What isHealth Impact Assessment?

University of Newcastle August 2012

Ben Harris-Roxas

www.harrisroxashealth.com

@ben_hr on Twitter

Section 1

Who am I?

I’ve been working on HA since 2003

Mainly throughsupporting and conducting HIAs

I consult and also teach atUNSW, UWS and Macquarie University

Trained more than 550 people in HIA

Active in international HIA community

IAIA Health Section Co-Chair

Section 2

What 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 the environmental causes of

disease=

dealing with most public health concerns

or does it?

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

sanitation voted the most

important medical

advance since 1840.

air, water and soil quality and

toxicity

disease vector control

waste management

Image: ŧĒđĠūŸ®

housing quality and

overcrowding

But the global burden of disease has shifted

Source: WHO Global Burden of Disease 2002Source: WHO Global Burden of Disease 2002

Much of this disease stillhas environmental causes

Many of the new causes of disease seemed to be different in nature to

traditional environmental health concerns

Under-considered factors that powerfully influence health

and health related behaviours

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

The causes of the causes?

Image: Supermietzi

Schroder S. (2007) We Can Do Better: Improving the health of the American people. New England Journal of Medicine, 357, 1221-1228.

What determines health?(A fuzzy pie chart)

Genetics10-25%

Risk Factors20-40%

Opportunities/ Socioeconomic

Status20-30%

Environment & Place5-15%

Health Services15-30%

Dahlgren G, Whitehead M. (1991) Policies and Strategies to Promote Social Equity in Health. Stockholm: Institute of Futures Studies.

The Social Determinants of Health• Stress• Early life• Social exclusion• Work• Unemployment • Social support • Addiction• Food • Transport• The social gradient in health• .

Barton H, Grant M. (2006) A Health Map for the Local Human Habitat. Journal of the Royal Society for the Promotion of Health, 126, 252-253.

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

Murphy M et al. (2006) The Widening Gap in Mortality by Educational Level in the Russian Federation, 1980-2001. American Journal of Public Health, 96:1293–99.

cited in

Marmot M. (2007) Achieving Health Equity: From root causes to fair outcomes. Lancet, 370:1153-1163.

Section 3

What is HIA?

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 Paper

European Centre for Health Policy (1999) Gothenburg Consensus Paper on Health Impact Assessment: main concepts and suggested approach, WHO Europe: Brussels (adapted by Mahoney & Morgan).

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 & Quigley

Taylor L, Quigley R. (2002) Health Impact Assessment: A review of reviews. London: National Health Service, Health Development Agency.

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

When is an HIA done?

Explicit Focus on the Distribution of Impacts

1. Age

2.Gender

3.Socioeconomic status

4.Location

5.Ethnicity and culture

6.Existing levels of health and disability

7..

Thinking about the distribution of impacts:Avoidability and fairness

Lead exercise

Section 4

Steps of HIA

The Steps of HIA

• Screening

• Scoping

• Identification

• Assessment

• Decision-making and recommendations

• Evaluation and follow-up

• .

If you implement the

proposal

These will be the impacts

If you make these changes

These will be the gains

Assessment Recommendations

Where does health risk assessment (HRA) fit in?

HRA is a structured framework for assessing risks associated with environmental hazards

(prospectively and retrospectively)

“The process of estimating the potential impact of a chemical, biological, physical or social agent on a specified human population under a specific set of conditions and for a certain time frame’

enHealth HRA Guidelines

Scoping Activity

Master 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 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

Now (2003)

Now (2003)

Now (2003)

Now (2003)

After Construction

Brief video (if there’s time)then

Group work – scoping exercise

So what happened?

Section 6

Where did HIA come from?

