7th international health impact assessment conference health impact assessment: making the...

7th International Health Impact Assessment

Conference

Health Impact Assessment: Making the Difference

Supported by:

Plenary 3Chair: Stephen Palmer



Conference


Supported by:

First MinisterRt. Hon Rhodri Morgan

Welsh Assembly Government



Conference


Supported by:

Meri Koivusalo

Researcher, National Research and Development Centre for Health (STAKES),

Helsinki, Finland


National Research and Development Centre for Welfare and Health

Knowledge for welfare and health

Health impact assessment and Health in all policies – Finnish experiences and policy issues

Meri KoivusaloSTAKES



HiAP and HIA – the Finnish policy context

Health in all policies (HiAP) - a broad approach to integrating health in all policies which incorporates methods such as health impact assessment (HIA)

HiAP is grounded in a tradition of active public health policies, population-based measures and “healthy public policies”

Long history in Finland North Carelia project and focus on diet and cardiovascular diseases Public policies to change work-place and school diets Influencing pricing and consumer choice towards healthier products and tackling the

current “pizza epidemic”

Administrative tradition of supporting intersectoral consultation, but HiAP generally has to operate in a more contested environment



Health impact assessment

Since 1994 part of statutory environmental impact assessment (EIA) procedures

EIA defined broadly and also covers human health and social impacts

Human impact assessment integrates health and social impact assessments (www.stakes.fi/sva/huia/)

HIA mostly implemented at project and local level

http://www.stakes.fi/sva/huia/




HIA as part of public health programme HEALTH 2015

Commitments to develop and implement HIA Health impacts of other sectoral policies are assessed every fourth year as part of the public health report Commitment to guidance for action on HIA at the level of policies and decisionsResources for Finnish Ministry of Social Affairs and Health to develop and maintain HIA related activities Commitment to enhancing HIA at local level in municipalities and within business



HIA & HIAP – politics, policies and practice

HIA supported, but has limited institutional strength

National level action constrained Decentralisation of administration and independence of municipalities Increasing importance of European level priorities and commercial

policies

Complexity of HIA decisions on nuclear power and departure from environmental policy aims with respect to dioxin levels in Baltic herring Overall policy priorities do not seem to be geared towards healthy public policies, but are more driven by the quest towards innovation and competitiveness

Health care dominates health policy debates Overall productivity aims aimed to diminish size and functions of public

administration



European Union and HIAFinnish longer term aim to emphasise the role and relevance of HiAP approach as part of European Union public health strategy

European Union policies are used to promote the importance of the HiAP approach and HIA in the context of national policies

New debate and discussion in the context of the proposed Constitutional Treaty and health systems

Impact of EU policies felt in relation to required changes in alcohol policies and taxation



Health in All Policies

A special Finnish presidency theme in health

Opens a political window of opportunity at European level

Increasing concerns over not just the health impacts of other policies but health system impacts, and in particular internal markets, trade and interpreting the four freedoms within European Union



Health in All Policies and the EU

HiAP conference 20-21.9.2006 and a book on HiAP High level Expert Conference Plenaries to take up also HIA issues and work

Six preliminary workshops - Health inequalities- Nutrition, physical activity and major diseases- Health targeted alcohol policy- Transport policy and health & planning- Mental Health

Expected outcomes: Draft conclusion on HiAP for European Commission policies and Member State activities

Conclusions for adoption by the Ministerial Council



HIA and European UnionHow to influence the ways in which impact assessment is implemented in EU?

