What isHealth Impact Assessment?  University of Newcastle August 2012             Ben Harris-Roxas         www.harrisroxas...
Section 1Who am I?
I’ve been working on HA since 2003         Mainly through supporting and conducting HIAs    I consult and also teach atUNS...
Trained more than 550 people in HIAActive in international HIA community    IAIA Health Section Co-Chair
Section 2What is health and what creates it?
• Historical  understandings
Miasma model of disease
Environmental   causes
The view that health ismerely the absence of illness and disease
controlling theenvironmental causes of        disease            =dealing with most public    health concerns      or does...
many of the early gains in public health were  linked to improving the environmental         factors that cause disease th...
sanitationvoted the most  important   medicaladvance since    1840.
air, water andsoil quality and     toxicity
disease vector control
waste                 managementImage: ŧĒđĠūŸ®
housing quality andovercrowdin      g
But the global burdenof disease has shifted
Source: WHO Global Burden of Disease 2002
Much of this disease still has environmental causes Many of the new causes of   disease seemed to be    different in natur...
NSW Health (2006) Report of the NSW Chief Health Office, NSW Health: Sydney.http://www.health.nsw.gov.au/public-health/cho...
The causes of the causes?       Image: Supermietzi
Schroder S. (2007) We Can Do Better: Improving the health of the American people. NewEngland Journal of Medicine, 357, 122...
What determines health?                   (A fuzzy pie chart)       Genetics                       Opportunities/       10...
Dahlgren G, Whitehead M. (1991) Policies and Strategies to Promote Social Equity in Health.Stockholm: Institute of Futures...
The Social Determinants of Health•   Stress•   Early life•   Social exclusion•   Work•   Unemployment•   Social support•  ...
Barton H, Grant M. (2006) A Health Map for the Local Human Habitat. Journal of the RoyalSociety for the Promotion of Healt...
NSW Health (2006) Report of the NSW Chief Health Office, NSW Health: Sydney.http://www.health.nsw.gov.au/public-health/cho...
Murphy M et al. (2006) TheWidening Gap in Mortality byEducational Level in theRussian Federation, 1980-2001. American Jour...
Section 3What is HIA?
A combination of procedures, methods  and tools by which a policy, program or  project may be assessed for its potential  ...
HIA is a developing approach that can   help to identify and consider the potential   - or actual - health impacts of a pr...
Key Aspects of HIA• A prospective activity• Uses a combination of  methods• Looks at intended and  unintended impacts• Loo...
When is an HIA done?
Explicit Focus on the      Distribution of Impacts1. Age2.Gender3.Socioeconomic status4.Location5.Ethnicity and culture6.E...
Thinking about the distribution of impacts:        Avoidability and fairness             Lead exercise
Section 4Steps of HIA
The Steps of HIA• Screening• Scoping• Identification• Assessment• Decision-making               and recommendations• Evalu...
Assessment                    Recommendations    If you                 These will be     If you make    These will beimpl...
Where does health risk assessment          (HRA) fit in?
HRA is a structured framework for assessing    risks associated with environmental hazards (prospectively and retrospectiv...
“The process of estimating the potentialimpact of a chemical, biological, physical orsocial agent on a specified human pop...
Scoping ActivityMaster Plan for Cheonggyecheon,              Seoul
First, get in your time machine –back to 2003
• Project timeline 2003 - 2005• US$900 million project
After Construction   Now (2003)
• Proponent receptive to HIA, but must be  completed in 5 months (mustn’t hold up  construction!)• Proponent is Seoul City...
Now (2003)
Now (2003)
Now (2003)
Now (2003)
After Construction
Brief video (if there’s time)             thenGroup work – scoping exercise
So what happened?
Section 6Where did HIA come from?
Environmental health     Social view of health             EquityEach bring with them their own  disciplinary beliefs, val...
HIA                                                                                                                       ...
Section 7What forms does it take?
There are currently four models of  HIA being used internationally       (to varying extents)
Mandated HIA generally occurs in the  context of an EIA, IIA, or ESHIA and is done to meet a regulatory or        statutor...
