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.
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
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.
Villawood East Master Plan HIA
Villawood East is a public housing estate in Western Sydney, established during the early 1950s and in need of improvement. NSW Finance and Services and NSW Family & Community Services are developing a Master Plan for the Villawood East area. The key objectives of the Master Plan are to:
- Reduce the concentration of public housing and increase the availability of affordable housing.
- Enhance the urban structure.
- Enable the formulation of detailed planning controls to achieve high quality urban design outcomes.
In 2008 Housing NSW , Sydney and Sydney South West Local Health Districts and the Centre for Health Equity Training Research and Evaluation formed the Health and Housing Partnership. The vision of the housing and health partnership is working together to improve the health and wellbeing of the communities of South West Sydney. As part of the partnership’s strategic development, in late 2010 it was decided to follow the planning process for the Master Plan being developed for Villawood East. Health would collaborate with housing NSW across the process to understand the points where health could usefully add value to that process. This health impact assessment (HIA) forms part of this
- Villawood East Master Plan HIA (print version)
- Villawood East Master Plan HIA (screen version)
- Villawood East Master Plan Literature Review (print version)
- Villawood East Master Plan Literature Review (screen version)
Draft Residential Densities Strategy Mackay: Health Impact Assessment
Carless, F. & Gunning, C. (2011). Draft Residential Densities Strategy Mackay: Health Impact Assessment. Mackay Public Health Unit, Queensland Health: Mackay.
The Mackay Regional Council area is one of the fastest growing in Queensland, with strong growth forecast over the coming decades. Managing the challenges associated with high population growth is one of the drivers of Council’s Draft Residential Densities Strategy which outlines its vision for more compact urban areas within the region.
Recognition of the relationship between land use planning and health is not new and nationally there is much interest in translating this knowledge into practice. A tool which has emerged to contribute to this practice is Health Impact Assessment (HIA), a process which engages decision makers to consider health impacts in their planning, policy and program deliberations. To identify indirect health impacts that may be associated with the Draft Residential Densities Strategy, Queensland Health initiated a Health Impact Assessment with assistance from the Department of Communities, Mackay Regional Council and the Centre for Health Equity Training Research and Evaluation. Using a rapid HIA process, including collection of data via literature review and stakeholder consultation, and development of a population profile, the HIA project team generated a set of recommendations.
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)
Marang Dhali Eating Well EFHIA
David Meharg, Aboriginal Population Health Trainee
Western NSW Local Health District
This prospective desk-based Equity Focused Health Impact Assessment (EFHIA) aims to examine the equity issues relating to Marang Dhali Eating Well (MDEW). MDEW is a locally designed Aboriginal food and cooking program to improve food security in four Aboriginal communities within the Western New South Wales Local Health District (Western NSW LHD). This EFHIA makes predictions about the potential health impacts of MDEW and recommendations to maximise health gains and minimise health risks.
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.
Health Impact Assessment of the Northern Territory Emergency Response
Australian Indigenous Doctors’ Association and Centre for Health Equity Training, Research and Evaluation, UNSW. Health Impact Assessment of the Northern Territory Emergency Response. Canberra: Australian Indigenous Doctors’ Association, 2010.
The Australian Indigenous Doctors’ Association (AIDA), in collaboration with the Centre for Health Equity Training, Research and Evaluation (CHETRE) at the University of New South Wales (UNSW) and with financial support from the Fred Hollows Foundation, undertook a health impact assessment (HIA) of the Northern Territory Emergency Response (NTER).
The purpose of the HIA is to predict what are likely to be positive, negative and/or unintended health consequences of the NTER, using a combination of evidence from a variety of sources.
The measures of the NTER outlined in the legislation, in associate media releases, and the NTER: One Year On report (Department of Families, Housing, Community Services and Indigenous Affairs, 2008) were assessed for their predicted health impacts based on the findings of community meetings with more than 250 Aboriginal people living in the prescribed communities, interviews with 25 Aboriginal and non-Aboriginal stakeholders, and a series of commissioned expert reviews.
