Health in Regional Public Policy Using IA to Improve Health - HDA England - 2005

8/14/2019 Health in Regional Public Policy Using IA to Improve Health - HDA England - 2005

1/24

Health in Regional Public Policy:Using assessment techniques to improve

the impact of policy on health

School forHealth


2/24

1

Contents

Foreword.. 2Aim 3Objectives 3Introduction.. 3

Regional application of impact assessments. 4What tools to use and how to use them successfully 4When to implement an assessment. 5Advantages and challenges of impact assessment techniques.. 6Conclusion 9References 10Appendices- Impact assessment methods

1- Health impact assessment 142- Risk assessment. 163- Economic impact assessment.. 174- Environmental impact assessment.. 185- Social impact assessment. 20

6- Sustainability impact assessment.... 227- Integrated impact assessment.. 23

Acknowledgements

Written by:Jean Brown, independent public health management consultant and part-timePhD student at the University of Durham [email protected]; ElizabethShassere and Soumen Sengupta, Health Development Agency, North EastRegional Office, University Science Park, John Snow House, Stockton Rd,Durham DH1 3YG

Project funded by the Health Development Agency (North East Regional Office)and developed in partnership with School of Health, University of Durham

Special thanks to:David Chappel (NEPHO), Lucy Hamer (HDA), Elaine Rodger (RANE), LorraineTaylor (HDA), and Derek Ward (GONE) for their comments and guidance toinform this work.All of those colleagues within the North East Region and nationally who providedfeedback and input to the completion of this report.

Electronic copies of this report can be accessed at www.hiagateway.org.uk

From 1 April 2005, the National Institute for Clinical Excellence will take on thefunctions of the Health Development Agency (HDA). The new organisation willbe the National Institute for Health and Clinical Excellence (to be known asNICE). It will be the independent organisation responsible for providing nationalguidance on the promotion of good health and the prevention and treatment of illhealth. For more information please see the NICE website at www.nice.org.uk

Health Development Agency - March 2005


3/24

2

Foreword

The health and well-being that communities experience are primarilydetermined by a range of economic, environmental and social factors. Whilehealth care services do have an important contribution to make, securinglong-term health improvement demands active engagement from other

agencies and sectors.

The White PaperChoosing Health has stated that health is to be incorporatedas an explicit element of the regulatory impact assessment that is undertakenof all national public policies. This resource seeks to build on this welcomedevelopment, and outlines the potential contribution that impact assessmentcan make to improving regional public policy. It briefly describes a number ofimpact assessment methods, and addresses some of the challenges theseapproaches might present in practice.

It is intended as an introduction to impact assessment for those involved inpolicy development and decision-making in the statutory and non-statutorysectors, particularly those whose primary roles or organisations are nothealth-related. Furthermore, while it has been prepared with specific regard toregional policy development it is not targeted at a solely regional audience - itshould be of assistance to those working to effect more local change too.

Fundamentally, the use of impact assessment methods should facilitateevidence-based decision-making at policy level, and ultimately support theimplementation of more evidence-based action in practice. However, they areonly part of the health improvement process, and in themselves do notguarantee real change. In order to be of substantive value, they need to bebacked up by a genuine commitment and willingness to accept their findings

and, critically, change policy accordingly.

We hope that you will find this document useful as you work to developpolicies that make a positive contribution to the health and well-being of all ourcommunities.

Soumen Sengupta David J. HunterRegional Associate Director (NorthEast), Health Development Agency

Professor of Health Policy andManagement, School for Health,

University of Durham


4/24

3

Aim

To relate policy assessment techniques to the development of regional publicpolicies to increase the positive effects and minimise the negative impact ofthese policies on health.

Objectives

To develop greater understanding of the different kinds of impact assessmentand the value of conducting impact assessment in developing regional publicpolicy

To highlight the advantages and challenges of impact assessment techniques

To assist partners and key stakeholders in choosing an appropriate impactassessment technique

Introduction

Though the public health white paperChoosing Health: making healthychoices easieris an NHS document, much what it proposes are high levelcross-cutting efforts that must transcend sector boundaries1. The growingawareness of the wider determinants of public health has led to an increase inrequirements to assess the risks posed to health by policies and decisionsmade in traditionally non-health arenas. Increasingly, governments andnational bodies are calling for such assessments to be carried out in relationto policies developed in departments responsible, for example, for economicor fiscal policy, education, housing and transport.