Environmental health

Social view of health

Equity

Each bring with them their own

disciplinary beliefs, values,

support base and baggage

1950s 1960s 1970s 1980s 1990s 2000sEnvironmental Disasters

Regulatory Environmental Impact Assessment

Environmental Health

Health EquityHIA

1956 Clean Air Act (UK)

1969 Santa Barbara Channel (USA)

1969 US National Environmental Policy Act (USA)

1978 Love Canal (USA)

1984 Bhopal (India)

1986 Ottawa Charter

1990 Concepts & Principles of Equity in Health

1997 Jakarta Declaration

1998 Independent Inquiry into Inequalities in Health (UK)

1999 Gothenburg Consensus Paper on HIA

2008 WHO Commission on the Social Determinants of Health: Closing the Gap in a Generation

Social View of Health

1972 Lake Pedder Dam controversy (Australia)

1974 Environmental Protection (Impact of Proposals) Act (Australia)

2005 Health included in IFC Performance Standards

1994 Framework for Environmental and Health IA (Australia)

2007 1st Asia-Pacific HIA Conference (Australia)

1978 Seveso (Italy)

1990 Environmental Protection Act (UK)

1980 The Black Report (UK)

1972 The Indian Wildlife (Protection) Act

1974 Lalonde Report (Canada)

1998 Merseyside Guidelines for HIA

1978 WHO Seminar on Environmental Health Impact Assessment (Greece)

2004 Equity Focused HIA Framework (Australia)

1978 Declaration of Alma Ata

1992 Asian Development Bank HIA Guidelines

1959 Minamata Bay (Japan) 1980 International

Association for Impact Assessment formed

1969 Cuyahoga River Fire (USA)

1962 Silent Spring

2007 HIA’s use included in Thailand’s Constitution

1998 The Solid Facts

1979 Three Mile Island (USA)

2005 Guide to HIA in the Oil and Gas Sector

1986 Chernobyl (Ukraine)

1989 Exxon Valdez Oil Spill (USA)

2009 Montara West Atlas Oil Spill (Australia)

2010Marmot Review

Section 7

What forms does it take?

There are currently four models ofHIA 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 statutory requirement

Example: Basslink Integrated IA

HIA for decision support is generally done voluntarily with the goal of improving decision-making and

implementation

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 National Emergency Response in the

Northern Territory

Community empowerment HIAs are usually undertaken by communities

whose health is likely to be affected by a proposal

Example: Goodooga EquityFocused HIA

Mandated Decision Support• If HIA is mandated the

process will have to be more prescribed,

• standards of practice will need to be described,

• tighter definitions of evidence that can be challenged in court will need to be determined,

• accreditation of practitioners• Triggers will need to be

clear• Clarification of the roles &

responsibilities of proponents of government policy

• If decision support forms are pursued the process is more chaotic(more of a process than a methodology)

• Less clarity about who will do it and where it might sit within organisations

Advocacy Community Empowerment

• Seeks to reframe or challenge issue/proposal

• Requires a close link to evidence to be credible

• Hard to involve proponents and decision-makers

• Who would do it routinely is unclear

• Often seeks to bring in other evidence/only selective evidence

• May have an agenda – need to be explicit about this

• Difficulty: no control over process or decisions

• Community unlikely to be bound by disciplinary traditions/evidence

• Often linked to social learning, i.e. changing understandings, enabling dialogue

• Is a democratic and political process, rather than a technocratic or rational process

• May look quite different to other HIAs

This diversity is widespread and the challenges efforts to make HIA embedded in the policy development and decision making process

Example: Lack of consensus about HIA from the National Public Health Partnership

But also enables responsiveness to emerging issues

Section 8

What type of things are HIAs done on?

Harris-Roxas B, Harris P. Learning by Doing: The value of case studies of health impact assessment. NSW Public Health Bulletin, 2007:161-163.

Types of Health Impacts

Increasingly also on:

• Climate change (adaptation)

• Transition-to-town issues (food miles, sustainability, etc)

• Energy

• Social programs and education

• .

Section 9

HIA Resources

HIA Blog

healthimpactassessment.blogspot.com

HIA Connect

www.hiaconnect.edu.au

Section 10

Q & A

Section 11

HIA Exercise(If there’s time)

ASEAN Highway

What are the potential health impacts?

What information could we use to assess these potential impacts?

ben@harrisroxashealth.com

@ben_hr or @hiablog

healthimpactassessment.blogspot.com

linkedin.com/in/benharrisroxas

These slides are available at

www.slideshare.net/benharrisroxas