on behalf of all DHBs
PUBLIC HEALTH SERVICES
SOCIAL ENVIRONMENTS AND
HEALTH PROMOTING SCHOOLS
TIER LEVEL TWO
SERVICE SPECIFICATION
Status:
RECOMMENDED
Approved for recommended nationwide use
for the non-mandatory description of
services funded by DHBs.
Status:
MANDATORY 
Approved for mandatory nationwide use for
the description of services to be funded by
the Ministry of Health.
Review History
Date
Approved by Nationwide Service Framework
Coordinating Group (NCG)
Published on NSFL
Review : Public Health Handbook (2003):
Amendments: inserted in standard service specification template,
added Purchase Unit table, Service linkages and Quality requirements,
includes linkages to tier one Public Health Services tier three Refugee
and Migrant service specification.
Consideration for next Service Specification
Review
March 2010
within three years
Note: Contact the Service Specification Programme Manager, National Health Board Business Unit,
Ministry of Health to discuss the process and guidance available in developing new or updating and
revising existing service specifications. Web site address Nationwide Service Framework Library:
http://www.nsfl.health.govt.nz/
Public Health Services - Social Environments and Health Promoting Schools tier two service specification
Nationwide Service Framework
1
PUBLIC HEALTH SERVICES SOCIAL ENVIRONMENTS AND HEALTH PROMOTING SCHOOLS
TIER LEVEL TWO
SERVICE SPECIFICATION
This tier two Service Specification for Public Health Services - Social Environments and
Health Promoting Schools service specification must be used in conjunction with the
overarching tier one Public Health Services service specification.
Refer to the Public Health tier one service specification under the following headings for
generic details on:







Service Objectives
Service Users
Access
Service Components
Service Linkages
Exclusions
Quality Requirements
The above heading sections are applicable to all Service delivery.
1.
Service Definition
This Service includes:

social environment:
- healthy cities and communities
- healthy housing

health promoting schools (previously known as Healthy Schools/Kura Waiora) and

health impact assessment.
1.1`
Social Environment
Social environment initiatives focus on strengthening community action to create
environments that enhance social cohesion reduce health inequalities and achieve population
health and wellbeing.
1.2
Health Promoting Schools (HPS)
Health Promoting Schools refer to the Ottawa Charter-based community action approach to
promoting health and wellbeing in the school setting. Community action for health refers to
collective efforts by communities which are directed towards increasing community control
over the determinants of health, and thereby improving health. The Ottawa Charter
emphasises the importance of concrete and effective community action in setting priorities for
health, making decisions, planning strategies and implementing them to achieve better health
(WHO Health Promotion Glossary, WHO, 1998).
Community action utilises action and strategies to address local priorities. It is about finding
ways to enhance the community and the environments that people live in. It relates to the
concept of community empowerment where individuals and organisations in the community
Public Health Services - Social Environments and Health Promoting Schools tier two service specification
Nationwide Service Framework
2
apply their skills and resources in collective efforts to address health priorities and meet their
respective health needs (WHO Health Promotion Glossary, WHO, 1998). Community action
is complemented by the implementation and enforcement of relevant national/local policies
and regulations – together they form an important mechanism for increased control over
determinants of health and for improving the health of disadvantaged people groups.
1.3. Health Impact Assessment (HIA) is defined as a combination of procedures,
methods and tools by which a policy may be assessed and judged for its potential effects on
the health of the population, and distribution of those effects within the population.
There are two levels of health impact assessment:

policy level HIA

project level HIA.
2.
Service Objectives
2.1 Social Environment

promote the health and wellbeing of communities and population groups through
community initiatives and intersectoral action to enhance the social settings where
people live, work and play

increase community participation in national, regional and local planning processes that
affect community wellbeing

strengthen strategic alliances and interagency networks to promote supportive social
environments.
2.2 Health Promoting Schools
Initiative objectives are to work:

in partnership with Māori, Pacific and other high needs groups to achieve Whanau
Ora/community health and wellbeing

in partnership with schools and their communities to promote school social and physical
environments that improve the health and wellbeing of young people, thereby
contributing to positive learning outcomes and reducing barriers to learning