Assessing policies for their impact or possible effects on health and itsunderlying determinants is essential to improving health and reducing healthinequalities. Assessments aim to generate a set of evidence basedrecommendations that inform the decision making process associated withthe policy or proposal. These recommendations can highlight the practicalways to enhance the positive aspects of the policy and minimise the negativeimpacts on health and inequalities2.

Whilst an impact assessment might not always be appropriate, there areoccasions when such an approach can be very helpful in policy development.This report relates impact assessment with the development of regionalpublic policy, describes the techniques and clarifies their appropriate

use, and addresses their advantages and challenges. The types ofassessment covered are:1) risk assessment;2) economic assessments;3) environmental assessments,4) health impact assessment;5) social impact assessment;6) sustainability impact assessment and7) integrated impact assessment.


5/24

4

Regional application of impact assessments

In the UK, at a regional level, policy or strategy development is rather differentfrom that at national or more local level. Until relatively recently, a policy willoften have been constructed at a national (government) level and the regional

role might be to adapt and implement at regional level. Under thesecircumstances, a region might need to develop its own sub-policies. However,with the NHS Plan3 in 2000 and the move of directors of public health into thenine regional government offices in 2002, regions were enabled to approachhealth as well as its wider determinants as discussed earlier1. Analysis ofpolicy from a health viewpoint is also, therefore, very much a regionalresponsibility. Thinking of this in more positive terms, it is now becomingeasier for regional agencies to take actions that will benefit the specifichealth needs of their populations. Whether as intermediaries betweencentral and local services or as policy-makers in their own right, regionalorganizations increasingly need to assess implications and impacts ofpolicies. Theyhave an important part to play in the delivery of healthimprovement.

A number of policy vehicles can be identified as critical high level policiescrucial to the health portfolio:

Developing a framework of regional indicators as an overarchingintegrated reference for all agencies (Sustainable DevelopmentFramework)

The Regional Economic Strategy and investment for health The Regional Spatial Strategy The Regional Sustainability Strategy

The Regional European Action Plan The Framework for Education and Skills Action

As Derek Wanless points out in his 2002 report Securing our future health:taking a long-term view, good health is good economics4. Other importantpolicy areas include transport, housing, crime reduction, energy, sports,image, waste, biodiversity, culture and rural action.

This shows the great scope for regional policy-makers to influence the healthof their region. There are, inevitably, practical issues around capability andcapacity of the regional organizations. The agendas for these organizations(primarily Government Offices, Regional Assemblies and Regional

Development Agencies) are large and resources (mainly in terms of time andof suitable personnel) are limited and stretched. This report containsexamples of methods that might prove useful in such assessments at aregional level.

What tools to use and how to use them successfully

It has already been mentioned that there is no single tool that would beappropriate to all situations. With that in mind, it might be appropriate for a


6/24

5

selection of tools to be kept readily available, with initial screening carried outto identify the most appropriate, including different levels of assessment, in asimilar way to that suggested by Parry and Stevens and discussed in HealthImpact Assessment5. The criticisms voiced of single assessment and theawareness that many different assessments are going to have be carried out(with substantial overlaps between them) suggest that some form of

integrated assessment is probably going to become more practical and betterreceived than a straightforward health impact assessment. The North Westsintegrated appraisal toolkit mentioned in Appendix 7, Integrated ImpactAssessment, allows for flexibility and adaptation to local needs. There mightalso be useful suggestions when the ODPMs sustainability consultationfinishes.

Although integrated assessment is still in the early stages, advantage can betaken now in an ad hoc manner of any types of assessment that are known tobe taking place. For example, joint working arrangements for anenvironmental impact assessment that is under way for a particular policywould allow some form of health sector input, be it health services, public

health, or input from the wider health community. This could even be fairlyinformal. This would help to reinforce the value and workability of a properholistic assessment approach.

When to implement an assessment

Impact assessments can be prospective, concurrent or retrospective. Thechoice between these will depend on circumstances, such as the timing of thedecision to carry out a study in relation to the start of an intervention orimplementation of a policy. Other factors influencing the choice will be cost,availability of appropriate people to do the assessment, and the existence ornon-existence of related evidence bases.

