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Assessment:
A
Guide
For
Service Providers
The State of Queensland
Copyright protects this publication. However, Queensland Health has no objection to this
material being reproduced with acknowledgment, except for commercial purposes.
Permission to reproduce for commercial purposes should be sought from the Policy and
Quality Officer, Queensland Health, GPO Box 48, Brisbane Q 4001.
Suggested citation
Queensland Health. Health Impact Assessment: A Guide for Service Providers. Public Health
Services, Queensland Health. Brisbane 2003
Acknowledgments
Special acknowledgment needs to be given to the service providers who participated in the
focus group and developmental processes for this resource. Without their dedication, effort
and constructive comments this document could not have been produced.
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Health Impact Assessment: A Guide for Service Providers
Contents
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Health Impact Assessment: A Guide for Service Providers
Glossary of terms
Health: a state of complete physical, mental and social well being and not
merely the absence of disease and infirmity.
1
Queensland Health (2001) Social Determinants of Health: The Role of Public Health
Services – Summary Document. Brisbane: Public Health Services, Queensland Health.
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Health Impact Assessment: A Guide for Service Providers
2
Mahoney, M. and Wright, J. (2002) Health Impact Assessment: a tool for policy development
in Australia. An interim literature review and briefing paper. Melbourne: Deakin University
Faculty of Health and Behavioural Sciences.
3
Mcintyre, L. and Petticrew, M. (1999) Methods of Health Impact Assessment: a literature
review. Glasgow: University of Glascow, Medical Research Council Social and Public Health
Sciences Unit, Occasional Paper, December.
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Health Impact Assessment: A Guide for Service Providers
Introduction
It is now well recognised that many influences act on health. Some of the
major factors include poverty, transport, education and the environment and
are outside the jurisdiction of health services.4,5
This guide will offer service providers and others a useful introduction to
health impact assessment (HIA). Note there is no single correct method of
conducting HIA as conditions and circumstances vary. As a result this guide
offers those who wish to carry out a HIA the ways and means of developing
an approach which will be effective and easy to follow.
4
Acheson, D. (1998) Report of the independent inquiry into inequalities in health. London:
Stationary Office.
5
Queensland Health (2001) Social Determinants of Health – The Role of Public Health
Services. Brisbane: Public Health Services, Queensland Health.
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Health Impact Assessment: A Guide for Service Providers
Why it is important6
Responding to public concern about health. The organisation carrying out the
HIA as part of its work program can clearly indicate that it cares about the
community and is able to respond to public health concerns.
Making public policy healthy. By bringing public health issues into the
foreground of policy-making and decision-making.
6
National Health Strategy (2000) A Short Guide to Health Impact Assessment: Informing
Healthy Decisions. NHS: London.
7
Queensland Health (2002) Smart State: Health 2020 A Vision for the Future – Directions
Statement. Queensland Health p 44.
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Health Impact Assessment: A Guide for Service Providers
This resource will introduce you to the main elements of HIA. It enables all
sectors, public and private and their policy and decision-makers to:
This resource has grown out of the recognition by Public Health Services,
Queensland Health of the importance of assessing the possible impact on
health and health inequalities of policies and practices and the need to ensure
that improving health is seen as the responsibility of all of us.8
• community renewal
• local strategic partnerships
• community strategies
• local/regional transport plans and/or land use plans
• integration of services
• equity audits
• ability of councils to promote the wellbeing of communities.
8
Queensland Health (2001) Social Determinants of Health – The Role of Public Health
Services. Brisbane: Public Health Services, Queensland Health.
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Basically, HIA offers a way of understanding the potential risks and benefits to
health that are contained within any proposal, and doing so rigorously.
Having said this however, HIA is not a rigid approach,
rather it is characterised by its adaptability. It is HIA has been
sufficiently flexible to suit both the resources available defined as a
9
and the responsibilities of the decision-makers. (See combination of
appendix 2 for a sample case study in HIA). procedures or
methods by which a
HIA can provide a valuable tool to help inform policy, program or
decision-making processes at a number of levels and project may be
contexts: judged for the
effects it may have
• policy development and analysis on the health of a
• strategic development and planning population.
