outils de promotion de la santé

1. Centre for Primary Health Care and Equity
Health Impact Assessment
Évaluation d’impact sur la santé
Ben Harris-Roxas BSW MPASR PhD
Conjoint Lecturer, University of New South Wales, Sydney
Convenor, HIA Global Working Group, IUHPE
Consultant, ZEST Health Strategies

2. Sections
1. Health impact assessment
2. Evolution and forms
3. HIA practice
4. Evaluation of HIA
5. Lessons learned
6. Resources

3. A note on language
Evaluation vs assessment
Policy vs politics
Health vs health services

4. Section 1
Health impact assessment

5. A combination of procedures, methods and
tools by which a policy, program or project
may be assessed for its potential and often
unanticipated effects on the health of the
population and the distribution of these
impacts within the population.
Gothenburg Consensus Paper
European Centre for Health Policy (1999) Gothenburg Consensus Paper on Health Impact Assessment: main concepts and suggested
approach, WHO Europe: Brussels (adapted by Mahoney & Morgan).

6. Key Aspects of HIA
• Prospective (ex ante assessment)
• Combination of methods
• Looks at intended and unintended
impacts
• Distribution of impacts
• Evidence-informed recommendations

7. http://hiaconnect.edu.au/wp-content/uploads/2012/05/Health_Impact_Assessment_A_Practical_Guide.pdf

8. Distribution of Impacts
• Age
• Gender
• Socioeconomic status
• Location
• Ethnicity and culture
• Existing levels of health and
disability

9. If you
implement the
proposal
These will be
the impacts
If you make
these changes
These will be
the gains
Assessment Recommendations

10. Section 2
Evolution and forms

11. 1950s 1960s 1970s 1980s 1990s 2000s
Environmental Disasters
Regulatory Environmental Impact Assessment
Environmental Health
Health Equity
HIA
1956 Clean Air Act (UK)
1969 Santa Barbara
Channel (USA)
1969 US National
Environmental
Policy Act (USA)
1978 Love Canal (USA)
1984 Bhopal (India)
1986 Ottawa Charter
1990 Concepts &
Principles of Equity
in Health
1997 Jakarta
Declaration
1999 Gothenburg
Consensus Paper
on HIA
2008 WHO Commission
on the Social
Determinants of
Health
Social View of Health
1972 Lake Pedder Dam
controversy
(Australia)
1974 Environmental
Protection (Impact
of Proposals) Act
(Australia)
2005 Health included in
IFC Performance
Standards
1994 Framework for
Environmental and
Health IA
(Australia)
2007 1st Asia-Pacific HIA
Conference
(Australia)
1978 Seveso (Italy)
1990 Environmental
Protection Act (UK)
1980 The Black Report
(UK)
1972 The Indian Wildlife
(Protection) Act
1974 Lalonde Report
(Canada)
1998 Merseyside
Guidelines for HIA
1978 WHO Seminar on
Environmental
Health Impact
Assessment
(Greece)
2004 Equity Focused HIA
Framework
(Australia)
1978 Declaration of
Alma Ata
1992 Asian Development
Bank HIA
Guidelines
1959 Minamata Bay
(Japan) 1980 International
Association for
Impact Assessment
formed
1969 Cuyahoga River
Fire (USA)
1962 Silent Spring
2007 HIA’s use included
in Thailand’s
Constitution
1998 The Solid Facts
1979 Three Mile Island
(USA)
2005 Guide to HIA in the
Oil and Gas Sector
1986 Chernobyl
(Ukraine)
1989 Exxon Valdez Oil
Spill (USA)
2009 Montara West
Atlas Oil Spill
(Australia)
2010Marmot Review
Harris-Roxas B, Harris E (2011) Differing
Forms, Differing Purposes: A Typology of
Health Impact Assessment, Environmental
Impact Assessment Review, 31(4): 396-403.
doi:10.1016/j.eiar.2010.03.003
1999 Erika sinking in Bay
of Biscay (France)
2010 Deepwater Horizon
(USA)

