Health Impact Assessment--and beyond

A health impact assessment of the 2014 Commonwealth Games in Glasgow

OBJECTIVE

To influence the planning of the 2014 Commonwealth Games such that the positive impacts are maximized and the negative impacts are mitigated.

STUDY DESIGN

Participatory health impact assessment (HIA).

METHODS

A participatory HIA was performed using standard World Health Organization methods. A scoping event was held to involve decision makers in the process and to identify the key areas for consideration. A large community engagement exercise and a systematic review were conducted as part of the evidence-gathering phase. The results of the HIA were reported to the key decision makers involved in the Glasgow City Council legacy strategy.

RESULTS

The likely net health impact of hosting the Commonwealth Games was uncertain. It was suggested that the main mechanisms through which impacts were likely to be felt were: the economy; civic pride; engagement in decision making; the provision of new infrastructure; and participation in cultural events. A series of recommendations was produced in order to maximize positive health benefits and mitigate negative impacts.

CONCLUSIONS

HIA is a useful tool for engaging communities and decision makers in the public health agenda. HIAs of major multi-sport events are limited by a lack of quality evidence and the inability to predict impacts reliably.

Developing public sociology through health impact assessment

The renewed interest in 'public sociology' has sparked debate and discussion about forms of sociological work and their relationship to the State and civil society. Medical sociologists are accustomed to engaging with a range of publics and audiences inside and outside universities and are in a position to make an informed contribution to this debate. This paper describes how some of the debates about sociological work are played out through a 'health impact assessment' of a proposed housing renewal in a former coal mining community. We explore the dynamics of the health impact assessment process and relate it to wider debates, current in the social sciences, on the 'new knowledge spaces' within which contentious public issues are now being discussed, and the nature of different forms of expertise. The role of the 'public sociologist' in mediating the relationships between the accounts and interpretations of lay participants and the published 'evidence' is described as a process of mutual learning between publics, professionals and social scientists. It is argued that the continued existence and development of any meaningful 'professional sociology' requires an openness to a 'public sociology' which recognises and responds to new spaces of knowledge production.

A review of health impact assessment frameworks

BACKGROUND

Consideration of health impacts of non-health sector policies has been encouraged in many countries, with health impact assessment (HIA) increasingly used worldwide for this purpose. HIA aims to assess the potential impacts of a proposal and make recommendations to improve the potential health outcomes and minimize inequalities. Although many of the same techniques can be used, such as community consultation, engagement or profiling, HIA differs from other community health approaches in its starting point, purpose and relationship to interventions. Many frameworks have been produced to aid practitioners in conducting HIA.

OBJECTIVE

To review the many HIA frameworks in a systematic and comparative way.

STUDY DESIGN

Systematic review.

METHOD

The literature was searched to identify published frameworks giving sufficient guidance for those with the necessary skills to be able to undertake an HIA.

RESULTS

Approaches to HIA reflect their origins, particularly those derived from Environmental Impact Assessment (EIA). Early HIA resources tended to use a biomedical model of health and examine projects. Later developments were designed for use with policy proposals, and tended to use a socio-economic or environmental model of health. There are more similarities than differences in approaches to HIA, with convergence over time, such as the distinction between 'narrow' and 'broad' focus HIA disappearing. Consideration of health disparities is integral to most HIA frameworks but not universal. A few resources focus solely on inequalities. The extent of community participation advocated varies considerably.

CONCLUSION

It is important to select an HIA framework designed for a comparable context, level of proposal and available resources.

Criteria for use in the evaluation of health impact assessments

This paper reports the conclusions of a recent workshop that was established to discuss how health impact assessments (HIAs) might be evaluated. The main purposes of HIA are: (a) to predict the consequences of different decisions; (b) to make the decision-making process more open by involving stakeholders; and (c) to inform the decision makers. 'Prediction', 'participation' and 'informing decision makers' are thus the three domains in which HIA should be evaluated. In the 'prediction' domain, process criteria scrutinize the methods used to see if it is likely that they would produce reliable predictions. Outcome criteria involve verifying the predictions, but this is frequently impractical and predictions for the counter factual (the option not chosen) can never be verified. In the 'participation' domain, process criteria examine the ways in which stakeholders were involved, while outcome criteria explore the degree to which the stakeholders felt included. In the 'informing decision makers' domain, process criteria are concerned with the communication between decision makers and those doing the HIA, and should reflect upon the relevance of the HIA content to the decision makers' agenda. Outcome criteria explore the degree to which the decision makers considered that they had been informed by the HIA. This paper concludes with suggestions for the types of information that should be included in HIA reports in order to permit the readers to make an assessment of the 'quality' of the HIA using the three domain criteria outlined above.

Health impact assessment of housing improvements: incorporating research evidence

BACKGROUND

Health impact assessment (HIA) has been widely recommended for future social policies and investment, such as housing improvement. However, concerns have been raised about the utility and predictive value of an HIA. Use of existing research data would add more weight to forecasts by an HIA. METHODS, RESULTS, and

CONCLUSIONS

A recent systematic review of housing intervention studies found a lack of research. The authors recommended that a broader evidence base would be needed to support HIA. In response to consultation with policymakers and HIA practitioners this paper presents a way in which research can be used to inform HIA. Based on the systematic review, the authors have developed a table of synthesised findings indicating the expected health effects of specific housing improvements. The authors also reviewed observational data of housing associated health risks to highlight the key impacts to consider when doing a housing HIA. The findings are presented and the authors discuss how they should be used to inform evidence based housing HIA. In addition to considering the existing research, HIA must consider the local relevance of research. Consultation with local stakeholders also needs to be incorporated to the final assessment. The lack of data and the difficulties in gathering and reviewing data mean that not all HIAs will be able to be informed by research evidence. Well conducted prospective validation of HIAs would contribute to the development of healthy housing investment by informing future housing HIA.

A framework for the evidence base to support Health Impact Assessment

OBJECTIVE

To introduce a conceptual structure that can be used to organise the evidence base for Health Impact Assessment (HIA).

BACKGROUND

HIA can be used to judge the potential health effects of a policy, programme or project on a population, and the distribution of those effects. Progress has been made in incorporating HIA into routine practice, especially (in the UK) at local level. However, these advances have mainly been restricted to process issues, including policy engagement and community involvement, while the evidence base has been relatively neglected. RELATING POLICIES TO THEIR IMPACT ON HEALTH: The key distinctive feature of HIA is that determinants of health are not taken as given, but rather as factors that themselves have determinants. Nine ways are distinguished in which evidence on health and its determinants can be related to policy, and examples are given from the literature. The most complete of these is an analysis of health effects in the context of a comparison of options. A simple model, the policy/risk assessment model (PRAM), is introduced as a framework that relates changes in levels of exposures or other risk factors to changes in health status. This approach allows a distinction to be made between the technical process of HIA and the political process of decision making, which involves lines of accountability. Extension of the PRAM model to complex policy areas and its adaptation to non-quantitative examples are discussed. ISSUES FOR THE FUTURE: A sound evidence base is essential to the long term reputation of HIA. Research gaps are discussed, especially the need for evidence connecting policy options with changes in determinants of health. It is proposed that policy options could be considered as "exposure" variables in research. The methodology needs to be developed in the course of work on specific issues, concentrated in policy areas that are relatively tractable.

CONCLUSIONS

A system of coordination needs to be established, at national or supranational level, building on existing initiatives. The framework suggested in this paper can be used to collate and evaluate what is already known, both to identify gaps where research is required and to enable an informed judgement to be made about the potential health impacts of policy options. These judgements should be made widely available for policy makers and for those undertaking health impact assessment.