24 May 2011

Mental Health Impact Assessment: Advancing HIA practice in the US

Improving the consideration on mental health in health impact assessments has long been discussed as an area of practice that requires more attention. Dr Lynn Todman and Dr Eunha Kim from the Institute on Social Exclusion at the Adler School of Professional Psychology in Chicago have written a guest post on their work on Mental Health Impact Assessment (MHIA).

Historically, HIA practice, in the United States and globally, has been dominated by a focus on the impacts of public decisions on the social determinants of physical health outcomes such as cardiovascular, respiratory and infectious diseases; cancers; and HIV/AIDS. By comparison, the practice has not been as actively employed to assess the impact of public decisions on the social determinants of mental health.

This is despite well-established and documented evidence that social conditions have profound impacts on the incidence of such psychological disorders as anxiety, mood disorders (e.g., depression and bipolar), suicidality, substance (ab)use, and cognitive impairments. The relative de-emphasis of mental health in HIA practice is problematic for, at least, two reasons. The first and most obvious reason is that mental health is a critical element of overall health: “Mental health is an integral part of health; indeed, there is no health without mental health”. Second, mental health is an important mediator by which social conditions impact physical health: for instance, the emotional stress associated with poverty has documented relationships to the incidence of HIV/AIDS and cardiovascular disease. Therefore, minimizing or overlooking mental health considerations in HIA practice yields an incomplete understanding of the factors that shape health outcomes, and limits capacity for effective prevention and wellness promotion.

Supported in part by the Robert Wood Johnson Foundation and the W.K. Kellogg Foundation, the Institute on Social Exclusion at the Adler School of Professional Psychology has set out to address the relative neglect of mental health considerations in HIA practice. By synthesizing literatures, frameworks and methods mined from disciplines outside of the field of psychology and psychiatry, we are developing a process – Mental Health Impact Assessment (MHIA) – that will yield more comprehensive, in-depth and systematic considerations of mental health in HIA. In doing so, we are building on the important and pioneering Mental Well-Being Assessment (MWIA) toolkit that was developed in the United Kingdom and used since 2005.

Our work will also advance HIA practice, as implemented in the US, by executing a more rigorous process, impact and outcome evaluation; and by shifting the analytic focus, especially as regards mental health, from” risk and illness” to “protection and wellness” consistent with emergent practice and discourse on population health.

The 18-month MHIA project began in January 2011 and will focus on a legislative proposal that will impact the Chicago community of Englewood which is largely populated by low income African Americans. And, while the community exhibits a number of important strengths that promote its collective mental health and well being, such as dense social networks that embody feelings of pride, rich forms of mutual support, and a commitment to community revitalization, it is also plagued by social conditions that compromise community mental health: crime and violence; underperforming schools; substandard housing stock; joblessness; limited public services; and few neighborhood amenities; as well as broader determinants such as exclusion, racism and classism.

Early challenges and key lessons learned
In executing the MHIA, an early challenge was how best to define community mental health and well-being. Initially, we equated community mental health to population (or collective) mental health only to find out that, in the US, where we are conducting our work, community mental health does not connote population mental health. Instead, it refers to the practice of mental health professionals physically going into the communities where their clients live to dispense individualized care. This way of conceptualizing community mental health is incompatible with HIA practice wherein the unit of analysis is population health. In HIA practice, the relevant unit of analysis is the collective; in mental health practice – including community-based care – as conceptualized and conducted in the U.S., the dominant unit of analysis is the individual. It is our assessment – and the first lesson learned – that the differences in the relevant unit of analysis in HIA practice (the population) and mental health practice (the individual) underlies the relative limited uptake of mental health considerations in HIA.

A second challenge, which stems from the unit of analysis dichotomy, is methodological: How is community or “collective” mental health best measured? What are the appropriate indicators? Our emerging response to this challenge has been to rely on two analytic approaches. One approach involves the aggregation of community residents’ and other key stakeholders’ responses to instruments (e.g., questionnaires, interviews, surveys) informed by those that are traditionally used to assess psychological and emotional functioning, and wherein the unit of analysis is the individual. These will be combined with the results of other instruments designed to assess indicators of collective forms of psychological and emotional functioning (e.g., social capital, psychological sense of community). This analytic approach reflects yet another lesson learned: the importance of mining frameworks, measures, and indicators from disciplines outside of the field of mental health (e.g., political science, sociology, anthropology).

How You Can Get Involved
The Adler Institute on Social Exclusion is creating a Discussion Forum to facilitate exchanges of ideas, best practices, other resources and noteworthy events on the Social Determinants of Mental Health and Mental Health Impact Assessment. The Discussion Forum will help launch a global movement of public sector professionals, academics, communities, and other key stakeholders committed to addressing the social determinants of mental health.

For more information on the Discussion Forum, the MHIA or the Institute on Social Exclusion, please go to our website at www.adler.edu or contact us at ISE@adler.edu.

Related Links

18 May 2011

Interactive Map of HIAs in the USA

HIA Finds Oregon Farm to School Bill Would Benefit Health Through Job Creation

From the US Health Impact Project:

A bill in Oregon that would provide incentives to deliver fresh local food to schools would improve the health of the state’s residents and, at the same time, create hundreds of new farm-industry jobs over a five- to 10-year period, according to a study released by Upstream Public Health in Portland.

The researchers received a grant from the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, to conduct a health impact assessment (HIA) on the Farm to School and School Garden legislation, HB 2800.

