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
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)
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
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.
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.
Wise M, Harris P, Harris-Roxas B, Harris E. The role of health impact assessment in promoting population health and health equity, Australian Health Promotion Journal of Australia, 20(3):172-179, 2009.
Rapid Equity Focused HIA of the Australian Better Health Initiative: Assessing the NSW components of priorities 1 and 3
Centre for Health Equity Training, Research and Evaluation (CHETRE)
The Australian Better Health Initiative (ABHI) Implementation Plan has been developed as part of a Council of Australian Governments Reform Package aimed at achieving better health for all Australians. In NSW Approximately $20 million of new money has been allocated from Treasury for Priority Areas 1 & 3 of The ABHI Implementation Plan: Promoting healthy lifestyles and supporting lifestyle and risk modification. As part of the development of the ABHI Implementation Plan for NSW, NSW Health asked the UNSW Research Centre for Primary Health Care and Equity to conduct a Rapid Equity Focussed Health Impact Assessment (EFHIA) to:
- make practical recommendations in order to improve the equity of proposed strategies; and
- ensure that the strategies do not unintentionally widen the equity gap.