25 March 2014

Would you do health impact assessments if you didn't have to?

Carrot and Stick by Bruce Thomson
There's an interesting article by Elsa João and Anna McLauchlan in the latest issue of Impact Assessment and Project Appraisal. They asked 187 Scottish Strategic Environmental Impact Assessment (SEA) practitioners "if SEA was not compulsory, would you do it?"

This made me wonder about this question in relation to HIA. In many, if not most settings, there is not a requirement that makes HIA's use compulsory. For most HIA practitioners this question is not a hypothetical one. We encounter it in relation to every HIA.

Some recent  research I was involved in found that only 7% of HIAs conducted in Australia and New Zealand between 2005 and 2009 were done to meet a legal or regulatory requirement.

The overwhelming majority of Scottish survey respondents said they would do SEA even if it was not compulsory. In HIA practice we rarely have to wonder, which is a luxury in some ways. Most HIAs are done freely and to learn something. The link between voluntary involvement and the ability to learn something from HIAs is not theoretical. As my colleagues and I found in this study, the extent to which participants had a degree of choice or control over their involvement in an HIA had an impact on their receptiveness to learning from the HIA process and acting on its recommendations.

Interestingly, even though the survey was looking at SEA in Scotland where its use is mandated, the themes identified through the survey resonate with those we encounter in promoting HIA's use:

  • the perception that a similar process are already being done;
  • a lack of resources;
  • the need for a ‘leaner process’; and
  • the difficulties that can arise when external conditions or many decisions have already been determined.
The article is well worth reading, here's the abstract:
Strategic environmental assessment (SEA) is undertaken in more than 60 countries worldwide. Support to the SEA process can range from formal legal requirements to voluntary ‘ad hoc’ approaches. In the cases where SEA is legally required, such as in Europe where the SEA Directive sets a framework for SEA legislation in 28 countries, practitioners may engage with SEA but in a reluctant way. This paper reports on a unique survey of 203 key people responsible for implementing the SEA legislative requirement in Scotland. The majority (53%) of the 187 practitioners who answered the hypothetical question ‘If SEA was not compulsory, would you do it?’ said ‘Yes’. However, results suggest that the responses were much nuanced. Practitioners were asked to explicate their reasoning and, irrespective of whether the answer was ‘yes’ or ‘no’, common themes were evident in accompanying remarks. This paper enables reflection on reasons for acceptance or rejection of the SEA process by discussing: the perception that a similar process to SEA is already being done, the problem with lack of resources, the call for a ‘leaner process’ and the difficulties of undertaking SEA when conditions are already determined at a higher ‘tier’.

24 March 2014

From Katie Hirono on behalf of the US Society of Practitioners of Health Impact Assessment:
The Society of Practitioners of Health Impact Assessment (SOPHIA) seeks recommendations for exemplary HIA reports for the 2014 list of outstanding HIA reports. The SOPHIA Model HIA Reports Library functions as a periodically updated repository of exemplary HIA reports. The library is intended for:
  1. People who are unfamiliar with HIA and want to understand what a high caliber HIA report product might look like (for example, people thinking of commissioning an HIA)
  1. HIA practitioners seeking above average HIA reports as a reference
You may recommend HIAs done by yourself or other practitioners. The HIA can be on a project or policy, done in any location both in the U.S. and abroad, and be either stand-alone or done as part of an integrated assessment.  As we have already selected reports from 2009 – 2012, ideally these reports would have been released within the past 2 years. 
You must be a member of SOPHIA to submit a recommended HIA report (but can join easily here: http://hiasociety.org/?page_id=48). Or, click here to submit a recommendation: http://hiasociety.org/?page_id=29

20 March 2014

The effectiveness of HIAs conducted in Australia and New Zealand

It occurred to me that I haven't posted a link to the final report on the Australian Research Council-funded study on the effectiveness of HIAs conducted in Australia and New Zealand between 2005 and 2009. The report has lots of information in it. Download it here.

San Francisco Department of Public Health's annual Health Impact Assessment Practitioners' Training

We are excited to announce that registration is now open for the San Francisco Department of Public Health's annual Health Impact Assessment Practitioners' Training (July 14-17, 2014). Register early at the link http://bit.ly/1mhK7lh

What is Health Impact Assessment?
Health impact assessment (HIA) is most often defined as “a combination of procedures, methods and tools by which a policy, program or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population” (World Health Organization, 1999).  

The field of HIA and the process of getting health into decision-making continues to evolve and grow http://www.healthimpactproject.org/hia/us

How will you and your team enhance skill sets, leverage big data, meaningfully engage communities, and have collective impact? HIA is one of many tools that may be considered for health-protective policy and action.

About the SFDPH HIA Training

7th Annual Health Impact Assessment Practitioners Summer Training Course

TCE Oakland Conference Center, 1111 Broadway, 7th Floor, Oakland, CA

July 14-17, 2014 (attendance all four days is mandatory)

HIA practitioners at the San Francisco Department of Public Health and community, academic, and local government partners

$960 (includes the cost of course materials, breakfast and lunch; accommodations and travel not included).  We are working to raise funds to support attendance of organizations facing financial hardship. We STRONGLY encourage applications from community-based organizations who are actively planning, considering, or doing HIA to apply.

13 February 2014

When is an HIA not an HIA?

Guest post from Karen Bauer from the Denver HIA Collaborative:

Yesterday I attended a seminar given by the Denver Regional Council of Governments entitled Prescription for a Healthy Community.  The main speakers were the Colorado Health Foundation and Urban Land Institute.  To give you some idea of the influence that these organizations have, consider that the Colorado Health Foundation is the third largest health-focused foundation in the country, with $2.2 billion in assets, and ULI is a worldwide nonprofit representing land use and real estate development.  Its membership dues are $1200 annually.    
In 2013 ULI announced that their new initiative would be building healthy places.  Along with $4.5 million funding from the Colorado Health Foundation, they chose three locations in Colorado to receive the ULI treatment.  That means that ULI developed a TAP (technical advisory panel) that spent one week in each community to meet with stakeholders.  During that week they developed a report of opportunities and recommendations, which was then presented to the community. (I requested to see these reports, as they are not online).  After that, the community has the opportunity to apply for up to $1 million from the Foundation to implement their plans. 
I took a look at the ULI website to learn more about their initiative.  You can see that they are working completely outside of the world of HIA and its years of research, capacity building and expertise.  
A number of questions come to mind:
  1. Does the HIA community need to do more to gain recognition as the go-to organization for research, tools, assessments?
  2. Should we need a certification to go into a community to do a health assessment?
  3. Does this help or hurt our field?
  4. Maybe HIA has it wrong.  Is there something to be said for a one-week process? 
I would like to hear your comments, questions, concerns about this topic.

11 February 2014

Urban HEART Report

The WHO Centre for Health Development has published a report on the Expert Consultation on Urban HEART held in November 2013. It's a worthwhile read for anyone with an interest in HIA, health equity and urban planning issues at the city level.

29 January 2014

EPA Review of HIAs in the U.S

THE US EPA has published their review of HIAs in the U.S. Definitely worth reading:

Rhodus J, Fulk F, Autrey B, O’Shea S, Roth A: A Review of Health Impact Assessments in the U.S.: Current State-of-Science, Best Practices, and Areas for Improvement. In. Cincinnati: Office of Research and Development, National Exposure Research Laboratory, U.S. Environmental Protection Agency; 2013.


