HIA Section Background
Defining Health and its Various Determinants
The World Health Organization in its constitution of 1948 defines health as, “A state of complete physical, social and mental wellbeing, and not merely the absence of disease or infirmity”. This broad definition acknowledges that health can be affected by a wide range of factors, and that the motivation to maintain healthy lifestyles go beyond a person’s genetic make-up and self-discipline but include societal, environmental and economic aspects (Chesney et al, 2008; Green, 2008).
An individual’s or a community’s health status is not only dependant on its access to primary, secondary or tertiary healthcare services. It is also determined by the conditions in which people are born, live and work. These include access to adequate housing facilities, fresh food, sanitized water, clean air, transport facilities, educational systems, and employment, to name but a few.
All of these determinants can in turn be shaped by policies dictated and implemented by various economic sectors, departments, authorities, private entities and the prevailing political climate.
Health Impact Assessment can provide a mechanism through which different sectors of the economy can help in safeguarding and maintaining the health of their communities and populations. HIA can help to advance the well-being of all individuals, by improving community health and focusing on the needs of disadvantaged populations, so these too can engage in and achieve self-actualization. It can be used to promote the attainment of social justice through identifying health inequities, and through enhancing access to health services, healthy settings and environments aimed to ameliorate such disadvantages, by giving everyone an equal opportunity to achieve and enjoy good health (Gostin & Powers, 2006).
References
Chesney, M.A., Thurston, R.C., & Thomas, K.A., (2008). Creating Social and Public Health Environments to Sustain Behavior Change: Lessons from Obesity Research. In N. Schneiderman, M. Speers, J. Silvav, H. Tomes, & J. Gentry (Eds.), Integrating Behavioral and Social Sciences With Public Health (pp. 31-50). Washington, DC: American Psychological Assocation.
Gostin, L., & Powers, M. (2006). What does social justice require for the public’s health? Public health ethics and policy imperatives. Health Affairs, 25(4), 1053–1060.
Green, L. (Speaker) (2008). Policy and Theory. On Social and Behavioral and Cultural factors in Public Health. [DVD]. Baltimore, MD: Laureate Education, Inc.
Huitt, W. (2007). Maslow's hierarchy of needs. Educational Psychology Interactive. Valdosta, GA: Valdosta State University. Retrieved February 9, 2012 from,
IMPACT - International Health Impact Assessment Consortium, et al, (2004). European Policy Health Impact Assessment. Retrieved September 20, 2011 from
World Health Organization, Regional Office for Europe, (2001). Health impact assessment as part of strategic environmental assessment. Retrieved September 20, 2011 from
What are Health Inequities?
Health inequities are defined as differences in health outcomes which are systematic, unfair and avoidable.
They are generally associated with social and economic inequality and social marginalization and exclusion. For example, the lower a person’s income, level of education and social wellbeing is, the more like he/she is to suffer from negative health outcomes (bad health).
Research has shown that not all people living in the United States benefit equally from the public health and medical technological advances which have been achieved over the last decades (Lasser, Himmelstein, & Woolhandler, 2006).
References
Lasser, K., Himmelstein, D., & Woolhandler, S., (2006). Access to care, health status, and health disparities in the United States and Canada: Results of a cross-national population-based survey. American Journal of Public Health, 96(7), 1300-1307. doi: 10.2105/AJPH.2004.059402
Murray, C., Kulkarni, S., & Ezzati, M. (2005). Eight Americas: New perspectives on U.S. health disparities. American Journal of Preventive Medicine, 29(5S1), 4–10. doi:10.1016/j.amepre.2005.07.031
Equity in HIA
Addressing equity concerns within a HIA helps in identifying and responding to the requirements and needs of diverse communities within populations being served.
This requires a good understanding of the prime barriers which prevent people from having an equitable access to services and health care needs, particularly amongst disparity or vulnerable populations.
HIA provides the opportunity to assess health equity concerns and to develop and implement measures to mitigate or eliminate negative health and maximize positive health opportunities for vulnerable and marginalized groups.
The table below provides examples of disparity or vulnerable population groups.
References
Corburn, J. (2004). Confronting the challenges in reconnecting urban planning and public health. American Journal of Public Health 94(9), 541-546.
Dannenberg, A.L, Jackson, R.J., Frumkin, H., Schieber, R.A., Pratt, M., Kochtitzky, C., & Tilson, H.H. (2003). The impact of community design and land-use choices on public health: A Scientific Research Agenda. American Journal of Public Health, 93(9), 1500-1508.
Mahoney M., Simpson S., Harris E., Aldrich R., & Stewart Williams J. (2004).Equity Focused Health Impact Assessment Framework, the Australasian Collaboration for Health Equity Impact Assessment (ACHEIA). Retrieved September 20, 2011 from
Health Equity
Environmental justice posits that all people and communities have the right to live, work and recreate themselves in environments which are safe and conducive to health (Corburn, 2004; Dannenberg et al, 2003).
Achieving health equity means providing equally fair opportunities for all individuals to be able to achieve their full potential and to express their abilities in a constructive manner (Mahoney et al, 2004).
Achieving health equity entails addressing those factors, such as the social, environmental and economic determinants, which tend to place individuals or communities at a disadvantage (Mahoney et al, 2004).
The HIA Process
Screening:
Entails determining whether the policy, program, plan or project being considered is likely to have potential health and equity impacts or implications (both negative and positive);
The proposal may have potential impacts on vulnerable sections of the population;
Such impacts require a detailed assessment;
Performing an HIA will be the best option to effectively address the health and equity impacts identified.
