Iom Chia Hia Training Course Workbook (2008)
This document was uploaded by user and they confirmed that they have the permission to share it. If you are author or own the copyright of this book, please report to us by using this DMCA report form. Report DMCA
Overview
Download & View Iom Chia Hia Training Course Workbook (2008) as PDF for free.
More details
- Words: 7,084
- Pages: 87
Health Impact Assessment Training Course Workbook
Developed by Dr Salim Vohra, Director, Centre for Health Impact Assessment 2003-08
1. What is Health and Wellbeing?
Page 1
1.1 Health as a Relationship
What item did you pick from the health box? ………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………….
How do you see your item relating to health? ………………………………………………………………………………………………………………………. ………………………………………………………………………………………………………………………. ………………………………………………………………………………………………………………………. ………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………….
How do you see your item relating to ill-health? ………………………………………………………………………………………………………………………. ………………………………………………………………………………………………………………………. ………………………………………………………………………………………………………………………. ………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………….
1.2 Health as a Connection Write down other words and phrases that you connect with health and disease?
health
wellbeing
disease
2. What is Evidence?
2.1 Information or Evidence Used What different types and sources of information/ evidence do you generally tend to use in your work ?
Type & sources of Information Professional journals Local newspapers Private sector surveys e.g. MORI Polls National government reports, consultations e.g. Department of Health Your own and your colleagues’ judgement & experience Business reports and surveys, etc. User views/feedback/surveys Local views/surveys
resident’s
National newspapers Local government reports and consultations Others (please list below)
Used/ Not used
Why?
2.2 Information or Evidence Relied On and Trusted How do you judge or assess this information/ evidence? Which do you rely on more? Rank the information/evidence in terms of which you rely on/trust the most (rank 1) and which the least (rank 10)
Type & sources of Information Professional journals Local newspapers Private sector surveys e.g. MORI Polls National government reports, consultations e.g. Department of Health Your own and your colleagues’ judgement & experience Business reports and surveys, etc. User views/feedback/surveys Local views/surveys
resident’s
National newspapers Local government reports and consultations Others (please list below)
Rank
Why?
3. What is Screening?
Screening Which of the project, service, programmes and policies listed below is it worth doing a HIA on and why? Proposal – project, service, programme or policy
Do a HIA? Sure
Why? The building of a small block of flats for key workers on a brownfield site that will include landscaped gardens and where the nearest houses will be more than 500 metres from new block of flats. A £20,000 a year three-year drop-in adult education programme for refugees and asylum-seekers. A proposed new public transport infrastructure project with a new tram-link and re-configuration of some existing bus services. A local authority homelessness strategy. A £5 million large commercial office development within an existing commercial business park. A mobile phone transmitter mast on the roof of a local housing association residential block of flats of 20 storeys. A £500,000 refurbishment of an existing leisure centre in a run-down and deprived area to enhance the existing facilities. These include a swimming pool, football courts, a gym and fitness centre and an outdoor running track. A credit union project to help local people to access small loans and develop budgeting and saving skills. A £250,000 ‘healthy living’ health promotion programme aimed at educating people to eat more fruit and take more exercise. A £20 million regeneration programme involving the building of a range of business, leisure and residential developments including a range of programmes to tackle inequalities. The replacement of an old waste-to-energy incinerator with a new modern one in a sparsely populated area. The setting up of a community-wide children in schools art project run from a local community centre.
Page 12
Yes/ No/ Not
What informal/implicit criteria did you use to make your judgement? ……………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………………
What more information, if any, would you have liked to have had in order to make a decision? ……………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………………
Page 13
Page 14
4. A multi-layered case study to explore HIA
Yourboro Renaissance “Improving people’s lives through social, environmental and economic action”
“Dear Colleague, As you are aware this leading national government directed local programme has been working for many years with local communities through local governments to improve and enhance urban and rural neighbourhoods and environments. The Yourboro Renaissance team include internationally renowned economic, social, environmental, educational, regeneration and community development experts. They are currently working in urban-rural Yourboro to help deliver a major €20 million (social, environmental and economic regeneration and welfare programme based on the regional strategy “New Beginnings – an opportunity for all” involving new business, leisure and housing developments as well as educational, cultural and community programmes and activities. We need your help to ensure that we succeed in making Yourboro one of the most successful areas in Youregion. Below we provide some key information about Yourboro which we hope you will use to help us assess the health aspects of some of the existing and new initiatives which are outlined in this pack.” Regards,
Sally Wright Mayor
Page 1
Area Context The development parts of the regeneration will occur in a ‘brownfield’ area which was originally the site of mining works and heavy industry. The overall renaissance area straddles two adjoining local districts (and hence two local government authority boundaries). The renaissance area also encompasses some rural areas on the outskirts of Yourboro. The renaissance area is divided and defined by a number of large roads which separate commercial and residential areas. The area is a main thoroughfare for traffic, commercial and private into and out of Yourboro. Both local districts have pockets of affluence. The regeneration area encompasses some of these pockets of affluence from one of the local districts but not the other. There are also areas with high levels of poverty which have a high rating on the national Index of Deprivation. Services within the area are poor, there is only one large supermarket, very few local shops and public transport links are via buses only. The population is diverse with large numbers of ethnic minority residents, a mobile population, large numbers of young people and some refugees and asylum-seekers. The pockets of affluence are made up of newly arrived families and older couples while the social housing is mainly comprised of long-standing families and residents of the area. There are large numbers of community and voluntary sector organisations within the area but most, if not all, tend to operate in isolation and therefore are not well organised and not influential.
Fig. 1: High Level Map of the Area
Page 2
Historical Context The area still has a strong mining and rural identity even though all the mines have shut and there are only a few large farms in the area. The area has become increasingly urbanised with Yourboro having a population of over 250,000.
Social Context There are substantial concentrations of poverty, largely in the south-east of both districts. The districts have areas of significant deprivation and there are ‘crime hotspots’ with high levels of personal crime e.g. muggings and burglaries. There is also a well established ethnic minority community. Overall, the population of the area is young with very few people of middle age and small pockets with a high concentration of older residents. There are significant gaps in primary health care provision. `Parts of one of the districts have poor child health outcomes. There has been a recent influx of refugees and asylum seekers. Numbers of children from more affluent backgrounds attend fee paying schools outside the area for both primary and secondary education. All secondary age children travel outside the area to attend a secondary school.
