Introducing Health Impact Assessment: an analysis of political and administrative intersectoral working methods

BACKGROUND: Intersectoral Action for Health (IAH) and its Health Impact Assessment (HIA) tool are built on collaboration between actors and sectors, requiring multidimensional and horizontal way of working. The study aims to analyse the enablers and barriers when such a new way of working and tool have been initiated to replace a traditional, vertical operation at the local level in Slovakia-a country in transition-in 2004. METHODS: Up to date, there are few studies that have analysed intersectoral initiatives in relation to politics. In this study the conceptual framework of Kingdon has been used by which the actual problems, the governmental actions (or non-actions) (politics) and the understanding, implementation and evaluation of the initiative (policy) could be analysed. All actors involved, civil servants, politicians, representatives of the local public health institute and researchers, were interviewed and made to answer a questionnaire. RESULTS: The results showed that there were a number of factors behind the initiation of HIA, which either delayed or accelerated the process. The problems identified were e.g. the prevailing traditional health care focus and the deteriorating health status of the population. There was a lack of multi-intersectoral knowledge, co-operation and function between sectors and actors. Enablers on the other hand were the membership of international organizations which called for new solutions, and the strong political commitment and belief that intersectorality would have a positive effect on health. CONCLUSION: The actors on the local level would have the capacity to work intersectorally to bring about policy change if HIA was to be more supported/institutionalized.     

国际健康影响评价的制度建设：从政策到法律

健康影响评价来源于环境影响评价，“健康的公共政策”运动促进其进一步发展。世界各国的健康影响评价工作主要由公共卫生部门、非政府组织或者国际组织主导，应用于政策、规划和项目三个层面，以系统地评价其带来的潜在健康风险。健康影响评价广泛涉及环境、产业、社会以及城市化等多种领域，是一种多学科、跨部门的影响评价工具。健康影响评价按时间顺序分为前瞻性健康影响评价、回顾性健康影响评价和和即时性健康影响评价。从国际经验来看，健康影响评价立法大致分为三类：一是国家宪法先行，如泰国。二是地方立法先行，如加拿大和澳大利亚。三是环境影响评价立法中包含健康影响评价的条款，这是美国等世界大部分国家通行的一种健康影响评价立法方式。建议我国健康影响评价立法，可以针对国家可持续发展议程创新示范区、高风险行业如火电等行业、重大影响的项目、规划或者政策开展。     

Concepts and theory of health impact assessment

Health effects are often overlooked in the planning of policies, programmes or projects, which has led to international and national pressure for evaluation of potential influence. For this reason, Health Impact Assessment (HIA) has been emphasized by many national governments and international organizations such as the European Union and WHO. HIA is a helpful decision-making tool with methodology that was defined as "a combination of procedures, methods, and tools by which a policy, a program or a project may be judged as to its potential effects on health of a population and the distribution of effects within the population" in the WHO Gothenburg paper. In recent decades, many HIAs have been implemented for proposals including building new airports, dams, employment strategy, and housing policy. However, there is very little information on HIA in Japan, even among public health professionals and policy makers. In this review, we introduce basic concepts and theory, and discuss how to improve HIA activities in Japan.     

Health impact assessment: one way to introduce health in all policies. SESPAS Report 2010

Health impact assessment is a predictive tool to support decisions in policy-making. Current experience shows that health impact assessment could play an important role in the development of the Health in All Policies strategy. This strategy has been extensively used in other European countries and in a wide range of policy and administrative sectors. Health impact assessment is hardly ever mandatory and is frequently carried out separately from other impact assessments. The use of this process in Spain is relatively new, limited and fundamentally based on local level experiences and the screening of regional interventions. The current normative and organizational reform of public health in Spain provides an excellent opportunity to promote the development of health impact assessment. Some of the barriers to the development of this process are related to the biomedical model of health prevailing among health professionals, politicians, and the general population, political disaffection, lack of assessment culture, underdevelopment of community participation processes, and insufficient intersectoral work. Health impact assessment provides an opportunity to move toward improving the population's health and reducing inequalities in health. Consequently, political commitment, as well as investment in education and research, is needed to introduce and develop health impact assessment in all administrative settings and policy sectors.     

Health impact assessment: an introduction to the what,why and how

It is now widely recognised that policies, programs and projects within the health and other public and private sectors can have significant and often unintended negative impacts on health and well‐being . Health Impact Assessment (HIA) is one way of assessing and addressing these impacts prior to implementation. In many countries, including Australia, HIA has traditionally been undertaken as part of environmental impact assessment and translating the HIA process to this broader focus has raised some important issues, particularly whether the ‘value add’ of HIA outweighs the time and resources required. This paper aims to provide an introduction to HIA, a rationale of why you might use HIA in the project, program or policy development cycle, the steps that are generally followed in undertaking a HIA, and identification of some useful websites. We would encourage you to contribute to the knowledge in this field by ‘learning by doing’.     