A systematic review was conducted of health impact assessments (HIAs) from the U.S. to obtain a clear picture of how HIAs are being implemented nationally and to identify potential areas for improving the HIA community of practice. The review was focused on HIAs from the four sectors that the U.S. Environmental Protection Agency’s (EPA’s) Sustainable and Healthy Communities Research Program has identified as target areas for empowering communities to move toward more sustainable states. These four sectors are Transportation, Housing/Buildings/ Infrastructure, Land Use, and Waste Management/Site Revitalization. The review systematically documented organizations involved in conducting the HIAs; funding sources; the types of community-level decisions being made; data, tools, and models used; self-identified data needs; methods of stakeholder engagement; pathways and endpoints; characterization of impacts; decision-making outcomes and recommendations; monitoring and follow-up measures; prioritization methods employed; HIA defensibility and effectiveness; attainment of the Minimum Elements of HIA; areas for improvement; and identification of best practices. The results of the HIA reviews were synthesized to identify the state of the HIA practice in the U.S., best practices in HIAs, and areas in the overall HIA process that could benefit from enhanced guidance, strategies, and methods for conducting community-based risk assessments and HIAs. While HIAs have helped to raise awareness and bring health into decisions outside traditional health-related fields, the effectiveness of HIAs in bringing health-related changes to pending decisions in the U.S. varies greatly. The review found that there are considerable disparities in the quality and rigor of HIAs being conducted. This, combined with the lack of monitoring, health impact management, and other follow-up in the HIAs could be limiting the overall utilization and effectiveness of this tool in the U.S.


A review was conducted of 81 Health Impact Asessments (HIAs) from the U.S. to obtain a clear picture of how HIAs are being implemented nationally and to identify potential areas for improving the HIA community of practice. Improving HIAs across the US will lead to better informed decisions at the community level and ultimately to improvement in public health and the environment.

23 January 2014

Two online HIA courses from the Canadian National Collaborating Centre for Healthy Public Policy

The Canadian National Collaborating Centre for Healthy Public Policy is offering two online HIA courses in English and French:

Online Continuing Education Course – HIA Step by Step

A 12-hour online continuing education course on health impact assessment (HIA) of public policies will be offered by the NCCHPP starting in October 2013.
This online course will focus on the five steps of HIA and will take place over 4 weeks. It will allow you to become familiar with the HIA process applied to public policies, recognize its fundamentals, and think about the favourable conditions for successful HIA implementation.  
Next courses:
In English: March 3 to 28, 2014
In French: May 26 to June 20, 2014

Online University Course – Introduction to Health Impact Assessment

The Université de Montréal is offering a 45-hour online university course on health impact assessment (HIA) of public policies. This course has been developed by the NCCHPP in collaboration with Dr. Richard Massé, associate professor at the Department of social and preventive medicine at the Université de Montréal, and other partners.  
This course, launched in February 2013, aims to help participants to develop and improve their competencies for leading an HIA process relating to public policies, and to do this with partners from different sectors.  
The course takes place over the period of 6 weeks, for 1 graduate-level university credit.
Please note: This course is offered by the Université de Montréal, a francophone university. While the content of the HIA course and the online platform are entirely in English, all administrative tasks regarding this course must be done in French. This includes course registration and payment, retrieving grades and certificates, and asking for technical and administrative assistance.  
Next courses: March 19 to April 30, 2014 in French and May 1 to June 12, 2014 in English. 
More on their website

22 January 2014

IAIA14 Training Course: Health Impact Assessment of Industrial Projects

A really interesting and engaging two-day training program on HIA of industrial projects is being offered as part of IAIA15 in Chile. Find out more about the course and book early to avoid missing out.

You can find out more on the training program on the conference website.

3 December 2013

Global Health 2035

A really interesting and thoughtful piece by Dr Charles Clift at the Chatham House Centre on Global Health Security on the new Lancet commissioned report Global 2035: A World Converging Within A Generation (you will need to register to gain access to the full report).

He provides nice summary of the issues in the report and its historical context as a successor to the World Bank's 1993 Report Investing in Health.
My three take aways:
The report’s key innovation (akin to the DALY) is to support and popularize the concept of ‘full income’ – adding to conventional national income measures a valuation of the increase in life expectancy. On that basis it estimates that, between 2000 and 2011, 24 per cent of the growth in ‘full income’ in low and middle income countries was due to health improvements, equivalent to a 1.8 per cent per annum addition to GDP growth. Based on this methodology it concludes that ‘there is a very large payoff from investing in health’.
Its other big idea, captured in the title, is that with rising incomes in the developing world and continued improvements in health and delivery technologies, an achievable goal for nearly all countries in 2035 is to bring down infection, maternal and child mortality rates to the current levels of the four best performing middle income countries (Chile, China, Costa Rica and Cuba).
The Lancet also provides commentaries on the report by three global health leaders – Richard Horton (Lancet editor), Margaret Chan (WHO) and Mark Dybul (Global Fund) and heads of two key development institutions (Jim Kim of the World Bank and Helen Clark of the UN Development Programme). While the first group is largely favourably disposed, the latter two both focus on the commission’s failure to address the social and economic determinants of health. The report essentially argued that there are ‘complex and entrenched political obstacles’ to addressing them so it is better to focus on the health sector where a more immediate impact can be realized.
Kim and Clark argue strongly against this – they contend that there needs to be a balance between investments inside and outside the health sector if the goal of improving health is to be achieved. The global health community will need to heed these words if it wishes to find a proper place for health in the post-2015 development agenda.
I thought it ironic that the WB and UNDP (to a lesser extent) were advocating for a social determinants of health approach to the report (while the report authors were justifying why they didn't in the report)!

