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Health Impact Assessment (HIA) is a tool used to assess the potential effects of policies on population health. It involves various steps and objectives to promote healthy public policies and reduce health inequities. HIA integrates stakeholder involvement, considers social determinants of health, and aims to democratize decision-making processes. The implementation of HIA supports intersectoral actions and public participation. However, challenges such as methodological rigor and political context must be addressed. Supporting the practice involves capacity building, training, and the development of knowledge for practitioners. Suggested readings provide further insight, and resources like the HIA Gateway and HIA connect offer support for HIA implementation at different decision-making levels.
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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 2
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
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
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
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
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
…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
The HIA Steps P R O P O S A L Screening Scoping Appraisal Recommendations Evaluation 9
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
A tool that can be adapted to all levels of decision making LOCAL - PROVINCIAL- NATIONAL 11
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
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
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
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