HIA: Theoretical foundations and practical application

1
HIA Theoretical foundations and practical
application

• Erica Ison
• Specialist Practitioner in HIA
• Affiliated to the Public Health Resource Unit,
  Oxford, UK

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HIA scientific methodology or management tool?

• At first sight, HIA has a schizophrenic
  character. Its roles are
• To provide robust evidence to support
  decision-making the science part
• To make tangible and practical suggestions to
  support the healthiness of the design and
  implementation of proposals, which includes
  eliciting knowledge, experience and opinion from
  a range of stakeholders some of the management
  part

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Theory of HIA models of health

• There are two main models of health
• Biomedical, which describes health in terms of
  illness and disease, with a focus on cure,
  treatment and palliation
• Social or socio-economic, which uses the
  determinants of health to describe routes to
  well-being, with a focus on prevention of
  ill-health and health improvement

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Theory of HIA Models of HIA

• These two main models of health give rise to two
  main models of HIA
• Biomedical model
• Social or socio-economic model

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Models of HIA
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Which model of health do you use?

• As there are two main types of impact on health,
  direct and indirect, we need to use both models
  of health
• Direct impacts tend to reflect the biomedical
  model of health
• Indirect impacts through the determinants of
  health tend to reflect the social or
  socio-economic model of health

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Which model of HIA do you use?

• Because we are using two models of health, we
  need to use and combine the two main models of
  HIA
• Some practitioners prefer to use only one or
  other of the models of HIA

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Which model of HIA do you use?
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How do we use both models of HIA?

• We need to achieve a balance between the two
  models of HIA
• This balance may be different for different HIAs
  depending on
• the nature of the proposal being investigated
• which aspects of health it affects
• the definition of health you are working with
• This does not mean that one model of HIA can be
  ignored or neglected, even if that model does not
  need to be dominant

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What balance can we achieve between the models of
HIA?

• Practical considerations
• The balance may also depend on
• The availability of information for the HIA
• Access to information for the HIA
• The resources available financial and human
• The timescale available for the HIA study

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How do we make an HIA robust?

• We use
• Tools and checklists they enable us to be
  systematic
• Information from different sources this enables
  us to incorporate evidence and experience into
  the results of the HIA
• A range of methods to identify impacts on health

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HIA Tools and checklists

• A tool is structured so that it can support the
  user in making a decision, that is, it gives
  guidance on how to interpret any responses
• A checklist is either a list of items that acts
  as an aide memoire or a list of questions that
  triggers a response to consider but does not give
  the user guidance on how to interpret that
  response

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Tools for HIA

• The use of tools in HIA ensures that the
  methodology is systematic
• Most tools are based around the determinants of
  health, but can also include groups in the
  population and the nature of the impacts
• Most tools are designed for use during two stages
  in the HIA process
• Screening
• Appraisal

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Tools for HIA

• Many tools available, particularly for appraisal
• Most of the tools have not been validated
• Best advice when you feel confident, it is best
  to develop tools that are appropriate to the
  communities and conditions in the municipalities
  where you work tools can be developed anew or
  you can adapt tools that are already available

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Checklists for HIA

• Checklists in HIA can be designed for use
• during one stage of the process of HIA, e.g.
  scoping
• to undertake some of the tasks during one stage
  of the HIA, e.g. process evaluation
• Best advice checklists are helpful to ensure
  systematic coverage of issues in the HIA, and
  they are relatively easy to develop for use in
  your own municipality

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Sources of Information for Appraisal in HIA

• Information for appraisal comes from several
  different sources
• the published literature research information
  sometimes called the evidence base
• other HIAs on similar proposals contains both
  evidence and experience
• local data and statistics quantitative and
  qualitative information or evidence about the
  community
• stakeholder consultation, including the community
  mainly knowledge, experience and informed
  opinions

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What sort of information do we get from each
source?
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Methods that can be used during appraisal in HIA

• When considering the methods for HIA, there are
  some fundamental decisions to take which will
  determine the range of methods you can use
• Will you be consulting stakeholders?
• Will you be consulting the community as one of
  the groups of stakeholders?

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Methods not requiring stakeholder involvement

• Document analysis
• Literature review and assessment of the quality
  of the evidence to weight the impacts
• Desk-top analysis of the proposal by technicians,
  possibly using Lickert scales
• Mathematical or computer modelling of
  quantitative data to predict health outcomes
• Valuation of predicted impacts, in terms of
  finance or other variables, e.g. QALYs

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Methods not requiring stakeholder involvement

• Methodological issues
• Quality of data
• Coverage of data
• Assumptions made about data
• Sensitivity analysis - assessment of
  options/scenarios
• Valuation and weighting

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Methods of stakeholder consultation

• Two main types of method for stakeholder
  consultation
• Interactive, where stakeholders can interact with
  one another, e.g. focus group, workshop or open
  event
• Non-interactive, where stakeholders respond only
  to the HIA Assessor(s), e.g. interview or survey
  questionnaire

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Methods of stakeholder consultation

• Methodological Issues
• Sample size number of participants
• Representativeness of participants
• Demographics
• Socio-economics
• Special interests
• Hard-to-reach groups

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Methods Depths of Appraisal

• There are two main categories or depths of
  appraisal
• Rapid
• Comprehensive
• The defining feature between the two is whether
  new information is generated
• When the best available information is used, and
  no new information is generated rapid
• Primary research is undertaken and new
  information is generated comprehensive

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HIA on Londons Mayoral Strategies

• Mayor of London has made a political commitment
  to conducting HIA on all the mayoral strategies
• HIAs are undertaken by the London Health
  Commission, which is independent, for the Mayor
  of London
• London Health Commission submits HIA results to
  the Mayor, the Greater London Assembly and the
  team responsible for the strategy

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HIA on Londons Mayoral Strategies

• Transport
• Economic development
• Spatial development
• Waste management
• Noise
• Energy
• Biodiversity
• Air quality
• Culture
• Older people

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HIA on Londons Mayoral Strategies

• Preparation
• Scoping the main topic areas of the strategy that
  the HIA will focus on
• Literature review of potential impacts on health
  and effective interventions relating to the
  strategy
• Appraisal
• Rapid appraisal techniques used
• HIA stakeholder workshop before public
  consultation period stakeholders from the
  private, public and voluntary sectors no
  community
• Reporting the results

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HIA on Londons Mayoral Strategies

• Questions for the stakeholder workshop on the
  Noise Strategy
• What parts of the strategy need to be kept on the
  basis of the impacts on peoples health and
  well-being? How can we increase those positive
  effects?
• What parts of the strategy need to be changed
  because of their impacts on health and
  well-being? How can we change the proposal to
  reduce/avoid those negative effects?
• What could be added to the strategy to promote
  health and well-being?

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Evaluation of HIA on Londons Mayoral Strategies

• The HIAs have raised awareness of the social
  model of health and public health amongst those
  whose primary roles are not health related Most
  importantly they have influenced strategy.
• Opinion Leader Research, 2002