Is a bad HIA process better than no process? Opportunities for stakeholder lobbying prior to policy debate

The importance of impacts on health systems and regulatory measures of governments to promote and protect health being raised at European Union level



The Paradox and Potential of HIA

Institutionalisation of knowledge and practice of HIA remains a challenge in Finland

The promise of HIA is still greater than the practice

The quality and implementation of HIA varies at local and project level

Future prospects depend on the realisation of existing commitments

Potential for gains from strengthening the European dimension of work, training and action



HIA as an aid to Policy Making Should we more effectively use the legislative and policy-making potential of HIA

To support an emphasis on broader social determinants of health To support health systems impact assessment

HIA could be seen as mechanism for promoting transparency, debate and active policy-making

Moving from an emphasis on win-win to a method for challenging conflicting policy aims between sectors and creating space for health arguments

Limiting free movement of advertisements Regulation and use of pricing mechanisms to guide consumption



HIA in Finland

Human impact assessment website: www.stakes.fi/sva/huia/

HUIA: [email protected]

Health Inequalities: [email protected]

Health 2015 programme: [email protected] Website: www.terveys2015.fi/english.html

Health in all Policies (HiAP) presidency from 31.05.2005

Official web-site: www.eu2006.fi


mailto:[email protected]



http://www.terveys2015.fi/english.html

http://www.eu2006.fi/


Conference


Supported by:

Clemence Dallaire

Associate Professor, Faculty of Nursing, Universite Laval, Canada


Health Impact Assessment Québec’s experience

Clémence Dallaire, Laval U, Geneviève Hamel, MSSSGeneviève Lapointe, INSPQ

Québec

Population (2004) :

7,5 millions hab. Territory : 1,7 million km2

Province in a confederation Federal health law with 5 principles

Fiscal money transfert

Health: provincial jurisdiction Provincial health law Ministry of Health and Social Services

Public Health within Québec's Health and Social Services System

18 regional agencies/ PHRA

Hospitals Health and social services centers

Minister

Ministry of Health and Social Services

NPHD/ADM

Administratives (RAMQ)

Councils

National Public Health Institute

Public Health Law (2001)

Putting in place the conditions for public health main functions • Protection

• Promotion

• Prevention

• Surveillance

Divide responsabilities between national, regional and local level

Legal framework to act on public policy

three articles: 53-54-55

Québec Public Health Act Article 54

« The Minister is by virtue of his or her office the advisor of the Government on any public health issue. The Minister shall give the other ministers any advice he or she considers advisable for health promotion and the adoption of policies capable of fostering the enhancement of the health and welfare of the population.

In the Minister's capacity as government advisor, the Minister shall be consulted in relation to the development of the measures provided for in an Act or regulation that could have significant impact on the health of the population. »

Application strategies Intra-gouvernmental HIA process

NIPHQ: expertise Research

NIPHQ

Health & WelfareMinistry

Health & WelfareMinistry

Ministries

Executive Council

Ministers Council

GÉPPS

Research

1

1’

3

2

1

2

3

… …

Intra-gouvernmental HIA process

MHSS

What has been done to implement and to apply article 54 since 2002 ?

Elaboration of practical guide and tools for HIA A network of interministerials respondents

Horizontal mechanism to mobilize partners within Health ministry

1

Since 2002, it appears that

The other ministry's preoccupation with HIA differ: • along social or economic mission

Little use of the tools produced

Consultation if any • towards the end of the policy decision making process

• Consultation on very short notice

(ENAP, 2003; MSSS, 2005)

Executive Council : act as a security net

3 permanent ministerials committee social, economic and regional

The ministerial committee of social development: make sure that the best process to support decision making are used

93% of the demand for consultation to the Health ministery (62/67) during 2005 were send by the Executive Council in about half of those, there has been informal consultation between civil servants of different Ministries and the Health Ministry

At the very end of the process: security net

1’

Overview of the decision–making process

LegislativeAssembly

Council

of

Minister

ministerials

Committee

Minister

of Health

Elaboration of laws, regulation or program

Minister's power

Brief to C of M

Analysis Decision to proceed

Autorization to send it to Legislative Assembly

Analysis in

Parliamentary

commission

AdoptionRecomman-dations to

C of M

1st step 2nd step 3rd step

NIPHQNIPHQ

Health Ministry

other ministries

Executive Council

Council of Ministers

GÉPPS

Research

… …

MHSS and NIPHQ

• Produce synthesis of public policies and brief for the Health Minister

• To facilitate access to expertise and scientific knowledge repertoire of experts conference and scientific meetings Data Base