collaboratively with the education sector and school communities as they develop social
and physical school environments, which promote, improve and protect the physical,
social, cultural and emotional wellbeing of students and staff.
2.3 Health Impact Assessment
To ensure a systematic consideration of the potential health and well-being impacts of
policies being developed by public policy makers to achieve improved health outcomes and
reduce inequalities.
2.2 Maori Health
Refer to the tier one Public Health Services service specification.
Public Health Services - Social Environments and Health Promoting Schools tier two service specification
Nationwide Service Framework
3
3.
Service Users
3.1
Social Environments
Social Environments initiatives are undertaken primarily to ensure inclusion of vulnerable
population groups and promote social cohesion. Communities at risk of social marginalisation
may be identified on the basis of ethnicity, geography (including both rural and urban
communities), and age (youth and older people) and socio-economic status.
3.2
Health Promoting Schools
Schools that express agreement and commitment to becoming a Health Promoting School
(particularly the school principal and Board of Trustees.
3.3
Health Impact Assessment
Policy level HIA often focuses on the broader determinants of health such as urban planning
and growth, transport infrastructure and social cohesion. Many of the policy decisions on
these determinants are made outside of the health sector. The health system has an
important role in indirectly influencing these broader determinants of health.
District health boards, public health services, non-governmental organisations, iwi and local
Māori communities, local authorities and other public policy making bodies can apply HIA
methods and approaches.
4.
Access
Refer to the tier one Public Health Services service specification.
5.
Service Components
The following service component tables are in part two and part three of this service
specification

social environment
-
healthy cities and communities
healthy housing

health promoting schools (previously known as Healthy Schools/Kura Waiora)

health impact assessment.
5.1 Process
5.1.1 Social Environment Service
Components of
Service
Increase community
participation in
national, regional
and local planning
processes that affect
community
wellbeing.
Service Description/Activities

Promote evidence-based research and programme logic to
inform and support community engagement in national and
local policy and planning processes in order to work towards
improving social environments and population health
outcomes.

Provide resources to support community capacity and
capability to take action to improve population health and
Public Health Services - Social Environments and Health Promoting Schools tier two service specification
Nationwide Service Framework
4
Components of
Service
Service Description/Activities
reduce inequalities in health outcomes.

Enable and facilitate Maori participation and partnerships at all
levels of policy, planning, service delivery and evaluation of
programmes with the potential to promote whanau ora.

Enable and facilitate participation of Pacific peoples and other
minority population groups in programmes that may affect their
health and wellbeing.

Encourage researchers and planners across non-health
sectors to promote healthy social environments as
determinants of individual and community wellbeing

Work with non-health agencies to explore the extent that public
health issues are being addressed and the opportunity for
these issues to be placed on their policy and planning agenda

Build collaborative relationships across health and other
sectors, especially including local government, to address
urban and other community concerns.

Support the development/maintenance of national, regional
and local networks and intersectoral initiatives that address
social determinants of health (e.g. Healthy Cities/
Communities).

Enable Māori participation and partnerships at all levels of
programmes promoting healthy social environment.
Increase the use of
Health Impact
Assessment as an
inclusive approach
to evaluating the
impact of
programmes across
a wide range of
sectors on health
and wellbeing.

Undertake HIA activities (screening, scoping, appraisal and
reporting, evaluation) using current HIA tools available,
including the Public Health Advisory Committee’s Guide to
Health Impact Assessment and the Ministry of Health’s
Whanau Ora HIA tool

Build partnerships across a range of sectors to support the
development and effective use of HIA methods and
approaches.

Promote an organisational commitment to the adoption of HIA
(i.e. embedding HIA into organisational decision-making).
Monitor and assess
the quality and
effectiveness of
Social
Environment
initiatives

Encourage and/or support communities to assess health status
and maintain profiles of vulnerable population groups.

Encourage and/or facilitate local research projects to determine
community needs to guide the development of Social
Environment initiatives.
Strengthen strategic
alliances and
interagency
networks to promote
supportive social
environments
Public Health Services - Social Environments and Health Promoting Schools tier two service specification
Nationwide Service Framework
5
Components of
Service
Service Description/Activities

Encourage communities to undertake evaluation of initiatives
and strategies to assess programme effectiveness.

Identify, communicate and disseminate information about
effective community action initiatives.
5.1.2 Health Promoting Schools
Components of
Service
Service Description/Activities
Support the
development of
school
infrastructures that
promote the health
and wellbeing of
students and staff
Provide a Health Promoting Schools (HPS) advisory service to
schools and kura kaupapa
Introduce the concept of the HPS initiative to schools and Boards
of Trustees
Invite schools to commit to developing a HPS and establishing a
HPS team
Identify schools as .Active Health Promoting Schools, Towards
Health Promoting Schools and Standard Service Schools,
according to defined criteria, and provide defined levels of service
to each category
Encourage and assist schools to:

identify a staff person or community member to co-ordinate the
HPS team

undertake a school needs assessment

identify health promoting priorities (being mindful of Ministry of
Health priorities)

develop and implement an action plan

review and evaluate initiative, identifying areas of need and
setting goals for future action.
Encourage a workforce development plan to be implemented for
HPS teams that include principal, staff, parent/caregiver, student
representation
Assist schools to establish school health teams to drive the HPS
initiatives. These teams could include principals (or school
managers), health education teachers or other teachers, students,
parents/caregivers/whanau, public health nurses, other
community/agency members
Public Health Services - Social Environments and Health Promoting Schools tier two service specification
Nationwide Service Framework
6
Encourage schools and communities to give particular attention to
partnership with Māori and addressing Māori health and wellbeing
needs
Encourage schools to address health and wellbeing issues for
Pacific people, Asian, refugee/migrant and other groups with high
needs
Encourage schools to focus on and address health inequalities,
mental health issues, and nutrition and physical activity as part of
their HPS work.
Increase adoption of
policies and
environments that
promote the health
and wellbeing of
students and staff
Encourage and assist schools to develop and implement health
promoting policies, eg, Smokefree, SunSmart, Healthy Eating
Healthy Action, mental health promotion, environmentally safe
schools, behaviour management policies, bullying and nonviolence policies
Increase school
community
awareness and
knowledge about
health and wellbeing
Support workforce development for school managers, HPS teams,
Boards of Trustees and students involved with HPS
Promote the use of the national Health Promoting Schools
resources (available through authorised health education resource
centres in public health units), including Guidelines for Mentally
Healthy Schools, and HPS resources for Māori and Pacific
communities.
Encourage the school to comprehensively implement the Health &
Physical Education Curriculum
Assist schools to identify and access quality health education
programmes, agencies, resources and information to support the
delivery of the Health and Physical Education Curriculum
Develop and provide support/information/resources to schools and
their communities to address health priorities and needs
Encourage health promotion practitioners and researchers to raise
the profile of HPS through the media and through conferences,
workshops, and other community forums (eg, injury prevention,
mental health promotion, sexuality education and nutrition
educators/health promoters)
Develop and/or participate in developing and disseminating
newsletters, fact-sheets, website information and sharing
information regionally and nationally
Provide advice to the sector and the public on HPS.
Increase the level of
community action to
promote health and
wellbeing in schools
In conjunction with schools, work with Iwi and local Māori
communities to identify health and wellbeing issues and implement
appropriate strategies to encourage schools to be positive
environments for students and whanau
Public Health Services - Social Environments and Health Promoting Schools tier two service specification
Nationwide Service Framework
7
Provide opportunities for and encourage the involvement of
parents/caregivers and famil and whanau in HPS
Implementing programmes that build on factors that positively
influence whanau ora such as:

programmes that strengthen ties with whanau resulting in
shared and informed problem-solving

Building community cohesiveness through activities that make
Māori and key stakeholders effective in their respective roles.
Encourage, initiate or provide input to community events or
programmes that aim to promote health and wellbeing of school
communities.
Strengthen strategic
alliances and
interagency
networks to promote
health and wellbeing
in schools

Foster the development and maintenance of interagency
networks to ensure there is liaison and coordination between
schools and providers of health, social and education services

Foster relationships with Iwi and Māori organisations and work
collaboratively to create supportive school and community
environments

Enable Māori participation and partnerships at all levels of
public health services

Facilitate collaboration between sectors/agencies involved in
the school social environment and health promotion initiatives to
achieve cooperation, coordination and collaborative action

Develop and monitor the implementation of intersectoral
strategic action plans to deliver HPS initiatives in geographic
localities

Support the development of HPS regionally and nationally

Work with education sector stakeholders at Ministry, national
and regional levels to facilitate greater partnership in the
implementation of HPS.
Strengthen skills and 
knowledge of the
health sector and

other change
agencies to promote
health and wellbeing
in schools.
Ensure health provider staff are thoroughly inducted to HPS
and receive ongoing HPS workforce development training
Monitor and assess

the quality and
effectiveness of HPS
initiatives

Monitor and evaluate health provider HPS activities and ensure
these are consistent with Ministry of Health priorities and
strategies
Create training opportunities for other relevant health and social
service providers working with HPS.
Support schools to monitor and evaluate their respective HPS
Public Health Services - Social Environments and Health Promoting Schools tier two service specification
Nationwide Service Framework
8
initiatives. For example, schools may:
- develop baseline data for the purposes of monitoring
progress made towards the schools achieving their HPS
objectives
- include evaluation components in the design of programmes
delivered as part of a HPS initiative to assess their ongoing
effectiveness
- undertake and support local research projects to determine
needs and to guide programme development.
5.1.3 Health Impact Assessment
Components of
Service
Undertake HIA
activities (screening,
scoping, appraisal
and reporting,
evaluation) using
HIA tools available
in New Zealand and
internationally.
Service Description/Activities