12. Mandated
Decision Support
Advocacy
Community led
Harris-Roxas B, Harris E (2011) Differing Forms, Differing Purposes: A Typology of Health Impact Assessment, Environmental Impact Assessment
Review, 31(4): 396-403. doi:10.1016/j.eiar.2010.03.003

17. But this can lead to a lack of
consensus about what HIA is
(and what it isn’t)

18. Section 3
HIA Practice

19. Source: Harris E, Baum F, Harris-Roxas B, Kemp L, Spickett J, Keleher H, HarrisM, Morgan R, Dannenberg
A, Sukkumnoed D, Wendel A. The effectiveness of health impact assessments conducted in Australia and
New Zealand; Australian Research Council Discovery Project Grants; 2010-2011. [DP1096211]

20. Source: Winkler M et
al. (2013) Untapped
potential of health
impact assessment,
Bull World Health
Organ 2013;91:298–
305.
doi:10.2471/BLT.12.11
2318

21. Source: Harris-Roxas B, Harris P. Learning by Doing: The value of case studies of health impact assessment. NSW Public Health Bulletin,
2007:161-163.
Types of Health Impacts

22. Source: The Rise of HIAs in the United States
http://www.pewhealth.org/reports-analysis/data-visualizations/the-rise-of-hias-in-the-united-states-85899464695

23. Fredsgaard MW, Cave B, Bond A (2009) A Review Package for Health Impact Assessment Reports of Development Projects, Ben Cave Associates:
Leeds.
Bhatia R, Farhang L, Heller J, Lee M, Orenstein M, Richardson M and Wernham A. Minimum Elements and Practice Standards for Health Impact
Assessment, Version 3. September, 2014.
Rhodus J, Fulk F, Autrey B, O’Shea S, Roth A (2013) A Review of Health Impact Assessments in the U.S.: Current State-of-Science, Best Practices,
and Areas for Improvement, Office of Research and Development, National Exposure Research Laboratory, U.S. Environmental Protection Agency:
Cincinnati. http://www.epa.gov/research/healthscience/docs/review-hia.pdf

24. Essential components for HIA
reports
1. A documented and transparent
process.
2. A clear statement of the HIA's goals
and purpose.
3. A rigorous, documented approach to
gathering and assessing evidence.
4. Clear predictions of impacts.
5. Recommendations for enhancement
and mitigation.
Harris-Roxas B, Harris P, Wise M, Haigh F, Ng Chok H, Harris E (2013) Health Impact Assessment in Australia in Past Achievement,
Current Understanding and Future Progress in Health Impact Assessment (Ed Kemm J), Oxford University Press: Oxford, 223-243.
O'Mullane M, Harris-Roxas B. Health Impact Assessment, Journal of Environmental Assessment Policy and Management, 17(1):11,
2015. doi:10.1142/S1464333215500052

25. Section 4
Evaluation of HIA

26. Harris-Roxas B, Harris E (2013) The Impact and Effectiveness of Health Impact Assessment: A conceptual framework, Environmental Impact
Assessment Review, 42: 51-59. doi:10.1016/j.eiar.2012.09.003

27. Harris-Roxas B, Haigh F, Travaglia J, Kemp L. Evaluating the impact of equity focused health impact assessment on health service planning: Three case
studies, BMC Health Services Research, 14:371. doi:10.1186/1472-6963-14-371 www.biomedcentral.com/1472-6963/14/371

28. The factors that influence the impact and
effectiveness of HIAs
1. Informing implementation
2. Consolidating understanding of health and health
equity
3. Enabling discussion of alternatives
4. Clearer articulation of the values that inform health
planning and implementation
5. Time
6. The role of individuals
7. Conceptualisations of the purpose of EFHIA
Harris-Roxas B, Haigh F, Travaglia J, Kemp L. Evaluating the impact of equity focused health impact assessment on health service planning: Three case
studies, BMC Health Services Research, 14:371. doi:10.1186/1472-6963-14-371 www.biomedcentral.com/1472-6963/14/371