Web site: Portail

2

Portail Politiques publiques et santé

Launched in november 2004

Veille : 750 information sources

Content and utilization :- Visitors : 2 000 /month- Bimonthly bulletin ( 30 issues + 400 subscribers)- Publications database (800 items)

· Health determinants and risk factors · Healthy public policy · HIA

- Links (26 sites)- List of ressources (under development )

- http://politiquespubliques.inspq.qc.ca

Beyond article 54

NPHIQNPHIQ

National Collaborative Center on Public Policy and Risk Assessment

1 of 6 Canadian Centers in a newly established Public Health Network

Based on Quebec's experience

• Policy and knowledge transfert

• Pan canadian and international networking:

research , knowledge transfert, healthy public policy and HIA

CCN-PR

CCN-PR

NIPHQ

Health Ministry

Other ministries

Executive Council

Council of Minister

GÉPPS

ResearchResearch

… …

Research

Objectives

• To increase research and expertise capacity • To support tools development for HIA• To support knowledge transfert to policy makers

Exemples: GÉPSS

Concours projet: politiques publiques / saines habitudes de vie

3

GÉPPS - Program of research

To increase understanding of the healthy public policy process

To increase understanding of ethical and analytical issues related to healthy public policy process

To develop and implement a strategy of knowledge transfert and utilization that support healthy public policy process

To test new processes and tools for knowledge transfert and utilization

Axes de recherche

1) Decision-making process of a subsystem of public policy

(Sabatier,1999)

2) Prospective evaluation process of public policy

3) Transfert and knowledge utilization process

Program of research : 6 projects

s Projects Objectives

1-2-3 1. Collaborative reseach and partnership

4

1-2-3 2. Litterature review 1-2-3

1 3. Analysis of public policy subsystem

2

1-2 4. Analysis of policy-makers and decision-makers's values and beliefs

1

2 5. Analysis of HIA experiences and policy transfer

1

2-3 6. Integration of a prospective assessment process

3-4

What's next ?

Common goal To ensure an evidence-based policy decision-making process

How?

By developing useful knowledge on policy-making and by using knowledge on health determinants

By sharing this knowledge with policy-makers

By supporting the HIA process within Ministries and Organisms

THANK YOU


Conference


Supported by:

MORNINGCOFFEE



Conference


Supported by:

Plenary 4Chair: Alex Scott-Samuel



Conference


Supported by:

Beverlea Frowen

Head of Health, Social Care and Well Being, Welsh Local Government Association


Beverlea Frowen

DirectorSocial Services and Health Improvement

The Dragon’s Health: Breathing new life

Welsh Reflections on Healthy Public Policy

• Policy landscape• Key Drivers for Health Improvement• What Local Government is doing• Opportunities for the future

Policy Landscape

1.Twin Track approach- strong recognition of the value of ‘prevention’ and Local Governments role

2.Statutory duty to co-operate between NHS and LG

3.Public Sector collaboration not competition

Where has local government has come from..

Punch, 1852

• Wales: A Better Country

−“health & wealth creation at the heart of policy making”

• Health Challenge Wales

−Themes AND ‘any/every thing’ else

• Health, Social Care & Well-being Strategies

−Rebalancing prevention/promotion and treatment/care

• WLGA Approach

−Principles for health improvement and a support team

Policy & Structures at work…

Key actions progressing the agenda

• A new language for local government- creating the right environment

• Making the agenda more manageable

• Dedicated Health & Well-being Team

• Jointly launched HIA guidance in Nov ‘04

• Route to Health Improvement – May ‘06

The Route to Health Improvement

An organisational development package based on Five Key Features of a Health Improving Council

Health improvement is an integral part of all Council’s activity

1. Corporate Culture

2. Policy Development supports the core commitment to improve health

3. Collaboration brings added value to the

health improvement effort

4. Capacity totake forward theagenda is strengthened

5. Governance andPerformance Management

ensures healthy public policy

Keeping it simple – a new language

Life Circumstance

s

LifestyleShared Care

Improving & safeguarding the health of the most vulnerable people in society

Tackling the economic, social & environmental issues that impact on well-being

Encouraging & supporting

healthy attitudes and behaviour

Source: WLGA Route to Health Improvement.

