Professor Sally Macintyre Director of the Medical Research Council and Public Health Sciences Unit, Glasgow Health Impact Assessment: Making the Difference

Systematic review of area based regeneration initiatives in the UK l Little evidence of the impact of national urban regeneration on socio-economic or health outcomes. l Changes often no different from national trends. l However, some harms:  Single Regeneration Budget ; deterioration in self reported health  Urban programme and City Challenge; worsening of unemployment  Estate Action; increased housing costs  Housing improvement in 1930s Scotland; rents doubled, mortality rates increased (residents couldn’t afford adequate food) Thompson et al, 2006

It is adequate to know that some intervention does good in general? But: l ‘Bike ed’ : negative association was strongest in –Boys –Younger children –Children with parents in lower educational levels –Children lacking family members with bicycles l ‘Sesame street’ benefited all children but increased the gap between fast and slow learners l Dental health promotion effective in middle class but not lower class kids l ‘Sure Start’ may have adverse effects on the most vulnerable e.g. teenage mothers, workless families

Plausibility is an adequate basis for policy making? But: l Bicycle safety education will reduce bicycle accidents l Lying babies on their fronts is best l Supplementing diets with vitamin A will mimic good effects of fruit and vegetables l HRT will reduce CVD in postmenopausal women

Stages of HIA Screening Scoping Risk assessment Decision making Implementation and monitoring

Health Impact Assessment feedback loop l If HIA is to be useful, it needs robust information to feed into its predictions l Need to check how HIAs compare with what actually happened l Need to bring together the HIA and evaluation fields

HIV and Evaluation HIA : ‘any combination of procedures or methods by which a proposed policy or program may be judged as to the effects it may have on the health of the population.’ WHO 1999 Evaluation: ‘examines the outturn of a policy, programme or project against what was expected.’ HM Treasury Green Book

Evaluation: MRC SPHSU Systematic Reviews of Policy, Programmes and Projects l Health effects of new road building l Urban regeneration l Housing renovation l Promoting walking and cycling l Tobacco control programmes and their effects on social inequalities l Privatisation, deregulation and state subsidies to industry

Evaluation: MRC SPHSU Evaluation of health effects of Policy, Programmes and Projects l Traffic calming l Building of M74 extension l Central heating initiative l Sure Start l Rehousing and health (Renton, Scotland wide, Glasgow) l Swimming pool closure l Scottish ban on smoking in enclosed public places l Opening of a major new superstore l Healthy living centres l Closure of soft drinks factory

Hypermarket Study l New Tesco hypermarket opened November 2001 in Springburn. Comparison area Shettleston Both had: l No large supermarket l Depcat 7 (levels of deprivation) l 50% smoking prevalence l Declining rates of male life expectancy l Low levels of fruit and vegetable consumption (one-third eating fruit daily)

The Springburn Supermarket study Before (2001) and 1 year after (2002) Postal survey (2001/2002) Qualitative interviews (10 focus groups) Systematic mapping of local retailers: type, location every 6 months s

Hypermarket Study, change from baseline Intervention Community Fruit (portions per day 0.09 Veg (portions per day) 0.15 F+V (portions per day) 0.29 (p=0.07)

Hypermarket Study, change from baseline Intervention Community Control Community Fruit (portions per day Veg (portions per day) F+V (portions per day) 0.29 (p=0.07) 0.44 (p=0.003)

Hypermarket Study, change from baseline Controlling for baseline diet, age, sex, employment and education: No significant difference between areas in change in l fruit and/or vegetable consumption l among either switchers or non switchers

Hypermarket Study, change from baseline No significant changes in retail provision locally, although intervention area had l Greater decrease in shop vacancy rates l An extension of food retail outlets l A greater increase of service retail outlets (one butcher and one greengrocer closed in control area, no closures in intervention area)

Hypermarket Study – retrospective HIA l Three classes of MPH students (45 students) l Given details of the areas and the hypermarket development l Given Merseyside HIA guidelines l Asked to predict impacts on diet, social participation, employment opportunities, social networks, traffic and local environmental problems

Hypermarket Study – retrospective HIA l Three classes of MPH students (45 students) l Given details of the areas and the hypermarket development l Given Merseyside HIA guidelines l Asked to predict impacts on diet, social participation, employment opportunities, social networks, traffic and local environmental problems l Predicted –positive impact on diet –negative impact on shops

Inequalities and HIA - conclusion l Inequalities in health and life chances are pervasive l And are not always captured in aggregate data/outcomes l Little is known about how best to reduce inequalities in health l Health Inequalities Impact Assessment may have little data to guide predictions l Assumptions about likely impact may be wrong l Need to link HIA and HIIA with systematic reviews and controlled evaluations l Closing the feedback loop – retrospective HIA

Inequalities and HIA - conclusion l Inequalities in health and life chances are pervasive l And are not always captured in aggregate data/outcomes l Little is known about how best to reduce inequalities in health l Health Inequalities Impact Assessment may have little data to guide predictions l Assumptions about likely impact may be wrong l Need to link HIA and HIIA with systematic reviews and controlled evaluations l Closing the feedback loop – retrospective HIA With thanks to Mark Petticrew and Hilary Thomson

7th International Health Impact Assessment Conference Health Impact Assessment: Making the Difference Supported by: