Health Impact Assessment 101April 2014

Sandra WhiteheadFlorida Department of Health

Healthiest Weight Florida

Goals

• Define HIA and associated terms• Discuss the values underlying the process• Learn why an HIA should be conducted and when

it is appropriate• HIA and its relationship to Health in All Policies• Define the phases of an HIA• Discuss further learning opportunities and

resources available

What is HIA?

The National Research Council defines HIA as “a systematic process that uses an array of data sources and analytic methods, and considers input from stakeholders to determine the potential effects of a proposed policy, plan, program, or project on the health of a population and the distribution of those effects within the population. HIA provides recommendations on monitoring and managing those effects”

National Research Council, Improving Health in the United States, 2011

HIA Terms and Definitions

• Systematic process: o Definition of a problem for analysiso Observation of current baseline conditionso Predicting possible health effects and

outcomeso Assessing the likelihood, severity and

distribution of impactso Design solutions that minimize negative and

promote positive health outcomes

HIA Terms and Definitions

• Data sources and analytic methods: o Health data sourceso Social, built and

economic environmental data

o Software that models changing conditions

o GISo Key informants

HIA Terms and Definitions: Potential Health Effects

HIA Terms and Definitions

• Distribution of health effects: representation of whom, where and when the negative or positive health impacts will be seen

Value of HIA

• Democracy• Equity• Increases awareness

of health issues• Holistic approach to

health• Scientific and robust

practice

Why Conduct an HIA?

• HIA is an important tool for advancing health and equity • HIAs help inform decision makers and other stakeholders

about the likely health impacts associated with a proposed public decision

• They provide information that serves as the basis of recommendations for ensuring that the decision improves health outcomes, especially for the most vulnerable

• Identifies strategies for protecting and promoting public health

“Promoting Equity Through the Practice of Health Impact Assessment,” Heller, et al., 2013

When is it Appropriate to Conduct an HIA

As early as is practical in the decision making process

When health is not being considered as a factor

When conducting on-going work with decision makers and stakeholders

As part of a larger process

Health in All Policies and HIA

HIA is a tool that can be used to assess a single proposed decision and its potential impact on health

HiAP is an approach that uses multiple strategies to systematize and integrate the governmental decision-making process across agencies so that health is considered

Collins, J. & Koplan, J. (2009). Health Impact Assessment: A Step Toward Health in All Policies. JAMA. 2009;302(3):315-317

Six Phases

There are typically six steps in conducting an HIA

Screening – Determine whether an HIA is needed and the value addedScoping – Identify which health effects to consider and set the HIA parameters Assessment – Collect qualitative and quantitative information to create a profile of existing health conditions, and identify, evaluate, and prioritize the potential health impacts of the decisionRecommendations – Identify alternatives to the decision and/or strategies for promoting the positive health impacts and/or mitigating the adverse health impactsReporting – Write a final report and communicate the results of the HIA to decision-makers and other stakeholders for implementation/action Monitoring and Evaluation – Evaluate the processes involved in the HIA and the impacts of the decision on health (North American HIA Practice Standards Working Group 2010; Bhatia 2011; National Research Council 2011; Human Impact Partners 2011, 2012)

Phases of HIA

Screening

The purpose of screening is to “assess the value, feasibility and utility of the HIA in the decision making process,” (Bhatia, 2011)

Clearly define the decision to be informed and who is making the decision

Is health being considered already? Is it feasible to complete an HIA?Will an HIA be politically viable?What are the health issues involved?

Sample Screening Potential Effects on Health Determinants Nexus between Health Determinant and Health

OutcomesLikelihood of Impact (unlikely, possible,

likely)

Likely Magnitude of Impact (low, medium,

high)

Biophysical Environment Crowded conditions can increase the hazard for infections, respiratory disease, fires and poor mental health. Unaffordable rents or mortgages result in trade-offs between material needs such as housing, food, and medical care.

Housing Conditions

Fire, building safety

Security

Sanitation

Indoor air quality (including radon)

Asbestos

Lead

Crowding

Affordability and access

Housing segregation

ScopingDefine the HIA team, stakeholders and timeframes

for the processDefine the limits of the HIA:

GeographicDemographicHealth outcomes

What type of HIA will you perform?

Stakeholder RolesPrimary Stakeholders

(those directly affected , not just in terms of health, include

any populations disproportionately affected)

On working group

To be consulted Gather data from

Secondary Stakeholders

Key Informants (individuals with knowledge, experience, or information

Kinds of HIAsDesk Based Rapid Intermediate Comprehensive

No more than 3 impacts No more than 3 impacts, assessed in detail

3 to 10 impacts assessed in detail

All potential impacts assessed in detail

Provides a broad overview of potential health impacts

Provides a detailed overview of potential health impacts

Provides a thorough assessment of potential health impacts and more detail on predicted impacts

Provides a comprehensive assessment of potential health impacts

Is an “off the shelf” exercise based on collecting and analyzing existing, easily accessible data

Involves collecting and analyzing existing data with limited input from experts and key stakeholders

Involves collecting and analyzing existing and primary data as well as new qualitative data from stakeholders

Involves collecting and analyzing data from multiple sources (qualitative and quantitative)

2-6 weeks for one person full time

6 to 12 weeks for one person full time

12 weeks to 6 months one person full time

6 to 12 months for one person full time

Pathways Diagram

Assessment

• Determine the baseline health status, conditions “on the ground” related to health and vulnerabilities in the population or area

• Assess the likelihood, magnitude and direction of health impacts using available data, qualitative and quantitative analysis

• Identify strategies that eliminate, contain or mitigate negative impacts and enhance positive impacts

Reporting

• Communicate the results and recommendations of the HIA to decision makers and the general public

• Clearly relate the process, stakeholder participation and limitations of the HIA

Evaluation and Monitoring

Evaluation •Process evaluation: assesses the effectiveness, transparency and rigor of the HIA process itself

Monitoring Outcome evaluation: assesses changes in health status and health determinants as the decision is implemented

Resources

• Health Impact Project: www.healthimpactproject.org

• Human Impact Partners: www.humanimpact.org• UCLA Health Impact Assessment Clearinghouse:

www.hiaguide.org• Public Health England HIA Gateway:

http://www.apho.org.uk/default.aspx?QN=P_HIA• World Health Organization: www.who.int.hia/en

Resources

Improving Health in the United States: The Role of Health Impact Assessment (National Research Council 2011)

A Health Impact Assessment Toolkit: A Handbook to Conducting HIA, 3rd edition (Human Impact Partners 2011)

Health Impact Assessment: A Guide for Practice (Bhatia 2011)

Summary

• HIA is a systematic process to predict and address the potential health impacts of a single policy, program or project

• HIA includes a broad range of stakeholders in the process to create shared values focusing on improving and protecting public health

• HIA is evidence-based and uses established analytic tools to demonstrate and communicate the risks associated with the decision under consideration

Future Educational Opportunities

Healthiest Weight Florida and the Florida Public Health Institute will be sponsoring three in-person trainings around the state for those interested in the “how to” of HIA. The classes will be limited in size available on a first-come, first-served basis to those who have completed HIA 101.

Regional Trainings

Orlando: May 12-13East Central Florida Regional Planning Council in Altamonte Springs

Tallahassee: May 14-15Florida Department of Revenue

Sarasota: May 21-22FDOH in Sarasota (Ringling Blvd)