Example: Basslink Integrated IA
HIA for decision support is generally  done voluntarily with the goal of  improving decision-making and          implement...
Example: Lower HunterRegional Strategy HIA
HIA for advocacy is usually undertaken by organisations who are neither the   proponent or the decision-maker
Example: HIA of the NationalEmergency Response in the    Northern Territory
Community empowerment HIAs are usually undertaken by communitieswhose health is likely to be affected by             a pro...
Example: Goodooga Equity     Focused HIA
Mandated                      Decision Support• If HIA is mandated the         • If decision support forms  process will h...
Advocacy                       Community                                  Empowerment• Seeks to reframe or          • Diff...
This diversity is widespread and the challenges efforts to make HIA embedded in the policy  development and decision makin...
Section 8What type of things are HIAs done on?
Types of Health ImpactsHarris-Roxas B, Harris P. Learning by Doing: The value of case studies of healthimpact assessment. ...
Increasingly also on:• Climate change (adaptation)• Transition-to-town issues (food miles,  sustainability, etc)• Energy• ...
Section 9HIA Resources
HIA Blog      healthimpactassessment.blogspot.co
HIA Connect
Section 10  Q&A
Section 11  HIA Exercise(If there’s time)
ASEAN HighwayWhat are the potential healthimpacts?What information could we useto assess these potentialimpacts?
These slides are available atwww.slideshare.net/benharrisroxas   ben@harrisroxashealth.com   @ben_hr or @hiablog   healthi...
What is Health Impact Assessment?
What is Health Impact Assessment?
What is Health Impact Assessment?
What is Health Impact Assessment?
What is Health Impact Assessment?
What is Health Impact Assessment?
What is Health Impact Assessment?
What is Health Impact Assessment?
What is Health Impact Assessment?
What is Health Impact Assessment?
What is Health Impact Assessment?
What is Health Impact Assessment?
What is Health Impact Assessment?
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What is Health Impact Assessment?

  1. 1. What isHealth Impact Assessment? University of Newcastle August 2012 Ben Harris-Roxas www.harrisroxashealth.com @ben_hr on Twitter
  2. 2. Section 1Who am I?
  3. 3. I’ve been working on HA since 2003 Mainly through supporting and conducting HIAs I consult and also teach atUNSW, UWS and Macquarie University
  4. 4. Trained more than 550 people in HIAActive in international HIA community IAIA Health Section Co-Chair
  5. 5. Section 2What is health and what creates it?
  6. 6. • Historical understandings
  7. 7. Miasma model of disease
  8. 8. Environmental causes
  9. 9. The view that health ismerely the absence of illness and disease
  10. 10. controlling theenvironmental causes of disease =dealing with most public health concerns or does it?
  11. 11. many of the early gains in public health were linked to improving the environmental factors that cause disease the environmental determinants of health You’ll learn more about these during the course
  12. 12. sanitationvoted the most important medicaladvance since 1840.
  13. 13. air, water andsoil quality and toxicity
  14. 14. disease vector control
  15. 15. waste managementImage: ŧĒđĠūŸ®
  16. 16. housing quality andovercrowdin g
  17. 17. But the global burdenof disease has shifted
  18. 18. Source: WHO Global Burden of Disease 2002
  19. 19. Much of this disease still has environmental causes Many of the new causes of disease seemed to be different in nature to traditional environmental health concernsUnder-considered factors that powerfully influence healthand health related behaviours
  20. 20. NSW Health (2006) Report of the NSW Chief Health Office, NSW Health: Sydney.http://www.health.nsw.gov.au/public-health/chorep/dia/dia_typehos.htm
  21. 21. The causes of the causes? Image: Supermietzi
  22. 22. Schroder S. (2007) We Can Do Better: Improving the health of the American people. NewEngland Journal of Medicine, 357, 1221-1228.
  23. 23. What determines health? (A fuzzy pie chart) Genetics Opportunities/ 10-25% Socioeconomic Status 20-30%Risk Factors 20-40% Health Environment Services & Place 15-30% 5-15%
  24. 24. Dahlgren G, Whitehead M. (1991) Policies and Strategies to Promote Social Equity in Health.Stockholm: Institute of Futures Studies.