Prospective assessments might be viewed as ideal, in that they couldidentify possible harm to health before the policy or practice isimplemented and the damage is done. However, inevitably there will be anelement of guesswork involved in the estimations of the extent of suchharm. Scott-Samuel states that ideally assessment should take placeearly enough in the development of a policy or project to permitconstructive modifications to be carried out before its implementation butlate enough for a clear idea to have been formed as to the nature andcontent of the proposal6.

Concurrent assessments are conducted during implementation of thepolicy or intervention. A concurrent assessment allows the modification as

negative health impacts are realised, and monitoring of predictions ofpotential health impacts.

Retrospective assessments have value in providing much-neededevidence for subsequent prospective assessments7.There could beoccasions when a retrospective assessment is the only option, forexample if an unplanned event (such as a major foot and mouth outbreak,a nuclear disaster or a terrorist gas attack in an underground railwaysystem) has occurred. Retrospective analysis of such events can lead tosuggestions in changes in policy.


7/24

6

Whilst there appears little dissent from the idea that a policys effects onhealth and its determinants should be taken into account, it should not beautomatically assumed that a formal analyticalimpact assessment (such asthose described in this report) is the best way forward. There will beoccasions when such an approach is inappropriate, perhaps because of

serious resource difficulties or because unfortunate timing will not allow suchan assessment to have any influence.

However, should it be decided that a formal, analytical assessment isappropriate, then users of the techniques might wish to consider which type ofassessment is more suitable, looking at its advantages and possible pitfalls.

Advantages and challenges of impact assessment techniques

In this section, common advantages to public health are discussed, andpotential problems and ways to address them are paired in Table 1.

Advantages to public health common to several techniques

All of the techniques, by definition, have the potential in some way to identifyparts of a policy that are likely to affect health, its determinants or inequalities.Having identified these, a receptive policy-making structure will allow thepolicy to be adapted so that they have, at least, very little negative impactand, at most, a very positive impact on the lives and health of the population.

One very important advantage of many of the techniques is that they lead to araised awareness of the effects of non-health policies on health and of thescale and scope of the wider determinants of health. This awareness-raisingcan occur both within the NHS and in other stakeholder organizations, as wellas in the general public. It should therefore increase the likelihood that healthbecomes a regular, embedded element of policy-makers thinking.

Assessments (and, particularly, the evidence collection which is an integralpart of them) potentially increase the bank of evidence available forsubsequent studies. Ensuring that this evidence base is useful and usedrequires good dissemination of results, so that every new study can rely on itrather than having to start again, spending time and money replicating thework. It is not only the evidence underlying the assessments that is of valuebut also any evidence accumulating about the successful impact of theassessment itself. Particularly with Health Impact Assessment and Integrated

Impact Assessment, the primary output is a set of evidence-basedrecommendations geared to informing the decision-making processassociated with the proposal2.

Because the techniques are analytical, they tend to be relativelystraightforward to use. Simple, step-by-step processes can be developed.This adds to the ease of carrying out any policy assessment, possibly allowinga wider range of people to be involved than more complex processes.


8/24


9/24

8

and, particularly, of any successfulimplementations of findings could help toovercome this problem showing that theexercise has had a very practical, usefuloutcome.

Good communication and transparency(further discussed later) might help toincrease the knowledge and acceptance ofthe techniques and therefore thewillingness of the public to becomeinvolved.

The impact of the impactassessment

o Is it going to influencethe policy?

It is to be hoped that, as the techniquesbecome more widely accepted, appraisalsof their impact/influence become a routinepart of them and that dissemination of theresults also takes place to show howsuccessful (or otherwise) impact

assessments can be. (It might be that thePublic Health Observatories have a bigpart to play here.)

Evidence and data:transparency and credibility

o Availability of goodevidence, particularlyrobust data

o Acceptability ofapproach

Good dissemination of evidence helps tobuild confidence and credibility, as does awarts and all approach, allowing criticismand discussion of assumptions andpossible bias.

Selection criteria, timing and

weighting of findingso Identifying policies for

assessmento Assessing at the

appropriate stages ofpolicy development

o Avoiding bias

Plans need to be in place for an initial

screening of policies to determinesuitability or necessity for analyticalassessment and the extent and timing ofany such assessment

Whilst accommodating all concerns equallyseems unlikely, transparency should helpto allay such criticism.

A tick-box exercise? Increasingly, the need for healthconsideration is on the agenda of mostpublic organizations. Continuing to fosterthis culture might help to ensure that

professionals do not regard an assessmentas any form of tick-box exercise.Dissemination of evidence, of results and,in particular, of evidence of influence of theassessments will also be vital to show thevalue of the work.


10/24

9

Conclusion

Whatever the approach taken, it is important that a robust evidence base ismaintained, developed, and used. For example, a good selection of evidenceis accumulating on all the websites that specialise in health impactassessment. Assuring that this is readily accessible to potential users would

be a valuable step, helping to reduce the time taken and the amount ofrepetition that happens when trying to collect evidence. Similarly, thecontinued sharing of experience at a regional level could allow regionaldecision-makers to see other ways of approaching problems and to learn thetypes of approach that are less or more successful than others.

It is important to keep in mind that while impact assessment techniques canproduce effective recommendations to maximise health benefit and minimisehealth risk, just conducting an assessment is not adequate. There must becooperation and buy in from all parties with control over policy development inorder to make changes that will make a difference.


11/24

10

REFERENCES

1. Hunter, D J, Wilkinson, J, and Coyle, E (2005) Would regionalgovernment have been good for your health? British Medical Journal;330; 159-160

2. Quigley, R, Cavanagh, S, Harrison, D, Taylor, L (2003) Clarifying health

impact assessment, integrated impact assessment and health needsassessmentHealth Development Agency, London. www.hda.nhs.uk

3. Department of Health. The NHS Plan. A plan for investment, a plan forreform. London: Stationery Office, 2002.

4. Wanless, D, (2003) Securing Good Health for the Whole PopulationDepartment of Health, London. www.doh.gov.uk

5. Parry, J. and A. Stevens (2001). "Prospective health impact assessment:pitfalls, problems, and possible ways forward." Bmj 323(7322): 1177-82

6. Scott-Samuel, A. (1998). "Health impact assessment--theory into practice."J Epidemiol Community Health 52(11): 704-5

7. WHO Regional Office for Europe Health impact assessment.http://www.who.dk/eprise/main/WHO/Progs/HPA/HealthImpact/20020319_

1, jan 20048. Department of Health (2004). Choosing health: making healthy choices

easier. London, The Stationery Office.9. Chappel, D. and K. Bailey (2004). A framework for health? A screening

Health Impact Assessment of the pre-consultation draft of the RegionalSpatial Strategy, North East Public Health Observatory.

10. Taylor, L., N. Gowman, et al. (2003). Influencing the decision-makingprocess through health impact assessment. Learning from practicebulletin. London, Health Development Agency.

11. Lathers, C. M. (2002). "Risk assessment in regulatory policy making forhuman and veterinary public health." J Clin Pharmacol 42(8): 846-66

12. Rodricks, J. V. (1992). Calculated risks: the toxicity and human healthrisks of chemicals in our environment. Cambridge, Cambridge UniversityPress.

13. Nurminen, M., T. Nurminen, et al. (1999). "Methodologic issues inepidemiologic risk assessment." Epidemiology 10(5): 585-93

14. Powell, J. (2003). Health economics and public health. Public health forthe 21st century: new perspectives on policy, participation and practice. J.Orme, J. Powell, P. Taylor, T. Harrison and M. Grey. Maidenhead, OpenUniversity Press.

15. Mindell, J. and M. Joffe (2003). "Health impact assessment in relation toother forms of impact assessment." J Public Health Med 25(2): 107-12

16. WHO Regional Office for Europe (1985). targets for health for all: targets

in support of the European regional strategy for health for all, World HealthOrganization.17. DTLR (2001). Environmental Impact Assessment: a Guide to Procedures.

DTLR.http://www.planning.odpm.gov.uk/eia/guideline/index.htm,18. Kunzli, N. (2002). "The public health relevance of air pollution abatement."

Eur Respir J 20(1): 198-20919. Brickey, C. (1995). "Relevance of risk assessment to exposed

communities." Environ Health Perspect 103 Suppl 1: 89-91


12/24

11

20. de Hollander, A. E. M., J. M. Melse, et al. (1999). "An aggregate publichealth indicator to represent the impact of multiple environmentalexposures." Epidemiology 10(5): 606-617

21. Mindell, J., E. Ison, et al. (2003). "A glossary for health impactassessment." Journal of Epidemiology and Community Health 57(9): 647-651

22. Gostin, L. and J. M. Mann (1994). "Towards the development of a humanrights impact assessment for the formulation and evaluation of publichealth policies." Health Hum Rights 1(1): 58-80

23. O'Keefe, E. and A. Scott-Samuel (2002). "Human rights and wrongs: couldhealth impact assessment help?" J Law Med Ethics 30(4): 734-8

24. Burdge, Rabel J. 2004. The Concepts, Process and Methods of SocialImpact Assessment. (Social Ecology Press, PO Box 620863, Middleton,WI 53562) ISBN 0-941042-35-9.

25. DETR/MAFF (2000). Our countryside: the future - a fair deal for ruralEngland.DETR/MAFF,Cm4909.www.defra.gov.uk/rural/ruralwp/default.htm,

26. Local Government Association (2003). All together now? - social inclusion

in rural communities. Local Government27. Countryside Agency (2002). Rural proofing - policy-makers' checklist. The

Countryside Agency.http://www.countryside.gov.uk/ruralproofing,28. Powell, B. A., S. W. Mercer, et al. (2002). "Measuring the impact of

rehabilitation services on the quality of life of disabled people inCambodia." Disasters 26(2): 175-91

29. Pulice, R. T., L. L. McCormick, et al. (1995). "A qualitative approach toassessing the effects of system change on consumers, families, andproviders." Psychiatr Serv 46(6): 575-9

30. Bond, R., J. Curran, et al. (2001). "Integrated impact assessment forsustainable development: A case study approach." World Development29(6): 1011-1024

31. Office of the Deputy Prime Minister (2004). Assessing the impacts ofspatial interventions: Regeneration, Renewal and Regional Development('the 3Rs guidance').http://www.odpm.gov.uk/stellent/groups/odpm_about/documents/downloadable/odpm_about_029333.pdf

32. Bailey, C., J. Deans, et al. (2003). Integrated impact assessment: UKmapping project report, Northumbria University.

33. Fehr, R. (1999). "Environmental health impact assessment: Evaluation of aten- step model." Epidemiology 10(5): 618-625

34. Action for Sustainability (2003). implementing action for sustainability: anintegrated appraisal toolkit for the North West, North west regional

assembly.35. Harrison, D. (2002). The contribution of integrated impact assessment toregional integration, health development agency.


13/24

12

APPENDICES

Impact assessment methods


14/24

13

Appendix 1Health impact assessment

HIA is an approach that can help identify and consider the health andinequalities impacts of a proposal on a given population. The usual startingpoint for an HIA is a policy, programme, strategy plan, project or other

development that has not yet been implemented. Its primary output is a set ofevidence-based recommendations geared to informing the decision-makingprocess associated with the proposal2. Application of health impactassessment to a policy or strategy will necessarily focus on the widerdeterminants of health.

The public health white paper Choosing Health: Making Healthy ChoicesEasier8 emphasises that regional Department of Health representatives willlead on ensuring that regional partners take into account the health impact oftheir policies, such as housing, transport, planning, employment andeducation.

The process

Health Impact Assessment includes:1. The screening process, exploring which policies or programmes could

have an impact on health and what kind of impact.2. A scoping processis carried out if further information is needed to

determine what further work should be carried out, by whom and how3. The appraisal process, identifying and considering the evidence of health

impact4. Formulating and prioritizing recommendations5. Further engagementwith decision-makers6. Ongoing monitoring and evaluation2

Using Health Impact Assessment

At a regional level in England, a rapid health impact assessment was carriedout in the Government Offices North East (GONE) region on the RegionalPlanning Guidance RPG1. Guidance was also provided on the sorts ofimpacts to consider under each heading. At the time of writing (November2004), the North East Assembly is developing a Regional Spatial Strategy(RSS) to replace current Regional Planning Guidance in 2006. A screeningHealth Impact Assessment was carried out on the pre-consultation draft forthis RSS9 assessing nine of its 54 policies. The assessment considered

health impact, inequality impact, and effect on health services and allowed forcomments as well as scores.

Unique characteristics of HIA

Public or community understanding of health and determinants can beenhanced by the participatory nature of health impact assessments.10


15/24

14

No one blueprint could suffice for all occasions. The purpose and theapproach differ according to who is carrying them out and the resourcesavailable also vary.

