Impacts and Evidence: can integrated impact assessment

improve policy making?

Margaret Douglas, Susie Palmer, Kay Barton, Alastair Pringle - Scottish Government

Cath Denholm - Health Scotland

Equally Well (June 2008)

“Integrated impact assessment processes….should be developed and implemented at national and local levels…

Impact on health inequalities should be a clear component…

The Government should ensure that there is guidance and support…”

The case for and against an integrated approach

Potential benefits • Impact assessment fatigue• Similar issues covered in different forms of assessment • Simplifies and reduces work • Champions for different issues can work together

Potential problems• Health (or whatever your favourite issue is!) will not

receive adequate attention• Potential for superficial treatment of issues • Involving a wide range of stakeholders could create

additional work

Health Inequalities Impact Assessment (HIIA)

HEALTH &WELLBEING

HUMAN RIGHTS

EQUALITY

HEALTH &WELLBEING

HUMAN RIGHTS

EQUALITY

Health Inequalities Impact Assessment ProjectPopulations

women

carers

people with low literacy

staff older people

homeless people

minorityethnicpeople

LGBtransgender

disabled people

children /young people

people withdifferent religions / beliefs

people living in poverty/low income

people with long termmedical conditions

HEALTH &WELLBEING

HUMAN RIGHTS

Community capacity building

Promoting good relations

Discrimination

Socialenvironment

Equality of opportunity

Tackling harassment

Promoting positive attitudes

Physicalenvironment

Lifestyles

Access to and quality of services

Human rightsCommunication of information

Health Inequalities Impact Assessment ProjectImpacts

EQUALITY

The Process

Scoping (Facilitated Workshop)

Appraisal (Evidence Gathering)

Final HIIA Report

Process evaluation & outcome evaluation

Scoping Report

10 Projects

1

2

3StakeholderFeedback

Guidance & Support

• Scoping Tool• Guidance Documents

– The Process – Issues for Consideration: health & equalities – Issues for Consideration: human rights– Participant Information Sheet – key publications, web

resources, help lines etc • Training workshop - ‘Trialling the Tool’ • General support from HIIA Project Team• SHRC involvement & support • Scottish Government support - ASD

Process Evaluation: scoping workshops

• Overwhelmingly positive: all said it added value and most said it raised new issues

• Stage of policy is important• Mix of stakeholders allows wider perspectives • Participants must be well informed ahead of workshop • Importance of facilitation to challenge/ draw out different

views• Structured but informal discussion allowed open

discussion of range of issues • Large number of impacts and associated research

questions identified for most policies• Some raised issues wider than policy being assessed• All scoping reports included tentative recommendations

Process evaluation: Appraisal stage

• Most said increased understanding of health and equality, but not human rights

• Concern about assessing human rights issues • Commonly appropriate evidence was lacking• Most struggled to complete in the timescale• Was a pilot so not required for policy

development or approval• In many reports recommendations were same

as identified at scoping• Most felt appraisal stage added value

Outcomes

• Most stated plans to use the findings in policy development or related work

• Main benefits stated were:• Involvement of stakeholders allowed broader perspective

on issues• Time to reflect on priority impacts• Consideration of wider population groups • Human rights based approach• Better information for policy making• Creative process

• Most said confident to do another HIIA

Next Steps

• Revise HIIA guidance to address comments• Outcome evaluation (end 2011)

• Interest particularly in adopting workshop approach to EQIA

• All examples so far in Health Directorates and NHS Boards

• Need wider commitment to use as way to address inter-sectoral health determinants