Recent Advances in Health Impact Assessment and Health in All Policies Implementation: Lessons from an International Convening in Barcelona
Rogerson, B.; Lindberg, R.; Baum, F.; Dora, C.; Haigh, F.; Simoncelli, A.M.; Parry Williams, L.; Peralta, G.; Pollack Porter, K.M.; Solar, O. Recent Advances in Health Impact Assessment and Health in All Policies Implementation: Lessons from an International Convening in Barcelona. Int. J. Environ. Res. Public Health 2020, 17, 7714. https://doi.org/10.3390/ijerph17217714
Health Impact Assessment (HIA) and Health in All Policies (HiAP) are policy tools used to include health considerations in decision-making processes across sectors such as transportation, education, and criminal justice that can play a role in improving health and equity. This article summarizes proceedings from an international convening of HIA and HiAP experts held in July 2019 in Barcelona, Spain. The presentations and panel discussions included different models, best practices, and lessons learned, including from government, international banks, think tanks, and academia. Participants discussed ideas from around the world for cross-sector collaboration to advance health. The convening covered the following topics: community engagement, building greater understanding of and support for HiAP, and exploring how mandates for HIA and HiAP approaches may advance health and equity
HIA and EIA Are Different, but Maybe Not in the Way We Thought They Were: A Bibliometric Analysis
Kim J, Haigh FA. HIA and EIA Are Different, but Maybe Not in the Way We Thought They Were: A Bibliometric Analysis. Int J Environ Res Public Health. 2021 Aug 28;18(17):9101. doi: 10.3390/ijerph18179101. PMID: 34501690; PMCID: PMC8430742.
Background: The fields of Health Impact Assessment (HIA) and Environmental Impact Assessment (EIA) have grown with increasing numbers of disciplines and sectors contributing to their advancements, but with it, perceived conflict over methodological and disciplinary approaches to integrate health in impact assessments. This study maps the current field of HIA and health in EIA to examine the scientific landscape of the field.
Methods: We carried out a bibliometric analysis of HIA papers and EIA papers that included a health focus in peer-reviewed journals in the Web of Science Core Collection (n = 229). We carried out co-authorship and co-citation network analyses of authors and documents in VOSviewer.
Results: We identified two main co-authorship and co-citation groupings. Our document co-citation analysis also identified four clusters with two major groups, the Defining HIA cluster and the Describing the fields cluster versus the Active transport quantitative HIA cluster, and the Quantitative modelling tools cluster.
Conclusion: Our findings strongly suggest that there exist two groups of thought in the scholarly fields of HIA and health in EIA. Barriers to developing more methodologically integrated approaches to considering health within EIA are related more to disciplinary differences than field (HIA versus EIA)-based differences and we advocate for the development of transdisciplinary approaches to both HIA and EIA.
Keywords: bibliometric analysis; environmental impact assessment; health impact assessment; paradigm; public health.
A community grounded HIA: The benefits of conducting a HIA during the Airds Bradbury Estate Redevelopment
Jaques, K., Thorne, M., F. Haigh, A community grounded HIA: The benefits of conducting a HIA during the Airds Bradbury Estate Redevelopment. Chronicles of HIA 2017
Abstract
Background
This paper identifies and discusses the benefits of taking a ‘community grounded’ approach to HIA in the context of a place based urban renewal setting and reflect on whether this is a useful approach for people and organisations wishing to undertake HIA’s in similar settings. The HIA was on the redevelopment of the suburban town centre and focussed on the creation of a new multipurpose centre, improvements to a manmade pond and the relocation of sporting fields found in the area. The HIA team aimed to explore what the planned redevelopment of the local town centre area would mean for the local community and its potential health impacts upon residents.
Methods
The HIA followed the standard HIA steps. The HIA team took a community grounded approach where particular focus was given to engaging community members in the HIA process. This included community members being involved in the HIA working group, reference group and providing evidence for the HIA.
Results
The HIA report contained a series of recommendations for the redevelopment of the Airds Bradbury estate. These recommendations were presented to the Community Reference Group and were adopted by various stakeholders.
Conclusions
The community grounded approach influenced both how the HIA was carried out, the decisions that were made within the HIA and ultimately the findings and recommendations. The HIA of this latest stage of the Airds-Bradbury estate redevelopment was a useful project to encourage further collaboration, dialogue and planning between redevelopment agencies, Local Government, and residents of the Airds Bradbury social housing estate.
http://journals.iupui.edu/index.php/chia/article/view/21560
What makes health impact assessments successful? Factors contributing to effectiveness in Australia and New Zealand.
Haigh, F., E. Harris, B. Harris-Roxas, F. Baum, A. Dannenberg, M. Harris, H. Keleher, L. Kemp, R. Morgan, H. Ng Chok and J. Spickett (2015). “What makes health impact assessments successful? Factors contributing to effectiveness in Australia and New Zealand.” BMC Public Health15(1): 1-12.
BACKGROUND:
While many guidelines explain how to conduct Health Impact Assessments (HIAs), less is known about the factors that determine the extent to which HIAs affect health considerations in the decision making process. We investigated which factors are associated with increased or reduced effectiveness of HIAs in changing decisions and in the implementation of policies, programs or projects. This study builds on and tests the Harris and Harris-Roxas’ conceptual framework for evaluating HIA effectiveness, which emphasises context, process and output as key domains.
