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
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)
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.