1. Day 4 Session 3: Introduction to Health Impact Assessment Linsey Hovard South East Public Health Observatory 20 th January 2010

2. Learning Objectives 1.To be aware of the contribution of HIA to proposal and policy impact appraisal 2.To be aware of the process for carrying out an HIA 3.To have increased awareness of the role of health intelligence in HIA

3. What is HIA? “ A combination of procedures, methods and tools by which a policy, programme or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population". Source: WHO Regional Office for Europe (1999), Gothenburg consensus paper: Health impact assessment; main concepts and suggested approach, Brussels: European Centre for Health Policy.

4. Types of proposal appropriate for HIA Proposed spatial plans e.g. housing, roads and transport, retail development, employment strategies, community services and infrastructure. National / strategic policies e.g. Patient Choice, congestion charging. Proposals and policies for specific health determinants e.g. Liverpool alcohol strategy. Policies and proposals associated with noise, air pollution (e.g. waste / landfill strategies), environmental justice. Policies and proposals for changes in access to community services and infrastructure – health and other sectors.

5. Why carry out a HIA? An upstream process addressing health improvement upstream. Increases the profile of health within other sectors’ agendas. Supports proposals from the Marmot Review Task Group 7: –ability of system to take population health perspective –Championing local multi- sectoral work on social determinants –Local leadership on facilitating joint working –shared targets on shared objectives http://www.ucl.ac.uk/gheg/marmotreview/consultation/Delivery_systems_and_mechanisms_report

6. HIA and health inequalities HIA can contribute to reducing health inequalities by: - raising awareness among decision makers of the unequal distribution of health –demonstrating how a proposal may affect the health of particular groups within a population –providing recommendations on how a proposal could be modified to improve reduce health inequalities or prevent existing inequalities being exacerbated. Source: Institute of Public Health in Ireland 2009. Health Impact Assessment Guidance.

7. HIA: Typical stages Screening Scoping Identification of impacts – data collection Appraisal of impacts – triangulation: Stakeholders’ views, demographic data, information base. Identification and prioritisation of recommendations Implementation Monitoring and evaluation

8. Screening Several screening tools available – see handout. Usually carried out by a small group of key stakeholders Provides an early indication of: –Whether an HIA is the most appropriate way to assess the health and health equity issues in the proposal. –What areas of potential health and health (in)equality are there in the proposal? –Whether vulnerable groups in the population are likely to be affected by any potential health impacts. –Any areas of concern at the outset? – From decision-makers? From the community (e.g. previous consultation exercises)?

9. Table talk Take a few minutes to read the extracts from the screening tools you have been given. At your tables, please discuss: What do you think are the most useful questions in these parts of the screening tools and why?

10. Mental Health and Wellbeing Impact Assessment (MWHIA) Screening tool The MWIA includes some additional, specific determinants of health impact. For example ENHANCING CONTROL »Control over personal finances »Control over personal living environment »Control over personal decision making processes REDUCING ANXIETY »Knowledge & understanding of systems, services and support available »Access to advice & support »Self esteem FACILITATING PARTICIPATION Having a valued role (e.g. a job, school governor, on tenants association) Challenging discrimination

11. Equity-Focused Health Impact Assessment: Screening questions 1. Is it necessary to consider health within this policy or practice? 2. Does this policy or practice have any (potential) health impacts? 3. Are these health impacts likely to be differentially distributed by socioeconomic status, ethnicity, gender, geography, or some other factor? 4. Are these differential impacts fair? 5. Are these differential impacts avoidable? 6. Do the benefits of changing the policy or practice to moderate or remove these differential impacts outweigh the costs or disadvantages of doing so?

12. Scoping Type of HIA – prospective, concurrent, retrospective. Equity focussed? MWIA? Steering group /project management Values – definition of health, equity, democracy, sustainability. Geographical area and population groups– Data sources and accountability for data collection Scope of the literature /evidence review Other information to be taken into account –e.g. local policies, previous consultations and policy assessments. Stakeholders Methods and approach Timeframe

13. Data for HIA Data requirements are driven by the health determinants identified in screening and in stakeholder engagement. They typically include: Basic demographic, health and lifestyle profile – ONS, IMD and Community Health Profiles for the geographical areas specified. Ward /SOA level. Transport – car ownership, active travel indicators, public transport coverage, Housing – ownership, vacant housing. Crime and community safety – crime stats, designated public place orders, Education and employment statistics, economy – e.g. small business start-ups/ closures. Public services – e.g. health centres, Sure Start / Childrens’ Centres. Environment – flood risk, air quality monitoring sites.

14. Community Profile: HIA extract The LSOA in Murston Ward to the east of the planned development has the worst employment deprivation in Swale and the third lowest income deprivation. There are also two LSOAs: Milton Regis and St Michaels (on the edge of the planned development zone) that have some of the worst crime rankings in Swale. The other noticeable area of deprivation is in the east of Roman ward nearest the town centre, which has the third worst deprivation for the Living Environment domain of IMD 2007. Source: SEPHO 2009. Health Impact Assessment (HIA) Sittingbourne town centre and Milton Creek Supplementary Planning Document: Consultation draft.

15. HIA in context: Other policy impact assessments Environmental Impact Assessment(EIA) Strategic Environmental Assessment Equality Impact Assesment (EqIA) Move towards Integrated Impact Assessment – proponents and opponents

16. Sittingbourne and Milton Creek Masterplan: Sustainability Appraisal and HIA The SA conclusions for health were: – No significant effects on provision of health facilities; – Possible indirect beneficial effects on incidence of diseases such as obesity and heart disease by encouraging people to be more active. The HIA expanded on this assessment and highlighted health impacts on both new and existing communities in neighbouring (relatively deprived) wards.