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Plenary 5Chair: Owen Metcalf
Health Impact Assessment: Making the Difference
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Steve Cropper
Director, Research Institute for Public Policy and Management, Keele University
Health Impact Assessment: Making the Difference
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Community Involvement in Health Impact Assessment:
what’s the case?
Steve Cropper
Centre for Health Planning and Management
Research Institute for Public Policy and Management
Keele University
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HIA
• A means of ensuring that the health effects of any policies, programmes and projects are considered in the process of decision making
– Improve understanding – estimation of benefits and risks/harm arising– Identify potential actions to avoid negative effects and enhance positive
effects– Inform and influence decisions
• A ‘framework’into which evidence about impact can be placed and assessed
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Evidence
• Incomplete outcome sets• Uncertainty about the significance/value
placed on the outcomes identified• Incomplete understanding of pathways/ from
‘interventions’ to outcomes – theories of change
• Contest
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Status of HIA• ‘Point in time’ decision technology
– Propositional assessment
• ‘Means of adding to knowledge combining normative claims & evidentiary base
• Moral stance’ – questions about values– Risk society - limits to technocracy– Holistic conception of health
• Contribution to reparatory and democratising processes
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Status of ‘community’ in HIA
• Source of ‘evidence’ • Lay or ordinary knowledge• ‘’Local’ knowledge
• Guide and advisor
• Participant in decision
• Commissioner and conduit
Influence& Control
Informing value base of decision
Au M. Rein
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Lay or Ordinary Knowledge
• Knowledge that does not owe its origin, testing, degree of verification, truth status or currency to distinctive science techniques, but rather to common sense, casual empiricism, or thoughtful speculation and analysis.
Lindblom and Cohen (1979: 11)
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Local Knowledge
• Cultural rather than ‘simple truth’ & ‘plain fact’– Not just using eyes and ears, but using them
judiciously, intelligently, perceptively– A basis for making one’s way
• Addressing everyday problems in an everyday way (Geertz)
– Principles interpreted in lived context– Stories of contrast – here and there; then and now; us
and them– Ad hoc, but full of propositional knowledge too
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The Pool
….it brought life into that bit of the area because it was lit up..the whole place had an aura about it... But now you go up there, you’ve nae light, the building is dim the weans have smashed whatever lights hanging about, it’s dreary, it’s frightening, that’s how the shops are shutting because naebody is there at night whereas when the baths were opened at night it lit the whole area up”
Quote in Thomson, Kearns & Petticrew (2003)
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1 close swimmingpool ... open
swimming pool
2 sense of personalsafety in public
spaces
3 closure of otheramenities
4 changingappearance of the
area
5 attractiveness ofthe area
6 nae light ...area lit up
7 loss of life inthe area ... lifebrought into the
area
8 weans smashwhatever lights
9 shops are shutting
10 naebody is thereat night
11 nae reason foranybody to go up
there
12 emphasise scaleof under-investment
13 symbolic of widerarea decline
14 positiverelatinship betweenhealth and context
independent ofparticipation ref 14
-
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How can/do the views of local people add to understanding?
• Validate AND add to the set of impacts understood to arise from the policy/ programme/project
• Inform understanding of the significance of these impacts to and within the community
• Provide pathways knowledge – how will policy take effect
• Incorporation within/fusion with other evidence
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Two knowledge dynamics
HIA
CurrentDecision
HIA
HIA
Evidence Base
Future decisions
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What does HIA ‘give back’: cautions
• The prospectus – a chance to inform and influence - – community expectations: relationships to current, near
and far decisions
• Respect and admission of uncertainty: exposure - policy/programme (and ‘levers’ available to decisions makers) not always clear, defined –
• Community ‘capacity’– boundaries and legitimacy –
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Participation – political virtue
“How can citizens so disillusioned … become engaged in debate about future guiding values? Is it possible to use institutional design processes to break out of Putnam’s vicious circle of distrust, disengagement and weak democracy?”