Economic Context There are no major businesses in the area and a high ratio of economically active residents work outside the districts. In the rural areas there are high levels of unemployment especially among young people. Since the closing of the mines and the heavy industries the area’s economy has been stagnating. The rural areas had a thriving number of small farms which over the years have amalgamated so that now there are only a few large sheep and cattle farms. Tourism has been increasing in the area with people coming to enjoy the outdoors, walking and camping.
Environmental Context Page 3
The old mining and heavy industrial areas are brownfield sites with significant surface and soil contamination. Some of the rural parts have areas of outstanding beauty with rare species of flora and fauna.
Page 4
Key Initiatives of the Renaissance Programme 1. ‘New Waves’ Call Centre Part of a broader information technology and communications business development programme funded from national regeneration funding. The proposed site is on the border of the two local districts. It will become a call centre for a number of large companies and public agencies. One thousand part-time jobs, including call operators and call handlers, as well as ancillary staff e.g. cleaners, caterers, maintenance and management staff. The site is bounded by roads with a large social housing estate nearby. There are no existing local amenities near the site and the transport links to the site are currently by bus. All the staff will be newly recruited and the majority of posts will be part-time shift work, 24 hours a day, 7 days a week.
2. ‘Enhancing Community Care’ One-stop Primary Care Centre This will involve the relocation of the three major primary care practices from existing accommodation into a single purpose-built facility that will include a minor surgery unit, podiatry, community nursing, children’s and family planning services. Current primary care services are based in converted residential accommodation. Public transport services to the proposed site are currently very limited. The site for the proposed new facility will be a high density residential area with a mix of social and owner occupied housing.
3. ‘Kids in the Community’ Summer School The activities are free to all young people aged 14-25 years who live in the renaissance area. This will include the cost of weekly outings and all equipment. The programme aims to meet a range of young people's needs: school curriculum revision and enhancement, the opportunity to try subjects not studied at school and taster sessions for further education. Projects and courses giving young people the opportunity to immerse themselves in a creative art project for a week e.g. producing your own theatre performance, exhibitions and films will also be on offer. Courses and seminars offering information and advice on training and employment will be available. There will be varied opportunities to acquire and develop ICT skills, and to enjoy sport and fitness activities both to improve sports skills and to try something new. Young people will be directed to year round provision or specialist agencies as appropriate as part of the programme.
4. ‘Open Access - Equal Access’ Community Café Community consultation showed strong support for a community café. There are no multi-purpose community facilities where people with physical and learning disabilities can have access to and participate in a range of social and leisure activities. The lack of opportunity for disabled residents to access and participate in such activities has meant that they are amongst the most Page 5
excluded people in the area. Access to such facilities is vital to improving the quality of life, health status and social inclusion of disabled residents. The community café will have a coffee shop and restaurant as well as a range of indoor and outdoor leisure activities including a swimming pool. The café will also provide a range of outreach health, social care, education, training, employment support and welfare services.
5. ‘Homes for All’ Extending Housing Choice This is a new national government initiative to extend housing choice. Local authority owned and maintained properties across the area will be transferred to a number of social landlords who will then have responsibility to maintain and develop this housing stock. The selection process for social landlords has started and various housing associations are presenting their business cases to the local community. As yet there has been no detailed national guidance on how this initiative will work and no national or local authority monies have been earmarked. Additionally, the initiative will involve the refurbishment of existing housing, the demolition of housing that is judged as not worth refurbishing and the buying of new houses to supplement the housing associations housing portfolio. The aim is for the housing associations to create more balanced and mixed communities than has been the case in the past.
6.
‘Culture into Communities’ Theatre, Music, Gallery and Museum Complex There is no theatre, music venue, art gallery or museum in the area. The ‘Culture into Communities’ complex will provide a state-of-the-art theatre, music venue, art gallery and museum for the renaissance area. The events proposed will include national and international theatre performances, opera, classical music, pop music events, international and national art exhibitions and a museum recording and archiving the historical, social and cultural changes to the area over the last one hundred years. The complex will be managed by a national art and heritage charity that has a strong international presence.
7. ‘Transport for the New Millennium’ Tram-link The aim of ‘Transport for the New Millennium’ is to improve the roads from the renaissance area to the major urban conurbation of Yourboro as well as to extend the existing tram-link network in Yourboro into the renaissance area. This will substantially improve the public transport infrastructure of the area and increase the economic benefits of companies locating here. The construction of the tram-link network will take ten years and involve the purchase of, used and unused, rural and urban land.
Page 6
Using a HIA tool
Page 7
Screening Assess whether an proposal (plan, policy programme, project or service) should have a health impact assessment undertaken by answering as honestly as you can the following questions.
Name of Proposal: …………………………………………………………… Answers favouring doing a HIA
From your knowledge and/or in your judgement
Answers favouring not doing a HIA
Health Impacts Yes / not sure
Does the proposal affect health directly?
No
Yes / not sure
Does the proposal affect health indirectly?
No
Yes / not sure
Are there any potentially serious negative health impacts that you currently know of?
No
Yes / not sure
No / not sure
No
Is further investigation necessary because more information is required on the potential health impacts?
Yes
Are the potential health impacts well known and is it straightforward to suggest effective ways in which beneficial effects are maximised and harmful effects minimised?
No / not sure
Yes
Do you (or others) judge the identified health impacts as being small in effect?
Community Yes / not sure
Is the population affected by the proposal large?
No
Yes / not sure
Are there any socially excluded, vulnerable or disadvantaged groups likely to be affected?
No
Yes / not sure
Are there community concerns about any potential health impacts?
No
Proposal Yes / not sure
Is the size of the proposal large?
No
Yes / not sure
Is the cost of the proposal high?
No
Yes / not sure
Is the nature and extent of the disruption caused by the proposal likely to be major?
No
Organisation Yes
Is the proposal a high priority/ important for the organisation/ partnership? = For
TOTAL
Screening contd… Page 8
No
Against =
Assess what kind of HIA should be done on your proposal by answering as honestly as you can the following questions. Rapid
Type of HIA
Comprehensive
Yes
Is there only limited time in which to conduct HIA?
