HIA in Decision Making: What We Know and What We Need to Know presentation made at the 2015 Global Health Forum on “Public Health Governance” in Taiwan

1. HIA in Decision Making:
What We Know and What
We Need to Know
2015 Global Health Forum in Taiwan
“Public Health Governance”
We Need to Know
Francesca Viliani
International SOS - Head of Public Health Consulting Services and
Community Health Programs

2. AGENDA
•Presentation
•Definition, process and purpose
•Use and Actors
•What we know and what research tells
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•What we know and what research tells
•Conclusions

3. Who am I?
• I have been working on HIA since 2004
• Mainly conducting or supporting HIA of privately funded projects:
Mega Infrastructures, Extractive Industries and other Industrial
activities
• I have also developed HIA guidance and tools for private
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companies as part of their internal processes
• Finally, I carried out HIA trainings for consultants and individual
practitioners, private companies and consulting firms,
governmental departments at different levels

4. Health Impact Assessment - HIA
A combination of procedures, methods and tools that
systematicallysystematically judgesjudges the potential, and sometimes
unintended, effects of a policy, plan, programme orpolicy, plan, programme or
projectproject on the health of a population and the distribution
of those effects within the population. HIA identifiesidentifies
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of those effects within the population. HIA identifiesidentifies
appropriate actions to manage those effects.
European Centre for Health Policy, WHO Regional Office for Europe (1999) “Gothenburg Consensus
Paper” & International Association for Impact Assessment (2006) “Health Impact Assessment International
Best Practice Principles No. 5”

5. HIA as systematic process
Screening
Scoping
Consider whether to perform an HIA
Plan how to carry out the HIA - Terms of Reference
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Appraisal
Recommendations
Monitoring and
Evaluation
Assessment & Prioritization of Health Impacts
Formulates recommendations for decision makers
Implementation of recommendations
& Monitoring and Evaluation Plan

6. Is decision making systematic?
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7. public policy is made up of [often non-
linear and interconnected] stages
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Howlett, Ramesh, and Perl (2009). Policy cycles and subsystems (3rd ed.) & Harris P et al “HIA and Public Policy”

8. One acronym, multiple approaches
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Winkler, Mirko S. et al. “Untapped potential of health impact assessment.” Bulletin of the
World Health Organization 91 (4):237-312, 2013.

9. What is HIA Purpose?
• To develop evidence based recommendations which influence the decision
making process.
• The recommendations should alter the original proposal in ways that
enhance the positive impacts and reduce or eliminate the negative impacts.
The recommendations should also be context relevant, sensitive and
implementable
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• To bring people together: proponent, decision makers, communities,
academia and other stakeholders
• But also to foster interagency working & whole of government approaches
• It could lead to increased awareness of health and health inequalities and in
general it is a technical and social learning process
• It should compare the health consequences of implementing different options

10. HIA and Public Policies
HIA is one of the key strategies for Healthy Public
Policies / Health in All Policies
"Health in All Policies (HiAP) is an approach to public policies across
sectors that systematically takes into account the health implications of
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decisions, seeks synergies, and avoids harmful health impacts, in order to
improve population health and health equity”*
Efforts on technical and legal aspects of HIA, such as
institutionalisation & standardization
* Definition used by the 8th Global Conference on Health Promotion in Helsinki 2013

11. Is “Health” in
EIA also HiAP?
In EstoniaEstonia, where the majority of the local communities
are small and with limited institutional capacity, the
introduction of separate HIA is not judged to be
practical. Instead, the focus is on better coverage of
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practical. Instead, the focus is on better coverage of
public health aspects and stronger involvement of public
health specialists in the EIA process.
In SwedenSweden, health aspects are gradually being
introduced in EIA, at the same time that methodologies
for independent HIA are being developed in parallel to
EIA.
WHO Europe, EUPHA, IAIA (2014) Health in Impact Assessments: Opportunities not to be missed