HIA in ‘The Route toHealth Improvement’

“Health Impact Assessment…is used appropriately as part of

policy and decision making processes and in doing so builds partnerships

and fosters greater awareness of the collective impact of our actions”

Making linkages and learning

• Electronic database of notable practice• Self assessment framework and matrix of

three thresholds of status• Spearhead sites (building on learning zone

concept)• Stronger links to community planning• International network of collaborative

effort??

Three levels of preparedness

• Capacity - Leading the way..

• Members use community leadership role to drive health improvement

• Workforce and development planning focuses on health improvement

• Employees across the organisation have the appropriate knowledge, skills & attitudes for health improvement

-‘We don’t do health’


• Capacity – Getting there..• Awareness growing of potential to use

community leadership role

• Some employees in key positions understand the issues

• Health improvement is a side issue amongst roles and responsibilities and work force recruitment


• Capacity – Starting out..

• The community leadership role and community planning needs further development

• Health not a feature of organisational ‘psyche’

• Dominance of NHS to lead agenda

Where next for healthy public policy in Wales?

Councils acknowledged by all as health improvement agencies and in doing

so they are maximising the full potential of their roles and

resources

In the horizon

• Beecham Review

• Local Government white paper

• Changing relationships betweenCentral and Local Government

• NHS secondary care reforms

• New Funding regimes

The following have the potential to enhance our efforts or put the skids on some of it!

A final observation…

“inequalities in health are the most fundamental inequalities of all there is no greater inequality than being dead and being alive” Frank Dobson

Thank you for listening have a good second day and good luck with your efforts!

[email protected]

Beverlea FrowenDirector,

Social Services & Health Improvement


Conference


Supported by:

Mary Mahoney

Senior Lecturer and Coordinator, Deakin University, Australia


‘When all the ducks line up’ Healthy Public Policy in Victoria

Mary Mahoney, Coordinator

This presentation will…

Map the territory – healthy public policy in

Victoria and the role of HIA

Introduce the context specific drivers for HIA

Model the attributes for ‘sustainable HIA’

Explore the threats to ‘the ducks’

Mapping – the political scene

3 levels of government - federal, state and local each with differing responsibilities

Each state and territory differs so it is not possible to generalise between states

Federal government is liberal (i.e. conservative), and all states are Labor

Local government in Victoria - amalgamations in 1993 moving from 210 to 79

Mapping – Origins of Impact Assessment

Project-focused Impact Assessment Prediction of impacts of a proposed development on the environment with social and health IA as integral processes

Origins: EIA → SIA → EHIA → Policy applications

Strategic planning and policy makingTypes: PIA + SEA + (P)HIA

Discrete applications IA types used for different purposes and driven by different needs in each context

Examples: SIA in LG

Mapping - Victorian policy context

State government level: All government agendas must reflect the Triple

Bottom Line principles of economic, environmental, social accountability

Whole of government focus on spatial disadvantage and health inequalities through Neighbourhood Renewal program

Increased emphasis on the social through A Fairer Victoria framework and the new state government Department of Victorian Communities.


State level legislative requirement The Environment Effects Act (1978) for

the Department of Human Services to review all Works Approvals to ensure that public health is not endangered by any proposal. If DHS objects to the application Environment Protection Agency must refuse the application.


