Health impact assessment:
appraising potential
consequences of policies
and interventions
Alex Scott-Samuel
IMPACT
International Health Impact
Assessment Consortium,
University of Liverpool
ihia.org.uk
What is HIA?
A combination of procedures,
methods and tools by which a
policy, programme 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
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Source: WHO Gothenburg consensus paper,
1999
Important
characteristics of HIA
• Prospective
• Decision support tool,
not evaluation method
• Trade-off between
brevity and rigour
ihia.org.uk
Uses of HIA
• creation of healthy public
policies / projects
• social and economic
development
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health advocacy
advocacy for disadvantaged groups
personal development
partnership building
Early origins: 1970-1990
• environmental impact
assessment
• healthy public policy
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Some types of
impact assessment
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health
environmental
social
economic
gender
disability
human rights
integrated
Two perspectives of HIA
View of health
Disciplinary roots
Ethos
Quantification
Broad
perspective
Tight
perspective
Holistic
Sociology,
epidemiology
Definition and
observation
Epidemiology,
toxicology
Democratic
Technocratic
In general
terms
Towards exact
measurement
Types of
evidence
Key informant
data
Measurements
Precision
Low
High
Source: National Assembly for Wales (1999) Developing
health impact assessment in Wales.
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Ron Labonte. Inequalities in Health in the City of Toronto. 1991
Levels of impact
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Health and the built environment
• Activity - foster incidental and recreational
activity
• Nutrition - provide / promote safe, affordable,
healthy food
• Housing - safe, affordable, acceptable
housing
• Transportation - safe, reliable, accessible,
affordable transportation
• Environmental quality - safe, clean water,
soil, air and building materials
• Aesthetics / ambience - well-maintained,
appealing, clean environments
ihia.org.uk
Source:www.preventioninstitute.org
The Merseyside
approach to HIA - 1
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Screening
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Steering group
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Scoping / terms of reference
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Select assessor
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Policy analysis
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Profiling of communities
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Collect data from stakeholders and
key informants
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Identify health determinants affected
The Merseyside
approach to HIA - 2
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Assess new and published evidence
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Establish priority impacts
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Recommend and justify options for
action
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Appraise assessment
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Negotiate favoured options
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Implement and monitor
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Evaluate and document
Health inequality
Unfair or unjust differences
in health determinants or
outcomes within or between
defined populations
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Equity
…from each according to his
abilities, to each according
to his needs…
Karl Marx, Critique of the
Gotha Programme (1875)
Distributional justice
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Health inequality in HIA
• inequality a screening (selection)
criterion
• vulnerable groups identified in
profiling and policy analysis
• distributional impacts (as well as
population impacts) identified
• recommendations take account of
impact inequalities
• monitoring and evaluation based
on inequality indicators and
outcomes
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Equity in HIA
• public involvement in HIA steering
groups
• ‘lay’ people as stakeholders and key
informants
• equitable valuation of lay
evidence and of evidence on lay
priorities
• ‘bias to the poor’ in
recommendations
• choice of paradigm (expertist vs
participatory)
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Some IMPACT
HIA projects
• Foresight Vehicle Initiative
• Castlefields regeneration
• Policy HIA for the EU –
European Employment Strategy
• Capacity building in Liverpool
• ‘Making it Better’ – healthcare
reconfiguration
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Methodological
controversies
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science and politics
value-free and value-laden
holism and reductionism
qualitative and quantitative
expertism and participation
duration and depth
equity and inequality
Gaps in current practice
• poor monitoring and evaluation
• limited application - especially re
public policy
• macroeconomic policy
• human rights
• foreign policy
• trade
• social and gender policy
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Gaps in current theory
• distributional effects poorly
operatioalised
• political determinants of health
insufficiently acknowledged, eg
power, ideology, class, interest
groups, institutions
• participatory research
• feminist research
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The future of HIA
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Causal drivers
• promotes healthy public policy
• promotes sustainable
development
• promotes organisation
development
• reduces health inequalities
Contextual drivers
• equity
• public participation
The future of HIA
ihia.org.uk
• whether takes off in USA
• healthy public policy relatively
unpopular
• disparities agenda
• NB there’s gold in them thar
HIAs
• acceptable to all US politicians?
• likely to thrive in EC
• good global prospects - human
rights, TNCs etc
Capacity building
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a limiting factor
training
advocacy
policy development
organisation development
ihia.org.uk
impact@liverpool.ac.uk
0151 794 5004