METHODS:
We reviewed 55 HIA reports in Australia and New Zealand from 2005 to 2009 and conducted surveys and interviews for 48 of these HIAs. Eleven detailed case studies were undertaken using document review and stakeholder interviews. Case study participants were selected through purposeful and snowball sampling. The data were analysed by thematic content analysis. Findings were synthesised and mapped against the conceptual framework. A stakeholder forum was utilised to test face validity and practical adequacy of the findings.
RESULTS:
We found that some features of HIA are essential, such as the stepwise but flexible process, and evidence based approach. Non-essential features that can enhance the impact of HIAs include capacity and experience; ‘right person right level’; involvement of decision-makers and communities; and relationships and partnerships. There are contextual factors outside of HIA such as fit with planning and decision making context, broader global context and unanticipated events, and shared values and goals that may influence a HIA. Crosscutting factors include proactive positioning, and time and timeliness. These all operate within complex open systems, involving multiple decision-makers, levels of decision-making, and points of influence. The Harris and Harris-Roxas framework was generally supported.
CONCLUSION:
We have confirmed previously identified factors influencing effectiveness of HIA and identified new factors such as proactive positioning. Our findings challenge some presumptions about ‘right’ timing for HIA and the rationality and linearity of decision-making processes. The influence of right timing on decision making needs to be seen within the context of other factors such as proactive positioning. This research can help HIA practitioners and researchers understand and identify what can be enhanced within the HIA process. Practitioners can adapt the flexible HIA process to accommodate the external contextual factors identified in this report.
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-2319-8
Is health impact assessment useful in the context of trade negotiations? A case study of the Trans Pacific Partnership Agreement
Hirono K, Haigh F, Gleeson D, et al. Is health impact assessment useful in the context of trade negotiations? A case study of the Trans-Pacific Partnership Agreement. BMJ Open 2016;6(4).
Abstract
Objective The Trans Pacific Partnership Agreement (TPP) is a recently concluded free trade agreement involving Australia and 11 other Pacific-rim nations, which has the potential for far-reaching impacts on public health. A health impact assessment (HIA) was carried out during the negotiations to determine the potential future public health impact in Australia and to provide recommendations to mitigate potential harms. This paper explores the findings and outcomes of the HIA, and how this approach can be used to provide evidence for public health advocacy.
Design A modified version of the standard HIA process was followed. The HIA was led by technical experts in HIA, trade policy, and health policy, in collaboration with advocacy organisations concerned with the TPP and health. The HIA reviewed the provisions in leaked TPP text in order to determine their potential impact on future health policy. As part of this process, researchers developed policy scenarios in order to examine how TPP provisions may affect health policies and their subsequent impact to health for both the general and vulnerable populations. The four policy areas assessed were the cost of medicines, tobacco control, alcohol control and food labelling.
Results In all areas assessed, the HIA found that proposed TPP provisions were likely to adversely affect health. These provisions are also likely to more adversely affect the health of vulnerable populations.
Conclusions The HIA produced relevant evidence that was useful in advocacy efforts by stakeholders, and engaging the public through various media platforms.
Development of an Urban Health Impact Assessment methodology: indicating the health equity impacts of urban policies
Pennington, A., H. Dreaves, A. Scott-Samuel, F. Haigh, A. Harrison, A. Verma and D. Pope “Development of an Urban Health Impact Assessment methodology: indicating the health equity impacts of urban policies.” The European Journal of Public Health. 2015.
Background: An overarching recommendation of the global Commission on Social Determinants of Health was to measure and understand health inequalities and assess the impact of action. In a rapidly urbanising world, now is the time for Urban HIA. This article describes the development of robust and easy-to-use HIA tools to identify and address health inequalities from new urban policies. Methods: Rapid reviews and consultation with experts identified existing HIA screening tools and methodologies which were then analyzed against predefined selection criteria. A draft Urban HIA Screening Tool (UrHIST) and Urban HIA methodology (UrHIA) were synthesised. The draft tools were tested and refined using a modified Delphi approach that included input from urban and public health experts, practitioners and policy makers. Results: The outputs were two easy-to-use stand-alone urban HIA tools. The reviews and consultations identified an underpinning conceptual framework. The screening tool is used to determine whether a full HIA is required, or for a brief assessment. Urban health indicators are a readily available and efficient means of identifying variations in the health of populations potentially affected by policies. Indicators are, however, currently underutilised in HIA practice. This may limit the identification of health inequalities by HIA and production of recommendations. The new tools utilise health indicator data more fully. UrHIA also incorporates a hierarchy of evidence for use during impact analysis. Conclusion: The new urban HIA tools have the potential to enhance the rigour of HIAs and improve the identification and amelioration of health inequalities generated by urban policies.
https://academic.oup.com/eurpub/article/27/suppl_2/56/3062458
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.
http://www.biomedcentral.com/1471-2458/14/699/abstract
Background
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).
Methods
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.
Results
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.
Conclusions
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.
http://www.tandfonline.com/doi/abs/10.1080/14615517.2015.1006417#.VPO1ril62-I
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.
http://www.biomedcentral.com/1472-6963/14/371
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.
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).
Abstract
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.
Background
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.
Methods
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.
Results
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.
Conclusions
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.
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
Abstract
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
Abstract
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 master plan, 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.
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
doi:10.1016/j.eiar.2011.10.006
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.