Local government level: Health Act (1958) legislated a requirement for all

council to produce Municipal Public Health Plans (MPHP)

Local Government Act (2003) requires Council Plans to be prepared focused on the quality, sustainability, prosperity

Planning and Environment Act 1987 requires Municipal Strategic Statements linked to objectives for land use and development

Mapping - Supportive partnerships

Key partnerships between Government departments e.g. housing, public health,

infrastructure, sustainability and environment VicHealth Planning Institute of Australia (PIA) Municipal Association (MAV) Local government association (VLGA) Heart Foundation Cancer Council Victorian Council of Social Services

Mapping – supportive frameworks

Environments for Health Planning Framework - A practical guide to assist in the integration of

public health considerations into council’s broader planning responsibilities

Underpinned by principles of leading communities to better health and environmental dimensions of health i.e. built, social, economic and natural environments

Mapping – supportive frameworks

Other examples Leading the Way

introducing the social model of health to councillors Healthy by Design

resource for planners for designing liveable and healthy communities

VicLanes resource for LG on people’s health promoting behaviour by

location Safer by Design Guidelines

planning and design of safer communities Good practice funding

to support elements of MPHPs

Mapping - Implications for HIA

Status quo +: enhancing HIA in EIA but adding a specific HIA protocol developed and assessed by health sector

Checklist approach: specialist HIA using equity audits, RIS approaches and rapid appraisals

Strategic placement of HIA in decision-making: high level applications across government

Combined approaches: incorporating A, B & C Human or Sustainability: new whole of government

application with multiple methodologies (Source: HIA Forum, Melbourne, 2002)

Drivers for HIA – important features

In seeking to introduce HIA it was important to exploit all opportunities for formal mechanisms to

address the role of health in development argue for legislative status capitalise on existing strengths within the system build on existing goodwill, informal networks,

champions, community concerns, and changes occurring

develop a common agreement about language build on current guidelines to produce comprehensive,

well supported processes for all to use urge for improved access to evidence

Context specific drivers for HIA

Ranging from formal to less formal including: the need to comply with formally-required

processes the growing imperative to take health into

account in planning a growing awareness of the complexity of the

problems and the need for diverse solutions the growing awareness of the need to work

together Awareness of gaps within existing approaches

Context specific drivers cont’d

Comparisons between councils/departments Innovative practices emerging from within

government which provided examples for others

Availability of resources to support and encourage change (and dissemination)

Publicity about the potential role of HIA (timely, accessible, relevant and flexible)

Impetus to regenerate other forms of HIA in the light of new enthusiasm about its use in policy contexts

Progress in Victoria

Ministerial push for expanding HIA in Review of Health Act

Inclusion in further roll out of Neighbourhood Renewal programs

Funding for capacity building and demonstration projects across the state

Use in non-health sector and health care services

Integrated options under discussion Funded positions within government ‘Grass roots’ interest and commitment

Attributes for an effective and sustained use of HIA in HPP

Supportive agendas of government √

Appropriate organisational structures √

Realistic legislative requirements √

Enabling planning frameworks √

Willingness to adopt a social model of health √

Preparedness to adopt innovative approaches to planning √

Commitment by professionals to principles of HPP √

Desire to create a different future for the population through flexible policy and planning processes

√

Opportunities for intersectoral working across government √

In the Victorian context

It has been crucial to blend top-down support with bottom-up impetus, capacity building and driving

It has been less important to have legislative requirements than grass roots acceptance of the need for HIA and the value it can bring to current working practices

Threats to the ducks

HIA turning into a passing fad HIA seen as panacea delivering more than it can Unrealistic expectations about how quickly a new

process can be introduced HIA as an idea not an action Change of focus of the state government

With thanks …

for the chance to tell this story and close the loop to the key people who have guided our development to the people who have made available key papers,

and reports or developed websites which have permitted a sharing of knowledge

for the collegiality within the HIA network

So overall what does the Victorian situation actually look like?


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Supported by:

LUNCHPlease ensure that you return to your chosen workshop or session by 1.15 pm



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Supported by:

7th international health impact assessment conference health impact assessment: making the...

Documents

public health programme

human health

health stakes

hia health impacts

healthhealth impact

finnish policy context

level of policies

social impact assessments