Health Impact Assessment in a Network of European Cities

The methodology of health impact assessment (HIA) was introduced as one of four core themes for Phase IV (2003–2008) of the World Health Organization European Healthy Cities Network (WHO-EHCN). Four objectives for HIA were set at the beginning of the phase. We report on the results of the evaluation of introducing and implementing this methodology in cities from countries across Europe with widely differing economies and sociopolitical contexts. Two main sources of data were used: a general questionnaire designed for the Phase IV evaluation and the annual reporting template for 2007–2008. Sources of bias included the proportion of non-responders and the requirement to communicate in English. Main barriers to the introduction and implementation of HIA were a lack of skill, knowledge and experience of HIA, the newness of the concept, the lack of a legal basis for implementation and a lack of political support. Main facilitating factors were political support, training in HIA, collaboration with an academic/public health institution or local health agency, a pre-existing culture of intersectoral working, a supportive national policy context, access to WHO materials about or expertise in HIA and membership of the WHO-EHCN, HIA Sub-Network or a National Network. The majority of respondents did not feel that they had had the resources, knowledge or experience to achieve all of the objectives set for HIA in Phase IV. The cities that appear to have been most successful at introducing and implementing HIA had pre-existing experience of HIA, came from a country with a history of applying HIA, were HIA Sub-Network members or had made a commitment to implementing HIA during successive years of Phase IV. Although HIA was recognised as an important component of Healthy Cities’ work, the experience in the WHO-EHCN underscores the need for political buy-in, capacity building and adequate resourcing for the introduction and implementation of HIA to be successful.     

The operational definition of a functional local public health agency: the next strategic step in the quest for identity and relevance.

In 2002, the National Association of County and City Health Officials embarked on a quest to clarify, in a uniform way, the functions of governmental local public health agencies. Over the next 3 years, a diverse group of local health department officials and their partners developed an Operational Definition of a Functional Local Health Department, which included 45 standards matched to the 10 Essential Services. These standards serve as the first comprehensive and uniform articulation of local health department activities for which 250 prototype metrics have subsequently been developed. This article articulates the historical and policy significance of the Operational Definition, the methodological development of the recently published prototype metrics, and presents ideas for use of the metric tool especially in light of current accreditation and quality improvement initiatives.     

Qualitative and quantitative approaches to health impact assessment: An analysis of the political and philosophical milieu of the multi-method approach

Health Impact Assessment (HIA) is a relatively new, but increasingly important, contributor to both local and national decision-making processes. Adopting a multi-method approach, it incorporates qualitative and quantitative analyses to determine the various health impacts of policies and projects. HIA thus reflects recent developments in sociological theory, which have promoted qualitative techniques and challenged the dominance of quantitative methods. HIA embodies a particular renegotiation of the qualitative/quantitative opposition; each individual HIA represents an empirical instance of this renegotiation. As such, HIA can be conceptualized as a kind of ‘political space’, in which the opposition in question is structured by various social forces and plays out in concrete ways. Moreover, and notwithstanding the supposed methodological rapprochement, an analysis of a number of HIAs claims to expose a continuing, but perhaps unsurprising, privilege in favour of quantitative methods. In the first place, the paper contends that closer examination reveals this privileging to be unjustified, both empirically and theoretically, and alternative methodological and epistemological configurations are suggested accordingly. Specific gestures are made in this respect toward the work of Martin Heidegger and Jacques Derrida. In particular, the paper argues for a broad hermeneutic approach that both encompasses and situates the methodological tensions HIA stages. Second, attention is drawn to the fact that various and particular sociopolitical conditions maintain the characteristic architecture of the opposition. The political importance of HIA across a series of key issues is underscored in support of a more radical interpretation. For once situated within its wider cultural context, HIA ceases to resemble some straightforwardly neutral technology for health protection and delivery. If, instead, one reads it as an indicative micropolitical phenomenon, then one can begin to interrogate this simple policy tool in more complex ways. HIA both reveals, and is implicated in, a more fundamental and diffuse process that is presently resisting, undermining and regenerating traditional power distributions within the administration of health and beyond. The paper implicitly argues that HIA can only be properly understood within this context and, equally, allows one a certain analytical access to this context.     

Bridging health and foreign policy: the role of health impact assessments

Health impact assessment (HIA) is an important tool for exploring the intersection between health and foreign policy, offering a useful analytical approach to increase positive health impacts and minimize negative impacts. Numerous subject areas have brought health and foreign policy together. Yet further opportunities exist for HIA to address a broader range of health impacts that otherwise may not be seen as relevant to foreign policy. HIA may also improve the quality of scientific evidence available to policy-makers. The Framework Convention on Tobacco Control offers lessons for the strategic use of HIA. However, HIA alone is limited in influencing these decision-making processes, notably when issues diverge from other core concerns such as economics and security. In such cases, HIA is an important tool to be used alongside the mobilization of key constituencies and public support.