Background• This presentation is based on a paper that is being prepared for Impact Assessment and Project Appraisal by members of the f International Association for Impact Assessment’s Health Section. S ti• The paper presents an overview of HIA activity internationally and future directions for the field.• It is an update of the last IAIA effort to describe the state of the It is an update of the last IAIA effort to describe the state of the impact assessment field in Vanclay and Bronstein’s 1995 book on Environmental and Social Impact Assessment. Environmental and Social Impact Assessment.• I’d like to acknowledge the contributions of the co‐authors so far.• I’d also like your feedback on the issues presented.Vanclay F, Bronstein D (Eds.) (1995) Environmental and Social Impact Assessment, Wiley: Chichester.
History• The evolution of HIA can be viewed as a little different from EIA • EIA has been strongly focused on major project assessment in many jurisdictions yj • In recent decades it has expanded to encompass other strategic assessment processes such as strategic strategic assessment processes such as strategic environmental assessment (SEA) • There’s a lot HIA can learn from other forms of impact assessment, but HIA can potentially inform other impact assessment processes too, e.g. practice norms about public i b bli dissemination of completed reports, etc
History• HIA can be seen as originating from three separate areas of activity • Environmental health • Social view of health • Health equity • Each bring with them their own disciplinary beliefs, values, g p y , , support base and baggageHarris‐Roxas B, Harris E (2011) Differing Forms, Differing Purposes: A Typology of Health Impact Assessment, Environmental Impact Assessment Review, 31(4):396‐403. doi:10.1016/j.eiar.2010.03.003
History• Environmental Health • Mostly grew out of work on major project assessment in developing countries p g • Has often focused on building health into EIA processes • Relies on scientific and predictive evidence • Often has a biomedical or toxicological focus, appropriately g , pp p y given the context and history of its use • Uses methodologies such as prospective health risk Uses methodologies such as prospective health risk assessment
History• Social View of Health • Grew out of an increasing recognition of the social determinants of health • Has often focused on policies and strategies rather than at the project level the project level • Sees HIA as applying to other sectors, not necessarily health • Involves working intersectorally/with other parts of govt • Defines health and acceptable evidence more broadly Defines health and acceptable evidence more broadly • Sees the process of the HIA itself as important • Uses methodologies such as quantitative modelling and q qualitative research
History• Health Equity • Grew out of the need for interventions that can address health inequalities in policy development and planning, i.e. q p y p p g, before inequalities come about • Often conflated with social health but it is possible to look at Often conflated with social health, but it is possible to look at social health without considering differential impacts • Forces a greater discussion of values • Tends to focus more on issues of differential health impacts p • Uses varies methodologies but participation is often valued highly as evidence within the HIA highly as evidence within the HIA
HIA Health Equity Social View of Health Social View of Health Environmental Health Regulatory Environmental Impact Assessment Environmental Disasters1950s 1960s 1970s 1980s 1990s 2000s1956 Clean Air Act (UK) 1962 Silent Spring 1972 Lake Pedder Dam 1980 The Black Report 1990 Concepts & 2004 Equity Focused HIA controversy (UK) ( ) Principles of Equity l f Framework k (Australia) in Health (Australia)1959 Minamata Bay 1969 Santa Barbara 1980 International (Japan) Channel (USA) 1990 Environmental 1972 The Indian Wildlife Association for 2005 Health included in Protection Act (UK) (Protection) Act Impact Assessment IFC Performance 1969 US National formed Environmental Standards 1992 Asian Development 1974 Lalonde Report Policy Act (USA) Bank HIA (Canada) 1984 Bhopal (India) 2005 Guide to HIA in the Guidelines Oil and Gas Sector 1969 Cuyahoga River 1974 Environmental 1986 Ottawa Charter Fire (USA) 1994 Framework for Protection (Impact ( p 2007 1st Asia‐Pacific HIA Environmental and En ironmental and of Proposals) Act 1986 Chernobyl Conference Health IA (Australia) (Ukraine) (Australia) (Australia) 1978 Seveso (Italy) 2007 HIA’s use included 1989 Exxon Valdez Oil 1997 Jakarta in Thailand’s Spill (USA) Spill (USA) Declaration 1978 L Love Canal (USA) C l (USA) Constitution C i i 1998 Independent 1978 WHO Seminar on 2008 WHO Commission Inquiry into Environmental on the Social Inequalities in Health Impact Determinants of Health (UK) Assessment Assessment Health: Closing the Health: Closing the (Greece) Gap in a 1998 Merseyside Generation Guidelines for HIASource: Harris‐Roxas B, Harris E. Differing forms, 1978 Declaration of 2009 Montara West differing purposes: A typology of health impact Alma Ata 1998 The Solid Facts Atlas Oil Spill , passessment, Environmental Impact Assessment (Australia)Review, 31(4): 396‐403. 1979 Three Mile Island doi:10.1016/j.eiar.2010.03.003 (USA) 1999 Gothenburg 2010Marmot Review Consensus Paper on HIA