Vivien Lowndes and David Wilson (2000)
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HIA and deliberative action
• “Community development therefore has to be propositional as well as oppositional….
– to help local groups to decide what they are for, not just what they are against. …
– to identify and develop the common interests within communities. … [and]
– to link local government in to these complex grassroots communities.”
(Benington: 1997: 239-40)
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Concluding Thoughts
• HIA as impure’ science– Value critical policy analysis/impact assessment
• Experiential and abstract knowledge• Fact and value• Thick description and interpretation as much as estimation
• Democratise policy/technological design and practice– HIA as start or catalyst to dialogue – beneficial in its own
right
• Insider..outsider strategies
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Anthea Cooke
Director, Inukshuk Consultancy
Health Impact Assessment: Making the Difference
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HIA & Community Participation – more trouble than worth?
Anthea CookeDirector – Inukshuk Consultancy, Specialist
HIA Advisor London Health Observatory
Inukshuk
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Inukshuk
More trouble than worth?
• What does the theory tell us?
• More trouble….?
• Case study
• Learning the lessons….
• Challenges…
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• Provides information about proposal to those affected
Inukshuk
Why do it?
• Improves quality of assessment by ensuring potential health impacts identified will match local experience
• Provides opportunities for stakeholders to express and consider concerns
• Can help manage expectations and misconceptions• Improves quality of final decision as local needs can be reflected and tailor made response
developed
• Affirms transparency of process by opening to public scrutiny
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Inukshuk
More trouble?• We’ve already said what we think – no-one’s listened before?
• You’ll only get the ‘usual subjects’ – representation
• It’s only ‘their’ opinions – we know what the evidence says works
• Hierarchy of evidence
• How can we can quantify impacts from people’s opinions?• Methods for collecting and appraising community evidence are patchy and not well
documented
• **** off you middle class white consultant – we can do this work ourselves…
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HIA as part of Masterplan for estate of approx 4,000 households, very disaffected community, partnership working with health broken down & health weakest aspect of a ‘failing’ NDC
• Community profile – revised the baseline• Scoped the HIA priorities with ‘stakeholder workshop’• Literature search on effectiveness of interventions• Tacked health into existing consultation rather than
separate process• Reviewed previous consultation documents• Steering group members made links with groups not previously consulted and interviews, visits & questionnaires using consistent methodology• Steering group workshop to prioritise
recommendations Inukshuk
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Inukshuk
Outcomes of HIA re Community participation?
• Agreed set of priorities for NDC and partners on health
and wellbeing
• Masterplan clearer about importance of transport,
service facilities, access to food & exercise opportunities
• Kick starting of renewed partnership with health and NDC• Steering group became NDC health planning group with
improved resident participation, health and local authority
• NDC 5 year Delivery Plan (health) now based on findings
of HIA, & influenced other parts such as Employment and Crime
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• Use systematic methods – not always easy when need different approaches
Inukshuk
Learning the lessons• Screening and scoping is essential – be clear whose evidence you need, why and status of
this, build on what is already known or collected
• Need to have policy makers on board from the beginning and to be able to demonstrate to people that it is worth getting involved
• Be willing to seek to give voice and value to those who are potentially affected by the proposed policy or programme
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Inukshuk
Learning the lessons• Realistic timescales – this work takes time and resources
• Better to focus on smaller number of projects and to base community participation on these as it makes it more real for the community
• Open and transparent process which recognizes it is a two way learning process, integrity crucial
• Develop a sustainable partnership with the communities involved – be clear how the work will go forward
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Inukshuk
Challenges to conference…• Is community participation in HIA more about community development than gathering
evidence – does it matter?
• How do we do community participation when the impacts of proposal are likely to be negative?
• How can we build credibility for qualitative evidence gathering with limited resources, time and credibility?
• Where is the funding to develop the methods?
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7th International Health Impact Assessment
Conference
Health Impact Assessment: Making the Difference
Supported by: