Health impact
assessment (HIA)
A tool to promote healthy
public policies
Overview
• Why HIA?
• Theory of HIA:
– Definition and roots
– Basic principles and objectives
• HIA in practice:
– The steps
– HIA, a diverse practice
– Issues and supporting the practice
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Why use this tool?
• Concern and shared responsibility towards
health: HIA is a way to act on the determinants
of health
• ‘‘Good governance’’ :
– Need for solid information
– Democratization of the process: public involvement and
intersectoral action
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HIA in the development of a policy
(Re) Emergence of a
problem
Perception of public and
private problems
Evaluation
Agenda setting
by the government
Implementation
Adoption of a policy
Formulation
Formulation
of
d’alternatives
alternatives
Adapted from Knoepfel, Larrue and Varone ( 2001)
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HIA
The most common definition
HIA is…
‘‘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, Gothenburg Consensus, 1999
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Two roots and their influence
• Environmental impact assessment (EIA)
– Methodological rigour (science)
– Expert-driven
• Health promotion
– Social determinants of health and equity (distributive
effects)
– Community participation/ Public involvement
(empowerment)
– To put into practice the Ottawa Charter strategy: healthy
public policies and a healthy environment
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Basic principles…
Reduction of social
inequities in health
Rigour and neutrality of the
analysis
Involvement of stakeholders
and intersectoral parties/
decision-makers
Democracy, sustainable
development, equity,
participation, ethical use of
evidence
Collective responsibility
towards the population
(Gothenburg Consensus)
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…and objectives
• To structure action to promote healthy public policies
• To give insight, in the context of decision-making on policies
outside the health sector, as to their potential unintended
negative effects on health and to propose ways to mitigate or
avoid them
• To support intersectoral actions
• To promote public involvement/ participation
• To reduce health inequities
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The HIA Steps
P
Screening
R
O
Scoping
P
O
S
A
L
Appraisal
Recommendations
Evaluation
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A diverse practice
• Based on research of evidence regarding links
between a policy and determinants of health
• Based on public involvement/ participation
• Based on the relation between the public health
sector and decision makers
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A tool that can be adapted to all
levels of decision making
LOCAL - PROVINCIAL- NATIONAL
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Issues and challenges
Methodological
- Management of uncertainties and multidisciplinary work
- Predictive capacity
- Availability of relevant data
Political and policy context
- Political will, ideological and cultural context
- Lack of knowledge about policy field
- Capacity to fit into the policy process
Organizational
- Legitimacy
- Capacity building/ skills development
- Resources
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Supporting the practice
• Ensure access to capacity building and to the development of knowledge
for HIA practitioners:
– HIA training
– Use of guides to support the practice
– Build capacities in intersectoral action
– Build capacities for public involvement/ participation
• Ensure access to scientific and administrative data
• Ensure a relation of trust between the health sector and other sectors in
which decisions that may have an impact on health are made
• Develop a workplace culture which promotes and values multidisciplinary
work within the organization in charge of the HIA
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Suggested readings
•
Bekker, M.P.M. (2007). The politics of healthy policies. Redesigning Health Impact
Assessment to integrate health in public policy. Delft: Eburon.
•
Douglas, M., Conway, L., Gorman, D., Gavin, S., Hanlon, P. (2001) Developing
Principles for health impact assessment. Journal of Public Health Medicine, 23,2,
148-154.
•
Kemm, J. (2001). Health Impact Assessment: a tool for Healthy Public Policy. Health
Promotion International, 16, 79-85.
•
Lemieux, V. (2002) L’étude des politiques publiques: Les acteurs et leur pouvoir. Les
Presses de l’Université Laval. Québec.
•
Mahoney, M. (2001). Health Impact Assessment: Environmental management versus
healthy public policy perspective - exploring the nexus between the two. In 28th
National Environmental Health Conference.
•
Wismar, M. et al. (2007).The effectiveness of Health impact assessment. Scope and
limitations of supporting decision-making in Europe, European observatory on Health
Systems and Policies.
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HIA in Practice: Selected Resources
•
HIA Gateway-Association of public health observatories:
http://www.apho.org.uk/default.aspx?QN=P_HIA
•
HIA connect (CHETRE-Centre for health equity training, research and evaluation):
http://www.hiaconnect.edu.au/
•
National Collaborating Centre for Healthy Public Policy (NCCHPP) - HIA section:
http://www.ncchpp.ca/627/Health+Impact+Assessment.htm
•
INSPQ - Public Policy and Health Portal, HIA section:
http://politiquespubliques.inspq.qc.ca/en/index.html
•
NCCHPP - HIA Guides and Tools:
http://ccnpps.ca/docs/HIAGuidesTools2008en.pdf
•
Swiss portal (in French):
http://www.impactsante.ch/spip/
•
World Health Organization - HIA section:
http://www.who.int/hia/en/
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