Health Impact Assessment of the Redevelopment of Liverpool Hospital
Sydney South West Area Health Service
A Steering Committee was established in July 2006 to conduct a prospective HIA on the Redevelopment of Liverpool Hospital. The focus of this project was on the construction phase of the redevelopment and the scope covered four issues – reduced parking for staff, patients and visitors; health and wellbeing of staff and the community; community and patient safety (non-traffic related); and increased traffic in the area (general and construction traffic). Recommendations were developed for the Executive User Group (EUG) and these are currently being monitored by the EUG.
In August 2007, the Executive User Group (EUG) for the Liverpool Hospital Redevelopment endorsed the conduct of a second Health Impact Assessment (HIA) for the redevelopment. The scope for the HIA was defined as being environmental effects; health promoting effects and effects on patient recovery and staff wellbeing. The current status of the redevelopment in August 2008 determined that we should focus on developing recommendations for the detailed design and commissioning phases of the project. An EFHIA was chosen for this project because it was thought that the most value that could be added at these stages of the design process would be to focus on a consideration of equity issues related to the redevelopment. This consideration is most relevant to the Liverpool Hospital Redevelopment
- Phase 1 HIA Report
- Phase 2 Equity Focussed HIA
- Journal Article: HIA in Urban Settings
- Journal Article: HIA of Construction Phase of Hospital Redevelopment
Haigh F (2012) Health Impact Assessment for Policies, Plans and Projects, New Planner. June 2012.6
South East Queensland Regional Plan Health & Social Impact Assessment
Queensland Health, Queensland Department of Communities & Queensland Office of Urban Management
Abstract: A health and social impact assessment of the South East Queensland Regional Plan was undertaken in 2005 (Queensland Government, 2005). It is one of few attempts nationally and globally to apply health and social impact assessment to a regional planning process. The assessment methodology builds on existing evidence-based research, methodologies and the combined professional experience of both health and social impact assessment practices in Queensland. The approach adds further strength and rigour to planning strategies to enhance the health and well-being of communities. The way the South East Queensland Regional Plan is implemented, and how the plan influences access to jobs, education, affordable housing and social infrastructure, and the achievement of social inclusion and connectedness within communities, will be central to future health and well-being of people in South East Queensland.
Equity Focused HIA of the South Australian ABHI School and Community Initiatives
Centre for Health Equity Training, Research and Evaluation (CHETRE)
(EFHIA) undertaken on the South Australian Program Reference Document of the School and Community Based Activities under the Australian Better Health Initiative 2006-2010. The EFHIA focussed on four components: Regional Healthy Weight Coordinators, the Healthy Ways project in Aboriginal communities, CYWHS parent focused project, and professional development to support these initiatives.
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.
Flinders Street Redevelopment Project (Townsville) HIA
Queensland Health Tropical Population Health Services
In November 2008 a Rapid Desktop Health Impact Assessment was conducted on the Flinders Street Redevelopment project by the Health Promotion Service of the Tropical Population Health Services, Population Health Queensland. The identified health determinants were safety and security, access for all ages and abilities, social connectedness, participation and identity.
Harris, P., Spickett, J. Health Impact Assessment in Australia: A review and directions for progress. Environmental Impact Assessment Review, 2011, 31(4):425-432.
Good for Kids Good For Life Equity Focused Health Impact Assessment
Hunter New England Area Health Service
This report outlines the methods and findings from the Hunter New England Area Health Service’s (HNE AHS) ‘Good for Kids. Good for Life.’ program (Good for Kids) Health Impact Assessment (HIA). The HIA was completed in the period December 2006 – August 2007 and was implemented under the direction of a Good for Kids HIA working party and staff of the Good for Kids program. As an HIA development site, the working party and program staff received additional support from the University of NSW Research Centre for Primary Health Care and Equity (CHETRE).
The purpose of the Good for Kids equity-focused HIA was to improve the equity with which the program was delivered to Aboriginal and non-Aboriginal children. The use of HIA’s in Aboriginal health contexts has been limited, so the HIA working party took the opportunity modify the HIA so that it better reflected the principles of Aboriginal Health. This involved drawing on equity-focussed HIA methodology, learning from HIA’s completed in indigenous communities overseas and adopting an Aboriginal model of health.← Older posts