Health Impact Assessment in New South Wales & Health in All Policies in South Australia: differences, similarities and connections
Delany T, Harris P, Williams C, Harris E, Baum F, Lawless A, Wildgoose D, Haigh F, MacDougall C, Broderick D et al: Health Impact Assessment in New South Wales & Health in All Policies in South Australia: differences, similarities and connections. BMC Public Health 2014, 14(1):699.
Policy decisions made within all sectors have the potential to influence population health and equity. Recognition of this provides impetus for the health sector to engage with other sectors to facilitate the development of policies that recognise, and aim to improve, population outcomes. This paper compares the approaches implemented to facilitate such engagement in two Australian jurisdictions. These are Health Impact Assessment (HIA) in New South Wales (NSW) and Health in All Policies (HiAP) in South Australia (SA).
The comparisons presented in this paper emerged through collaborative activities between stakeholders in both jurisdictions, including critical reflection on HIA and HiAP practice, joint participation in a workshop, and the preparation of a discussion paper written to inform a conference plenary session. The plenary provided an opportunity for the incorporation of additional insights from policy practitioners and academics.
Comparison of the approaches indicates that their overall intent is similar. Differences exist, however, in the underpinning principles, technical processes and tactical strategies applied. These differences appear to stem mainly from the organisational positioning of the work in each state and the extent to which each approach is linked to government systems.
The alignment of the HiAP approach with the systems of the SA Government increases the likelihood of influence within the policy cycle. However, the political priorities and sensitivities of the SA Government limit the scope of HiAP work. The implementation of the HIA approach from outside government in NSW means greater freedom to collaborate with a range of partners and to assess policy issues in any area, regardless of government priorities. However, the comparative distance of HIA from NSW Government systems may reduce the potential for impact on government policy. The diversity in the technical and tactical strategies that are applied within each approach provides insight into how the approaches have been tailored to suit the particular contexts in which they have been implemented.
Including health in environmental impact assessments: is an institutional approach useful for practice?
Harris PJ, Haigh F: Including health in environmental impact assessments: is an institutional approach useful for practice? Impact Assessment and Project Appraisal 2015:1-7.
Internationally the inclusion of health within environmental impact assessment (EIA) has been shown to be limited. While health-focused research has focused on the technical provision of health information, policy analysis theory may enable description and explanation of the institutional conditions surrounding health inclusion in EIA. However, whether this framework is considered useful by practitioners has yet to be tested. To investigate this, data were collected via a workshop (n = 22) and the results were analysed using ?Institutionalist? units of analysis (ideas, actors, organisations and institutions). These results were then emailed to participants who were asked to undertake a follow-up survey about the analysis and approach (n = 9). The workshop results suggested various influences on how and why health is considered or not in EIAs. Overall the survey respondents agreed that the approach was conceptually and practically useful but that the framework alone is insufficient and further work is needed to convince potential users of the value of health in EIA. The findings support the need for more detailed research.
Evaluating the impact of equity focused health impact assessment on health service planning: three case studies
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 2014, 14(1):371.
BACKGROUND:Health impact assessment has been identified internationally as a mechanism to ensure potential health impacts and health equity impacts of proposals are considered before implementation. This paper looks at the impact of three equity focused health impact assessments (EFHIAs) of health service plans on subsequent decision-making and implementation, and then utilises these findings to test and refine an existing conceptual framework for evaluating the impact and effectiveness of health impact assessments for use in relation to EFHIAs.
METHODS:Case study analysis of three EFHIAs conducted on health sector plans in New South Wales, Australia. Data was drawn from 14 semi-structured interviews and the analysis of seven related documents (draft plans and EFHIA reports).
RESULTS:The case studies showed that the EFHIAs all had some impact on the decision-making about the plans and their implementation, most clearly in relation to participants’ understandings of equity and in the development of options for modifying service plans to ensure this was addressed. The timing of the EFHIA and individual responses to the EFHIA process and its recommendations were identified as critical factors influencing the impact of the EFHIAs. Several modifications to the conceptual framework are identified, principally adding factors to recognise the role individuals play in influencing the impact and effectiveness of EFHIAs.
CONCLUSION:EFHIA has the potential to improve the consideration of health equity in health service planning processes, though a number of contextual and individual factors affect this. Current approaches can be strengthened by taking into account personal and organisational responses to the EFHIA process.
