7th international health impact assessment conference health impact assessment: making the...
TRANSCRIPT
7th International Health Impact Assessment
Conference
Health Impact Assessment: Making the Difference
Supported by:
7th International Health Impact Assessment
Conference
Health Impact Assessment: Making the Difference
Supported by:
First MinisterRt. Hon Rhodri Morgan
Welsh Assembly Government
Health Impact Assessment: Making the Difference
7th International Health Impact Assessment
Conference
Health Impact Assessment: Making the Difference
Supported by:
Meri Koivusalo
Researcher, National Research and Development Centre for Health (STAKES),
Helsinki, Finland
Health Impact Assessment: Making the Difference
National Research and Development Centre for Welfare and Health
Knowledge for welfare and health
Health impact assessment and Health in all policies – Finnish experiences and policy issues
Meri KoivusaloSTAKES
National Research and Development Centre for Welfare and Health
Knowledge for welfare and health
HiAP and HIA – the Finnish policy context
Health in all policies (HiAP) - a broad approach to integrating health in all policies which incorporates methods such as health impact assessment (HIA)
HiAP is grounded in a tradition of active public health policies, population-based measures and “healthy public policies”
Long history in Finland North Carelia project and focus on diet and cardiovascular diseases Public policies to change work-place and school diets Influencing pricing and consumer choice towards healthier products and tackling the
current “pizza epidemic”
Administrative tradition of supporting intersectoral consultation, but HiAP generally has to operate in a more contested environment
National Research and Development Centre for Welfare and Health
Knowledge for welfare and health
Health impact assessment
Since 1994 part of statutory environmental impact assessment (EIA) procedures
EIA defined broadly and also covers human health and social impacts
Human impact assessment integrates health and social impact assessments (www.stakes.fi/sva/huia/)
HIA mostly implemented at project and local level
National Research and Development Centre for Welfare and Health
Knowledge for welfare and health
HIA as part of public health programme HEALTH 2015
Commitments to develop and implement HIA Health impacts of other sectoral policies are assessed every fourth year as part of the public health report Commitment to guidance for action on HIA at the level of policies and decisionsResources for Finnish Ministry of Social Affairs and Health to develop and maintain HIA related activities Commitment to enhancing HIA at local level in municipalities and within business
National Research and Development Centre for Welfare and Health
Knowledge for welfare and health
HIA & HIAP – politics, policies and practice
HIA supported, but has limited institutional strength
National level action constrained Decentralisation of administration and independence of municipalities Increasing importance of European level priorities and commercial
policies
Complexity of HIA decisions on nuclear power and departure from environmental policy aims with respect to dioxin levels in Baltic herring Overall policy priorities do not seem to be geared towards healthy public policies, but are more driven by the quest towards innovation and competitiveness
Health care dominates health policy debates Overall productivity aims aimed to diminish size and functions of public
administration
National Research and Development Centre for Welfare and Health
Knowledge for welfare and health
European Union and HIAFinnish longer term aim to emphasise the role and relevance of HiAP approach as part of European Union public health strategy
European Union policies are used to promote the importance of the HiAP approach and HIA in the context of national policies
New debate and discussion in the context of the proposed Constitutional Treaty and health systems
Impact of EU policies felt in relation to required changes in alcohol policies and taxation
National Research and Development Centre for Welfare and Health
Knowledge for welfare and health
Health in All Policies
A special Finnish presidency theme in health
Opens a political window of opportunity at European level
Increasing concerns over not just the health impacts of other policies but health system impacts, and in particular internal markets, trade and interpreting the four freedoms within European Union
National Research and Development Centre for Welfare and Health
Knowledge for welfare and health
Health in All Policies and the EU
HiAP conference 20-21.9.2006 and a book on HiAP High level Expert Conference Plenaries to take up also HIA issues and work
Six preliminary workshops - Health inequalities- Nutrition, physical activity and major diseases- Health targeted alcohol policy- Transport policy and health & planning- Mental Health
Expected outcomes: Draft conclusion on HiAP for European Commission policies and Member State activities
Conclusions for adoption by the Ministerial Council
National Research and Development Centre for Welfare and Health
Knowledge for welfare and health
HIA and European UnionHow to influence the ways in which impact assessment is implemented in EU?
Is a bad HIA process better than no process? Opportunities for stakeholder lobbying prior to policy debate
The importance of impacts on health systems and regulatory measures of governments to promote and protect health being raised at European Union level
National Research and Development Centre for Welfare and Health
Knowledge for welfare and health
The Paradox and Potential of HIA
Institutionalisation of knowledge and practice of HIA remains a challenge in Finland
The promise of HIA is still greater than the practice
The quality and implementation of HIA varies at local and project level
Future prospects depend on the realisation of existing commitments
Potential for gains from strengthening the European dimension of work, training and action
National Research and Development Centre for Welfare and Health
Knowledge for welfare and health
HIA as an aid to Policy Making Should we more effectively use the legislative and policy-making potential of HIA
To support an emphasis on broader social determinants of health To support health systems impact assessment
HIA could be seen as mechanism for promoting transparency, debate and active policy-making
Moving from an emphasis on win-win to a method for challenging conflicting policy aims between sectors and creating space for health arguments
Limiting free movement of advertisements Regulation and use of pricing mechanisms to guide consumption
National Research and Development Centre for Welfare and Health
Knowledge for welfare and health
HIA in Finland
Human impact assessment website: www.stakes.fi/sva/huia/
HUIA: [email protected]
Health Inequalities: [email protected]
Health 2015 programme: [email protected] Website: www.terveys2015.fi/english.html
Health in all Policies (HiAP) presidency from 31.05.2005
Official web-site: www.eu2006.fi
7th International Health Impact Assessment
Conference
Health Impact Assessment: Making the Difference
Supported by:
Clemence Dallaire
Associate Professor, Faculty of Nursing, Universite Laval, Canada
Health Impact Assessment: Making the Difference
Health Impact Assessment Québec’s experience
Clémence Dallaire, Laval U, Geneviève Hamel, MSSSGeneviève Lapointe, INSPQ
Québec
Population (2004) :
7,5 millions hab. Territory : 1,7 million km2
Province in a confederation Federal health law with 5 principles
Fiscal money transfert
Health: provincial jurisdiction Provincial health law Ministry of Health and Social Services
Public Health within Québec's Health and Social Services System
18 regional agencies/ PHRA
Hospitals Health and social services centers
Minister
Ministry of Health and Social Services
NPHD/ADM
Administratives (RAMQ)
Councils
National Public Health Institute
Public Health Law (2001)
Putting in place the conditions for public health main functions • Protection
• Promotion
• Prevention
• Surveillance
Divide responsabilities between national, regional and local level
Legal framework to act on public policy
three articles: 53-54-55
Québec Public Health Act Article 54
« The Minister is by virtue of his or her office the advisor of the Government on any public health issue. The Minister shall give the other ministers any advice he or she considers advisable for health promotion and the adoption of policies capable of fostering the enhancement of the health and welfare of the population.
In the Minister's capacity as government advisor, the Minister shall be consulted in relation to the development of the measures provided for in an Act or regulation that could have significant impact on the health of the population. »
Application strategies Intra-gouvernmental HIA process
NIPHQ: expertise Research
NIPHQ
Health & WelfareMinistry
Health & WelfareMinistry
Ministries
Executive Council
Ministers Council
GÉPPS
Research
1
1’
3
2
1
2
3
… …
Intra-gouvernmental HIA process
MHSS
What has been done to implement and to apply article 54 since 2002 ?
Elaboration of practical guide and tools for HIA A network of interministerials respondents
Horizontal mechanism to mobilize partners within Health ministry
1
Since 2002, it appears that
The other ministry's preoccupation with HIA differ: • along social or economic mission
Little use of the tools produced
Consultation if any • towards the end of the policy decision making process
• Consultation on very short notice
(ENAP, 2003; MSSS, 2005)
Executive Council : act as a security net
3 permanent ministerials committee social, economic and regional
The ministerial committee of social development: make sure that the best process to support decision making are used
93% of the demand for consultation to the Health ministery (62/67) during 2005 were send by the Executive Council in about half of those, there has been informal consultation between civil servants of different Ministries and the Health Ministry
At the very end of the process: security net
1’
Overview of the decision–making process
LegislativeAssembly
Council
of
Minister
ministerials
Committee
Minister
of Health
Elaboration of laws, regulation or program
Minister's power
Brief to C of M
Analysis Decision to proceed
Autorization to send it to Legislative Assembly
Analysis in
Parliamentary
commission
AdoptionRecomman-dations to
C of M
1st step 2nd step 3rd step
NIPHQNIPHQ
Health Ministry
other ministries
Executive Council
Council of Ministers
GÉPPS
Research
… …
MHSS and NIPHQ
• Produce synthesis of public policies and brief for the Health Minister
• To facilitate access to expertise and scientific knowledge repertoire of experts conference and scientific meetings Data Base
Web site: Portail
2
Portail Politiques publiques et santé
Launched in november 2004
Veille : 750 information sources
Content and utilization :- Visitors : 2 000 /month- Bimonthly bulletin ( 30 issues + 400 subscribers)- Publications database (800 items)
· Health determinants and risk factors · Healthy public policy · HIA
- Links (26 sites)- List of ressources (under development )
- http://politiquespubliques.inspq.qc.ca
Beyond article 54
NPHIQNPHIQ
National Collaborative Center on Public Policy and Risk Assessment
1 of 6 Canadian Centers in a newly established Public Health Network
Based on Quebec's experience
• Policy and knowledge transfert
• Pan canadian and international networking:
research , knowledge transfert, healthy public policy and HIA
CCN-PR
CCN-PR
NIPHQ
Health Ministry
Other ministries
Executive Council
Council of Minister
GÉPPS
ResearchResearch
… …
Research
Objectives
• To increase research and expertise capacity • To support tools development for HIA• To support knowledge transfert to policy makers
Exemples: GÉPSS
Concours projet: politiques publiques / saines habitudes de vie
3
GÉPPS - Program of research
To increase understanding of the healthy public policy process
To increase understanding of ethical and analytical issues related to healthy public policy process
To develop and implement a strategy of knowledge transfert and utilization that support healthy public policy process
To test new processes and tools for knowledge transfert and utilization
Axes de recherche
1) Decision-making process of a subsystem of public policy
(Sabatier,1999)
2) Prospective evaluation process of public policy
3) Transfert and knowledge utilization process
Program of research : 6 projects
s Projects Objectives
1-2-3 1. Collaborative reseach and partnership
4
1-2-3 2. Litterature review 1-2-3
1 3. Analysis of public policy subsystem
2
1-2 4. Analysis of policy-makers and decision-makers's values and beliefs
1
2 5. Analysis of HIA experiences and policy transfer
1
2-3 6. Integration of a prospective assessment process
3-4
What's next ?
Common goal To ensure an evidence-based policy decision-making process
How?
By developing useful knowledge on policy-making and by using knowledge on health determinants
By sharing this knowledge with policy-makers
By supporting the HIA process within Ministries and Organisms
7th International Health Impact Assessment
Conference
Health Impact Assessment: Making the Difference
Supported by:
7th International Health Impact Assessment
Conference
Health Impact Assessment: Making the Difference
Supported by:
7th International Health Impact Assessment
Conference
Health Impact Assessment: Making the Difference
Supported by:
Beverlea Frowen
Head of Health, Social Care and Well Being, Welsh Local Government Association
Health Impact Assessment: Making the Difference
Beverlea Frowen
DirectorSocial Services and Health Improvement
The Dragon’s Health: Breathing new life
Welsh Reflections on Healthy Public Policy
• Policy landscape• Key Drivers for Health Improvement• What Local Government is doing• Opportunities for the future
Policy Landscape
1.Twin Track approach- strong recognition of the value of ‘prevention’ and Local Governments role
2.Statutory duty to co-operate between NHS and LG
3.Public Sector collaboration not competition
• Wales: A Better Country
−“health & wealth creation at the heart of policy making”
• Health Challenge Wales
−Themes AND ‘any/every thing’ else
• Health, Social Care & Well-being Strategies
−Rebalancing prevention/promotion and treatment/care
• WLGA Approach
−Principles for health improvement and a support team
Policy & Structures at work…
Key actions progressing the agenda
• A new language for local government- creating the right environment
• Making the agenda more manageable
• Dedicated Health & Well-being Team
• Jointly launched HIA guidance in Nov ‘04
• Route to Health Improvement – May ‘06
The Route to Health Improvement
An organisational development package based on Five Key Features of a Health Improving Council
Health improvement is an integral part of all Council’s activity
1. Corporate Culture
2. Policy Development supports the core commitment to improve health
3. Collaboration brings added value to the
health improvement effort
4. Capacity totake forward theagenda is strengthened
5. Governance andPerformance Management
ensures healthy public policy
Keeping it simple – a new language
Life Circumstance
s
LifestyleShared Care
Improving & safeguarding the health of the most vulnerable people in society
Tackling the economic, social & environmental issues that impact on well-being
Encouraging & supporting
healthy attitudes and behaviour
Source: WLGA Route to Health Improvement.