No
Yes
Is there only limited opportunity to influence the decision?
No
Yes
Is the timeframe for the decision-making process set by external factors beyond your control?
No
Yes
Are there only very limited resources available to conduct HIA?
No
Assess who should do the HIA on your proposal by answering as honestly as you can the following questions. External
Assessors
Internal
No
Do personnel in the organisation or partnership have the necessary skills and expertise to conduct the HIA?
Yes
No
Do personnel in the organisation or partnership have the time to conduct the HIA?
Yes
(Adapted from a screening tool developed by Erica Ison in Resources for Health Impact Assessment, 2000)
Page 9
Page 10
5. What is Scoping?
Page 11
Scoping Question Answer Who will lead on the project management of your HIA? Will you have a HIA steering group, if yes, who will make up the members, what will be its terms of reference?
Are there other professional or community stakeholders - not included on your steering group – who should be involved in the design of your HIA? When do the decision-makers you are aiming to influence make their decision and hence when does your HIA report need to be completed by? Why is the proposal being undertaken? What are the proposal’s aim and objectives?
Why do you want to do this HIA? What are your HIA’s aim and objectives?
What geographical area will your HIA cover?
What population group will your HIA encompass? Will the population assessed reside within the geographical area described above or include workers living outside the area, travelling families, etc?
Scoping contd… Page 12
Question Answer What definition of health will you use for your HIA?
What HIA model/approach do you want to use?
Are there any specific health impacts that you want your HIA to focus on?
Do you know which specific population subgroups/ community groups will be directly affected by the proposal under consideration?
Will your HIA give specific detailed recommendations or will you just detail the potential health impacts so that your steering group and other decision-makers can then separately think about the implications and recommendations? Other issues relevant to your local or organisational setting
Page 13
Methodology Question Answer Depending on what HIA model you chose in scoping, will you use a quantitative, qualitative or mixed approach? Why?
What health evidence and research sources will you use? What sources won’t you be able to use? Why?
Current evidence on health needs (public health, local authority, etc) Research review evidence on health impacts
Will you do an informal ‘windscreen’ or ‘walkabout’ observation of the geographical area and community?
Will your HIA include a formal consultation of professional and community stakeholders? Why? What method/s are you thinking of using?
Baseline Assessment Page 14
Question Answer What are the characteristics of the local people – age, gender, ethnicity?
What is the health situation like of local people?
What is the social situation like?
What is the economic situation like?
What is the local environment like?
Baseline Assessment contd… Page 15
Question Answer
What health & social care services are there in the area/ serving local people?
What voluntary sector and charity services are there?
What retail, shopping and banking services are there?
What culture and leisure services are there e.g. cinemas, theatres, sports centres?
What urban/rural regeneration or other area or health improvement programmes are there?
Policy context (and policy evidence) Question Answer Page 16
What international policies does the proposal link into?
Which parts of these policies does the proposal follow and which parts does it ignore? What are the reasons for this?
What national/regional policies does the proposal link into?
Which parts of these policies does the proposal follow and which parts does it ignore? What are the reasons for this?
What local policies does the proposal link into?
Which parts of these policies does the proposal follow and which parts does it ignore? What are the reasons for this?
Page 17
Page 18
6. What is Analysis?
Page 19
genetic effects
sex
sexual behaviour
noise
vibration public & environmental health services
soil qualit y
waste management
working condition s income
Personal circumstances means of transport education
substance misuse
air quality
natural resources
social contact
Determinants of
Health & Wellbeing
civic design
green space
prescriptio n drugs
family relationships
employment status
water quality
Environment
natural hazards
alcohol
Lifestyle leisure activities
smell
smoking
exercise
Biological factors
age
housing tenure
housing conditions
land use & planning
community participation
social support
peer pressure
Social influences discrimination
fear of discrimination
crime & anti-social behaviour
fear of crime & anti-social behaviour
research & technological development business activity availability of employment
Economic conditions
quality of employmen t
job creation distribution of incomes
availability of training
Adapted from ‘Rapid Health Impact Assessment: a guide to research’ by Amanda Harris, Mar 2002
voluntary & charity groups health & social care services shops and banking services public Page 20 transport
childcare
community facilities
Availability & access workplaces, employment opportunities advice & services services
leisure facilities housing education & training
Health appraisal – rapid Yes, No, Not Sure
adapted from the British Columbia HIA model as described by Erica Ison in Resources for HIA, 2000
If Yes, is the health impact likely to be positive or negative (+/-)?
Who or what people or group(s) will this impact potentially affect?
How is the impact likely to occur? How do you know this?
If the impacts are negative
What possible mitigation measure(s) would reduce the negative affects?
Will the proposal affect the creation and distribution of income or wealth levels? Will the proposal affect employment opportunities? Will the proposal affect learning opportunities? Will the proposal create healthier beginnings for children? Will the proposal affect the number and quality of personal connections? Will the proposal affect crime and safety? Will the proposal affect people’s ability to influence their lives and locality? Will the proposal affect the local environment?
Health effects and pathways of impact
adapted from the Westminster Toolkit: Health and Wellbeing, 2004
Page 21
Impact
Employment
Effects on health and wellbeing
Pathway of impact
Leads to poverty and a reduction in personal and social esteem. Poverty excludes people from: • • • •
being able to afford quality and variety of foods engaging in opportunities for leisure and physical recreation enhancing their education and learning having warm and comfortable homes
If the impacts are negative
What possible mitigation measure(s) would reduce the negative effects?
Through reducing employment opportunities, affecting there social and welfare entitlements, affecting the viability of the organisations they work for, reducing their opportunities for education and training, reducing their ability to travel and access
Ensuring that existing employment, education, training, amenities and public transport are not reduced.
Construction work that causes vibration and subsidence in existing homes.
Ensuring housing meets ‘decent homes’ standards especially social housing.
Poor maintenance of social housing.
Building more cheap and affordable homes.
Homes where large families live in overcrowded conditions.
Improving the access to housing maintenance services.
Direct changes to an education or training programme e.g. closure of a school and move to a new one.
Ensure that existing education and training opportunities are not reduced or affected.
Increasing and promoting the range of employment, education, training, amenities, public transport and welfare.
It also increases their •
difficulties in travelling and therefore accessing other services and amenities
•
levels of stress
All leading to poorer physical growth and development, reduced immunity to disease and reduced physical and mental health wellbeing. •
Housing
Poor housing that is damp, cold with poorly maintained water, electric and gas appliances has an effect on physical growth and development, reduced immunity to infections and mental health and wellbeing. •
Education
Affects all age groups but greatest effects on older people, those with disabilities and children.
Access to education improves the life chances and opportunities of people in terms of access to employment, uptake of health promotion and disease prevention information and being able to articulate need and hence access services more effectively. •
Impact
Affects all age groups but greatest effects on those already on low incomes, those with disabilities and children.
Affects all age groups but greatest effects on children and young people.
Effects on health and wellbeing
Pathway of impact
Page 22
Increase educational opportunities.
Disruption to access to an education or training facility or disruption of their ability to deliver e.g. construction.
If the impacts are negative
What possible mitigation measure(s) would reduce the negative effects?
Transport
Can lead to traffic which leads to poorer outdoor air quality which in turn leads to respiratory problems. •
Affects all age groups but greatest effects on those with preexisting chronic illnesses and children.
New roads, greater flows of traffic because of new or denser housing developments, greater flows of heavy traffic because of new or expanded business/ industrial facilities.
Can lead to improved access to services and amenities e.g. health and social care, parks, leisure centres, etc. which leads to increased health and wellbeing. Increased opportunities for business expansion leading to more employment opportunities. •
Crime and safety
Actual experience of crime causes stress and physical injury which reduces physical and mental health and wellbeing.
Access to health and social care services
Social cohesion and capital
Environment
Ensure that residential and outdoor play areas are not built near roads with heavy motor traffic. Increase public transport provision wherever possible.
Affects all age groups but greatest effects on older people, those with disabilities and those with very young children.
Fear of crime causes stress which reduces immunity to disease and mental wellbeing.
•
Reduce the outdoor air pollution caused by motor vehicles and industrial factories.
Affects all age groups but fear of crime greatest among women.
Construction and changes in a locality can bring in new people and new routines in a community which can make crime easier to commit and less easy to notice. Buildings that do not have natural surveillance from neighbours can create isolated areas where crime can occur without being noticed.
Reduced access to health services leads to ill-health becoming worse, less amenable to treatment and more likely to lead to a permanent physical or mental impairment. Reduced access to social care services leads to stable chronic conditions becoming worse and the loss of independent living skills which in turn lead to greater physical and mental impairment.
Disruption to or reduction of public transport – buses, tube trains, trams, cycle routes, pedestrian paths, etc.
Disruption and reduction in the quality of the social relationships and social networks that local people and communities have can lead to feeling isolated and excluded which in turn can lead to depression and poor mental wellbeing. It can also make individual more vulnerable to crime and to reduce their access to health and social care services.
An proposal that is disliked and not wanted by the community.
Dirty and poor quality built environments as well as little or poor quality green space have a negative effect on mental wellbeing.
Reduction in street cleaning amenities and park officers, etc.
Health appraisal – detailed
Improve local people’s relationships with the Police. Build neighbourhood community networks e.g. neighbour-hood watch. Ensure schools, youth facilities and others are brought together to develop a collaborative strategy.
Appropriate planning and communication about disruption to access. Ensuring alternatives are developed.
Closure of local facilities or disruption during a move to a new facility.
An proposal that benefits some people at the expense of others.
adapted from the East London and Merseyside HIA models
Page 23
Use ‘designing out crime’ building design principles.
Ensuring that there is acceptance of an proposal by local people and affected groups. Ensuring that everyone benefits and those that don’t are compensated.
Ensuring that green space is looked after and managed.
What are the potential effects on …..?
Themes
Will the change be +/for people’s health?
What stakeholder/s are likely to be affected?
When is the impact likely to occur (start, during or end of the proposal)
infectious diseases
e.g. TB, measles, food poisoning, salmonella, BSE, SARS
non-infectious/ chronic diseases e.g. heart disease, cancer,
accidents & physical injuries
mental health & wellbeing
Health appraisal – detailed contd…
Page 24
EVIDENCE OF IMPACT EVIDENCE OF IMPACT - TYPE
- SOURCE
(reports, reviews, surveys, experiences)
(agency, institution, expert, community)
Mitigations (how can the negative impacts be reduced)
Enhancements
What are the potential effects on …..?
Themes
Will the change be +/for people’s health?
What stakeholder/s are likely to be affected?
When is the impact likely to occur (start, during or end of the proposal)
housing & accommodation
education & learning
employment & economy
transport & connections
Health appraisal – detailed contd…
Page 25
EVIDENCE OF IMPACT EVIDENCE OF IMPACT - TYPE
- SOURCE
(reports, reviews, surveys, experiences)
(agency, institution, expert, community)
Mitigations (how can the negative impacts be reduced)
Enhancements
What are the potential effects on …..?
Themes
Will the change be +/for people’s health?
What stakeholder/s are likely to be affected?
When is the impact likely to occur (start, during or end of the proposal)
crime & safety
social capital & community cohesion
health & social care services
retail shops and other amenities
Health appraisal – detailed contd…
Page 26
EVIDENCE OF IMPACT EVIDENCE OF IMPACT - TYPE
- SOURCE
(reports, reviews, surveys, experiences)
(agency, institution, expert, community)
Mitigations (how can the negative impacts be reduced)
Enhancements
What are the potential effects on …..?
Themes
Will the change be +/for people’s health?
What stakeholder/s are likely to be affected?
When is the impact likely to occur (start, during or end of the proposal)
culture & leisure
lifestyle & daily routines
energy & waste
land & spatial
Page 27
EVIDENCE OF IMPACT EVIDENCE OF IMPACT - TYPE
- SOURCE
(reports, reviews, surveys, experiences)
(agency, institution, expert, community)
Mitigations (how can the negative impacts be reduced)
Enhancements
Blank Page for Notes
Page 28
Evaluating the evidence Assess how strong the evidence of positive or negative health impacts is likely to be by answering as honestly as you can the following questions.
Answers showing the evidence is more likely to be of good quality
To your knowledge
Answers showing the evidence is less likely to be of good quality
Research Yes
Does the evidence for each impact come from more than one source?
