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 2Target area and population

Extent affected(Very significant = 1; very insignificant = 5)

Will the following neighbourhood beaffected 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 beaffected 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 CommitteeSolihull Community & Economic Regeneration Team,Solihull CVS,Solihull Ward councilorsPotential 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

ContactsStakeholders/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 QuantitativeData 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 Analysisand Prioritisation

• Models• Matrices• Mathematical modelling & health

economics • Transparent synthesis of evidence• Delphi, consensus building

methods and tools• Prioritisation criteria

��� ���!�������

������������� �

����� ��"��

��������

��� �������� �

��� ���� ���

"��

��������

����� ��#��� ������ ������ ���"�������

���������

�����

������

���

�������� �����

•����������������

•���������

•��������������

��������������

•���������� �������������

•!�������� ������

•"��������������������

•#�������

•����������������

�������

•$�%���������

•&�������'�

�������'������

�����������

•������

•(�����������

• 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 2020Air pollutant emissions per year (kT):PM10s 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

Dec

reas

e in

mor

talit

y

60000

40000

20000

0

-20000

-40000

0 95

RTA – UnderlyingOther – UnderlyingRTA – Underlying + FVIOther – Underlying + FVI

Total reduction in mortality over 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 CPosition remains

as at 2000Implementation

of UK & EU Transport

Policies

Implementation of Policies + FVI

Deaths 87,530 52,906 52,887Serious 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 CPosition

remains as at 2000

Implementation of UK & EU

Transport Policies

Implementation of Policies

+ FVI

Total £7,166,533,829 £7,030,007,211 £7,022,277,279Serious 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

0

10000

20000

30000

40000

50000

60000

70000

2006 2012 2022 2030

Year

Ser

iou

s an

no

yan

ce n

ois

e 54

LA

eq

ext

no ext

baseline

Modelling noise impacts in BIA HIA: annoyance

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

2006 2012 2022 2030

year

high

ly d

istu

rbed

sle

ep

extno extbaseline

Modelling noise impacts in BIA HIA: sleep disturbance

Modelling noise impacts in BIA HIA: schools affected

0

5

10

15

20

25

30

35

2006 2012 2022 2030

nu

mb

er o

f p

rim

ary

sch

oo

ls 5

4Leq

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