insight to the enabling and limiting factors of HIA implementation and institutionalization and concludes with recommendations to increase and improve HIA practice.

The key factors enabling institutionalization of HIA were legislation; political willingness; involvement of research communities; awareness of the inadequacy of Environmental Impact Assessment or other assessments in considering health; capacity and resources; availability of international committal documents and tools; and public participation.

Challenges to institutionalization and systematic implementation included lack of clarity around methodology and procedures; narrow definitions of health; lack of awareness of relevance to other sectors; and insufficient funding and tools.

Based on their experiences, key informants proposed these core recommendations: embed HIA in national normative systems; clarify definition and operationalization of HIA and develop guidelines and methodological criteria; strengthen and build capacity for HIA practice; and improve cooperation between sectors….”

U.S.A. Southeast Regional HIA Summit

From the organisers:

Registration is now open for the first ever Southeast Regional HIA Summit! July 31 – August 2, Davidson, NC.

This is NOT your typical conference. Let’s face facts…HIA practitioners are a special breed of people who are creative enough to bridge the gap between multiple fields and operate outside of the box on a daily basis. Whenever we get together the atmosphere is more like a family reunion than a meeting. Add in the small-town charm of Davidson, NC and southern hospitality and you just know you are in store for a good time.

Here’s what the first Southeast Regional HIA Summit has to offer:

• Opportunities to LISTEN: Hear from Dr. John Santopietro, M.D., Carolinas HealthCare System, on The State of Mental Health in the U.S. and Mitchell Silver, AICP, Past President of the American Planning Association on Building Healthy Communities.
• Chances to LEARN: From each other during small group discussions− HIA Speed Dating, HIA Tool Exchange, Troubleshooting your HIA, Developing the HIA Message, Sustaining an HIA Program, and HIA and Health Equity.
• Time to HAVE FUN: Networking during community activities including bicycling on Davidson’s greenway, paddling on Lake Davidson and viewing the Davidson Design for Life Documentary at Our Town Cinema.
• And much, much more!
  
  

Likely participants include: HIA practitioners, researchers, and funders; professionals and educators from the fields of planning, policy, and public health; and interested government officials and not-for-profit leaders. To get the most out of the Summit, you should have direct experience in conducting HIA; be currently involved in conducting your first HIA; or at least have a basic understanding of the process and principles of HIA.

Everything you need to know about the Summit may be found on our web page:

• Preliminary schedule-of-events
• Hotel information
• Online registration or a printable registration form (Early Bird Registration Deadline is June 15)
• Travel scholarship
• How to get to Davidson, NC
  
  

For more information and questions, please contact Courtney Spear, Summit Conference Planner at 704.400.0880 or courtneyhspear@gmail.com

The Rise of HIAs in the United States

The Health Impact Project has put out a nice infographic about the use of HIA across the U.S.:

Source

The untapped potential of health impact assessment

A fascinating paper by Mirko Winkler and colleagues has been published in the WHO Bulletin:

Countries and regions that are promoting HIA's use or have produced HIA guidance. Source

A paper on the “untapped potential of health impact assessment” has been published in the current issue of the Bulletin of the World Health Organization. In this policy and practice piece, current health impact assessment (HIA) practice is summarized, the potential of HIA to become a critical player with the major drivers of global change (e.g. population growth and urbanization, growing pressure on natural resources and global climate change) is outlined, and it is discussed where and how HIA can become fully integrated into the impact assessment suite. HIA has an important role to play in of the unfolding 21st century’s sustainable development agenda, and if the Rio+20 agenda is to genuinely benefit vulnerable populations, then “health” must be an equal participant and partner at the table.

Link to article 

"There are already mechanisms in place": same old arguments against health impact assessment?

The Australian Senate

The Australian Senate Standing Committees on Community Affairs released a report on Australia's domestic response to the World Health Organization's (WHO) Commission on Social Determinants of Health report "Closing the gap within a generation" last night. The response to the report seems lukewarm to me, though that may be coloured by my personal sense that this represents another missed opportunities for intersectoral action for health in Australia. The Social Determinants of Health Alliance released a fairly upbeat press release.

From an HIA and Health in All Policies perspective there are a few interesting sections. I'll post two reasonable lengthy excerpts below so you can make up your own mind. This is from the Government response section: