Health Impact Assessment: Promoting Healthy Public Policies

1. Health impact assessment (HIA) A tool to promote healthy public policies

2. 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 2

3. 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 3

4. 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 HIA Adoption of a policy Formulation d’alternatives Formulation of alternatives Adapted from Knoepfel, Larrue and Varone ( 2001) 4

5. 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 5

6. 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 6

7. Reduction of social inequities in health Rigour and neutrality of the analysis Involvement of stakeholders and intersectoral parties/ decision-makers Collective responsibility towards the population Basic principles… Democracy, sustainable development, equity, participation, ethical use of evidence (Gothenburg Consensus) 7

8. …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 8

9. The HIA Steps P R O P O S A L Screening Scoping Appraisal Recommendations Evaluation 9

10. 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 10

11. A tool that can be adapted to all levels of decision making LOCAL - PROVINCIAL- NATIONAL 11

12. 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 12

13. 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 13

14. 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. 14

15. 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/ 15