Impact Evaluation of Three Health Equity Impact Assessments
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Impact Evaluation of Three Health Equity Impact Assessments

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Presentation for IAIA'10 International Association for Impact Assessment Conference in Geneva. http://iaia.org/iaia10/

Presentation for IAIA'10 International Association for Impact Assessment Conference in Geneva. http://iaia.org/iaia10/

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  • HEIA is being increasingly promoted as a mechanism to prevent and redress health inequities, notably in the WHO Commission on the Social Determinants of Health final report.
  • but little is known about its effectiveness and under which circumstances it is most useful.
  • This study looked at the impact of three HEIAs on decision-making and implementation.
  • The HEAIs were rapid and conducted on health sector plans.
  • The impact evaluations were conducted between 18 and 24 months after the HEIAs were completed.
  • Data came from narrative interviews and document analysis.
  • Analysis was conducted using Colaizzi's analytic appriach.
  • The HEIAs did change decision-making and implementation in all three cases, but these changes were hard to attribute solely to the HEIA.
  • This conceptual framework shows the factors that are important to look at in evaluating HIAs.
  • And this shows the factors that we can see in these three HEIAs, in terms of both direct and indirect changes and the factors that determine those changes.
  • All three HEIAs identified potential health inequity impacts that had not been previously considered in planning.
  • We also found that it was hard for people to recognise that their understanding of potential health equity impacts had changed,
  • For example "I’m not convinced that [the HEIA] made people do things differently, because I think that they probably, should’ve, would’ve, hopefully would’ve, done those things anyway."
  • To paraphrase Dick Cheney, we may be dealing with thing we don’t know we didn't know?
  • There was not necessarily consensus about the purpose of doing of doing the HEIA,
  • For example, "We didn’t have a shared understanding of why we were undertaking it. Our purposes were probably different from [the other group's] purposes, and maybe that’s where they don’t work, but if you have two differing purposes, unless you can fully appreciate what those two different purposes are, maybe it doesn’t work out as well as it could."
  • My observation (and this is not the purpose of this study), having done several impact evaluations now of HIAs and HEIAs, is that there is more explicit conflict and discomfort about values in HEIAs, which may be expected due to the more explicit examination of the values underpinning a proposal. This requires further investigation.

Impact Evaluation of Three Health Equity Impact Assessments Impact Evaluation of Three Health Equity Impact Assessments Presentation Transcript

  • Impact Evaluation of Three Health Equity Impact Assessments B Harris-Roxas, P Bazeley, L Kemp Centre for Health Equity Training, Research and Evaluation (CHETRE) Part of the UNSW Research Centre for Primary Health Care and Equity Sydney, Australia
  • Page 29 Page 22 Page 30 Page 30
    • But little is known about its effectiveness and the circumstances under which it is effective
    • Impact of three health equity impact assessments (HEIAs) on subsequent decision-making and implementation
    • Rapid
    • Health sector proposals
    • Impact evaluation 18-24 months following completion
    • Narrative interviews
    • Document analysis
    • Analysis: Approach outlined by Colaizzi*
    * Colaizzi PF. Psychological Research as the Phenomenologist Views It . In: Valle RS, King M, editors. Existential Phenomenological Alternatives for Psychology . New York: Oxford University Press, 1978:48-71.
    • Evidence of changes to decision-making and implementation, but these were hard to attribute solely to the HEIAs
  • Parameters Decision-making processes Decision-makers Type of HIA Broader Context Inputs Proposal Capacity and experience Resources Time Organisational arrangements Process Procedural fidelity Involvement of decision-makers and stakeholders Transparency Trade-offs Review Proximal Impacts Informing decisions Changing decisions and implementation Changes in health determinants Predictive efficacy Achieving goals Distal Impacts Understanding Participatory learning Influencing other activities Engagement Perception of HIA Values, Purpose and Goals
  • Parameters Decision-making processes Decision-makers Type of HIA Broader Context Inputs Proposal Capacity and experience Resources Time Organisational arrangements Process Procedural fidelity Involvement of decision-makers and stakeholders Transparency Trade-offs Review Proximal Impacts Informing decisions Changing decisions and implementation Changes in health determinants Predictive efficacy Achieving goals Distal Impacts Understanding Participatory learning Influencing other activities Engagement Perception of HIA Values, Purpose and Goals
    • All three HEIAs identified potential health inequity impacts that had not been previously identified in planning
    • But it was hard for people to recognise that their understanding of potential health equity impacts had changed
    • "I’m not convinced that [the HEIA] made people do things differently, because I think that they probably, should’ve, would’ve, hopefully would’ve, done those things anyway."
    • The things we don’t know we didn’t know?
    • Lack of consensus about the purpose of doing of doing the HEIAs
    • "We didn’t have a shared understanding of why we were undertaking it. Our purposes were probably different from [the other stakeholders’] purposes, and maybe that’s where they don’t work, but if you have two differing purposes, unless you can fully appreciate what those two different purposes are, maybe it doesn’t work out as well as it could."
    • More explicit conflict, discussion of values and desired outcomes
    • More information
    • http://bit.ly/g0CDI
    • [email_address]