HEALTH IMPACT ASSESSMENT

Health impact assessment may simply defined as any combination of procedures or methods by which a proposed policy or program may be judged as to the effects it may have on the health of a population

 However, the ”full” definition of health impact is much broader and puts on table also identification and prediction of risks. It also opens both the positive and negative impact and focus on different timing of impact by introducing  immediate and delayed impact.

 Health impact assessment - a methodology which enables the identification, prediction and evaluation of the likely changes in health risk, positive and negative, single or collective, of a policy programme, plan or development action on a defined population. These changes may be direct and immediate or indirect and delayed.

 THE PURPOSE/FUNCTION OF HIA IS TO:

1.  Inform and influence the decision maker

  The overarching aim of HIA is to create conditions to encourage and support the protection and improvement of people’s health and wellbeing. The purpose of all HIA is to inform and influence decision making associated with either the development of healthy public policy, healthy strategy development or planning; the undertaking of programmes and projects; or other developments.

HIA is a practical approach that can inform and influence decision makers about how a proposal (or variations) would impact on people’s health (and provide information to stakeholders and the public). It provides the decision maker with recommendations to mitigate or negate possible risks to health, and opportunities to improve people’s health.

 Decisions are not taken within the HIA; they are taken by the decision-makers who are typically politically accountable. To influence a proposal, an assessment of the proposals decision making context is required to identify opportunities and barriers that may be encountered for the presentation of recommendations. Obviously, there is no point in carrying out an HIA where a decision is not open to influence. Finally, there is often multiple decision points along the proposals process because the development is often incremental and so there are many opportunities for HIA to influence decisions – but at each stage the questions addressed by the HIA may be different.

 2.  Help address inequalities in health

A major purpose for many HIAs to be undertaken is a desire to tackle inequalities. HIA attempts to reduce inequity that results from avoidable and unjust differences in health status between different peoples.To achieve this, HIA outlines inequalities that may arise from a proposal by determining whether health impacts are likely to be distributed unevenly within a population, or between groups, rather than just predicting the impact on the whole population. Because of this, HIA is able to identify both the ‘winners’ and ‘losers’ of a proposal, and recommend how the distribution of impacts can be changed, or how ‘losers’ may be compensated.

 3.  Promote joined up working

Because of the broad nature of the determinants of health – HIA usually requires a broad range of stakeholders to participate. This sets the stage for joined up working within and between agencies. In some cases, agencies are already involved in interagency and multidisciplinary working before the HIA begins, but often with HIA ‘unusual links are formed’. Public health staff are able to build coalitions and links with policy makers and planners, and these have the potential to influence future work beyond the end of a single HIA.

 4.  Place public health on the agenda

A further benefit to join up working is that HIA can place public health issues on the agenda of many different agencies and individuals, and introduces the wider determinants of health to them. Tying HIA into a systematic process that promotes the determinants of health is recommended. HIA performs an educational role for policy makers, planners and developers (and vice versa for public health staff learning about how policy makers, planners and developers think and work). It is difficult to determine how important this is, but suffice to say this is considered to be a key component of building healthy communities, as recommended by the Ottawa Charter (First International Conference on Health Promotion, 1986) and Jakarta Declaration (Fourth International Conference on Health Promotion, 1997). Policy process research suggests that a network of actors are instrumental for developing sound policy and influencing decisions. Similarly, implementing decisions often requires the action of multiple actors.

 5.  Reduce conflict between stakeholders

An advantage of stakeholder participation is that there is the opportunity for the airing of different views on a proposal, and sometimes conflicts can be resolved.

 6.  Encourage sustainable development

Undertaking HIA is one way to provide information and recommendations that can be used to pursue the goal of sustainability.

 Thus, before undertaking any agendas/programs on implementation, HIA is a must.