HIA in ‘The Route toHealth Improvement’
“Health Impact Assessment…is used appropriately as part of
policy and decision making processes and in doing so builds partnerships
and fosters greater awareness of the collective impact of our actions”
Making linkages and learning
• Electronic database of notable practice• Self assessment framework and matrix of
three thresholds of status• Spearhead sites (building on learning zone
concept)• Stronger links to community planning• International network of collaborative
effort??
Three levels of preparedness
• Capacity - Leading the way..
• Members use community leadership role to drive health improvement
• Workforce and development planning focuses on health improvement
• Employees across the organisation have the appropriate knowledge, skills & attitudes for health improvement
-‘We don’t do health’
Three levels of preparedness
• Capacity – Getting there..• Awareness growing of potential to use
community leadership role
• Some employees in key positions understand the issues
• Health improvement is a side issue amongst roles and responsibilities and work force recruitment
Three levels of preparedness
• Capacity – Starting out..
• The community leadership role and community planning needs further development
• Health not a feature of organisational ‘psyche’
• Dominance of NHS to lead agenda
Where next for healthy public policy in Wales?
Councils acknowledged by all as health improvement agencies and in doing
so they are maximising the full potential of their roles and
resources
In the horizon
• Beecham Review
• Local Government white paper
• Changing relationships betweenCentral and Local Government
• NHS secondary care reforms
• New Funding regimes
The following have the potential to enhance our efforts or put the skids on some of it!
A final observation…
“inequalities in health are the most fundamental inequalities of all there is no greater inequality than being dead and being alive” Frank Dobson
Thank you for listening have a good second day and good luck with your efforts!
Beverlea FrowenDirector,
Social Services & Health Improvement
7th International Health Impact Assessment
Conference
Health Impact Assessment: Making the Difference
Supported by:
Mary Mahoney
Senior Lecturer and Coordinator, Deakin University, Australia
Health Impact Assessment: Making the Difference
This presentation will…
Map the territory – healthy public policy in
Victoria and the role of HIA
Introduce the context specific drivers for HIA
Model the attributes for ‘sustainable HIA’
Explore the threats to ‘the ducks’
Mapping – the political scene
3 levels of government - federal, state and local each with differing responsibilities
Each state and territory differs so it is not possible to generalise between states
Federal government is liberal (i.e. conservative), and all states are Labor
Local government in Victoria - amalgamations in 1993 moving from 210 to 79
Mapping – Origins of Impact Assessment
Project-focused Impact Assessment Prediction of impacts of a proposed development on the environment with social and health IA as integral processes
Origins: EIA → SIA → EHIA → Policy applications
Strategic planning and policy makingTypes: PIA + SEA + (P)HIA
Discrete applications IA types used for different purposes and driven by different needs in each context
Examples: SIA in LG
Mapping - Victorian policy context
State government level: All government agendas must reflect the Triple
Bottom Line principles of economic, environmental, social accountability
Whole of government focus on spatial disadvantage and health inequalities through Neighbourhood Renewal program
Increased emphasis on the social through A Fairer Victoria framework and the new state government Department of Victorian Communities.
Mapping - Victorian policy context
State level legislative requirement The Environment Effects Act (1978) for
the Department of Human Services to review all Works Approvals to ensure that public health is not endangered by any proposal. If DHS objects to the application Environment Protection Agency must refuse the application.