- Evaluating the impact of equity focused health impact assessment on health service planning: three case studies
Characteristics of health impact assessments reported in Australia and New Zealand 2005–2009
Haigh, F., E. Harris, H. N. G. Chok, F. Baum, B. Harris-Roxas, L. Kemp, J. Spickett, H. Keleher, R. Morgan, M. Harris, A. M. Wendel and A. L. Dannenberg (2013). “Characteristics of health impact assessments reported in Australia and New Zealand 2005–2009.” Australian and New Zealand Journal of Public Health 37(6).
Objective: To describe the use and reporting of Health Impact Assessment (HIA) in Australia and New Zealand between 2005 and 2009.
Methods: We identified 115 HIAs undertaken in Australia and New Zealand between 2005 and 2009. We reviewed 55 HIAs meeting the study’s inclusion criteria to identify characteristics and appraise the quality of the reports.
Results: Of the 55 HIAs, 31 were undertaken in Australia and 24 in New Zealand. The HIAs were undertaken on plans (31), projects (12), programs (6) and policies (6). Compared to Australia, a higher proportion of New Zealand HIAs were on policies and plans and were rapid assessments done voluntarily to support decision-making. In both countries, most HIAs were on land use planning proposals. Overall, 65% of HIA reports were judged to be adequate.
Conclusion: This study is the first attempt to empirically investigate the nature of the broad range of HIAs done in Australia and New Zealand and has highlighted the emergence of HIA as a growing area of public health practice. It identifies areas where current practice could be improved and provides a baseline against which future HIA developments can be assessed. Implications: There is evidence that HIA is becoming a part of public health practice in Australia and New Zealand across a wide range of policies, plans and projects. The assessment of quality of reports allows the development of practical suggestions on ways current practice may be improved. The growth of HIA will depend on ongoing organisation and workforce development in both countries.
The effectiveness of health impact assessment in influencing decision-making in Australia and New Zealand 2005-2009.
Haigh, F., F. Baum, A. Dannenberg, M. Harris, B. Harris-Roxas, H. Keleher, L. Kemp, R. Morgan, H. Chok, J. Spickett and E. Harris (2013). “The effectiveness of health impact assessment in influencing decision-making in Australia and New Zealand 2005-2009.” BMC Public Health 13(1): 1188.
Health Impact Assessment (HIA) involves assessing how proposals may alter the determinants of health prior to implementation and recommends changes to enhance positive and mitigate negative impacts. HIAs growing use needs to be supported by a strong evidence base, both to validate the value of its application and to make its application more robust. We have carried out the first systematic empirical study of the influence of HIA on decision-making and implementation of proposals in Australia and New Zealand. This paper focuses on identifying whether and how HIAs changed decision-making and implementation and impacts that participants report following involvement in HIAs.
We used a two-step process first surveying 55 HIAs followed by 11 in-depth case studies. Data gathering methods included questionnaires with follow-up interview, semi-structured interviews and document collation. We carried out deductive and inductive qualitative content analyses of interview transcripts and documents as well as simple descriptive statistics.
We found that most HIAs are effective in some way. HIAs are often directly effective in changing, influencing, broadening areas considered and in some cases having immediate impact on decisions. Even when HIAs are reported to have no direct effect on a decision they are often still effective in influencing decision-making processes and the stakeholders involved in them. HIA participants identify changes in relationships, improved understanding of the determinants of health and positive working relationships as major and sustainable impacts of their involvement.
This study clearly demonstrates direct and indirect effectiveness of HIA influencing decision making in Australia and New Zealand. We recommend that public health leaders and policy makers should be confident in promoting the use of HIA and investing in building capacity to undertake high quality HIAs. New findings about the value HIA stakeholders put on indirect impacts such as learning and relationship building suggest HIA has a role both as a technical tool that makes predictions of potential impacts of a policy, program or project and as a mechanism for developing relationships with and influencing other sectors. Accordingly when evaluating the effectiveness of HIAs we need to look beyond the direct impacts on decisions.
- The effectiveness of health impact assessment in influencing decision-making in Australia and New Zealand 2005-2009
Housing, Health and Master Planning: rules of engagement
Harris P, Haigh F, Thornell M, Molloy L, Sainsbury P. Housing, Health and Master Planning: rules of engagement. Public Health 2014http://dx.doi.org/10.1016/j.puhe.2014.01.006
Objectives: Knowledge about health focussed policy collaboration to date has been either tactical or technical. This article focusses on both technical and tactical issues to describe the experience of cross-sectoral collaboration between health and housing stakeholders across the life of a housing masterplan, including but not limited to a health impact assessment(HIA).