Health impact assessment can mean different things to differentprofessional groups. There is a lack of clarity and of shared understandingof exactly what HIA is comprised.

Much of the data that could help health impact analysis is not readilyavailable but remains in the grey literature5, difficult to access and easilyoverlooked.

Lack of attention to inequalities and too much focus strictly on economicscan minimise the potential benefits to the community.

Communication of results of assessments to both policy-makers and thecommunity can be challenging, both do the logistics of the exercise and intranslating the results into accessible language for a variety ofprofessionals and lay people.

Recent years have seen tremendous growth in both the theory and theapplication of health impact assessment. Major national and internationalcentres have developed, providing a wealth of information. The Londonregion has also used the technique in efforts to engage the public in policymaking, with assessments carried out on several strategies, includingtransport. Many of the centres listed On the Health Impact Assessmentgateway website (http://www.hiagateway.org.uk) contain up-to-date examplesof guidelines and variations on the HIA process.


16/24

15

Appendix 2Risk assessment

Risk assessment has been used historically for longer than any of the othertechniques in this report. It is a method for systematically identifying andassessing factors that influence the probability and consequences of a

negative event occurring11

.

The process

Risk assessment for environmental or occupational exposures classicallyinvolves four phases:1. hazard identification (the detection of the potential for agents to cause

adverse health effects in exposed populations);2. exposure assessment (the quantification of exposures and the estimation

of the characteristics and sizes of the exposed populations);3. dose-response assessment (understanding the distribution of risk in the

populations);

4. risk characterization (the evaluation of the impact of a change in exposurelevels on public health effects).12,13

Using Risk Impact Assessment

This technique is mostly used in exposures to potentially toxic substances.However, as it is a rigorous approach, other types of assessments incorporatemany of the techniques. It can also in itself provide an evidence base forenvironmental and health assessments.

Unique characteristics of RIA

It can be difficult to balance scientific evidence with social concern.


17/24

16

Appendix 3Economic impact assessment

Economic impact assessment considers the effects of a policy or project onthe economy or on particular aspects of it. It systematically assesses therelative values of different courses of action. It has relevance to health in at

least two ways:1) Health status is known to be influenced by economic circumstances, so

that if an economic impact assessment leads to an improvement ineconomic situation, this could be expected to have a knock-on effect onhealth.

2) With regard to specific health policy, if economic evaluations lead to asaving in cost in a particular area of health spending, this could free upfunding for further investment in other areas of health care expenditure.

An economic evaluation will basically look at costs (including resources,generally expressed in monetary terms) and outcomes. Where the outcome(the change in the burden of disease that results from the intervention) is

measured in health indicators, this is referred to as a cost-effectivenessanalysis an example of health indicators would be the number of deaths orcases. Where the outcome is measured in units that reflect not just healthindicators but also less quantifiable factors such as quality of life, this isreferred to as a cost-utility analysis. In cost-benefit analysis, all outcomesare measured in monetary units.

The process

A framework for economic evaluation of public health interventions comprisesfour stages:1. Pre-implementation- defining interventions and identifying key components2. Piloting- greater definition of the problem and identifying comparison

group, costs and outcome measures3. Main evaluation - measure costs and outcomes of interventions4. Long-term implementation.14

Using Economic Impact Assessment

Economic evaluations could certainly be used in the development of anypolicy aimed at addressing a particular major disease or the burden of thatdisease or, indeed, a risk factor for a disease (such as smoking). DerekWanless, in his 2003 report Securing Good Health for the Whole Population,

describes trends in smoking cessation and presents evidence to question theway data is looked at to inform resource allocation and measurement ofimpact.4 He emphasizes that the correct indicators must be chosen to ensurean accurate economic impact assessment.

Unique characteristics of EIABecause it aims to be rational and structured, there is scope for ignoringcertain ethical issues at the expense of purely financial returns or gains inefficiency.


18/24

17

Appendix 4Environmental impact assessment

What is it?

An environmental impact assessment determine[s] potential environmental,

social and health effects of a proposed development in a form that permits alogical and rational decision to be made.15

The term environmental health assessment is frequently used to denote anenvironmental impact assessment that has a specific human healthcomponent. Joint health and environment assessments are further discussedunderIntegrated Impact Assessment later in this document.