No
Yes
Is the evidence for each impact of more than one type (i.e. both quantitative and qualitative and/or a range of quantitative and qualitative studies/reports)?
No
Yes
Has some or all the evidence for each impact been reviewed by other research experts (peer-reviewed and/or published)
No
No
Is the evidence for each clear and consistent or are there areas of ambiguity and differences of emphasis in the different types and sources of evidence?
Yes
Yes
Is there broad consensus among front-line experienced experts and professionals that the impacts can/do occur in these kinds of proposals? Is there broad consensus among experienced front-line experts and professionals that the evidence for each impact is sound?
Front-line experts and professionals
Yes
No No
Lay publics Yes
Is there broad consensus among resident and communities who have experienced the impacts (lay experts) that these impacts can/do occur in these kinds of proposals?
No
Yes
Is there broad consensus among the public (non-experts) that the evidence for each impact is sound?
No
Assessors/Evaluators Yes
Do the assessors/evaluators of the evidence of impact have experience and expertise in reviewing health and social care evidence?
No
Social Context No
More likely =
Is there current heightened public concern and/ or local, regional or national political issues surrounding some or all the impacts?
TOTAL
Page 29
Yes
Less likely =
Page 30
7. What is Consultation?
Page 31
7.1 Who to consult? Write down the key individuals and groups you have consulted in the past.
Stakeholder
Why did you want to consult them?
Page 32
7.2 How to consult? Write down the key methods you have used to consult these individuals and groups.
What methods have you used to talk to them?
Page 33
Page 34
Page 35
8. Developing a Consultation Plan
Page 36
Consultation plan What group/s of people is the proposal aimed at? ………………………………………………………………………………………………………… ………………………………………………………………………………………………………… What group/s of people does the proposal not target or exclude from benefiting? ………………………………………………………………………………………………………… ………………………………………………………………………………………………………… What public, voluntary and private sector organisations will the proposal benefit or work with? ………………………………………………………………………………………………………… ………………………………………………………………………………………………………… What public, voluntary and private sector organisations will the proposal not benefit or work with? ………………………………………………………………………………………………………… ………………………………………………………………………………………………………… What do other influential stakeholders think e.g. journalists, local politicians, professional groups? ………………………………………………………………………………………………………… …………………………………………………………………………………………………………
What is the overall aims/objectives of the consultation? ………………………………………………………………………………………………………… ………………………………………………………………………………………………………… ………………………………………………………………………………………………………… ………………………………………………………………………………………………………… Page 37
…………………………………………………………………………………………………………
Page 38
Consultation plan Aim of consultation
Key issues to be discussed
Stakeholder
Public
Consultation plan contd… Page 39
Consultation method/s
Potential difficulties in doing the consultation
Options
Aim of consultation
Key issues to be discussed
Stakeholder
Professionals
Page 40
Consultation method/s
Potential difficulties in doing the consultation
Options
9. Consultation Role Play Exercise
Page 41
Stakeholder Consultation Meeting The occasion The scene is a stakeholder consultation meeting to discuss the implications of the proposed developments/projects.
The stakeholders The following stakeholders are represented at the meeting
Residents
Media
Private Developer
Local Authority
Health Agency
Existing Businesses
Local Voluntary Group
The issues Each stakeholder sees things from a range of perspectives, have different priorities and see a lot to gain and lose. Some issues are described in the prompts below. You may identify other and more interesting issues that you would like to bring up.
The task Each stakeholder group has 15 minutes to think through what the key issues are for them before the meeting starts. The meeting will be chaired and facilitated by a community development and stakeholder engagement officer from one of the local district authorities (the trainers).
The agenda 1. Introductions (going round the table with each stakeholder group saying who they are and why they are here). 2. Each stakeholder then tells the others what their key concerns/ objections are (max 3min) 3. A round table discussion ensues with the group aiming to reach some consensus on the way forward and how key objections and issues can/ should be dealt with. 4. Five key recommendations on what should be done next are developed by the group as a whole.
Page 42
Blank Page for Notes
Page 43
Page 44
10. Key Conclusions, Mitigations and Enhancements
Page 45
Key conclusions IMPLEMENTATION OR CONSTRUCTION PHASE Question Answer What are the key potential positive impacts?
What are the key potential negative impacts?
What groups are likely to be affected positively? How? Will this widen existing health inequalities?
What groups are likely to be affected negatively? How? Will this widen existing health inequalities?
How strong is the evidence for the positive effects? Do the affected communities agree?
How strong is the evidence for the negative effects? Do the affected communities agree?
Key conclusions contd… Page 46
OPERATION OR WORKING PHASE (short & long term) Question Answer What are the key potential positive impacts? - short term - long term
What are the key potential negative impacts? - short term - long term
What groups are likely to be affected positively? How? Will this widen existing health inequalities?
What groups are likely to be affected negatively? How? Will this widen existing health inequalities?
How strong is the evidence for the positive effects? Do the affected communities agree?
How strong is the evidence for the negative effects? Do the affected communities agree?
Key conclusions contd… Page 47
END OF PROPOSAL PHASE Question Answer What are the key potential positive impacts?
What are the key potential negative impacts?
What groups are likely to be affected positively? How? Will this widen existing health inequalities?
What groups are likely to be affected negatively? How? Will this widen existing health inequalities?
How strong is the evidence for the positive effects? Do the affected communities agree?
How strong is the evidence for the negative effects? Do the affected communities agree?
Page 48
Mitigation and enhancement Question Answer What are the key options to reduce (mitigate) the potential negative impacts for each stage:
implementation/ construction phase operation/ working phase (short & long term) end of proposal phase
What are the key options to increase (enhance) the positive impacts?
implementation/ construction phase operation/ working phase (short & long term) end of proposal phase
Page 49
Page 50
11. What is Monitoring and Evaluation?
Page 51
11.1 Outputs What health and wellbeing (or other) outputs are you currently measuring in your work ?
Area
Output
Why?
Diseases
Crime
Employment
Education
Transport
Housing
Health & social care services
Social capital
Culture & leisure
Quality of life
Page 52
11.2 Outcomes What health and wellbeing (or other) outcomes are you currently measuring in your work ?
Area
Outcome
Why?
Diseases
Crime
Employment
Education
Transport
Housing
Health & social care services
Social capital
Culture & leisure
Quality of life
Page 53
Page 54
Monitoring and evaluation Question Answer What monitoring processes will you put in place to ensure that negative health effects are reduced? What indicators will you use?
