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

THANK YOU

Jean Turgeon, Enap, Responsable et chercheur principal

France Gagnon, Téluq, Chercheure principale Clémence Dallaire, ULaval, Chercheure principale

Jacques Auger, Oap/Enap, Collaborateur

Danielle Blondeau, ULaval, Co-chercheure

Jacques Bourgeault Enap/Uqam, Co-chercheur

Louis Côté, Oap/Enap, Co-chercheur

Louis Demers, Enap, Co-chercheur

Lucie Richard, UdeMontréal, Collaboratrice

Mélanie Michaud, Enap, Professionnelle de recherche