An introduction to a generic Health Impact Assessment Methodology - - PDF document

An introduction to a generic Health Impact Assessment Methodology

Debbie Abrahams, International Health Impact Assessment Consortium, University of Liverpool

Presentation Overview

• Overview of HIA procedure

and methods

• Examples from HIA practice

A Generic Health Impact Assessment Methodology (EPHIA)

Screening 1

• A quick assessment of the

health effects of a policy

• Identifies policies that may

need HIA

Screening 2

Target area and population

Extent affected (Very significant = 1; very insignificant = 5) Will the following neighbourhood be affected by the proposal: Yes/No/Unsure 1 2 3 4 5 Qualitative description Alt Valley? City Centre? Eastern Link? North Liverpool? South Central? South Liverpool? South Suburbs? City-wide? Extent affected (Very significant = 1; very insignificant = 5) Will the following population groups be affected by the proposal: Yes/No/Unsure 1 2 3 4 5 Qualitative description All population groups? Black communities? Asian communities? Irish communities? Refugees and asylum seekers? Infants and young children (under 5s)? Children (5-15)? Young people (16-24)? Adults (25-64)? Older people (65+)? Women? Men? People with mental health problems? People with disabilities? People with learning difficulties?

Scoping 1

• Agree the detailed design and plan, e.g.:

– Aim/objectives – Methods – Geographical boundaries – Units of analysis – Outputs

• Terms of Reference & Steering Group
• Scoping report

– Data map – Document map – Stakeholder map

Scoping 2

• FV - DoH, FV Steering Group reps,

Access & Diversity Officer, HIA assessment team

• EES - DWP, DfES, DTI, DoH, HDA,

TUC, CBI, EOC, CRE, UCL, EFILWC, HIA assessment team

• BIA – BIA plc, SHA, PCTs, LAs, BIA

Consultative Committee, HIA assessment team

Scoping 3

Households/Groups in wards via: BIA Consultative Committee Solihull Community & Economic Regeneration Team, Solihull CVS, Solihull Ward councilors Potential groups identified: Masterplan consultation attendees, Knowle Society, Lions, Rotary Clubs, Community Associations, Neighbourhood Forums, Tenants Groups (W) Households in following 4 SMBC wards: Bickenhill, Elmdon, Meriden, Knowle Community - population proximal to development

Contacts Stakeholders/Key Informants Stakeholder/Key informant Category

Stakeholder map

Policy Analysis 1

• Context setting
• Audit and analysis of key

documents

• Analysis criteria:

– Policy development – Policy intent – Policy implementation – Health in policy planning

Policy Analysis 2

• Example from ‘Our health our care our

say’ HIA:

– Audit and analysis of over 20 official documents, including:

• OHOCOS and associated documents
• Independence, well being & choice (DH,

2005), NSF for Children, Young People & Maternity Services (DH, 2004a), Choosing Health (DH, 2004b)

• Caring about Carers: A National Strategy

for Carers (DH, 1999) …

• The Children Act 2004, Every Child Matters

(DfES, 2004)

Profiling 1

• Context setting
• Informed by policy analysis
• Continuing process
• Involves secondary data

Profiling 2

Qualitative and Quantitative Data Collection 1

• Literature reviews:

– Sources, searching, strength/hierarchy of evidence – Reviews of interventions, e.g., housing, transport – Examples of searches

Qualitative and Quantitative Data Collection 2

• Participatory, qualitative approaches:

– Defines perceptions, opinions, values, providing insight and understanding – Involves identifying stakeholders – Defining a sample frame and engaging – Designing and applying tools, e.g., in semi-structured interviews, focus groups – Analysing the data, e.g., content analysis using NVIVO

Qualitative and Quantitative Data Collection 2 Qualitative and Quantitative Data Collection 3

• Example from FV HIA:
• Sample methods - purposive/snowball

automotive manufacturers (development), stratified, random different socio- economic groups (operation)

• Focus groups, semi-structured interviews
• Question guides for each sample group

(generation of themes informed by policy analysis)