You can subscribe to the Global Health Security Newsletter produced by Chatham House by clicking this link.

27 November 2013

Launch: Effectiveness of Health Impact Assessment in New Zealand and Australia Report

The Centre for Health Equity Training, Research, and Evaluation invites you to attend the launch of The Effectiveness of Health Impact Assessment in New Zealand and Australia: 2005-2009 Report

Friday, 13 December, 2013
2 – 4 pm
Lavender Bay rooms 1&2,
North Sydney Harbourview Hotel
17 Blue Street, North Sydney

Webinar facilities will be available for our interstate and international attendees. RSVP to Heike Schutze: h.schutze@unsw.edu.au

21 November 2013

Reminder: Important dates for IAIA14

IA14, the 34th annual IAIA conference, will be held 8-11 April 2014 in Viña del Mar, Chile.  For more information, visithttp://iaia.org/conferences/iaia14/.

Important Dates:
6 December:  Paper/Poster Abstract Submissions Due
6 December:  Student Fee Waiver Applications Due

Paper/Poster Abstracts Invited:  The online submission form for IAIA14 paper/poster abstracts is available on the conference website under the Submissions menu. The submission deadline is 6 December 2013.

Student Fee Waivers: The Student Fee Waiver program allows up to ten students a waived conference registration fee in exchange for providing in-kind services on-site at the conference. For more information, contact Loreley Fortuny at IAIA HQ (impact@iaia.org) for program guidelines and an application form.  Completed forms are due 6 December.

Sponsorship opportunities:  IAIA is currently seeking sponsors for the IAIA14 conference.  Download the Sponsorship Opportunities brochure to find out the various ways your company can reach out to over 700 environmental professionals from 80+ nations.

8 November 2013

WHO Urban HEART Consultation Day 3

I've been invited to participate in a WHO Consultation on Urban HEART in Kobe. This is a post on Day 3 of the Consultation, there are also posts on Day 1 and Day 2.

Workshop 3: Review of Urban HEART guidance

There was a widespread view that the current Urban HEART guidance works quite well but that there are a few areas where it might be enhanced. There was discussion about the selection of interventions and responses being difficult in practice, and that it involves considerable negotiation. There wasn't agreement about the best ways to reflect this in the guidance but it was a recurrent theme, and one that's familiar in the context of HIA and negotiating recommendations.

Community participation is another aspect of Urban HEART that has been difficult to provide guidance on. Participatory rapid assessments, health assemblies, surveys, workshops, and the use of mobile and electronic engagement tools were all discussed as ways to involve communities in Urban HEART processes, though these were all recognised as having limitations.

There was quite a lot of discussion about the extent to which HIA might be integrated into Urban HEART, though it was agreed that Urban HEART and HIA are complementary rather than being processes that could be integrated. This is because Urban HEART helps to identify needs and areas for action at the city level, whereas HIA is most useful where there is a proposal or a limited set of options to assess. So whilst there are procedural similarities they serve quite different purposes and integrating them might complicate things rather than helping. The diagram below from the Urban HEART User Guide shows how WHO conceptualises Urban HEART's role in local planning cycles. Some related procedures like multi-criteria decision analysis and equity lenses were also discussed, and how they might be integrated into Urban HEART.

