HIA in Decision Making: What We Know and What We Need to Know

2015 Global Health Forum in Taiwan “Public Health Governance”

We Need to Know

Francesca VilianiInternational SOS - Head of Public Health Consulting Services and

Community Health Programs

AGENDA

•Presentation

•Definition, process and purpose

•Use and Actors

•What we know and what research tells

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•What we know and what research tells

•Conclusions

Who am I?

• I have been working on HIA since 2004

• Mainly conducting or supporting HIA of privately funded projects:

Mega Infrastructures, Extractive Industries and other Industrial

activities

• I have also developed HIA guidance and tools for private

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companies as part of their internal processes

• Finally, I carried out HIA trainings for consultants and individual

practitioners, private companies and consulting firms,

governmental departments at different levels

Health Impact Assessment - HIA

A combination of procedures, methods and tools that

systematicallysystematically judgesjudges the potential, and sometimes

unintended, effects of a policy, plan, programme or policy, plan, programme or

project project on the health of a population and the distribution

of those effects within the population. HIA identifiesidentifies

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of those effects within the population. HIA identifiesidentifies

appropriate actions to manage those effects.

European Centre for Health Policy, WHO Regional Office for Europe (1999) “Gothenburg Consensus Paper” & International Association for Impact Assessment (2006) “Health Impact Assessment International Best Practice Principles No. 5”

HIA as systematic process

Screening

Scoping

Consider whether to perform an HIA

Plan how to carry out the HIA - Terms of Reference

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Appraisal

Recommendations

Monitoring and Evaluation

Assessment & Prioritization of Health Impacts

Formulates recommendations for decision makers

Implementation of recommendations & Monitoring and Evaluation Plan

Is decision making systematic?

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public policy is made up of [often non-linear and interconnected] stages

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Howlett, Ramesh, and Perl (2009). Policy cycles and subsystems (3rd ed.) & Harris P et al “HIA and Public Policy”

One acronym, multiple approaches

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Winkler, Mirko S. et al. “Untapped potential of health impact assessment.” Bulletin of the

World Health Organization 91 (4):237-312, 2013.

What is HIA Purpose?

• To develop evidence based recommendations which influence the decision

making process.

• The recommendations should alter the original proposal in ways that

enhance the positive impacts and reduce or eliminate the negative impacts.

The recommendations should also be context relevant, sensitive and

implementable

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• To bring people together: proponent, decision makers, communities,

academia and other stakeholders

• But also to foster interagency working & whole of government approaches

• It could lead to increased awareness of health and health inequalities and in

general it is a technical and social learning process

• It should compare the health consequences of implementing different options

HIA and Public Policies

HIA is one of the key strategies for Healthy Public

Policies / Health in All Policies

"Health in All Policies (HiAP) is an approach to public policies across

sectors that systematically takes into account the health implications of

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decisions, seeks synergies, and avoids harmful health impacts, in order to

improve population health and health equity”*

Efforts on technical and legal aspects of HIA, such as

institutionalisation & standardization

* Definition used by the 8th Global Conference on Health Promotion in Helsinki 2013

Is “Health” in EIA also HiAP?

In EstoniaEstonia, where the majority of the local communities

are small and with limited institutional capacity, the

introduction of separate HIA is not judged to be

practical. Instead, the focus is on better coverage of

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practical. Instead, the focus is on better coverage of

public health aspects and stronger involvement of public

health specialists in the EIA process.

In SwedenSweden, health aspects are gradually being

introduced in EIA, at the same time that methodologies

for independent HIA are being developed in parallel to

EIA.

WHO Europe, EUPHA, IAIA (2014) Health in Impact Assessments: Opportunities not to be missed

HIA and Private Sector

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IOGP/IPIECA (Oil&Gas): 2005, reviewed 2015

ICMM (mining and metals): 2009

World Bank International Finance Corporation: 2009

Forthcoming IOGP-IPIECA HIA Guidance

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IFC Performance Standard (2006-2009)100%

99%95%

87%

44%50%

60%

70%

80%

90%

100%

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44%

27%

5%

16%

0%

10%

20%

30%

40%

PS1 E&S Assessment &

Mgt.

PS2 Labor & Wkg cond.

PS3 Pollution Prev. &

Abatement

PS4 Community

Health & Safety

PS5 Involuntary

Resettlement

PS6 Biodiversity

PS7 Indigenous

Peoples

PS8 Cultural Heritage

What we know about HIA…

• A comparison of 45 local, national, and international guidelines*

• Almost all describe HIA as participatory and democratic process

• More than half mention the importance of HIA's relationship with

other impact assessments and discuss integration as well as the

need for authoritative support of HIA work

• Concern about the different purposes and practicality of using HIA in

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private sector VS public sector

• Need to incorporate into guidelines a standard vocabulary to describe

the characteristics and process of HIA and to develop more

standardized means of evaluating the HIA process, impact, and

outcomes

* K.A. Hebert et al “ Health impact assessment: A comparison of 45 local, national, and international guidelines”

Environmental Impact Assessment Review 34 (2012) 74–82

HIA research HIA and policy making

• Tend to focus on the technical ‘what?’ questions which are internal to

the conduct of HIAs

• Not engaged much with the external tactical conditions associated

with what HIA is ultimately trying to influence, public policy and decision

making

• Some recommendations

• HIA experts need to be both tactical and technical

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• HIA experts need to be both tactical and technical

• HIA can tactically position health as a relevant public policy issue

• HIA requires strengthening to work as a policy formulation process

• Institutional support for collaboration between Public Health (the best

positioned for intersectoral collaboration) and other sectors

• Not framing health in terms of hospitals and diseases, but social

determinants of health and health equity might not be the other best

alternatives

Harris P. at al. “The fit between health impact assessment and public policy: Practice meets theory” Social Science &

Medicine 108 (2014) 46e53

Revised framework for evaluating impact and effectiveness of HIA

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F Haigh et al. (2015). What makes health impact assessments successful? Factors contributing to effectiveness in

Australia and New Zealand. BMC Public Health: 15:1009 DOI 10.1186/s12889-015-2319-8.

HIAs are a useful tool to promote public health

• Success of HIAs should be defined by their impacts on decisions

as well as on the environments in which those decisions are made

• Influences decisions in non health-related sectors;

• Strengthens cross-sector collaborations;

• Raises awareness of health issues among decision makers;

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• Raises awareness of health issues among decision makers;

• Influences changes beyond the decision target;

• Builds consensus and relationships among decision makers and their

constituents;

• Gives community members a stronger voice in decisions that affect

them.

Bourcier E, Charbonneau D, Cahill C, Dannenberg AL. (2015). An Evaluation of Health Impact Assessments in the United States, 2011–2014. Prev Chronic Dis:12:140376.

Recommendations for HIA practitioners to make HIA more effective

• Early phases essential to select if HIA is the right process for the object to be examined;

• Clarify early in the process: purposes, goals, values and expected outcomes;

• Select an appropriate team to conduct the HIA (mix of competences) as well as identify

key stakeholders and their relative points of influence within systems

• Involve stakeholders such as decision makers, people with knowledge about and access

to decision making processes and also people with relevant skills as early as possible;

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• Ensure HIA processes include potentially affected communities and pay more attention to

the needs of vulnerable populations;

• Craft clear, actionable recommendations; eventually with the support of the involved

decision makers

• But especially be both technical and tactical: understand the context and the actors,

proactively engage, if opportune utilise the flexible but structured HIA process

Thank you

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© Francesca Viliani - 2013