The process

As well as being part of the World Health Organisations Targets for Health forAll by the Year 200016, environmental impact assessment is now an integral

part of EC directives (Directive (85/337/EEC as amended by 97/11/EC) and astatutory planning requirement in the UK. Department of Transport, LocalGovernment, and the Regions (DTLR) guidelines specify the circumstancesunder which environmental impact assessment must take place and indicatethe types of questions that must be posed and answered.

It is a procedure that must be followed for certain types of development beforethey are granted development consent17. The procedure requires thedeveloper to:1. Compile an Environmental Statement (ES) describing the likely significant

effects of the development on the environment and proposed mitigationmeasures.

2. Circulate the ES to statutory consultation bodies and make it available tothe public for comment.

3. The competent authority (e.g., local planning authority), must take accountof the ES and its contents, together with any comments before it may grantconsent.

Using Environmental Impact Assessment

Specific aspects of public health concern have been addressed in someenvironmental assessments. For example, air pollution attributable cases(mortality, chronic bronchitis incidence, hospital admissions, acute bronchitis

among children, restricted activity days, asthma attacks) were studied usingresults of a tri-national (Austria, France and Switzerland) impact assessmentstudy18.

Unique characteristics to EIA

Action taken following identification of issues around toxins, pollutants,noise and other factors through environmental impact assessment canhave a very direct effect on human health.


19/24

18

Can evaluate risks to the environment of individual hazards, rather thanconsidering cumulative impacts of several substances19,20.

Environmental health problems are complex and require interdisciplinaryworking. On its own, an environmental impact assessment does not focuson human health. Therefore, it does not meet the needs of a healthassessment. Impacts on human health must be specifically incorporated.

The timing of environmental assessments can reduce their impact. Whenthe assessment is of a project rather than a policy, it is often at too late astage to influence the broader policy itself21.


20/24

19

Appendix 5Social impact assessment

Developed in the USA to fulfil requirements under the National EnvironmentalPolicy Act (NEPA) for assessment of impacts on the human environment,social impact assessment looks at many of the determinants of health. Within

the UK, it is sometimes used where particular proposals do not need anenvironmental impact assessment15. Connected with social impactassessment are various other assessments, such as human rights impactassessment22,23 and equity assessment.

The process

The Interorganisational Committee on Guidelines and Principles for SocialImpact Assessment provide the following process outline for SIA:1. Public involvement - Develop an effective public involvement plan2. Identification of alternatives - Describe the proposed action or policy

change and reasonable alternatives.

3. Baseline conditions - Describe the relevant human environment/area ofinfluence and baseline conditions.

4. Scoping - Identify the full range of probable social impacts that will beaddressed based on discussion or interviews with numbers of allpotentially affected.

5. Projection of estimated effects - Investigate the probable impacts.6. Predicting responses to impacts7. Indirect and cumulative impacts - Estimate subsequent impacts and

cumulative impacts.8. Changes in alternatives - Recommend new or changed alternatives and

estimate or project their consequences.9. Mitigation - Develop a mitigation plan.10. Monitoring Develop a monitoring program.24

Using Social Impact Assessment

Rural-proofing, connected with social exclusion, is an aspect of social impactassessment that has had a lot of coverage in recent years. Even as early as1981, attempts were being made to consider effects of changes in policy orservices on rural communities. In the UK, the rural white paper addressed theissues of rural communities and stated the government would establish arural-proofing mechanism to ensure that all major policies were assessed fortheir rural impact25. The Local Government Association produced a paper to

help local authorities to deal with the problems of social exclusion in ruralcommunities26 and the Countryside Agency produced a checklist(http://www.countryside.gov.uk/Images/CA%2035_tcm2-12127.pdf) for policy-makers, advising what steps to take and including a set of questions to beposed of any policy27.

Other examples include the use of quality of life measures to assess theimpact of changes in rehabilitation services on disabled people28 and a studyof perceptions of mental health patients, providers and families following a


21/24

20

policy of moving from hospital-based towards community-based mental healthservices29.

Unique characteristics of SIA

Social Impact Assessment can indicate measures of social exclusion and

rural social exclusion, which are on the public health agenda for reducinghealth inequalities. Assessment addressing those problems will thereforebe of great relevance to public health.