History• The Gothenburg Consensus Paper was important in the development of the HIA field. It identified the values participants f f f saw as governing HIA’s use: • Democracy • Equity • Sustainable Development • Ethical Use of Evidence Ethical Use of Evidence• These values reflect the context in which the Consensus Paper was developed by European HIA practitioners• The ways and extent to which these values inform actual HIA The ways and extent to which these values inform actual HIA practice warrants attention as wellECHP (1999) Gothenburg Consensus Paper on Health Impact Assessment: Main concepts and suggested approach, European Centre for Health Policy, WHO Regional Office for Europe. http://www.euro.who.int/document/PAE/Gothenburgpaper.pdf
International PerspectivesInternational Perspectives• There are currently several approaches to legislating and institutionalising HIA’s use: ’ • Requiring health be considered as party of EIAs or broader q g p y impact assessment (many WPRO countries’ EIA legislation; IFC Performance Standards; Equator Principles; EIA legislation in other regions) • Requiring stand‐alone HIAs on a type/category of proposals (Thai National Health Act; Lao PDR; Tasmania, Australia) • Giving health authorities the right to conduct HIAs where Giving health authorities the right to conduct HIAs where they deem it necessary or appropriate (Victoria, Australia) • L i l ti th i ht f Legislating the right for communities to request HIAs be iti t t HIA b conducted or to be involved in them (Thai Constitution) • Regulations or policies that support HIA’s use but do not require it (many local governments and authorities in Europe; New South Wales, Australia; New Zealand)
International PerspectivesInternational Perspectives• The following approaches are not exactly requirements for HIA but may be related or lead to HIA’s use ’ • Requiring a health review or screening of all government q g g g policies (Netherlands during the national government’s screening program; Quebec Provincial Government; NSW Aboriginal health Impact Statement) • The discretionary use of non‐HIA processes to look at health issues (South Australia’s Health Lens)• Capacity has been a critical factor in determining the extent to which these legislative mechanisms have been actually which these legislative mechanisms have been actually implemented•M Many HIAs are conducted outside legislative requirements, HIA d t d t id l i l ti i t though the extent varies markedly depending on context
Current HIA PracticeCurrent HIA Practice• HIA’s use has grown rapidly• Scoping is critical • Poor HIAs are too often the result of poor scoping/Terms of Poor HIAs are too often the result of poor scoping/Terms of Reference • There needs to be a more rigorous approach to scoping to ensure that a more comprehensive potential health impacts are at least considered • At the moment we often lapse into stereotypical approaches p yp pp to identifying potential impacts
Current HIA PracticeCurrent HIA Practice• Strength of evidence used to make predictions • We can be better at transparently stating the degree of uncertainty y • We also need to be realistic that predicting many important impacts will always rely on weaker or more speculative impacts will always rely on weaker or more speculative evidence
Current HIA PracticeCurrent HIA Practice• The resourcing of HIA – too much or too little? • HIA requires resources and needs to be responsive to decision‐making needs but also still be detailed and credible g • But how much is the right amount? • It has been suggested that within the context of integrated IAs/ESHIAs that between 10%‐20% of the overall IA budget should be spent on health (Birley M, IAIA Conference 2006 and 2007) •I ’ l It’s less clear what the appropriate level of funding is for HIAs l h h i l l f f di i f HIA of policiesHarris‐Roxas B, Harris P, Harris E, Kemp L (2011) A Rapid Equity Focused Health Impact Assessment of a Policy Implementation Plan: An Australian case study and impact evaluation, International Journal for Equity in Health, 10(6), doi:10.1186/1475‐9276‐10‐6.