Mapping - Victorian policy context
Local government level: Health Act (1958) legislated a requirement for all
council to produce Municipal Public Health Plans (MPHP)
Local Government Act (2003) requires Council Plans to be prepared focused on the quality, sustainability, prosperity
Planning and Environment Act 1987 requires Municipal Strategic Statements linked to objectives for land use and development
Mapping - Supportive partnerships
Key partnerships between Government departments e.g. housing, public health,
infrastructure, sustainability and environment VicHealth Planning Institute of Australia (PIA) Municipal Association (MAV) Local government association (VLGA) Heart Foundation Cancer Council Victorian Council of Social Services
Mapping – supportive frameworks
Environments for Health Planning Framework - A practical guide to assist in the integration of
public health considerations into council’s broader planning responsibilities
Underpinned by principles of leading communities to better health and environmental dimensions of health i.e. built, social, economic and natural environments
Mapping – supportive frameworks
Other examples Leading the Way
introducing the social model of health to councillors Healthy by Design
resource for planners for designing liveable and healthy communities
VicLanes resource for LG on people’s health promoting behaviour by
location Safer by Design Guidelines
planning and design of safer communities Good practice funding
to support elements of MPHPs
Mapping - Implications for HIA
Status quo +: enhancing HIA in EIA but adding a specific HIA protocol developed and assessed by health sector
Checklist approach: specialist HIA using equity audits, RIS approaches and rapid appraisals
Strategic placement of HIA in decision-making: high level applications across government
Combined approaches: incorporating A, B & C Human or Sustainability: new whole of government
application with multiple methodologies (Source: HIA Forum, Melbourne, 2002)
Drivers for HIA – important features
In seeking to introduce HIA it was important to exploit all opportunities for formal mechanisms to
address the role of health in development argue for legislative status capitalise on existing strengths within the system build on existing goodwill, informal networks,
champions, community concerns, and changes occurring
develop a common agreement about language build on current guidelines to produce comprehensive,
well supported processes for all to use urge for improved access to evidence
Context specific drivers for HIA
Ranging from formal to less formal including: the need to comply with formally-required
processes the growing imperative to take health into
account in planning a growing awareness of the complexity of the
problems and the need for diverse solutions the growing awareness of the need to work
together Awareness of gaps within existing approaches
Context specific drivers cont’d
Comparisons between councils/departments Innovative practices emerging from within
government which provided examples for others
Availability of resources to support and encourage change (and dissemination)
Publicity about the potential role of HIA (timely, accessible, relevant and flexible)
Impetus to regenerate other forms of HIA in the light of new enthusiasm about its use in policy contexts
Progress in Victoria
Ministerial push for expanding HIA in Review of Health Act
Inclusion in further roll out of Neighbourhood Renewal programs
Funding for capacity building and demonstration projects across the state
Use in non-health sector and health care services
Integrated options under discussion Funded positions within government ‘Grass roots’ interest and commitment
Attributes for an effective and sustained use of HIA in HPP
Supportive agendas of government √
Appropriate organisational structures √
Realistic legislative requirements √
Enabling planning frameworks √
Willingness to adopt a social model of health √
Preparedness to adopt innovative approaches to planning √
Commitment by professionals to principles of HPP √
Desire to create a different future for the population through flexible policy and planning processes
√
Opportunities for intersectoral working across government √
In the Victorian context
It has been crucial to blend top-down support with bottom-up impetus, capacity building and driving
It has been less important to have legislative requirements than grass roots acceptance of the need for HIA and the value it can bring to current working practices
Threats to the ducks
HIA turning into a passing fad HIA seen as panacea delivering more than it can Unrealistic expectations about how quickly a new
process can be introduced HIA as an idea not an action Change of focus of the state government
With thanks …
for the chance to tell this story and close the loop to the key people who have guided our development to the people who have made available key papers,
and reports or developed websites which have permitted a sharing of knowledge
for the collegiality within the HIA network
So overall what does the Victorian situation actually look like?
7th International Health Impact Assessment
Conference
Health Impact Assessment: Making the Difference
Supported by:
LUNCHPlease ensure that you return to your chosen workshop or session by 1.15 pm
Health Impact Assessment: Making the Difference