An HIA is a study that explores the health impacts of a proposed project, plan or policy in areas that might not otherwise take full account of the health implications—like education, land use, agriculture or energy—and then makes recommendations to maximize the benefits and minimize any potential risks.

Read more about this HIA, including the full report

“This report is especially valuable because it shows how health impact assessment can help policy makers find unexpected ways to improve health and, at the same time, provide economic benefits—something that is more important now than ever given the current fiscal climate,” said Aaron Wernham, M.D., director of the Health Impact Project.

Farm to School and School Garden Legislation, Oregon HB 2800 , as introduced

The bill would reimburse schools—equivalent to 15 cents per lunch and seven cents per breakfast—for purchasing Oregon food products and provide competitive education grants to schools to support teaching gardens and cross-curricular nutrition education activities that could help kids learn about local food production and increase their preference for fruits and vegetables. The funding for the program would come from the Economic Development Fund, which is a portion of Oregon’s Lottery Fund.

The researchers conducted interviews with stakeholders, reviewed existing research on the health impacts of Farm to School programs and collaborated with an economist to analyze the bill’s impact on employment in the state.

The HIA concluded that HB 2800, if enacted as introduced, would:

  • Create at least 800 new agricultural jobs over the next five to 10 years in both urban and rural areas of the state. Research shows that employment improves health because it helps people afford safe places to live, buy adequate amounts of food, pay for health insurance and cover health care costs.
  • Have the potential to increase students’ satisfaction with school meal offerings, which research shows can increase student participation in the federal school meals program. This program provides nutritionally balanced, low-cost or free breakfasts and lunches to children each school day. In 2009, 14 percent of households in the state—nearly 500,000 people, including working families—had to cut back on food or even regularly skip meals because of economic hardships. The legislation could mean more children in these families would get nutritious meals at school. Hunger can affect health by causing chronic illness and developmental delays.
  • Have the potential for a small to moderate, long-term impact on childhood obesity by increasing fruit and vegetable consumption and increasing physical activity because more children are participating in school-based gardens.

“We found that this bill would offer the state of Oregon an economic benefit and, at the same time, provide a number of important health benefits—for example, shaping children's preferences for healthy food,” says Tia Henderson, Ph.D., research coordinator at Upstream Public Health and co-author of the report.

The Upstream Public Health HIA is one of 13 demonstration grants funded by the Health Impact Project. The other HIAs address a range of decisions, including a light rail corridor connecting the Twin Cities in Minnesota and a plan to re-develop an old automobile factory site in Atlanta, which would result in over 6.5 million square feet of office space, hotels, shopping and parking facilities. The project is accepting proposals through June 1, 2011 for its next round of grants.

“This is a fast-growing field, with health impact assessments being conducted all across the country,” said Dr. Wernham. “We are witnessing a rapid increase in demand—and support—for this important policy-making tool, including funding at the local, state and national levels.”

For more information about health impact assessments, to submit a proposal or to see an interactive, searchable map of ongoing and completed HIAs in the United States, please visit: www.healthimpactproject.org.

The Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, is a leading national initiative dedicated to promoting the use of health impact assessments in the United States. Learn more at www.healthimpactproject.org.

17 May 2011

Some news on increasing inequality

News from the High Pay Commission that the UK risks a return to Victorian levels of inequality:
"...a new ICM poll shows that 72% of the public think high pay makes Britain a grossly unequal place to live, while 73% say they have no faith in government or business to tackle excessive pay."
Meanwhile the Guardian data blog shows that the proportion of national income controlled by both the top 1% and top 10% is rising sharply.

Meanwhile a 2010 report from the Centre for Economic Policy Research at the Australian National University on Evidence and Perceptions of Inequality in Australia shows that:
..Australia has become a more divided and less fair society since the 1980s.
It's interesting that whilst there is widespread concern about increasing inequalities there appears to be very little political will to tackle the issue.

10 May 2011

Materials from Granada HIA Conference now online

From the conference organisers:

... new post-conference materials have been posted at the live-streaming website created to follow the conference on line (http://si.easp.es/eis2011/). More precisely, you’ll find there the authors' presentations in electronic version, the videos of all plenary sessions (currently in original version, soon also available in a dubbed version), the book of abstracts and a photo gallery. Additional information/documentation will be posted in the coming weeks.

Great job by the organisers

3 May 2011

Save the HIA Gateway Campaign - A PARTIAL SUCCESS - 2011-12 funding agreed

Dear All,

Apologies for the delay in spreading this good news.

Thank you for your support and comments which has made the English Department of Health formally extend the funding of the HIA Gateway from the next 3 months to the next 12 months!

If you would like to see the letter from Dame Sally Davies, the Chief Medical Officer, dated 13th April, then please click here.

If you would like to see the holding letter sent by Rt Hon. Andrew Lansley, received 9th March, then please click here.

The final letter that was sent in January can be seen by clicking here.

I'm calling this a partial success as we still need to maintain the pressure to ensure that funding is carried forward to future years indefinitely but it is a very positive step given the massive changes being proposed by the current English/UK Government across public health and healthcare.

So please use the HIA Gateway at www.hiagateway.org.uk as much as possible.

If you do have any thoughts on ensuring the future of the HIA Gateway then get in touch with me or the wider International HIA email network by clicking or pasting the following link https://www.jiscmail.ac.uk/cgi-bin/webadmin?A0=HIANET 

Or you could get in touch with the English Department of Health yourself via the first post and contacts listed in it.

All my best,