• program and/or project development
• commissioning or providing services.
9
National Health Executive (2001) A Short Guide to Health Impact Assessment-Informing
Healthy Decisions. London: National Health Executive.
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Health Impact Assessment: A Guide for Service Providers
Step 1: Screening
Decide what proposals or projects require assessment.
Step 2: Scoping
Decide the parameters for carrying out the HIA.
10
There are various models of HIA but they exhibit commonalities with the Merseyside model
in Figure 2. For example, Queensland Health’s Environmental Health Unit is currently
drafting a HIA framework to capture their current focus. See the section on Further
Information for resources relating to other models.
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Health Impact Assessment: A Guide for Service Providers
Step 1: Screening
In order to make the most efficient use of This step applies to the
available expertise it is important to be selective selection of a project or
about what assessment work is undertaken. practice for their potential
Screening is about rapidly assessing likely to affect the health of a
population. It helps
projects for HIA in relation to a number of issues
determine whether a HIA
and can give a useful indication of resource is worth doing. Issues to
requirements. Issues to consider include:11 cover include economic,
outcome, epidemiological
and strategic issues.
11
Scott-Samuel, A.; Birley, M. and Ardern, K. (2001) The Merseyside Guidelines for Health
Impact Assessment. Merseyside Health Impact Assessment Steering Group.
12
See National Public Health Partnership (2001) Health Impact Assessment Guidelines.
NPHP
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A key function of this stage is to filter out proposals that are unlikely to benefit
from HIA. For example, if:
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Health Impact Assessment: A Guide for Service Providers
Step 2: Scoping
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Health Impact Assessment: A Guide for Service Providers
Note:
Rapid appraisal is considered by many organisations as an entry point for
Health Impact Assessment. There are no clear boundaries around the three
levels – you may wish to adopt elements from all three if necessary and
appropriate for your needs.
• Rapid: this entails a ‘quick and dirty’ investigation of the health impacts of
a project. It usually involves an exchange of existing knowledge and
expertise, and research from previous HIAs. Rapid HIA is usually carried
out quickly and with relatively minimal resources. Duration: days.
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• the scope of the work including geographical and time boundaries, what to
include and exclude, range and extent of the potential impacts, specific
health determinants affected
• program outline, eg timelines
• budget/funding issues.
Different types of partnerships will expect different input from members of the
steering group. With some extended projects a relatively hands-off steering
group may be the most appropriate only meeting at three-monthly intervals
and focusing attention on key review points. With other projects the steering
group may be more hands-on with members committing time to the day-to-
day tasks of the HIA.
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13
based on Scott-Samuel, A.; Birley, M. and Ardern, K. (2001) The Merseyside Guidelines for
Health Impact Assessment. Merseyside Health Impact Assessment Steering Group, p11.
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Note:
Recommendations are usually produced in a report format. Consideration
should also be given to providing feedback of the findings and
recommendations from the HIA process to the local community involved in
and affected by the project.
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• they may or may not have been involved in the assessment process
• the decision-makers may have other priorities to consider besides health.
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♦ Process – this involves assessing how the HIA was conducted, who was
involved, and how useful and valuable was the process.
♦ Impact – this entails following how far recommendations were adopted
and implemented by the project proponents and if not, why not?
♦ Outcome – evaluation means assessing whether the anticipated positive
effects on health, well being and equity were in fact enhanced, and any
negative effects minimised and if not, why not, and how can plans be
further adapted?
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Health Impact Assessment: A Guide for Service Providers
Procedures Methods
Interview
Select assessor
stakeholders and
key informants
Appraise the
assessment Assess evidence
STEP 5: NEGOTIATE
FAVOURED OPTIONS Establish priority
impacts
Implement
STEP 4: DEVELOPING
RECOMMENDATIONS
STEP 6: MONITORING AND
EVALUATION (in relation to
both the overall proposal
and benefit of the HIA)
(based on: Scott-Samuel, Birley and Ardern, (2001) The Merseyside Guidelines for
Health Impact Assessment. Merseyside Health Impact Assessment Steering Group,
p6.)