12. HIA and Private Sector
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IOGP/IPIECA (Oil&Gas): 2005, reviewed 2015
ICMM (mining and metals): 2009
World Bank International Finance Corporation: 2009

13. Forthcoming IOGP-IPIECA HIA Guidance
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14. IFC Performance Standard (2006-2009)
100%
99%
95%
87%
44%
50%
60%
70%
80%
90%
100%
14
44%
27%
5%
16%
0%
10%
20%
30%
40%
PS1 E&S
Assessment &
Mgt.
PS2 Labor &
Wkg cond.
PS3 Pollution
Prev. &
Abatement
PS4
Community
Health &
Safety
PS5
Involuntary
Resettlement
PS6
Biodiversity
PS7
Indigenous
Peoples
PS8 Cultural
Heritage

15. What we know about HIA…
• A comparison of 45 local, national, and international guidelines*
• Almost all describe HIA as participatory and democratic process
• More than half mention the importance of HIA's relationship with
other impact assessments and discuss integration as well as the
need for authoritative support of HIA work
• Concern about the different purposes and practicality of using HIA in
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private sector VS public sector
• Need to incorporate into guidelines a standard vocabulary to describe
the characteristics and process of HIA and to develop more
standardized means of evaluating the HIA process, impact, and
outcomes
* K.A. Hebert et al “ Health impact assessment: A comparison of 45 local, national, and international guidelines”
Environmental Impact Assessment Review 34 (2012) 74–82

16. HIA research HIA and policy making
• Tend to focus on the technical ‘what?’ questions which are internal to
the conduct of HIAs
• Not engaged much with the external tactical conditions associated
with what HIA is ultimately trying to influence, public policy and decision
making
• Some recommendations
• HIA experts need to be both tactical and technical
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• HIA experts need to be both tactical and technical
• HIA can tactically position health as a relevant public policy issue
• HIA requires strengthening to work as a policy formulation process
• Institutional support for collaboration between Public Health (the best
positioned for intersectoral collaboration) and other sectors
• Not framing health in terms of hospitals and diseases, but social
determinants of health and health equity might not be the other best
alternatives
Harris P. at al. “The fit between health impact assessment and public policy: Practice meets theory” Social Science &
Medicine 108 (2014) 46e53

17. Revised framework for evaluating impact and
effectiveness of HIA
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F Haigh et al. (2015). What makes health impact assessments successful? Factors contributing to effectiveness in
Australia and New Zealand. BMC Public Health: 15:1009 DOI 10.1186/s12889-015-2319-8.

18. HIAs are a useful tool to promote
public health
• Success of HIAs should be defined by their impacts on decisions
as well as on the environments in which those decisions are made
• Influences decisions in non health-related sectors;
• Strengthens cross-sector collaborations;
• Raises awareness of health issues among decision makers;
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• Raises awareness of health issues among decision makers;
• Influences changes beyond the decision target;
• Builds consensus and relationships among decision makers and their
constituents;
• Gives community members a stronger voice in decisions that affect
them.
Bourcier E, Charbonneau D, Cahill C, Dannenberg AL. (2015). An Evaluation of Health Impact Assessments in
the United States, 2011–2014. Prev Chronic Dis:12:140376.

19. Recommendations for HIA practitioners to make HIA
more effective
• Early phases essential to select if HIA is the right process for the object to be examined;
• Clarify early in the process: purposes, goals, values and expected outcomes;
• Select an appropriate team to conduct the HIA (mix of competences) as well as identify
key stakeholders and their relative points of influence within systems
• Involve stakeholders such as decision makers, people with knowledge about and access
to decision making processes and also people with relevant skills as early as possible;
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• Ensure HIA processes include potentially affected communities and pay more attention to
the needs of vulnerable populations;
• Craft clear, actionable recommendations; eventually with the support of the involved
decision makers
• But especially be both technical and tactical: understand the context and the actors,
proactively engage, if opportune utilise the flexible but structured HIA process

20. Thank you
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© Francesca Viliani - 2013