Build partnerships
across a range of

Carry out HIAs by systematically applying the steps in health
impact assessment methodology:
- screening including judging whether the policy has the
potential to affect the health of the population
- scoping including establishing the foundations and
boundaries for undertaking the HIA
- appraisal and reporting including describing the potential
benefits and risks to health, and determining their nature
and magnitude
- evaluation including process, impact and outcome
evaluation.
Document the outcomes of each stage of the HIA process,
even if a complete HIA does not proceed.
Enable Māori participation and partnerships during each
stage of an HIA.
Identify and facilitate the participation of health and nonhealth sector agencies in an HIA process to reflect the
determinants of health or policy decisions that are being
considered.
Identify and consolidate opportunities for integrating HIA
methods with other impact assessments (such as social
impact assessment, cultural impact assessment, and
environmental impact assessment) that are being undertaken
on the same policy proposal.
Identify and include current local or regional indicators for
monitoring health outcomes social, economic, environment,
cultural wellbeing in the appraisal and reporting stages of an
HIA.
Develop regional or local HIA networks that include health
and non-health sector agencies to build the capacity and
increase the evidence base for HIA.
Identify appropriate regional or local partners or services that
Public Health Services - Social Environments and Health Promoting Schools tier two service specification
Nationwide Service Framework
9
sectors to support
the development
and effective use of
HIA methods and
approaches.




Develop an
organisational
commitment to the
adoption of HIA (ie.
embedding HIA into
an organisation’s
decision-making).



Provide awareness
raising
presentations,
training sessions in
the use of HIA, its
value and benefits
within and across
organisations.



have programme goals, objectives, resources and people
necessary to apply health impact assessment methods and
activities.
Work with iwi and local Māori communities to identify how
HIA tools, including the Whanau Ora HIA tool, can be applied
to assess the impacts on whanau ora of a proposed policy
Participate in policy-making process led by non-health
sectors to promote and apply HIA methods and approaches.
Identify resources required to develop, negotiate, implement,
evaluate and sustain the planned HIA activities.
Develop and evaluate measurable HIA outcomes that are
meaningful to all partners involved.
Identify and enhance opportunities to embed HIA methods
and approaches into the core business of the service or
organization.
Establish or reorient positions to focus on HIA activities
including embedding HIA within organizational practices,
providing technical advice and support on HIA,
commissioning HIAs and identifying and delivering
opportunities for HIA training.
Establish an organizational database of completed HIAs,
including literature reviews and recommendations, and HIA
practitioners to support the local and regional capacity and
evidence-base for HIA and provide this information to the
Ministry of Health’s HIA Support Unit to assist in capturing the
overall development of HIA across the country.
Promote the HIA tools and guidelines available in New
Zealand, including the Public Health Advisory Committee’s
guidelines on HIA (2nd edition, 2005) and the Ministry of
Health’s Whanau Ora HIA tool (2007).
Identify and explore opportunities to resource HIA local and
regional training needs.
Develop, distribute and update locally-relevant information
about the use and benefits of HIA, including the resources
available at a national and local level.
5.2 Settings
5. 2.1 Social Environment Service
Social environment initiatives are also well suited to health promotion in the primary
healthcare setting.
5.3 Service Levels
5.3.1
Designation of Health Promoting Schools
Based on the level of commitment and community action, schools will be designated to one of
three categories, according to specific criteria outlined below. This will assist health providers
Public Health Services - Social Environments and Health Promoting Schools tier two service specification
Nationwide Service Framework
10
to prioritise time and resource allocation to different schools, given the limited capacity of
staff. It is recognised that there is a range of interest and skill relating to the Health Promoting
Schools initiative. Agreed levels of service will be delivered to schools in each category to
support staff with appropriate levels of interest, training and experience in Health Promoting
Schools.
5.3.2
Category 1: Active Health Promoting Schools
Category 1 schools express agreement and commitment to becoming a Health Promoting
School (particularly the school principal and Board of Trustees), demonstrated through, for
example, a Memorandum of Understanding between the school and the health provider, and
the provision of teacher release time for the initiative. Active Health Promoting Schools will
work towards:







a representative health team (of which a Health Promoting School service provider may
be a part) working towards a shared vision, identification of needs, action planning,
linking with other agencies (eg, NGO health providers, Social Workers in Schools), etc
two-way communication channels between staff and the community including Māori
consultation (ie, surveys, hui, etc) with community regarding the initiative
identification of school and community health needs
implementation of an action plan to address the identified needs
collaboration in planning, resourcing and implementing school community health
promotion initiatives
review and evaluation of initiatives, identification of areas of need and setting goals for
future action.
The Service is likely to include:



5.3.3
advice for or participation in the school health team
assistance with needs assessment
support for maintenance of community and Health Promoting Schools networks.
Category 2: Towards Health Promoting Schools
Category 2 schools include, for example, schools that have:



expressed interest in becoming a Health Promoting School
key school staff meeting with the HPS service provider who introduces HPS framework
and process to the school
a nominated lead teacher for Health Promoting Schools.
Service is likely to include:



5.3.4
raising awareness of the Health Promoting Schools framework and process to schools
building relationships with senior management, Board of Trustees and other key school
staff
provision of some implementation resources and support.
Category 3: Standard Service Schools
Category 3 schools include schools that do not express interest or commitment towards
becoming a Health Promoting School.
Public Health Services - Social Environments and Health Promoting Schools tier two service specification
Nationwide Service Framework
11
Service includes:


the Health Promoting School newsletter to the school
at a minimum, an annual PHN visit.
Priority assignment is dynamic. For example, over a period of two years schools may move
from Category 2: Towards Health Promoting Schools to Category 1: Active Health Promoting
Schools, or vice versa. Active Health Promoting Schools may take a role in mentoring/
supporting other schools to understand and reap the benefits of embedding the Health
Promoting School process into the school infrastructure.
5.4 Key Inputs Health Promoting Schools
The Health Promoting Schools service specifications will be delivered via the following roles:

local Health Promoting School advisors

work within schools relating to the Health Promoting Schools initiative by, for example,
public health nurses (PHNs), Māori and Pacific health workers

regional co-ordination of the Health Promoting Schools initiative across the Northland,
Midcentral, Central and South Island regions.
5.5 Pacific Health
The Pacific Health and Disability Action Plan (MoH 2002) prioritises the health of Pacific
children and youth and promoting healthy lifestyles and wellbeing. The Action Plan
prescribes community-based, intersectoral action “to mobilise Pacific peoples to develop
responses to their own needs from within their own contexts”, and “facilitates agreement from
its consumer community on matters such as values, beliefs, ethics, protocols and etiquette,
and overall world view”.
6. Service Linkages
Social environment programmes may be undertaken by population groups with particular
cultural values or concerns that need to be considered in order to protect and promote their
health and wellbeing and ensure social cohesion.
Sector
Nature of linkage(s)
Public Health Provider Accountabilities
Physical
environment
services
Legislation and local
authority by-laws
Social environment programmes are in
many cases linked to physical
environment services, especially where
legislation and local authority by-laws are
a factor.
DHB public health
units.
Programme delivery
Programmes to enhance social
environments.
Other
health
promotion service
deliverers
Work together with
health
promotion
activities
To work with Healthy Eating, Healthy
Action, injury prevention, tobacco control
and reducing harm from alcohol and other
drugs and problem gambling.
Public Health Services - Social Environments and Health Promoting Schools tier two service specification
Nationwide Service Framework
12
Sector
Nature of linkage(s)
Public Health Provider Accountabilities
Primary
Health
Care Providers
Nutrition
and
Physical Activity,
Mental
Health
Promotion,
Tobacco Control,
Communicable
Diseases,
Injury
Prevention
Healthy
Eating,
Healthy
Action,
and reducing harm
from alcohol and
other drugs and
problem gambling
Health promotion
Delivery of social environment initiatives.
Work on particular
issues in schools
Health Promoting Schools is a settingsbased approach that focuses on issues
that are identified as priorities for the
school community and for reducing health
inequalities.
7.
Exclusions
This service specification covers policy-level health impact assessment activities. The
Physical Environmental Health, Public Health service specification relates more directly to
project-level health impact assessment methods and approaches used in resource
management processes.
8.
Quality Requirements
The service must comply with the Provider Quality Standards described in the Operational
Policy Framework or, as applicable, Crown Funding Agreement Variations, contracts or
service level agreements.
8.1 Additional Quality Requirements
Use standard methodology (screening, scoping, appraisal and reporting, and evaluation) for
health impact assessment as outlined in the Public Health Advisory Committee guidance (2 nd
edition, 2005) and the Ministry of Health’s Whanau Ora HIA tool (2007) or other internationally
recognised and adopted health impact assessment methods. See Appendix One for details
on Health Promoting Schools quality requirements.
Guidelines for best practice in relation to most social environment programmes have been
developed and remain under review by international bodies, including WHO e.g.