Study design: A single explanatory case study of collaboration on a master plan to regenerate a deprived housing estate in Western Sydney was developed to explain why and how the collaboration worked or did not work. Methods: Data collection included stakeholder interviews, document review, and reflections by the health team. Following a realist approach, data was analysed against established public policy theory dimensions.
Results: Tactically we did not know what we were doing. Despite our technical knowledge and skills with health focussed processes, particularly HIA, we failed to appreciate complexities inherent in master planning. This limited our ability to provide information at the right points. Eventually however the HIA did provide substantive connections between the master plan and health. We use our analysis to develop technical and tactical rules of engagement for future cross-sectoral collaboration.
Conclusions: This case study from the field provides insight for future health focussed policy collaboration. We demonstrate the technical and tactical requirements for future intersectoral policy and planning collaborations, including HIAs, with the housing sector on master planning. The experience also suggested how HIAs can be conducted flexibly alongside policy development rather than at a specific point after a policy is drafted.
The fit between health impact assessment and public policy: practice meets theory.
Harris P, Sainsbury P, Kemp L. The fit between health impact assessment and public policy: practice meets theory. Social Science & Medicine 2014;108:46-53. http://dx.doi.org/10.1016/j.socscimed.2014.02.033
Knowledge about health focussed policy collaboration to date has been either tactical or technical. This article focusses on both technical and tactical issues to describe the experience of cross-sectoral collaboration between health and housing stakeholders across the life of a housing master plan, including but not limited to a health impact assessment (HIA).
A single explanatory case study of collaboration on a master plan to regenerate a deprived housing estate in Western Sydney was developed to explain why and how the collaboration worked or did not work.
Data collection included stakeholder interviews, document review, and reflections by the health team. Following a realist approach, data was analysed against established public policy theory dimensions.
Tactically we did not know what we were doing. Despite our technical knowledge and skills with health focussed processes, particularly HIA, we failed to appreciate complexities inherent in master planning. This limited our ability to provide information at the right points. Eventually however the HIA did provide substantive connections between the master plan and health. We use our analysis to develop technical and tactical rules of engagement for future cross-sectoral collaboration.
Project report: The Effectiveness of Health Impact Assessment in New Zealand and Australia: 2005-2009
Harris E, Haigh F, Baum F, Harris-Roxas B, Kemp L, Ng Chok H, Spickett J, Keleher H, Morgan R, Harris M, Dannenberg AL. The Effectiveness of Health Impact Assessment in New Zealand and Australia 2005-2009. Sydney: Centre for Primary Health Care and Equity, Faculty of Medicine, University of NSW, 2013.
Povall SL, Haigh FA, Abrahams D, Scott-Samuel A. Health equity impact assessment. Health Promotion International. 2013.
The World Health Organization’s Commission on Social Determinants of Health has called for ‘health equity impact assessments’ of all economic agreements, market regulation and public policies. We carried out an international study to clarify if existing health impact assessment (HIA) methods are adequate for the task of global health equity assessments. We triangulated data from a scoping review of the international literature, in-depth interviews with health equity and HIA experts and an international stakeholder workshop. We found that equity is not addressed adequately in HIAs for a variety of reasons, including inadequate guidance, absence of definitions, poor data and evidence, perceived lack of methods and tools and practitioner unwillingness or inability to address values like fairness and social justice. Current methods can address immediate, ‘downstream’ factors, but not the root causes of inequity. Extending HIAs to cover macro policy and global equity issues will require new tools to address macroeconomic policies, historical roots of inequities and upstream causes like power imbalances. More sensitive, participatory methods are also required. There is, however, no need for the development of a completely new methodology.
Villawood East HIA Literature Review: Housing Estate Redevelopment and Health
Villawood East is a housing estate in South Western Sydney, NSW, Australia. It was built as a public housing estate, mostly during the early 1950s. The estate has been identified as being in need of improvement; the housing is of a low standard and in need of upgrading and is considered unsuitable for the current and future population. NSW Finance and Services and NSW Family & Community Services are developing a Master Plan for the redevelopment of the Villawood East area.
A HIA of the Master Plan has been carried out collaboratively by the Centre for Health Equity Training Research and Evaluation (CHETRE), Population Health South Western Sydney & Sydney Local Health Districts, the NSW Department of Family and Community Services (FACS) and the NSW Land and Housing Corporation HIA .