What monitoring processes will you put in place to ensure that positive health effects are enhanced? What indicators will you use?
How will you evaluate the proposal in terms of health outputs and health outcomes? - process evaluation - impact evaluation - outcome evaluation
Page 55
Process evaluation Did the proposal have explicit values to guide its design and implementation and what were they? ……………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………… To what extent did the proposal work to these values? ……………………………………………………………………………………………………………………………… If the proposal did not have explicit values what values should have been used to guide the design and implementation and to what extent did the proposal work to these values? ……………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………………
Impact evaluation What were the objectives of the proposal in the short term? ……………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………… To what extent did it achieve those objectives? What enhanced and what hindered the achievement of those objectives? ……………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………… Were these the right objectives for the proposal? ……………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………………
Outcome evaluation What were the objectives of the proposal in the long term? ……………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………… To what extent did it achieve those objectives? What enhanced and what hindered the achievement of those objectives? ……………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………… Were these the right objectives for the proposal? ………………………………………………………………………………………………………………………………
Page 56
………………………………………………………………………………………………………………………………
Page 57
12. What can we do? What should we do?
Page 58
Upstreamers versus Downstreamers
“Once upon a time in a land far, far away. Villagers living in a village on the banks of a river began to find drowning people being washed away by the river and calling out for help.
1. As a villager what 3 things would you do in the short term?
Short term options 1
2
3
Questions 1. Why did you choose the options that you did? ……………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………
2. Did you use any criteria if so what were they? ……………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………
Page 59
2. What 3 things would you or could you do in the long term?
Long term options 1
2
3
Questions 3. Why did you choose the options that you did? ……………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………
4. Did you use any criteria if so what were they? ……………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………
Page 60
Recommendations Question Answer What key recommendations emerge from your assessment?
Should the proposal go ahead? How should the proposal be taken forward so that it is provides the greatest health benefits? Which mitigation and enhancement options will local people and/or other key stakeholders find most acceptable?
Page 61
Blank Page for Notes
Page 62
13. To Do of Not to Do That is the Question?
Page 63
On the horns of an ethical dilemma or two! The following are amalgamations of real life situations faced by HIA practitioners during the course of planning, implementing and writing up a HIA.
Case
1
You are asked to undertake a rapid HIA which the client – a local authority wants to keep confidential for their use only on an issue of local community concern. However as part of the HIA you have talked to many local residents who will be affected by the proposal and who have expressed a strong desire to read the report.
2
You are asked to undertake a HIA to help in a planning inquiry - involving legal representation - to present a case that one development option is better than another for a private sector developer. The client wishes to present the best case possible for the positive health benefits of their case.
3
You are doing an HIA on a new proposed proposal and are asked to identify only the positives to help support the business case for the proposal to be funded by a national government department.
4
You are asked to undertake a HIA on the siting of a mobile phone transmitter mast on a run-down council estate. This has upset and angered many local residents especially those with children who are opposed to the siting. The income from the mast siting will be used to refurbish the estate.
5
You have presented your HIA statement/report and while some aspects of the recommendations have been actioned many of the key issues have not been taken forward or even discussed. You are keen to help to move forward the programme but other organisational priorities and the uncertainty around when and if the proposal will go ahead has made the HIA less pertinent and relevant to the organisation.
Page 64
Page 65
What’s the key ethical dilemma is involved here?
How would you resolve this and what would the likely consequences of your decision be?
Page 66
HIA evaluation Question Answer What was the proposal that was assessed?
What type of HIA did you undertake? What HIA model/method did you use? Why? What were the costs (financial, human, time) involved and could these have been better spent elsewhere?
Did you use a wide range of evidence sources to make the assessment and did they inform the HIA’s recommendations?
Were health inequalities assessed and if so how were they assessed? How were recommendations formulated and prioritised? What factors influenced this decision-making process?
Were decision-makers involved and engaged in the process and if so how was this done? What were their expectations and were they fulfilled?
Were the recommendations delivered in a form and within a timescale that was relevant and appropriate to decision makers?
What did the steering group, consultees and others involved in the HIA think about the HIA process and the method used?
HIA evaluation contd… Page 67
Question Answer
Were all or some of the recommendations accepted and implemented by the decision makers? What factors contributed to their acceptance or rejection?
Were the aim and objectives of the HIA met?
What other impacts were associated with the HIA? - improved partnership working, - raising the profile of local health needs and putting health on partner agencies’ agendas, - organisational development - new ways of working within and across the organisations involved
(Adapted from the Health Development Agency Learning from Practice Bulletin ‘Evaluating Health Impact Assessment’ by Taylor, L., Gowman, N., Quigley, R. 2003.)
Page 68
Centre for Health Impact Assessment, Institute of Occupational Medicine Research House Business Centre, Fraser Road, Perivale, Middlesex. UB6 7AQ Tel: 020 8537 3491/2
Fax: 020 8537 3493
Website: www.iom-world.org
Developed by Dr Salim Vohra, Director, Centre for Health Impact Assessment 2003-08
1. What is Health and Wellbeing?
Page 1
1.1 Health as a Relationship
What item did you pick from the health box? ………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………….
How do you see your item relating to health? ………………………………………………………………………………………………………………………. ………………………………………………………………………………………………………………………. ………………………………………………………………………………………………………………………. ………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………….
How do you see your item relating to ill-health? ………………………………………………………………………………………………………………………. ………………………………………………………………………………………………………………………. ………………………………………………………………………………………………………………………. ………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………….
1.2 Health as a Connection Write down other words and phrases that you connect with health and disease?
health
wellbeing
disease
2. What is Evidence?
2.1 Information or Evidence Used What different types and sources of information/ evidence do you generally tend to use in your work ?
Type & sources of Information Professional journals Local newspapers Private sector surveys e.g. MORI Polls National government reports, consultations e.g. Department of Health Your own and your colleagues’ judgement & experience Business reports and surveys, etc. User views/feedback/surveys Local views/surveys
resident’s
National newspapers Local government reports and consultations Others (please list below)
Used/ Not used
Why?
2.2 Information or Evidence Relied On and Trusted How do you judge or assess this information/ evidence? Which do you rely on more? Rank the information/evidence in terms of which you rely on/trust the most (rank 1) and which the least (rank 10)
Type & sources of Information Professional journals Local newspapers Private sector surveys e.g. MORI Polls National government reports, consultations e.g. Department of Health Your own and your colleagues’ judgement & experience Business reports and surveys, etc. User views/feedback/surveys Local views/surveys
resident’s
National newspapers Local government reports and consultations Others (please list below)
Rank
Why?
3. What is Screening?
Screening Which of the project, service, programmes and policies listed below is it worth doing a HIA on and why? Proposal – project, service, programme or policy
Do a HIA? Sure
Why? The building of a small block of flats for key workers on a brownfield site that will include landscaped gardens and where the nearest houses will be more than 500 metres from new block of flats. A £20,000 a year three-year drop-in adult education programme for refugees and asylum-seekers. A proposed new public transport infrastructure project with a new tram-link and re-configuration of some existing bus services. A local authority homelessness strategy. A £5 million large commercial office development within an existing commercial business park. A mobile phone transmitter mast on the roof of a local housing association residential block of flats of 20 storeys. A £500,000 refurbishment of an existing leisure centre in a run-down and deprived area to enhance the existing facilities. These include a swimming pool, football courts, a gym and fitness centre and an outdoor running track. A credit union project to help local people to access small loans and develop budgeting and saving skills. A £250,000 ‘healthy living’ health promotion programme aimed at educating people to eat more fruit and take more exercise. A £20 million regeneration programme involving the building of a range of business, leisure and residential developments including a range of programmes to tackle inequalities. The replacement of an old waste-to-energy incinerator with a new modern one in a sparsely populated area. The setting up of a community-wide children in schools art project run from a local community centre.
Page 12
Yes/ No/ Not
What informal/implicit criteria did you use to make your judgement? ……………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………………
What more information, if any, would you have liked to have had in order to make a decision? ……………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………………
Page 13
Page 14
4. A multi-layered case study to explore HIA
Yourboro Renaissance “Improving people’s lives through social, environmental and economic action”
“Dear Colleague, As you are aware this leading national government directed local programme has been working for many years with local communities through local governments to improve and enhance urban and rural neighbourhoods and environments. The Yourboro Renaissance team include internationally renowned economic, social, environmental, educational, regeneration and community development experts. They are currently working in urban-rural Yourboro to help deliver a major €20 million (social, environmental and economic regeneration and welfare programme based on the regional strategy “New Beginnings – an opportunity for all” involving new business, leisure and housing developments as well as educational, cultural and community programmes and activities. We need your help to ensure that we succeed in making Yourboro one of the most successful areas in Youregion. Below we provide some key information about Yourboro which we hope you will use to help us assess the health aspects of some of the existing and new initiatives which are outlined in this pack.” Regards,
Sally Wright Mayor
Page 1
Area Context The development parts of the regeneration will occur in a ‘brownfield’ area which was originally the site of mining works and heavy industry. The overall renaissance area straddles two adjoining local districts (and hence two local government authority boundaries). The renaissance area also encompasses some rural areas on the outskirts of Yourboro. The renaissance area is divided and defined by a number of large roads which separate commercial and residential areas. The area is a main thoroughfare for traffic, commercial and private into and out of Yourboro. Both local districts have pockets of affluence. The regeneration area encompasses some of these pockets of affluence from one of the local districts but not the other. There are also areas with high levels of poverty which have a high rating on the national Index of Deprivation. Services within the area are poor, there is only one large supermarket, very few local shops and public transport links are via buses only. The population is diverse with large numbers of ethnic minority residents, a mobile population, large numbers of young people and some refugees and asylum-seekers. The pockets of affluence are made up of newly arrived families and older couples while the social housing is mainly comprised of long-standing families and residents of the area. There are large numbers of community and voluntary sector organisations within the area but most, if not all, tend to operate in isolation and therefore are not well organised and not influential.
Fig. 1: High Level Map of the Area
Page 2
Historical Context The area still has a strong mining and rural identity even though all the mines have shut and there are only a few large farms in the area. The area has become increasingly urbanised with Yourboro having a population of over 250,000.
Social Context There are substantial concentrations of poverty, largely in the south-east of both districts. The districts have areas of significant deprivation and there are ‘crime hotspots’ with high levels of personal crime e.g. muggings and burglaries. There is also a well established ethnic minority community. Overall, the population of the area is young with very few people of middle age and small pockets with a high concentration of older residents. There are significant gaps in primary health care provision. `Parts of one of the districts have poor child health outcomes. There has been a recent influx of refugees and asylum seekers. Numbers of children from more affluent backgrounds attend fee paying schools outside the area for both primary and secondary education. All secondary age children travel outside the area to attend a secondary school.
Economic Context There are no major businesses in the area and a high ratio of economically active residents work outside the districts. In the rural areas there are high levels of unemployment especially among young people. Since the closing of the mines and the heavy industries the area’s economy has been stagnating. The rural areas had a thriving number of small farms which over the years have amalgamated so that now there are only a few large sheep and cattle farms. Tourism has been increasing in the area with people coming to enjoy the outdoors, walking and camping.
Environmental Context Page 3
The old mining and heavy industrial areas are brownfield sites with significant surface and soil contamination. Some of the rural parts have areas of outstanding beauty with rare species of flora and fauna.
Page 4
Key Initiatives of the Renaissance Programme 1. ‘New Waves’ Call Centre Part of a broader information technology and communications business development programme funded from national regeneration funding. The proposed site is on the border of the two local districts. It will become a call centre for a number of large companies and public agencies. One thousand part-time jobs, including call operators and call handlers, as well as ancillary staff e.g. cleaners, caterers, maintenance and management staff. The site is bounded by roads with a large social housing estate nearby. There are no existing local amenities near the site and the transport links to the site are currently by bus. All the staff will be newly recruited and the majority of posts will be part-time shift work, 24 hours a day, 7 days a week.
2. ‘Enhancing Community Care’ One-stop Primary Care Centre This will involve the relocation of the three major primary care practices from existing accommodation into a single purpose-built facility that will include a minor surgery unit, podiatry, community nursing, children’s and family planning services. Current primary care services are based in converted residential accommodation. Public transport services to the proposed site are currently very limited. The site for the proposed new facility will be a high density residential area with a mix of social and owner occupied housing.
