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Clarifying HIA IIA HNA - HDA England - 2003

Clarifying HIA IIA HNA - HDA England - 2003

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Published by: PublicHealthbyDesign on Feb 24, 2010
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Clarifying health impact assessment,integrated impact assessment andhealth needs assessment
Health Development Agency 
Health impact assessment (HIA), integratedimpact assessment (IIA) and health needsassessment (HNA) are approaches used acrosssectors to help improve health and reducehealth inequalities. Sectors using them includelocal, regional and national government,voluntary agencies and the NHS.This summary is designed to provide clarityabout these approaches, providing adescription of the common features and
Health impactassessmentIntegrated impactassessmentHealth needsassessmentStarting point
Primary output isrecommendations to:
Suggest how to maximisebenets and minimisenegatives of a proposal,or change ways ofworking.Inform decision-makingSuggest how tomaximise benets andminimise negatives ofa proposal, or changeways of working.Inform decision-makingInform decisionsabout strategies,service priorities,commissioning, andlocal delivery plans,and inform futureHIAs and IIAs
Aims to take accountof inequalities, helpimprove healthand reduce healthinequalities by:
Comparing howproposals may impact onmost vulnerable groupsin populationComparing howproposals may impact onmost vulnerable groupsin populationDescribing healthneeds and healthassets of differentgroups in localpopulation
Involvement ofstakeholders
Involvement ofcommunity
Ideally (dependent onresources)Ideally (dependent onresources)Always
Involvement frommany sectors
Uses researchmethods
Based ondeterminants ofhealth
tasks within each, and how the differentapproaches may link together. Below is asummary table, followed by more detailedinformation about these three rapidlydeveloping and commonly used decision-making approaches. For each we describe:What it isThe policy contextWho is doing it, and on whatLinks to further information.
Six steps to HIA
Deciding whether to undertake an HIA(screening)
Deciding how to undertake the HIA(scoping)
Identifying and considering the evidenceof health impact (appraisal)
Formulating and prioritisingrecommendations
Further engagement with decision-makers
Ongoing monitoring and evaluation.
Health impact assessment (HIA)
What is HIA? 
HIA is an approach that can help identify andconsider the health and inequalities impactsof a proposal on a given population. Theusual starting point for an HIA is a proposal(policy, programme, strategy, plan, projector other development) that has not yetbeen implemented. Its primary output is aset of evidence-based recommendationsgeared to informing the decision-makingprocess associated with the proposal. Theserecommendations aim to highlight practicalways to enhance the positive aspects of aproposal, and to remove or minimise anynegative impacts on health and inequalities(known as a prospective HIA).Sometimes an HIA is carried out on a proposalthat has already started (a concurrent HIA);rarely, an HIA is carried out on proposals thathave been completed (a retrospective HIA).HIA uses the wider determinants of healthas a basis for assessing proposals anddetermining how they may exert their impacton the health of a population. Determinantssuch as transport, housing, education, theenvironment and economic activity havemajor effects on the current and future healthof a population.A wide range of stakeholders can be involvedin the HIA approach, and often HIA includesa signicant level of community involvementand consultation, where appropriate. TheHIA framework is designed to take accountof, and to balance, the best availableevidence from a variety of both quantitativeand qualitative sources. At its best, it aimsto consider a range of different types ofevidence – going beyond published evidencefrom specic research ndings to includethe views and opinions of key players whoare involved or affected by a proposal orarea of work. HIAs can be undertakencomprehensively (usually over months) orrapidly (usually within days/weeks – and incertain circumstances within hours). The keystages of an HIA are outlined in the followingbox.
The policy context 
