Implementation of Health Impact Assessment

1
Implementation of Health Impact Assessment

• Gabriel Gulis, PhD
• University of Southern Denmark
• Esbjerg, Denmark
• ggulis_at_health.sdu.dk

2
Objective

• What is HIA?
• Is HIA implemented? If so, how?
• Can we define a standard HIA methodology?

3
Method

• ECHP Brussels HIA mailing list
• Mailed questionnaire survey
• 2002-2003

4
HIA

• Gothenburg consenzus paper
• any combination of procedures or methods by
  which a proposed policy or program may be judged
  as to the effects it may have on the health of a
  population

5
Other impact assessments?

• EIA? SEA?
• Although SEA moved up EIA into level of policy
  making, the main scope is still on project level
  and environment
• Social impact assessment?
• Social impacts are primary and the only
  addressed, health only at limited extent
• Human impact assessment?
• Seems to be the most comprehensive, however not
  yet clear methodology and rather development,
  economy based
• Risk assessment?
• The heart of HIA, but HIA is not limited to
  risk-factor (health hazard) health outcome
  approach
• Epidemiology?
• The same is true as with risk assessment,
  epidemiology provides basic information, data,
  relation, knowledge, but HIA adds for example
  evaluation and monitoring. Moreover, HIA shall
  always be decision making related
• Needs assessment?
• Frequently input part of a HIA, a part compared
  to which health impacts are assessed

6
Implementation

• Definition adoption, putting policy into
  practice, behavioral change, putting rules into
  practice
• Policy implementation track Mazmanian, Sabatier
  (tractability of the problem (technical,
  diversity, target group), ability to structure
  (objectives, theory, financing, planning,
  rules), non-statutory variables (SES, public
  support, attitudes..), stages ( implementing
  agencies, compliance, impacts))
• Diffusion of innovation innovation, time,
  communication channels, social system
• Elements legislation, training, infrastructure

7
Results

• 17 questionnaires returned
• UK 7
• 5 England
• 1 Wales
• 1 Scotland
• Finnland
• Czech Republic
• Denmark
• USA Minnesota
• Estonia
• Sweden
• Australia
• Malta
• Germany Hamburg
• Slovak Republic

8
Legislation

• Germany (Hamburg), Finland, Australia and Czech
  republic, Slovak Republic reported HIA requested
  by law
• Czech Republic and Slovak Republic as part of
  health policy legislation, Australia and Finland
  by sectoral legislation, Germany within EIA
• No local level, Czech Republic and Germany on
  regional level, Czech Republic, Slovak Republic,
  Germany and Finland on national level, Australia
  did not report levels
• Germany 1990, Finland 1994 and Czech republic
  2000, Australia not available and Slovak Republic
  not clear

9
Training

• Regular training with HIA included in university
  curricula exists in England, Australia, Scotland,
  USA-Minnesota, Czech Republic, Slovak Republic
  and Sweden
• Within medical curricula or public health
  curricula (Slovak Republic)
• In construction and land planning only in England
• Graduate training in England, USA-Minnesota,
  Czech Republic, Slovak Republic and Sweden
• Post-graduate training in England, Australia,
  Scotland, Slovak Republic and Czech republic

10
Infrastructure

• Out of Germany Hamburg and Slovak Republic each
  country reported some kind of leadership
  infrastructure for HIA
• High rank governmental offices, Ministries of
  health, national institutes, research institutes
• Wales HIA support unit at the National assembly
• Denmark municipality of Nordborg

11
Methodology

• National guidelines exist out of Germany, Slovak
  Republic, Denmark and Malta
• Merseyside methodology
• Follow-up of use of HIA recommendations rather
  rarely, mostly cases in UK

12
Conclusions

• HIA past, recent and future
• The Effectiveness of HIA project
• Other new project funded by EC
• Link to decision makers, politicians
• Capacity building
• Legislation does it help if HIA is required by
  law?