  25. 25. The Social Determinants of Health• Stress• Early life• Social exclusion• Work• Unemployment• Social support• Addiction• Food• Transport• The social gradient in health• .
  26. 26. Barton H, Grant M. (2006) A Health Map for the Local Human Habitat. Journal of the RoyalSociety for the Promotion of Health, 126, 252-253.
  27. 27. NSW Health (2006) Report of the NSW Chief Health Office, NSW Health: Sydney.http://www.health.nsw.gov.au/public-health/chorep/ses/ses_lomidhilex.htm
  28. 28. Murphy M et al. (2006) TheWidening Gap in Mortality byEducational Level in theRussian Federation, 1980-2001. American Journal ofPublic Health, 96:1293–99.cited inMarmot M. (2007) AchievingHealth Equity: From rootcauses to fair outcomes.Lancet, 370:1153-1163.
  29. 29. Section 3What is HIA?
  30. 30. A combination of procedures, methods and tools by which a policy, program or project may be assessed for its potential and often unanticipated effects on the health of the population and the distribution of these impacts within the population. Gothenburg Consensus PaperEuropean Centre for Health Policy (1999) Gothenburg Consensus Paper on Health ImpactAssessment: main concepts and suggested approach, WHO Europe: Brussels (adapted byMahoney & Morgan).
  31. 31. HIA is a developing approach that can help to identify and consider the potential - or actual - health impacts of a proposal on a population. Its primary output is a set of evidence-based recommendations geared to informing the decision making process. Taylor & QuigleyTaylor L, Quigley R. (2002) Health Impact Assessment: A review of reviews. London: NationalHealth Service, Health Development Agency.
  32. 32. Key Aspects of HIA• A prospective activity• Uses a combination of methods• Looks at intended and unintended impacts• Looks at the distribution of impacts• Results in evidence- informed recommendations
  33. 33. When is an HIA done?
  34. 34. Explicit Focus on the Distribution of Impacts1. Age2.Gender3.Socioeconomic status4.Location5.Ethnicity and culture6.Existing levels of health anddisability7..
  35. 35. Thinking about the distribution of impacts: Avoidability and fairness Lead exercise
  36. 36. Section 4Steps of HIA
  37. 37. The Steps of HIA• Screening• Scoping• Identification• Assessment• Decision-making and recommendations• Evaluation and follow-up•.
  38. 38. Assessment Recommendations If you These will be If you make These will beimplement the the impacts these changes the gains proposal
  39. 39. Where does health risk assessment (HRA) fit in?
  40. 40. HRA is a structured framework for assessing risks associated with environmental hazards (prospectively and retrospectively)
  41. 41. “The process of estimating the potentialimpact of a chemical, biological, physical orsocial agent on a specified human populationunder a specific set of conditions and for acertain time frame’ enHealth HRA Guidelines
  42. 42. Scoping ActivityMaster Plan for Cheonggyecheon, Seoul
  43. 43. First, get in your time machine –back to 2003
  44. 44. • Project timeline 2003 - 2005• US$900 million project
  45. 45. After Construction Now (2003)
  46. 46. • Proponent receptive to HIA, but must be completed in 5 months (mustn’t hold up construction!)• Proponent is Seoul City Government, who are reasonably convinced the proposal is a good idea• Proponent has asked that the HIA’s focus should be on improving proposal and tweaking, not suggesting new major initiatives or “vetoing” the initiative
  47. 47. Now (2003)
  48. 48. Now (2003)
  49. 49. Now (2003)
  50. 50. Now (2003)
  51. 51. After Construction
  52. 52. Brief video (if there’s time) thenGroup work – scoping exercise
  53. 53. So what happened?
  54. 54. Section 6Where did HIA come from?