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HIA has the potential to offer a great deal to the community, to partnership
arrangements, to individual organisations, and to individuals within the
organisations. However, at times, management may be understandably
hesitant about introducing this approach into their organisation, citing a
number of issues as possible barriers, namely:
Rapid appraisal is generally considered the entry point for HIA as it can be
undertaken in a relatively short space of time and does not require the
intensive use of resources. As such it offers organisations an attractive
opportunity to make a practical start in HIA. It is a systematic study of the
health impacts based on:
Scoping:
• all relevant stakeholders are identified
• the assessor is likely to be appointed from within the organisation or
partnership
• the impacts of particular concern are highlighted, especially if relevant to
at-risk populations.
Appraisal:
• information on the proposal to be appraised, a basic community profile, the
health impacts of particular concern are circulated to all stakeholders prior
to the workshop
• during the workshop participants identify health impacts
• opportunities for searching current literature for evidence is constrained by
time limitations, therefore, placing more emphasis on knowledge of
assessor and other stakeholders
• the recommendations about modifications to the proposal or project may
tend to be broad depending on the evidence and/or experience of the
assessor.
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One of the reasons HIA can be used effectively in this context concerns the
values-base underpinning its usage and development as a methodology. The
dominant value underpinning the use of HIA is sustainability and it is from this
starting point that the others stem (and are outlined in Box 2 below):
Sustainability: appraising health impacts in both the short- and long- terms,
and those that are direct and indirect; working to prevent negative impacts, to
reduce disability and social dependence, and to promote empowerment and
self-help (for individuals and communities); using limited resources effectively
to achieve health gain that may affect several generations.
Promotion of health: working to attain the maximum gain for the population.
Equity: addressing not only the impact of a policy, program or project on the
health of a population, but also the distribution of that impact within the
population, for example, in terms of sex, age, ethnic background or socio-
economic status, which accords with the aims of reducing inequalities in
health.
14
Ison, E. (2000) Resource for Health Impact Assessment. Volume 1: (The Main Resource).
London: NHS Section 3.2 Inset 3.C.
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15
Ison, E. (2000) ibid Section 3:9.
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Further information
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16
based on Milner, S. (1999) “The Health Impact Assessment of Non-Health Public Policy”.
In, Department of Health, Health Impact Assessment: Report of a Methodological Seminar.
DOH: UK: 42.
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Queensland Health (2003) Assessing the utility of HIA for service integration:
Health impact assessment of the Goodna Service Integration Project – a case
study. Queensland: Public Health Services, Queensland Health.
Background: the study was concerned with the health impact assessment for
a model of service integration – the Goodna Service Integration Project that
was trialled in West Moreton. The West Moreton Public Health Unit,
Queensland Health undertook the study in collaboration with the Goodna
Service Integration Project Team. In addition, Public Health Services wished
to investigate the utility of this methodology as a tool for assessing service
integration.
The steering group identified key informants for initial discussion as well as
helping to identify major stakeholders and key informants for interviews and
focus groups. During the course of the interviews and focus groups other
informants were suggested that it was felt could contribute to the assessment
process.
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It was agreed that health outcomes in terms of health impacts from the project
should be based on the model of health determinants identified within the
Merseyside model and assessed according to whether positive or negative
impacts, their potential impact being definite, probable or speculative and
whether in the short, medium and long terms.
The main points and themes from discussions were extracted for inclusion
into these four elements to assess the merits of HIA for service integration.
Evaluation:
HIA of the Service Integration Project: process evaluation only as impact and
outcome evaluation will be dependent upon the take-up of the
recommendations.
Utility of the methodology: evaluation of the utility of this approach for service
integration involved identification of findings within the four elements of
service integration. Key learning points were also identified to contribute to
future usage of HIA methodologies.
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17
Note: you may wish to add a column for comments for those responses that need
clarification
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Health Impact Assessment: A Guide for Service Providers
PUBLIC SERVICES
Access to and
location of
health care
facilities
Quality of
health care
facilities
Child care
Social services
Housing and
home services
Employment
and social
security
Public
transport
Policing
NGOs
agencies and
services
PUBLIC POLICY
Economic,
social,
environment
and health
trends
Local and
national
priorities
Policies
Programs
Projects
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