Ben Cave Associates were commissioned to carry out a literature review to inform the HIA focussing on the scoped areas of health impact: mental health, social cohesion, access to services and access to good quality space / urban design.
- Villawood East HIA Literature Review (print version)
- Villawood East Literature Review (screen version)
Harris P, Haigh F, Harris E. (2012) Incorporating health considerations in land-use planning and policy development: a review of activities in Stoke City Council in the UK and suggestions for application in NSW.
There has been increased interest in the relationship between health and the urban environment in recent years. However there has been limited knowledge about how to strategically develop collaborations between organisations which aim to influence ‘healthy’ planning practice. In Sydney, New South Wales, Australia an ongoing collaboration between the Sydney and South Western Sydney Local Health Districts and the Centre for Health Equity Training, Research and Evaluation at the University of New South Wales has been investigating the use of tools, processes and other ways to progress health and equity in urban focussed policy and planning. We have reviewed activities developed by ‘Stoke Healthy City’ in the U.K. to inform our work. The work in Stoke was intuitively appealing because of an explicit intention to work at multiple levels and with different tools and processes. These tools and activities are not particularly innovative in themselves. For example, the Sydney and South Western Sydney Local Health Districts already utilise HIA and health development checklists and have a long history of strong community engagement. However, what is unique about Stoke is that it has brought together a range of activities and tools that can be utilised at different stages within the planning and policy development process in order to mainstream the consideration of health into all levels of activity. Given the recent and upcoming changes to the land use and community strategic planning systems in New South Wales the activities detailed in this report provide practical examples of what is required to influence healthy urban planning and policy development.
Harris PJ, Kemp LA, Sainsbury P. The essential elements of health impact assessment and healthy public policy: a qualitative study of practitioner perspectives. BMJ Open. 2012 Nov 19;2(6).
Open Access, available from http://bmjopen.bmj.com/content/2/6/e001245.full
Objectives This study uses critical realist methodology to identify the essential and contingent elements of Health Impact Assessment (HIA) and Healthy Public Policy (HPP) as operationalised by practitioners.
Design Data collection—qualitative interviews and a workshop were conducted with HIA and HPP practitioners working in differing contexts.
Data analysis Critical realist analytical questions identified the essential elements of HIA and HPP, the relationship between them, and the influences of public policy and other contingencies on the practice of both.
Participants Nine interviews were conducted with purposively sampled participants working in Europe, USA and Australasia. 17 self-selected participants who worked in Europe, South East Asia and Australasia attended the workshop.
Results The results clarify that HIA and HPP are different but mutually supporting. HIA has four characteristics: assessing a policy proposal to predict population health and equity impacts, a structured process for stakeholder dialogue, making recommendations and flexibly adapting to the policy process. HPP has four characteristics: concern with a broad definition of health, designing policy to improve people’s health and reduce health inequities, intersectoral collaboration and influencing the policy cycle from inception to completion. HIA brings to HPP prediction about a policy’s broad health impacts, and a structured space for intersectoral engagement, but is one approach within a broader suite of HPP activities. Five features of public policy and seven contingent influences on HIA and HPP practice are identified.
Conclusions This study clarifies the core attributes of HIA and HPP as separate yet overlapping while subject to wider influences. This provides the necessary common language to describe the application of both and avoid conflated expectations of either. The findings present the conceptual importance of public policy and the institutional role of public health as distinct and important influences on the practice of HIA and HPP.
Haigh F (2012) Health Impact Assessment for Policies, Plans and Projects, New Planner. June 2012.6
Haigh F, Harris P, Haigh N. (2012) Health Impact Assessment research and practice: A place for paradigm positioning? Environmental Impact Assessment Review 33(1):66-72
In this article, we provide a critical review of the place of paradigm in health impact assessment (HIA) research and practice. We contend that most HIA practitioners have given insufficient attention to paradigm positioning when developing and applying HIA methodologies and that some concerns about current HIA practice can be attributed to this. We review HIA literature to assess the extent and nature of attention given to paradigm positioning and these related concerns. We then respond to our critique by exploring the implications, opportunities and challenges of adopting a critical realist paradigm, which we believe has the potential to help HIA practitioners to develop HIA methodology in a way that addresses these issues.
Housing density and health: A review of the literature and Health Impact Assessments
Haigh, F., Ng Chok, H. & Harris, P. (2011). Housing density and health: A review of the literature and Health Impact Assessments. Centre for Health Equity Training, Research and Evaluation (CHETRE), University of New South Wales: Sydney.