Prioritising health in policy and project appraisal: Are HIAs used for policy in Ireland? Research findings Monica O’Mullane Institute of Public Health Ireland 11 th November 2008

11th November 08HIA Forum, Institute of Public Health2 Today’s presentation Rationale for this area of research HIA and Policy Appraisal Work done already on the link between HIA & Policy Use of HIAs in Policy: The Irish experience Findings & Conclusions

11th November 08HIA Forum, Institute of Public Health3 Rationale for this area of research Recent debate and commentary on the feasibility of HIA Move away from a concern about design of HIA, towards current issues..  Community involvement and role within the HIA process  Policy and the link between HIA and decision makers (Kemm, 2006)

11th November 08HIA Forum, Institute of Public Health4 Purpose of HIA To influence decision making so that policies, projects and programmes can improve pop health or mitigate risks Intended and unintended consequences can be foreseen 3 ways to influence decision making with HIA 1. By raising awareness among decision makers 2. By helping decision makers identify and assess possible health consequences 3. By helping those affected by policies to participate in policy formation and to contribute to decision making

11th November 08HIA Forum, Institute of Public Health5 HIA and Policy Appraisal Separate conceptual root for policy appraisal Potential for analysis of HIA drawing from the policy sciences (Lasswell & Positivism 1951;Lindblom, 1959; Lowi, 1972; Walt, 1994) “Policy is rather like an elephant- you can recognize it when you see it but cannot easily define it” (Cunningham, 1963) Policy-oriented approach

11th November 08HIA Forum, Institute of Public Health6 Work done already on the link between HIA & Policy Although policy sciences have much to offer, IAs have been marginalised in the field (Weston, 2002) IA: Bridge between policy-makers and science Bekker et al, (2004): Rational, Incremental, Mixed scanning models Putters 1996: Rational v incremental Putters 2005  must spend less time defining HIA, and more time understanding the policy process which must assimilate HIA knowledge How to evaluate HIA as a policy-aiding tool? European Observatory on Health Systems and Policies (Wismar, 2004; Wismar et al. 2007)

11th November 08HIA Forum, Institute of Public Health7 Some Irish HIAs…

11th November 08HIA Forum, Institute of Public Health8 HIA: What Irish Health Strategies say.. South National Health Strategy (2001) “HIA will be introduced as part of the public policy development process” (Objective 1.1) North Investing for Health (2002) “This programme (of HIA) will address issues of coordination, capacity building, tool development and quality assurance”

11th November 08HIA Forum, Institute of Public Health9 Use of HIAs in Policy: The Irish experience (case studies) Housing  HIA of Northern Ireland Housing Executive Proposal toRedevelop Dove Gardens Estate (2005)  HIA of Travellers’ Accommodation Programme in Donegal, ( )(06) Physical Environment  HIA of the Draft Air Quality Action Plan for Belfast (2006)  HIA of Traffic and Transport in Ballyfermot (2004)

11th November 08HIA Forum, Institute of Public Health10 Study question How and why do structures and values influence the use of HIAs in policy?

11th November 08HIA Forum, Institute of Public Health11 1New institutionalism: Normative dimension 2 Impact Assessment and Value judgements UTILISATION  (3 indicators: *Instrumental; *conceptual; *persuasive) 3Political dimension HIA Literature; Previous work and calls for further research

11th November 08HIA Forum, Institute of Public Health12 Research conclusions: Dimensions of use  Instrumental: Ballyfermot, Belfast, Derry  Conceptual: Ballyfermot, Donegal, Belfast, Derry  Persuasive: Donegal, Belfast, Derry

11th November 08HIA Forum, Institute of Public Health13 Barriers & Enablers to the use of HIAs Irish HIAs in Practice: The time has come? Enablers and Barriers of the Place of HIA in the Policy Process (Hayes, 2006) Check-list approach; Snowballing

11th November 08HIA Forum, Institute of Public Health14 Enablers and Barriers of the Place of HIA in the Policy Process (Hayes, 2006) Enablers Involved in planning and conduct of HIA Input from outside decision-making process Clear organisational commitment Subject non-controversial Realistic recommendations Barriers Lack of awareness of health by other sectors Lack of knowledge of policy-making environment

11th November 08HIA Forum, Institute of Public Health15 Research findings: Additional Enablers Institutional leadership Political will Involvement of the community sector

11th November 08HIA Forum, Institute of Public Health16 Research findings: Additional Barriers Lack of institutional leadership and support for HIA Lack of understanding of HIA and of what decision makers require from the process Institutional values and norms Lack of willingness of engage in cross- sectoral working

11th November 08HIA Forum, Institute of Public Health17 Overall conclusions Combining theoretical & empirical findings  HIAs are used in policy development Practically, HIA use is influenced by  the tier of government (local)  the involvement of key partners (planning services)  the conceptualisation health  the role of the policy-makers and the community receiving the policy product.  The mainstreaming of the tool is important into the future. Its incorporation into an Integrated Impact Assessment (IIA) is one feasible route for it attaining a legislative footing.