Current HIA PracticeCurrent HIA Practice• A more nuanced approach to the consideration of alternatives• At the moment most HIAs focus minimally on alternatives, and those that do are limited to • Siting alternatives (known as “end of pipe”, area or size alternatives) or alternatives) or • Technological alternatives• More attention needs to be paid to • Knowledge alternatives (issue definition alternatives) Knowledge alternatives (issue definition alternatives) • Institutional alternatives (ways of doing business) • Goal alternatives (what you’re trying to achieve)Sukkumnoed D, et al (2007) HIA Training Manual: A learning tool for healthy communities and society in Thailand, Southeast Asia, and beyond, Health Systems Research Institute: Bangkok.
Current HIA PracticeCurrent HIA Practice• There is an emphasis on community consultation and researching stakeholder views • There’s less clarity about how this should be reconciled with y competing or contradictory forms of evidence• A greater understanding of and consensus about the type of A greater understanding of and consensus about the type of baseline measurements and monitoring that are required
Opportunities and ThreatsOpportunities and Threats• The opportunities and threats to HIA and its use are often the same • Better integration of health and HIA into other assessment g processes • At the moment health is often limited to health risk At the moment health is often limited to health risk assessment that are conducted as stand‐alone assessments within larger assessment processes within larger assessment processes
Opportunities and ThreatsOpportunities and Threats• Capacity • We need to recognise that there are currently few incentives for practitioners to build others’ capacity p p y • The focus at the moment is often on introductory training but the need is greatest for experienced HIA practitioners, but the need is greatest for experienced HIA practitioners i.e. people who have done several HIAs, people who can commission and review them, etc commission and review them etc
Opportunities and ThreatsOpportunities and Threats• A more nuanced understanding of what we’re trying to learn through HIA • Technical learning, which involves searching for technical g, g solutions to fixed policy objectives • Conceptual learning which involves redefining policy goals Conceptual learning, which involves redefining policy goals, problem definitions and strategies • Social learning, which emphasises dialogue and increased interaction between policy actors • Because of HIA’s rather diverse origins we can’t assume there’s a shared understanding of what we’re seeking to learn through doing HIAs in all contextsGlasbergen P (1999) Learning to Manage the Environment in Democracy and the Environment: Problems and Prospects (Eds Lafferty W and Meadowcroft J), Edward Elgar: Cheltenham, p 175‐193.
Opportunities and ThreatsOpportunities and Threats• Recognising that there is a diversity of HIA practice that allows it to be responsive but challenges efforts to standardise practice ff • Who is HIA for? Who does it? When? • The answers to these questions will be different in different contexts• Ensuring recommendations are made, acted upon and monitored• Independence: realistic or desirable? How can we ensure p independence? Should we?• HIA reporting could also be improved HIA reporting could also be improved
Where to next?Where to next?• We’ve actually come a long way as a field in relatively short time• In 1995 Birley and Peralta wrote that: “At present HIA is a blunt tool with the rudiments of an accepted methodology”• This is no longer the case. There is greater consensus about the procedural elements of HIA (e.g. screening, scoping, etc) and procedural elements of HIA (e g screening scoping etc) and well as when it is most usefulBriley M, Peralta G (1995) Health Impact Assessment of Development Projects in Environmental and Social Impact Assessment (Eds Vanclay F and Bronstein D), Wiley: Chichester, p 153‐170.
Where to next?Where to next?• Potential activity: • Industry‐specific HIA guidance, eg mining, wind power, etc ( (some already exists) y ) • Regional guidance, e.g. for WPRO region • Better guidance and professional development specifically focused on scoping • Improved methods for economic appraisal of health impacts
Where to next?Where to next?• There is need for a new international consensus on HIA • Revisiting the values that govern HIA’s use to ensure they’re relevant to the current diversity of HIA practice y p • This is no easy task but will be necessary to ensure that HIA practice is not fractured and continues to benefit from being practice is not fractured and continues to benefit from being used in a variety of forms and settingsKrieger G, Utzinger J, Winkler M, Divall M, Phillips S, Balge M, Singer B. Barbarians at the gate: storming the Gothenburg consensus, The Lancet, 375(9732): 2129‐2131, 2010. doi: 10.1016/S0140‐6736(10)60591‐0Vohra S, Cave B, Viliani F, Harris‐Roxas BF, Bhatia R. New international consensus on health impact assessment, The Lancet, 376(9751):1464‐1465, 2010. doi:10.1016/S0140‐6736(10)61991‐5
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