1. Using Public Health Tools for change Dr Bobbie Jacobson & Dr Jenny Mindell London Health observatory Monitoring health and health care in the capital, supporting practitioners and Informing decision makers.

2. What is Health Equity Audit (HEA)? Health equity audit is a process by which: partners systematically review inequities in the causes of ill health, and access to effective services and their outcomes, for a defined population Further action is agreed and incorporated into policy, plans and practice. actions taken are reviewed to assess whether inequities have been reduced Source: “Health Equity Audit Made Simple.” http://www.lho.org.uk/HIL/Inequalities_In_Health/Attachments/PDF_Files/equit yauditfinal21.1.3.pdf

3. What is Health Impact Assessment (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” WHO European Centre for Health Policy. Health Impact Assessment. www.euro.who.int/document/PAE/Gothenburgpaper.pdf

4. What is Health Needs Assessment (HNA)? It is a process by which a populations’ average ability to benefit is increased in relation to risk or need. The overall aim is to provide information to plan support and change in services for the better and to improve health in other ways. Adapted from Stevens A, Raftery J, Mant J An Introduction to health needs assessment http://hcna.radcliffe-oxford.com/http://hcna.radcliffe-oxford.com/

5. What is Race Equality impact assessment (REIA)? “A way of systematically assessing and consulting on the effects that a proposed policy is likely to have on people depending on their racial group”.

6. Public Health Tools for Change: How are they related? HNA: analysis of need; can contribute to equity profile and priorities for action HIA: helps identify positive / negative health effects of proposed policy / actions 1 2 3 4 5 6 Health Equity profile Use evidence to prioritise effective actions Agree key local objectives with partners Influence change in investment / delivery Review progress against local objectives The Health equity audit cycle Agree partners, Priorities and topics Race equality impact assessment

7. Screening Scoping Literature review Local data Local knowledge Influencing decisions Recommendations Policy analysis Appraisal The stages of Health Impact Assessment

8. Similar Techniques – Different purposes Use of local data to profile the area –demography –determinants of health –health data Use of literature for evidence of (cost-) effective interventions –on health, determinants, and inequalities Information gathered from stakeholder and community members & organisations

9. What are the differences in Purpose? HEA –To reduce inequities HIA –To improve health consequences of a proposal and to reduce inequalities HNA –To determine average health status and ability to benefit from services REIA – To prevent adverse effects of policies on race equality

10. What Kinds of Health Inequality?

11. Inequalities (differences) and inequities (unfair differences) are: The prime focus of HEA An integral component of HIA Not always a part of HNA The prime focus of REIA

12. What are the differences in process? HEA is cyclical HIA is linear and looks forward HNA is linear and looks back REIA is linear but in includes effects on implementation – it also looks forward

13. Making a difference through HEA: The Improvement in W Hertfordshire Coronary Revascularisation Equity before and after Introducing the CHD NSF

14. Making a Difference Through Health Impact Assessment – Some Examples Transport proposals –Manchester airport – rail link added, car parking reduced, jobs & training for local people –London mayoral transport strategy – impacts of HIA demonstrated, eg more emphasis on walking, cycling, and buses –Nottingham Local Transport Plan – promotion of walking & cycling, supported workplace parking levy Regeneration

15. LHO Further Work on HEA Baseline survey of HEA in London Further workshops and development of master classes with APHO Development of benchmarking tools for PCTs/LSP Modelling ways of closing the gap in life expectancy Further analysis of inequalities in access to health and health care – e.g. the new London Regional HES Service A register of audits

16. LHO Further Work on HIA Training courses (at LHO and elsewhere) Guide to commissioning HIA: –Points to consider –List of available consultants and areas covered Costing tool (due on web November 2004) Resource to aid commissioning, conducting or appraising reviews of evidence for use in HIA Review of available instruments for conducting HIA Supporting HIA practitioners in London Supporting other PHOs’ HIA leads Possible ‘train the trainer’ courses

17. Resources for Health Equity Audit DH Health Equity Audit: A Guide for the NHS www.doh.gov.uk/healthinequalities/hea_guide_nhs.pdf Health Equity Audit: A Self assessment Tool for PCTs www.doh.gov.uk/healthinequalities/hea_guide_nhs.pdf Health Equity Audit Made Simple http://www.lho.org.uk/Health_Inequalities/Attachments/PDF_Fil es/equityauditfinal21.1.3.pdfhttp://www.lho.org.uk/Health_Inequalities/Attachments/PDF_Fil es/equityauditfinal21.1.3.pdf The Health Poverty Index: www.hpi.org.uk/index.phpwww.hpi.org.uk/index.php

18. R esources for Health Impact Asessment HDA’s HIA Gateway www.hiagateway.org.ukwww.hiagateway.org.uk World Health Organisation www.who.int/hia/enwww.who.int/hia/en London Health Observatory www.lho.org.ukwww.lho.org.uk The London Health Commission (LHC) http://www.londonshealth.gov.uk/hia.htm http://www.londonshealth.gov.uk/hia.htm IMPACT (International Health Impact Consortium, Liverpool) www.ihia.org.uk www.ihia.org.uk HIARU (Health Impact Assessment Research Unit, Department of Public Health and Epidemiology, Birmingham) www.publichealth.bham.ac.uk/hiaru www.publichealth.bham.ac.uk/hiaru HEA: A Baseline Survey of PCTs in England

19. London Health Observatory Monitoring health and health care in the capital, supporting practitioners and Informing decision makers. http://www.lho.org.uk