Download - Monica O’Mullane Institute of Public Health Ireland 11 th November 2008 [email protected]

Prioritising health in policy and project appraisal: Are HIAs used for policy in Ireland? Research findings

Monica O’MullaneInstitute of Public Health Ireland11th November [email protected]

11th November 08 HIA Forum, Institute of Public Health 2

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


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)


Purpose of HIATo 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 HIA1. By raising awareness among decision

makers2. By helping decision makers identify and

assess possible health consequences3. By helping those affected by policies to

participate in policy formation and to contribute to decision making


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


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)


Some Irish HIAs…


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”


Use of HIAs in Policy: The Irish experience (case studies) Housing

HIA of Northern Ireland Housing Executive Proposal to Redevelop Dove Gardens Estate (2005)

HIA of Travellers’ Accommodation Programme in Donegal, (2005- 2008)(06)

Physical Environment HIA of the Draft Air Quality Action Plan for

Belfast (2006) HIA of Traffic and Transport in Ballyfermot

(2004)


Study question

How and why do structures and values influence the use of HIAs in policy?


1New institutionalism:Normative dimension

2 Impact Assessment and Value judgements

UTILISATION (3 indicators: *Instrumental; *conceptual; *persuasive)

3Political dimensionHIA Literature; Previous work and calls for further research


Research conclusions: Dimensions of use Instrumental: Ballyfermot, Belfast,

Derry Conceptual: Ballyfermot, Donegal,

Belfast, Derry Persuasive: Donegal, Belfast,

Derry


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


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


Research findings: Additional Enablers

Institutional leadership Political will Involvement of the community sector


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


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.