Policy impact appraisal is not new. It hasoccurred for economic, environmental,political and social reasons, with health beinga recent addition. HIA has been endorsed andsignalled in a range of European and nationalpolicies and strategies. For example, at theEuropean level Article 152 of the AmsterdamTreaty calls for the EU to examine the possibleimpact of major policies on health (EuropeanCommission, 1999).At national level, despite there being nostatutory requirement to undertake HIA, thereis recognition within the UK of the valueof HIA as a resource to support efforts toimprove health, and particularly to addresshealth inequalities. The government hasclearly signalled its acknowledgement of theimportance of the determinants of health,and its commitment to promoting HIA at apolicy level (Department of Health, 1999).The recommendations of the Acheson Reporton inequalities in health also reect theimportance of assessing the impact of policyon health inequalities (Department of Health,1998). The value and importance of HIA havealso been strongly endorsed or signalled bya range of other policies, programmes andguidance, eg:
New Deal for Transport 
(DETR, 1998)
New Deal for Communities
(Cabinet Ofce,1998)
National Service Framework for coronary heart disease
(Department of Health, 2000)
Modernising Government 
(Cabinet Ofce,1999)
Power to promote or improve economic, social or environmental well being
(DETR, 2001)
Health and Neighbourhood Renewal 
(Department of Health and NeighbourhoodRenewal Unit, 2002)
Tackling health inequalities: a programmefor action
(Department of Health, 2003a)
Who is doing it, and on what? 
Even though HIA is still a relatively new anddeveloping approach in England, there isevidence of variable but steadily increasingactivity. A number of specialist centres,specialist practitioner posts and independentHIA practitioners are emerging to support andpromote HIA. Embedding HIA in the decision-making processes within organisations isalso occurring – this is a key requirement forsustainability of the HIA approach.Such centres and practitioners are oftenresponsible for commissioning and managingHIA, and/or promoting and supporting itsdevelopment. HIA is undertaken on a widerange of topics, such as housing and leisureinitiatives, road and airport developments,and industrial developments. Over 100completed HIA case studies are availablefrom www.hiagateway.org.uk. Many HIAsare initiated from within local strategicpartnerships, and other related work, eg:
neighbourhood renewal
community strategies
local and regional transport and land-use plans
local delivery plans
Best Value
Integrated Pollution Prevention ControlRegulations
equity audits
regeneration initiatives.
Further information 
For further information about the HIAapproach, a key website providing detailedinformation and links to completed HIA casestudies, reports, journal articles, HIA toolkits,training courses, and contact details of peopleworking in HIA is at www.hiagateway.org.uk.Other useful websites are:
www.ihia.org.uk/about.html (IMPACT,England and international)
www.plymhealthimpact.co.uk/index.html(Plymouth HIA website)
www.hiadatabase.net (Netherlands andinternational)
www.who.int/hia (World HealthOrganization headquarters)
www.euro.who.int/echp (WHO Europe,Brussels)
www.euro.who.int/eprise/main/WHO/ Progs/HMS/Home (WHO Europe, Rome)
www.whiasu.cf.a.uk (Welsh health impactassessment support unit)
www.hpw.wales.gov.uk/English/national/ index.htm (Welsh Assembly Government)www.iaia.org (international)A number of regional public healthobservatories (PHOs), as well as manyuniversities, are developing expertise in HIAand producing various resources, and/orproviding access to local-level informationon health. Examples include Northern &Yorkshire PHO, London’s Health Observatory,Birmingham University, Imperial College,Northumbria University and LiverpoolUniversity, to name a few.
What is IIA? 
IIA is an approach that assesses the possibleimpact of proposals (strategies, policies,programmes, projects, plans or otherdevelopments) on a range of issues thatpreviously may have been assessed separately– such as economic, environmental,sustainability, equal opportunities, health,wellbeing and quality of life. As with HIA,its primary output is a set of evidence-basedrecommendations geared to informing thedecision-making process associated withthe proposal. These recommendations aimto highlight practical ways to enhance thepositive aspects of a proposal, and to removeor minimise any negative impacts on healthand inequalities. The approach is mosteffective when applied to proposals that
Integrated impact assessment (IIA)

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