Healthy Cities: Goldstein G. 2000. Healthy Cities: Overview of a WHO international
programme. Rev. Environ Health; 15(1-2):207-14
Health Promoting Schools: St Leger L. 2008. Guidelines for Health Promoting Schools.
International Union for Health Promotion and Education.
Health Impact Assessment:
Public Health Services - Social Environments and Health Promoting Schools tier two service specification
Nationwide Service Framework
13
9.
Purchase Units and Reporting Requirements
Purchase Units are defined in the joint DHB and Ministry’s Nationwide Service Framework
Purchase Unit Data Dictionary. The following Purchase Units apply to this Service:
PU Code
PU
Description
Purchase Unit Definition
PU
Measure
PU Measure
Definition
National
Collections
or payment
systems
RM00110
Social
Environment
Healthy cities and
communities and social
environments; Health
Promoting Schools/Healthy
schools – Kura Waiora
Service
Service
purchased in a
block
arrangement
uniquely agreed
at a local level.
National Nonadmitted
Patient
Collection
(NNPAC) –
Optional
9.1
Reporting Requirements
As per the individual service contracts.
10.
Service Planning Information
10.1
Social Environments
“Social environments pose the highest public health risk for serious illness and premature
death.” (Daniels, Kennedy & Kawachi, 2000 as cited in Task Force on Community Preventive
Services, 2003).
“Because many of the strongest influences on health and wellbeing come from outside the
health sector, effective action to sustain and improve the population’s health cannot be solely
the responsibility of the health sector ... effective solutions to health problems often require
collaborative action by key stakeholders joining together across sectors.” (Public Health
Advisory Committee, 2006. Health is Everyone’s Business: Working Together for Health and
Wellbeing).
In 1998 the WHO adopted an updated strategy for Health for All in the 21st century – Health
21. Within Europe four strategies for action were chosen to drive implementation of Health
21:
Multisectoral strategies to tackle the determinants of health, taking into account physical,
economic, social, cultural and gender perspectives and ensuring the use of health impact
assessments
Health outcome driven programmes and investments for health development and clinical care
Integrated family and community-oriented primary health care, supported by a flexible and
responsive hospital system
A participatory health development process that includes relevant partners for health at all
levels (e.g. local community, workplace, school) and that promotes joint decision-making,
implementation and accountability.
(Health 21 – the Health for All policy framework for the WHO European Region. Cited in
Review of Healthy Urban Planning - Report of the Public Health Advisory Committee to the
Minister of Health, February 2008.)
Public Health Services - Social Environments and Health Promoting Schools tier two service specification
Nationwide Service Framework
14
Public health has long been engaged with threats to health of urban environments. In
recent times, “new concerns have arisen about the potential impact of the contemporary
urban environment on population health; in particular the impact of transport, housing
development and land use planning on people’s lifestyles and opportunities to maintain
their health and wellbeing through the lifecourse”. (Review of Healthy Urban Planning Report of the Public Health Advisory Committee to the Minister of Health, February 2008.)
“Active community involvement is a necessary condition not only to identify the real health
needs of the population and to establish the priority interventions but also to strengthen
the social cohesion and individual self-determination, both very important especially for
mental health.” (Review of Healthy Urban Planning - Report of the Public Health Advisory
Committee to the Minister of Health, February 2008.)
10.2
Health Impact Assessment
Health impact assessment (HIA) is a formal process that aims to predict the potential effects
of policies on health and wellbeing and on the distribution of those impacts on population
groups. It can be applied to policy-making at central and local government level, and is most
effective when used in the policy development process. Its purpose is to assist decision
makers by giving them better information.
Health impact assessment is defined as a combination of procedures, methods and tools by
which a policy may be assessed and judged for its potential effects on the health of the
population, and distribution of those effects within the population.
HIA is currently used at the project level in many countries (in New Zealand it is usually within
resource management processes). Guidance on undertaking project level HIA in the context
of the Resource Management Act was published by the Public Health Commission in 1995.
The focus of this service specification is the use of HIA in policy-making, which is becoming
more frequent and is potentially more influential.
In HIA at the policy level, the primary focus is on health and its determinants, whereas when
HIA is applied to environmental management, health is just one component. Policy-linked
HIA has its roots in public health and the recognition that health is largely determined by
decisions made in other sectors. It aims to assist with meeting policy goals such as
‘outcomes-based’ decision-making where the focus is on actual outcomes for people rather
than ‘outputs’ of policy (e.g. a reduction in smoking prevalence is an outcome, while smoking
cessation programmes are outputs).
HIA is based on the recognition that the health status of people and communities is greatly
influenced by factors that lie outside the health sector, for instance, through social and
economic policies. HIA is a forward-looking approach that could potentially be used in policymaking in any sector. It can help to identify ways in which:

Positive health effects of the policy can be enhanced

Negative health effects of the policy can be diminished or removed

Health inequalities may be reduced or widened as a result of the policy.
It is important to acknowledge that policy HIA takes place in a very complex political and
administrative environment. Many factors influence how a policy is developed and finalized,
with political will being an important factor.
The four key stages in the process of health impact assessment are:
Public Health Services - Social Environments and Health Promoting Schools tier two service specification
Nationwide Service Framework
15

screening where policies are quickly judged for their potential to affect the health of the
population

scoping to establish the foundations and boundaries for undertaking the HIA

appraisal and reporting to describe the potential benefits and risks to health, determining
their nature and magnitude

evaluation including process, impact and outcome evaluation.
These stages can be undertaken all together to consist of a complete health impact
assessment. Alternatively, one or more of the stages can be done as an HIA activity. For
instance, local authorities in Australia have developed HIA screening tools to identify the
potential health and wellbeing impacts early in the policy development process. For more
information, see the Public Health Advisory Committee guide on HIA (2 nd edition, 2005).
The benefits of HIA are:

to help policy-makers incorporate evidence into policy-making

to assist policy makers meet public health requirements of legislation and policy
direction, such as the Local Government Act (2002) and the Land Transport
Management Act (2002)

to promote cross-sectoral collaboration

to promote a participatory, consultative approach to policy-making.
10.2.1 Health Impact Assessment Definition and Scope
The Ministry of Health’s Health Impact Assessment Support Unit was established in August
2007, and is based in the Office of the Director of Public Health. At its inception, the Unit
undertook a baseline exercise of HIA activity around New Zealand that showed that although
a large number of people had been trained in HIA this did not translate into actual HIAs.
As a result, the focus of the HIA Support Unit is on creating capacity and building the
evidence base for HIA at central and local government levels with district health boards,
public health services and local authorities playing key roles.
Capacity building is defined as:
“an approach to the development of skills, organizational structures, resources and
commitment to health improvements in health and other sectors, to prolong and
multiply health gain many times over” (NSW Health, 2001).
The five areas for action for building HIA capacity are:

organisational change including organizational structures, management support, policies
and procedures and strategic directions.

workforce development including professional development opportunities, external
courses, professional support and supervision and workforce learning.

resource allocation including financial and human resources, access to information,
specialist advice, decision-making tools and models and administration support.

partnership including shared goals, relationships, planning, implementation, evaluation
and sustained outcomes.
Public Health Services - Social Environments and Health Promoting Schools tier two service specification
Nationwide Service Framework
16

leadership including technical skills, personal qualities, strategic visioning, systems
thinking and organizational management.
An organisation’s approach to HIA should consider these five areas of capacity building and
take a “learning by doing” approach to the range of HIA activities (screening, scoping,
appraisal and reporting, and evaluation).
This service specification sets out how District Health Boards and public health services can
contribute to achieving the goals of the Ministry of Health’s HIA Support Unit which are also
aligned to wider health system improvement goals.
10.2.2 Health Impact Assessment Health Goal
The two health goals, using a capacity building approach, for this service are:

to improve health outcomes and reduce health inequalities through more robust policy
development that systematically and explicitly assess the health impacts of proposed
policies at the regional and local level

to embed HIA into public policy development processes at the regional and local level
so that potential impacts on health outcomes and inequalities can be identified and
addressed early in the processes.
The service objective is to ensure a systematic consideration of the potential health and wellbeing impacts of policies being developed by public policy makers to achieve improved health
outcomes and reduce inequalities.
10.2.3 Health Impact Assessment Rationale and Key Issues
Health impact assessment combines established methods used in other forms of impact
assessment, such as environmental impact assessment and social impact assessment, with a
public health approach, including a focus on differences of health impacts between population
groups. The internationally recognised principles of HIA are:

promoting maximum health of the population

sustainable development

equity

public participation

ethical use of evidence.
The following service components can be applied to the health system to assist in indirectly
influencing the broader determinants of health or by non-health sector agencies more directly
influencing the determinants of health that lie outside of the health sector.
Public Health Services - Social Environments and Health Promoting Schools tier two service specification
Nationwide Service Framework
17
Appendix One
Health Promoting Schools Quality Requirements
Health Promoting Schools (HPS) has developed out of the World Health Organization and is
based on the Ottawa Charter framework for health promotion. Overseas and local research
shows the HPS approach is a promising framework and process that addresses the health of
school communities. There is strong evidence that it is an effective way of reducing
inequalities in health and improving wellbeing.








Education is a key influence on current and future health status of young people
(NHMRC, 1996). The school is an ideal setting for an initiative that integrates education
and health. It is underpinned by achieving education for health outcomes and health for
education outcomes. (Davis JM & Cooke SM, 2007)
Poor health impacts on children and young people’s ability to learn. Educational goals
and learning are enhanced if a broader and more comprehensive focus to school health
is adopted.
HPS research on specific health issues shows major health gains from multi-faceted
school-based interventions.
Studies show that health and education programmes are cost-effective
There are increasing expectations and pressures on schools to address the health and
wellbeing needs of their students. HPS supports and facilitates the development of
whole school approach initiatives, which includes schools prioritising the delivery of a
comprehensive Health and Physical Education Curriculum at multiple levels
Maori continue to have poorer health outcomes than the general population, and are
exposed to greater risk, have poorer access to health services and die earlier than any
other ethnic group. There are significant disparities in the health status between Maori
and non-Maori.
Mental Health has been identified as a key strategic issue to be addressed within the
holistic framework of HPS. Evidence shows the effectiveness of this approach. This
focus links with the Mental Health Promotion Components of Service (section ten) in this
Handbook.
Local evaluations show that where the HPS initiative has the support of the school,
particularly the principal, schools have given high ratings for what the initiative has
achieved to date, and what they expect it to achieve in future.
Public Health Services - Social Environments and Health Promoting Schools tier two service specification
Nationwide Service Framework
18
Appendix Two
References and Supporting Documents

Acheson Sir Donald. 2000. Keynote address. 12th National Health Promoting Conference of
Australia . Inequalities in Health: Reflecting Back, Stepping Forward.

•Auckland District Health Board. 2001. Health Promoting Schools in Action in Aotearoa/New
Zealand: A resource to assist schools in the Implementation of Health Promoting Schools.
Auckland: Auckland District Health Board.

BRC. 1999. Evaluation of Healthy Schools / Health Promoting Schools / Kura Waiora, Midland,
Central and Southern HFA Regions. Wellington: Health Funding Authority (unpubl).

Daniels, Kennedy and Kawachi, 2000 as cited in Task Force on Community Preventive Services,
2003. Recommendations to promote healthy social environments. American Journal of Preventive
Medicine 24 (3S): 21-24

Davis JM & Cooke SM, 2007. Educating for a healthy, sustainable world: An argument for
integrating Health Promoting Schools and Sustainable Schools. Health Promotion International 22
(4): 346-353.

Goldstein G. 2000. Healthy Cities: Overview of a WHO international programme. Rev. Environ
Health; 15(1-2):207-14

Health 21 – the Health for All policy framework for the WHO European Region. Cited in Review of
Healthy Urban Planning - Report of the Public Health Advisory Committee to the Minister of
Health, February 2008.)

Lavin AT, Shapiro GR, Weill KS. 1992. Creating an Agenda for School-based Health Promotion: A
review of 25 selected reports. Journal of School Health; 62: 212-29.

Mental Health Foundation of New Zealand. 2001. Guidelines for Mentally Healthy Schools.
Auckland: Mental Health Foundation.

Ministry of Health. 2002. He Korowai Oranga. Ministry of Health, Wellington.

Ministry of Health. 2003. Health Promoting School: A Way of Working (booklet one), Health
Promoting Schools: The Process (booklet two), Health Promoting Schools: Mentally Healthy
Schools (booklet three), About Health Promoting Schools (pamphlet), Health Promoting Schools:
Support Manual. Ministry of Health. Wellington.

Ministry of Health, 2003. Achieving Health for All People: Whakatutuki te oranga hauora mo nga
tangata katoa. A framework for public health action for the New Zealand Health Strategy

Ministry of Health, 1997. Strengthening Public Health Action. Wellington: Ministry of Health

• NHMRC, 1996. Effective School Health Promotion. National Canberra: Health and Medical
Research Council. AGPS.

Ministry of Health, 2002. The Pacific Health and Disability Action Plan. Wellington: Ministry of
Health

Phoenix Research. 1999. Progress Report on Schools Involved in the Health Promoting Schools
Northern Region Pilot. Auckland: Health Funding Authority (unpubl).

PHC, Ministry of Health. 1995. Healthy Schools/Kura Waiora: Health Promotion Guidelines for
Schools. Wellington: Public Health Commission & Ministry of Health.

Public Health Advisory Committee, 2006. Health is Everyone’s Business: Working Together for
Health and Wellbeing
Public Health Services - Social Environments and Health Promoting Schools tier two service specification
Nationwide Service Framework
19

Signal L, Martin J, Cram F and Robson B, 2008. Health Equity Assessment Tool: A user's guide.
Wellington: Ministry of Health

St Leger L. 1999. The Opportunities and Effectiveness of the Health Promoting Primary School in
Improving Child Health: A review of the claims and evidence. Health Education Research: Theory
and Practice; 14:1. 51-69.

St Leger L. 2008. Guidelines for Health Promoting Schools. International Union for Health
Promotion and Education.


World Health Organization Health Promotion Glossary, WHO, 1998. Geneva
Wyllie A, et al. 1999. Health Promoting Schools in the Northern Region: Overview of evaluation
findings after two years of a pilot project. Auckland: Phoenix Research (unpubl).
Public Health Services - Social Environments and Health Promoting Schools tier two service specification
Nationwide Service Framework
20