• Content analysis of transcripts using

NVIVO

Impact Analysis

• Characterisation of evidence:

– Health Impacts – health determinants and health outcomes – Direction – positive or negative – Scale – severity and where possible size of population – Likelihood – definite, probable, possible, speculative – Latency – short, medium, long-term

Impact Analysis and Prioritisation

• Models
• Matrices
• Mathematical modelling & health

economics

• Transparent synthesis of evidence
• Delphi, consensus building

methods and tools

• Prioritisation criteria

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• Three scenarios (2000-2029)

– A (no policies), – B (UK, EC policies), – C (UK, EC, FV policies)

• Estimate changes in key health

determinants – air pollutants (PM10) – road traffic accidents

• Consensus panel, email discussion group

with FV Steering Group and Thematic Groups to generate values for scenario C

Scenario building in FV HIA

Health Determinant 20101 20102 2020 Air pollutant emissions per year (kT): PM

10s

10.1 0.15% 0.25% Road traffic accidents (1000s): Serious injuries 21 0.18% 0.55% Fatalities 2 0.03% 0.1%

1 Forecasts from Transport 2010 2 Added positive effect of the FV strategy on Transport 2010

Consensus panel in FV HIA

Age Decreas e in m ortality

60000 40000 20000

• 20000
• 40000

95 RTA – Underlying Other – Underlying RTA – Underlying + FVI Other – Underlying + FVI Total reduction in mortality

• ver period 2000 - 2029

Health impacts of Scenario C using ARMADA model

Mathematical modelling of FV impacts using ARMADA model

Base Figures 2000 -2029 - Road Deaths, Serious Injuries & Hospital Admissions from Air Pollution A B C Position remains as at 2000 Implementation

• f UK & EU

Transport Policies Implementation

• f Policies + FVI

Deaths 87,530 52,906 52,887 Serious Injuries 1,092,467 648,112 646,124 First Hospital Admissions for Respiratory / Cardio Vascular 17,831,237 17,753,250 17,729,778 Scenario

Total NHS Costs 2000 -2029 for First Hospital Stays for Serious Injuries & Hospital Admissions A B C Position remains as at 2000 Implementation

• f UK & EU

Transport Policies Implementati

• n of Policies

+ FVI Total £7,166,533,829 £7,030,007,211 £7,022,277,279 Serious Injuries £353,718,195 £241,104,240 £240,617,603 First Hospital Admissions for Respiratory / Cardio Vascular £6,812,815,634 £6,788,902,971 £6,781,659,675 All costs discounted at 6% Scenario

Economic analysis of FV impacts using ‘Willingness to Pay’ estimates

10000 20000 30000 40000 50000 60000 70000 2006 2012 2022 2030 Year S e rio u s a n n o y a n c e n o is e 5 4 L A e q ext no ext baseline

Modelling noise impacts in BIA HIA: annoyance

1000 2000 3000 4000 5000 6000 7000 8000 9000 2006 2012 2022 2030 year highly disturbed sleep ext no ext baseline

Modelling noise impacts in BIA HIA: sleep disturbance

Modelling noise impacts in BIA HIA: schools affected

5 10 15 20 25 30 35 2006 2012 2022 2030 n u m b e r o f p rim a ry s c h o o ls 5 4 L e q ext no ext baseline

Reporting

• First draft HIA report for peer review

and impact validation

• Second draft HIA report to HIA

Steering Group

• Revise into Final HIA Report
• Evidence-based recommendations
• Reporting tools: formats/negotiating

styles

Evaluation

• Process criterion, e.g.,:

– Effectiveness – Efficiency – Equity

• Impact criterion, e.g.,:

– Recommendations – Unintended effects

• Not routinely done!

Limitations of HIA

• Limitation of methods
• Capacity
• Impact Assessments perceived as

barrier to growth

• HIA development tends to be driven

from ‘bottom up’ (WHO, EC)

• Ad hoc v. institutionalisation
• Consultation device v. rational,

evidence-based decision-making

• Sell HIA to politicians – ideologically

and pragmatically