  55. 55. Environmental health Social view of health EquityEach bring with them their own disciplinary beliefs, values, support base and baggage
  56. 56. HIA Health Equity Social View of Health Environmental Health Regulatory Environmental Impact Assessment Environmental Disasters1950s 1960s 1970s 1980s 1990s 2000s1956 Clean Air Act (UK) 1 1972 Lake Pedder Dam 1980 The Black Report 1990 Concepts & 2004 Equity Focused HIA controversy (UK) Principles of Equity Framework (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 Standards Environmental 1992 Asian Development Policy Act (USA) 1974 Lalonde Report Bank HIA (Canada) 1 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 2007 1st Asia-Pacific HIA Environmental and of Proposals) Act Conference 1986 Health IA (Australia) (Australia) (Australia) 1978 Seveso (Italy) 2007 HIA’s use included 1989 Exxon Valdez Oil 1997 Jakarta Declaration in Thailand’s Spill (USA) Constitution 1978 Love Canal (USA) 1998 Independent 1978 WHO Seminar on 2008 WHO Commission Inquiry into Environmental on the Social Inequalities in Health Impact Determinants of Health (UK) Assessment Health: Closing the (Greece) Gap in a 1998 Merseyside Generation Guidelines for HIA 1978 Declaration of 2009 Montara West Alma Ata 1998 The Solid Facts Atlas Oil Spill (Australia) 1979 Three Mile Island (USA) 1999 Gothenburg 2010Marmot Review Consensus Paper on HIA
  57. 57. Section 7What forms does it take?
  58. 58. There are currently four models of HIA being used internationally (to varying extents)
  59. 59. Mandated HIA generally occurs in the context of an EIA, IIA, or ESHIA and is done to meet a regulatory or statutory requirement
  60. 60. Example: Basslink Integrated IA
  61. 61. HIA for decision support is generally done voluntarily with the goal of improving decision-making and implementation
  62. 62. Example: Lower HunterRegional Strategy HIA
  63. 63. HIA for advocacy is usually undertaken by organisations who are neither the proponent or the decision-maker
  64. 64. Example: HIA of the NationalEmergency Response in the Northern Territory
  65. 65. Community empowerment HIAs are usually undertaken by communitieswhose health is likely to be affected by a proposal
  66. 66. Example: Goodooga Equity Focused HIA
  67. 67. Mandated Decision Support• If HIA is mandated the • If decision support forms process will have to be are pursued the process is more prescribed, more chaotic• standards of practice will (more of a process than a need to be described, methodology)• tighter definitions of • Less clarity about who will evidence that can be do it and where it might sit challenged in court will need within organisations to be determined,• accreditation of practitioners• Triggers will need to be clear• Clarification of the roles & responsibilities of proponents of government policy
  68. 68. Advocacy Community Empowerment• Seeks to reframe or • Difficulty: no control over challenge issue/proposal process or decisions• Requires a close link to • Community unlikely to be evidence to be credible bound by disciplinary• Hard to involve proponents traditions/evidence and decision-makers • Often linked to social• Who would do it routinely learning, i.e. changing is unclear understandings, enabling• Often seeks to bring in dialogue other evidence/only • Is a democratic and political selective evidence process, rather than a• May have an agenda – technocratic or rational need to be explicit about process this • May look quite different to other HIAs
  69. 69. This diversity is widespread and the challenges efforts to make HIA embedded in the policy development and decision making processExample: Lack of consensus about HIA from the National Public Health Partnership But also enables responsiveness to emerging issues
  70. 70. Section 8What type of things are HIAs done on?
  71. 71. Types of Health ImpactsHarris-Roxas B, Harris P. Learning by Doing: The value of case studies of healthimpact assessment. NSW Public Health Bulletin, 2007:161-163.
  72. 72. Increasingly also on:• Climate change (adaptation)• Transition-to-town issues (food miles, sustainability, etc)• Energy• Social programs and education•.
  73. 73. Section 9HIA Resources
  74. 74. HIA Blog healthimpactassessment.blogspot.co
  75. 75. HIA Connect
  76. 76. Section 10 Q&A
  77. 77. Section 11 HIA Exercise(If there’s time)
  78. 78. ASEAN HighwayWhat are the potential healthimpacts?What information could we useto assess these potentialimpacts?
  79. 79. These slides are available atwww.slideshare.net/benharrisroxas ben@harrisroxashealth.com @ben_hr or @hiablog healthimpactassessment.blogspot.com linkedin.com/in/benharrisroxas

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