Health and Social Care Policy and the Interprofessional ... - CAIPE

Health Impact Assessment
A WHO consensus paper defined Health Impact Assessment (HIA) as ‘a
combination of procedures, methods, and tools by which a policy, programme
or plan may be judged as to its potential effects on the health of the
population and the distribution of those effects within the population’ WHO
1999 (Gothenburg consensus paper, European Centre for Health Policy).
HIA is a systematic assessment of the interrelated personal, social, cultural,
economic, and environmental factors that influence both individual and
population health status. Categories, known as determinants of health, are
measured against policy changes, thus offering the best opportunity for
improving the health of a population on an inter-sectoral basis. The ECHP is
beginning to use HIA as an integral part of its public health programme and
have developed a toolkit that could be used to assess the possible health
impacts of policies and proposals (see ECHP, 2001).
Unlike the Environmental Impact Assessment (EIA), where legal statutes
exist, HIA is not currently a mandatory requirement. However statutory
requirements for employment, housing and transport, and their cost
implications are being used increasingly in the overall HIA. Experts warn
however that HIA should be viewed only as one, rather than the, way of
embedding public health in policy development (Breeze & Hall 2001, Letho &
Ritsatakis 2001, Hubel & Hedin 2003).
In 2003 a survey of the HIA and government policy making in European
countries was coordinated by the Welsh Assembly Government (Wales, UK)
& the European Network of Health Promotion Agencies, Brussels in cooperation
with the European Commission, DG Health & Consumer Protection
Public Health Policy Unit (Luxembourg) and the World Health Organisation
(WAG, 2003). Of the 22 European countries that took part, all but one
admitted that health was a relevant theme across policies and programmes
developed in other policy areas. However, even though seven governments
appeared to be using HIA, the findings suggest that its use 'appears to be
driven by opportunism as opposed to a systematic approach' (p4). Its use also
varies across policy areas and reported as 'good in some policy areas but
poor in others' (p4). The report concluded that, although some governments
have allocated some resources to support the development and use of HIA,
there is a need to increase awareness and understanding of its role within and
between countries. It is this that ultimately will ensure integrated and intersectoral
policy and activity, which focus on the determinants of health.
According to Wismar (2004), sceptics question the effectiveness of HIA
because of the inherent difficulties of evaluating its effect on the health of the
nation. Indeed Wismar suggests that an evaluation would need to span a
decade or more to gather useful information. Definitive answers however, are
needed before that. Quigley &Taylor (2003) suggest that the effectiveness of
HIA could be assessed by measuring its influence on the decision-making
processes when writing policy.
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