29. Section 5
Lessons learned

30. Common criticisms
• HIA is expensive and time-consuming
• Health is already addressed through
planning and policy development
• HIA could create duplication and
inefficiencies

31. Government response
“Health impact assessments have been promoted as a means of assessing the
health impacts of policies, plans and projects using quantitative, quantitative and
participatory techniques. While we think that they may be a useful tool, we
believe that they have the potential to be expensive and time-consuming, and we
believe that this needs to be taken into account in any further consideration of
these.”
[Senate] Committee view
…There are already mechanisms in place to ensure that important issues are
considered across government when necessary, such as the requirements for
inter-departmental consultation in the preparation of cabinet submissions, the
requirement for Regulatory Impact Statements in conjunction with the
introduction of legislation, and statements of compatibility with human rights.
Community Affairs References Committee (2013) Australia's domestic response to the World Health Organization's
(WHO) Commission on Social Determinants of Health report "Closing the gap within a generation": Submissions received
by the Committee, Australian Senate: Canberra.

32. …but there is limited evidence to support these
claims empirically.
For example, I was involved in an equity focused
HIA that was completed in 5 days.
Harris-Roxas B, Harris P, Harris E, Kemp L (2011) A Rapid Equity Focused Health Impact Assessment of a Policy
Implementation Plan: An Australian case study and impact evaluation, International Journal for Equity in Health,
10(6). doi:10.1186/1475-9276-10-6

33. HIAs can be political
because decision-making is political

34. Decisions are made continually, never just once

35. Legislation vs capacity building
is not enough
We need a more sophisticated way of thinking

36. Maturity Model Level
5. Optimised
High functioning
4. Managed
Specific, Measurable Accurate Responsive, Timely (SMART)
3. Defined
Structured approach
2. Repeatable
Processes in place
1. Ad-hoc
Limited system in place
0. Not defined
No level of activity

37. Level Workforce Tools and resources
Organisational
development
Governance Partnerships Leadership Investment
Data and technical
systems
Optimised
High functioning
service coordination
Sustainable highly skilled
workforce
Practical HIA tools are
widely used
Sustainable organisational
development
High functioning HIA
governance and regulatory
mechanisms
Strong HIA partnerships
exist
Strong leadership to
provide support across
different settings
Ongoing investment in HIA
Relevant and intuitive data
systems exist to collect
consistent information
Managed
Specific, Measurable
Accurate Responsive,
Timely (SMART)
Skilled workforce provide
proactive support
HIA resources are
commonly used
Strong organisational
development exist
Strong HIA governance
and regulatory
mechanisms
Responsive and adaptable
HIA partnerships exist
Recognised leadership Diversified HIA investment
Data systems routinely
used to collect information
Defined
A structured approach
Skilled workforce
Relevant HIA resources
are customised and
adapted
Defined organisational
development
Defined HIA governance
and regulatory
mechanisms
Defined partnership
processes
Defined roles and
responsibilities
Sustained HIA investment
Relevant data and
technical systems exist
Repeatable
Processes in place
Reactive support provided
Relevant HIA resources
exist
Structured organisational
development
Repeatable HIA
governance and regulatory
mechanisms
Structured partnership and
governance processes
Identified leaders who may
be called upon again
Some investment in HIA Data systems built
Ad-hoc some level of
system in place
Ad-hoc workforce identified
HIA resources identified as
needed
Some organisational
development
Ad hoc governance and
regulatory mechanisms
Informal processes
A form of leadership in
place
Identified need for
investment in HIA
A system in place
Not defined No identified workforce No relevant resources No support
No governance and
regulatory mechanisms
No processes No support provided No investment
No Systems

38. Section 6
HIA Resources

39. healthimpactassessment.blogspot.com

40. http://www.inpes.sante.fr/evaluation-impact-en-sante/default.asp

41. http://www.ccnpps.ca/13/evaluation-d'impact-sur-la-sante.ccnpps

42. benhr.net/HIAebook

43. Acknowledgements

44. Cette présentation est disponible au
www.slideshare.net/benharrisroxas
b.harris-roxas@unsw.edu.au
@ben_hr