Coming Soon: link to the HIA Screening tool on Library webpage
Scoping
Serves to set the HIA’s key goals and objectives
Provides guidance for the health information which needs to be collected and assessed in order to build a comprehensive picture of the proposal’s health impacts.
Gives an opportunity to consider and address issues that are of particular concern to affected groups and individuals.
Focuses resources on issues required for decision-making purposes.
Serves as a platform to discuss and agree upon required impact assessment methods.
Serves to brainstorm alternatives to the proposal and to explore effective mitigation and monitoring measures.
Coming Soon: link to the HIA Scoping tool on Library webpage
Assessment
Entails collecting, assessing and prioritizing scientific and evidence-based information concerning the identified potential public health impacts of the proposal under consideration
Coming Soon: link to the HIA Developing Recommendations Guidelines/Tool on the Library webpage
Developing Recommendations
Prioritizing potential health impacts
Developing recommendations on prioritized health impacts
Negotiating recommendations with stakeholders and decision makers
Drafted recommendations may also need to be prioritized particularly if resources for their implementation are limited or there are competing priorities concerning their implementation.
Coming Soon: include link to the HIA Developing Recommendations Guidelines/Tool on the Library webpage
Reporting
Entails the development and implementation of a dissemination strategy for the HIA results and recommendations.
Coming Soon: include link to the HIA Developing Recommendations Guidelines/Tool on the Library webpage
Monitoring and Evaluation
Monitoring entails determining whether the recommendations set forth were actually implemented
Evaluation entails:-
Determining whether the HIA was effective in carrying out its objectives and health goals
Determining whether the methodologies employed throughout the process were effective and/or suitable
Identify areas which may require improvement
Coming Soon: include link to the HIA Monitoring and Evaluation Guidelines
Types of HIA: Type and Level of Assessment
TYPES OF ASSESSMENT
Prospective Assessment
Conducted during the development stage of a new policy or development.
Aims to predict the health impacts which may arise during the proposal’s development’s implementation phase.
Retrospective Assessment
Used to evaluate the health impacts and consequences of existing policies or developments, (that is policies and developments which have already been implemented)
Employed to assess outcomes resulting from unplanned developments and events
Concurrent Assessment
Is employed to assess the health impacts arising from policies, programs or developments, during their respective implementation.
Is particularly useful to examine the nature and magnitude of expected health impacts.
LEVELS OF ASSESSMENT
Desk-based HIA
Aim: To provide a broad overview of possible health impacts
Resources: limited; entails collecting and assessing existing access data and information
Rapid HIA
Aim: To provide more detailed information of possible health impacts than a desk-based HIA
Entails: Collecting and analyzing existing data; Collecting and analyzing new qualitative data from stakeholders.
Intermediate HIA
Aim: To provide a more detailed investigation of all health impacts over a longer period of time than the Rapid HIA, but a less comprehensive assessment than the in-depth HIA
Entails: A review of available evidence as well as of any similar HIAs; The engagement of stakeholders to share their perception, knowledge and experience concerning possible health impacts; the collection and analysis of new data
In-Depth HIA
Aim: To produce a comprehensive assessment of potential health impact.
Entails: collecting and analyzing data using multiple methods and sources, including qualitative and quantitative data collections methods; includes stakeholder participation.
(Adapted from IMPACT et al, 2004; Queensland Health, 2003; & IPH Ireland, 2009)
References
IMPACT - International Health Impact Assessment Consortium, et al, (2004). European Policy Health Impact Assessment. Retrieved September 20, 2011 from
Institute of Public Health in Ireland (2009).Health impact assessment guidance. Retrieved October 15, 2011 from
Legislation and Public Policy
National Environmental Policy Act
The National Environmental Policy Act’s statutory framework and its subsequent regulations set the ground for the protection of both the natural and human environment. Part of the Act’s purpose is to “stimulate the health and welfare’ of the human species. Additional aims of the Act, amongst others, include to:
‘Assure for all Americans safe, healthful, productive, and aesthetically and culturally pleasing surroundings’,
Attain the widest range of beneficial uses of the environment without degradation, risk to health or safety, or other undesirable and unintended consequence’, and to
‘….and maintain, wherever possible, an environment which supports diversity, and variety of individual choice’.
NEPA also compels federal executive branch agencies to take into consideration the environmental consequences of their actions. This also holds for state and local agencies, as well as private enterprises and parties, whose projects would require permits and licenses issued by federal agencies. This means that decision making processes conducted by such entities should include a routine procedure through which a thorough assessment of health and safety impacts arising from such actions or projects can be conducted.
Coming soon: link to the NEPA web link on the Library webpage
Clean Air Act
The Clean Air Act 42 {U.S.C. §7401 et seq. (1970)}, in its endeavor to regulate air emissions from both stationary and mobile sources, also aims ‘…to promote the public health and welfare and the productive capacity of [the US] population’. The Act also calls for the EPA administrator to encourage cooperation with states and local governments as well as all federal departments and agencies in a bid to prevent and control of air pollution, and thus safeguard human health.
Wisconsin Environmental Policy Act
The Wisconsin Environmental Policy Act, which is the based on the NEPA, requires all state agencies in Wisconsin to take into consideration the environmental implications of their respective proposed legislation or other major actions which may significantly impact ‘the quality of the human environment (Wisconsin Legislative Document, 2011). The agencies are thus requested to collect relevant information and prepare detailed statements highlighting the environmental (and thus health) impacts, including negative impacts of such proposals, and possible alternatives to their proposals, amongst others (Wisconsin Legislative Document, 2011).