7 November 2013

WHO Urban HEART Consultation Day 2

I've been invited to participate in a WHO Consultation on Urban HEART in Kobe. This is a post on Day 2 of the Consultation, there are also posts on Day 1 and Day 3.

Workshop 1: Review of Urban HEART concepts

The first workshop focused on factors affecting health equity that might be missing from or not sufficiently emphasised in Urban HEART. These include things like gender, food and nutrition, emergency preparedness, conflict and security, universal health coverage and environmental sustainability.

The issue of within-neighbourhood disaggregation was discussed, particularly in terms of age and gender, but there was a broad recognition that this data simply isn't available for most indicators and that this may add a layer complexity to an already imposing process. There was also a recognition that many indicators of health equity might not be sensitive enough, or may reflect structural or systemic inequalities, to change at the local or city level. These issues will be very familiar to those who have looked at equity and vulnerability within impact assessments.

There was quite a bit of discussion about the degree to which Urban HEART needs to be regarded as a standardised, readily-comprehensible approach or something that can be adapted to local needs. This is a debate I've encountered several times in relation to HIA and the answer seems to lie somewhere between those two extremes.

City case presentations

A presentation from Dr Oyelaran-Oyeyinka from UN-HABITAT emphasised the important role cities play as the engine rooms of economic development, though the challenge is to ensure that's inclusive development. Internationally the urban-rural divide is diminishing but the rich-poor divide is increasing.

Kelly Murphy from St Michael's Hospital in Toronto presented on her work adapting Urban HEART for use in developed countries. The City of Toronto has adopted Urban HEART as a mechanism to guide funding of Neighbourhood Improvement Areas and Issue to 2020.

6 November 2013

WHO Urban HEART Consultation Day 1

I've been invited to participate in a WHO Consultation on Urban HEART in Kobe. This is a post on some of the issues discussed on Day 1, with some of my thoughts and reflections scattered throughout. There are also posts on Day 2 and Day 3.

Urban HEART grew out of the Commission on the Social Determinants of Health's work and dates back to 2007. Early activity on piloting and developing a tool were led by a few countries, notably Iran. The final report from the CSDOH gave further impetus and led to more piloting of Urban HEART in more cities. After piloting Urban HEART was extensively reviewed and Version 1 was published in 2010.

Urban HEART is conceptualised by WHO as a tool for assessment and response to health equity issues at the city level. Urban HEART was designed to meet four criteria:
  • ease of use
  • comprehensive and inclusive
  • feasible and sustainable
  • links evidence to action
It's a stepwise process with a lot of similarities to HIA. In contrast to HIA it doesn't need a proposal (even a general one or options) to assess. Rather it allows municipalities to identify issues for action and responses at the city level, and in that way it's more like a needs assessment or planning activity. It's useful where some willingness to act on health already exists, so Healthy Cities is a useful basis for action. Higher-order support is always required (which may be less true for HIA?).

Data that informs Urban HEART is almost always spread across agencies - no single one holds or reports on even the core indicators. This means multiple permissions and interagency liaison is often required, which reiterates the need for higher-order permission and negotiation at the earliest stages. Whilst this is undoubtedly desirable for HIAs as well it hasn't always been possible in my experience and HIAs often fly under the radar, at least in the early stages. I'm not sure that would be possible for Urban HEART but I'm not sure that's a bad thing. The under-the-radar HIAs I've been involved in have often encountered resistance when their recommendations are presented. A clear, unambiguous mandate and imprimatur as a basis for proceeding isn't a bad thing.

A survey of Consultation participants that was conducted in advance found that most participants thought Urban HEART works well overall, is easy to use and successfully links evidence to action, but is less successful at being comprehensive and organisationally sustainable.

Case studies from the City of Paranaque in the Philippines, Tehran in Iran and Indore in India provided a range of useful, practical lessons on the use of Urban HEART (and they were quite inspirational). The Inore case in particular modified the indicators in a way to suit the local context, in their case by ensuring that the indicators were all meaningful and comprehensible to anyone, from residents to national bureaucrats. The case studies also highlighted the need for Urban HEART to not be a one-off activity but as an activity that needs to be revisited/undertaken semi-regularly.