22/24

21

Appendix 6Sustainability impact assessment

Strongly linked to environmental impact assessment, techniques forassessing effects on sustainability have been used or suggested for use atinternational, national and UK regional levels. Sustainability encompasses

economic, environmental and social dimensions30

.

The ProcessThe Office of the Deputy Prime Minister in England has recently published aconsultation paper on sustainability appraisal of regional spatial strategies andlocal development frameworks. It suggests the following eight stages for useof sustainability assessment with Regional Spatial Strategies:Stage 1: Draw up a project plan in consultation with the Government Office (GO).Stage 2: Develop strategic options in co-operation with GO and other stakeholders,Stage 3: Submission of the draft revision to the Secretary of State with SA Report;Stage 4: Examination-in-Public;Stage 5: Publication of the Panel Report;

Stage 6: Publication and consultation on proposedStage 7: Issue of revised RSS; andStage 8: Implementation, monitoring and review.31

http://www.odpm.gov.uk/stellent/groups/odpm_planning/documents/page/odpm_plan_030923.pdf

Using Sustainability Impact assessment

In the UK, under the Planning and Compulsory Purchase Act, 2004,Sustainability Impact Assessment is mandatory for Regional SpatialStrategies, Development Plan documents and Supplementary Planningdocuments.

Unique characteristics of SIA

As the emphasis on the societal element is stronger than in most otherassessments, there are definite advantages to public health in that evenmore of the underlying determinants of health are considered.


23/24

22

Appendix 7Integrated impact assessment

Integrated impact assessment has been defined as a diverse collection ofmethods and practice for which the common goal is to integrateenvironmental, economic, social and other forms of impact assessment32. In

many ways, this is similar to sustainability impact assessment.

There have been many instances where two or three types of impactassessment have been linked and essentially carried out together. Often thishas been in response to concerns that a particular aspect has not beencovered in one type of assessment. In particular, in recent years manyattempts have been made to combine health and environmental impactassessments.

The process

Key elements of an integrated environmental health impact assessment

model include:1. Project analysis2. Analysis of status quo (including regional analysis, population analysis,

and background situation)3. Prediction of impact (including prognosis of future pollution and prognosis

of health impact)4. Assessment of impact5. Recommendations6. Communication of results7. Evaluation of the overall procedure33

Using Integrated Impact Assessment

In the UK, the Office of the Deputy Prime Minister has published the 3 Rsguidance (regeneration, renewal and regional development), which aims toset out the broad framework within which the assessment of spatiallytargeted interventions should take place31. The techniques are intended alsoto be used on occasions when the prime focus of a policy is not one of thethree Rs.

In the North East region of England by the Government Offices, a rapidintegrated impact assessment was carried out in March 2003 on the regionalhousing strategy, as part of a set of pilots under the Department of

Transports Integrated Policy Appraisal initiative. This made use of BetterPolicy Makings Integrated Policy Appraisal screening checklist and summaryappraisal tables.

The North West region has developed an integrated impact assessmenttool34, available on the Health Impact Assessment gateway website(http://www.hiagateway.org.uk).


24/24

Unique characteristics of IIA

Integrated impact assessment has a significant capacity to consolidate rather than duplicate other assessment frameworks35.

There could be extra difficulties in prioritising and weighting differentoutcomes when more than one type of assessment is being used. Toproduce assessments with conclusions or recommendations,multidisciplinary teams need to find ways of agreeing priorities andeffectively rank outcomes against one another.

There are difficulties over finding appropriate methods for integratedassessments and also for incorporating the stakeholder consultationelement30. As a result of their findings from several case studies, Bond etal presented a set of recommendations, including: clarity from the outset ofthe roles of the different disciplines; planning of stakeholder consultation;development of effective communication of results; and assessment at thebeginning of the skills needed for the assessment, so that deficienciescould be addressed.

In the same way that there are no standard blueprints for health orenvironmental impact assessments, each occasion for use of integratedimpact assessment will have its own characteristics. This does mean thatthere is scope for subjectivity and political influence although ideally goodconsultation processes will help to avoid these.

Date post:	30-May-2018
Category:	Documents
Upload:	publichealthbydesign
View:	215 times
Download:	0 times

Health in Regional Public Policy Using IA to Improve Health - HDA England - 2005

Documents