3. ‘Kids in the Community’ Summer School The activities are free to all young people aged 14-25 years who live in the renaissance area. This will include the cost of weekly outings and all equipment. The programme aims to meet a range of young people's needs: school curriculum revision and enhancement, the opportunity to try subjects not studied at school and taster sessions for further education. Projects and courses giving young people the opportunity to immerse themselves in a creative art project for a week e.g. producing your own theatre performance, exhibitions and films will also be on offer. Courses and seminars offering information and advice on training and employment will be available. There will be varied opportunities to acquire and develop ICT skills, and to enjoy sport and fitness activities both to improve sports skills and to try something new. Young people will be directed to year round provision or specialist agencies as appropriate as part of the programme.
4. ‘Open Access - Equal Access’ Community Café Community consultation showed strong support for a community café. There are no multi-purpose community facilities where people with physical and learning disabilities can have access to and participate in a range of social and leisure activities. The lack of opportunity for disabled residents to access and participate in such activities has meant that they are amongst the most Page 5
excluded people in the area. Access to such facilities is vital to improving the quality of life, health status and social inclusion of disabled residents. The community café will have a coffee shop and restaurant as well as a range of indoor and outdoor leisure activities including a swimming pool. The café will also provide a range of outreach health, social care, education, training, employment support and welfare services.
5. ‘Homes for All’ Extending Housing Choice This is a new national government initiative to extend housing choice. Local authority owned and maintained properties across the area will be transferred to a number of social landlords who will then have responsibility to maintain and develop this housing stock. The selection process for social landlords has started and various housing associations are presenting their business cases to the local community. As yet there has been no detailed national guidance on how this initiative will work and no national or local authority monies have been earmarked. Additionally, the initiative will involve the refurbishment of existing housing, the demolition of housing that is judged as not worth refurbishing and the buying of new houses to supplement the housing associations housing portfolio. The aim is for the housing associations to create more balanced and mixed communities than has been the case in the past.
6.
‘Culture into Communities’ Theatre, Music, Gallery and Museum Complex There is no theatre, music venue, art gallery or museum in the area. The ‘Culture into Communities’ complex will provide a state-of-the-art theatre, music venue, art gallery and museum for the renaissance area. The events proposed will include national and international theatre performances, opera, classical music, pop music events, international and national art exhibitions and a museum recording and archiving the historical, social and cultural changes to the area over the last one hundred years. The complex will be managed by a national art and heritage charity that has a strong international presence.
7. ‘Transport for the New Millennium’ Tram-link The aim of ‘Transport for the New Millennium’ is to improve the roads from the renaissance area to the major urban conurbation of Yourboro as well as to extend the existing tram-link network in Yourboro into the renaissance area. This will substantially improve the public transport infrastructure of the area and increase the economic benefits of companies locating here. The construction of the tram-link network will take ten years and involve the purchase of, used and unused, rural and urban land.
Page 6
Using a HIA tool
Page 7
Screening Assess whether an proposal (plan, policy programme, project or service) should have a health impact assessment undertaken by answering as honestly as you can the following questions.
Name of Proposal: …………………………………………………………… Answers favouring doing a HIA
From your knowledge and/or in your judgement
Answers favouring not doing a HIA
Health Impacts Yes / not sure
Does the proposal affect health directly?
No
Yes / not sure
Does the proposal affect health indirectly?
No
Yes / not sure
Are there any potentially serious negative health impacts that you currently know of?
No
Yes / not sure
No / not sure
No
Is further investigation necessary because more information is required on the potential health impacts?
Yes
Are the potential health impacts well known and is it straightforward to suggest effective ways in which beneficial effects are maximised and harmful effects minimised?
No / not sure
Yes
Do you (or others) judge the identified health impacts as being small in effect?
Community Yes / not sure
Is the population affected by the proposal large?
No
Yes / not sure
Are there any socially excluded, vulnerable or disadvantaged groups likely to be affected?
No
Yes / not sure
Are there community concerns about any potential health impacts?
No
Proposal Yes / not sure
Is the size of the proposal large?
No
Yes / not sure
Is the cost of the proposal high?
No
Yes / not sure
Is the nature and extent of the disruption caused by the proposal likely to be major?
No
Organisation Yes
Is the proposal a high priority/ important for the organisation/ partnership? = For
TOTAL
Screening contd… Page 8
No
Against =
Assess what kind of HIA should be done on your proposal by answering as honestly as you can the following questions. Rapid
Type of HIA
Comprehensive
Yes
Is there only limited time in which to conduct HIA?
No
Yes
Is there only limited opportunity to influence the decision?
No
Yes
Is the timeframe for the decision-making process set by external factors beyond your control?
No
Yes
Are there only very limited resources available to conduct HIA?
No
Assess who should do the HIA on your proposal by answering as honestly as you can the following questions. External
Assessors
Internal
No
Do personnel in the organisation or partnership have the necessary skills and expertise to conduct the HIA?
Yes
No
Do personnel in the organisation or partnership have the time to conduct the HIA?
Yes
(Adapted from a screening tool developed by Erica Ison in Resources for Health Impact Assessment, 2000)
Page 9
Page 10
5. What is Scoping?
Page 11
Scoping Question Answer Who will lead on the project management of your HIA? Will you have a HIA steering group, if yes, who will make up the members, what will be its terms of reference?
Are there other professional or community stakeholders - not included on your steering group – who should be involved in the design of your HIA? When do the decision-makers you are aiming to influence make their decision and hence when does your HIA report need to be completed by? Why is the proposal being undertaken? What are the proposal’s aim and objectives?
Why do you want to do this HIA? What are your HIA’s aim and objectives?
What geographical area will your HIA cover?
What population group will your HIA encompass? Will the population assessed reside within the geographical area described above or include workers living outside the area, travelling families, etc?
Scoping contd… Page 12
Question Answer What definition of health will you use for your HIA?
What HIA model/approach do you want to use?
Are there any specific health impacts that you want your HIA to focus on?
Do you know which specific population subgroups/ community groups will be directly affected by the proposal under consideration?
Will your HIA give specific detailed recommendations or will you just detail the potential health impacts so that your steering group and other decision-makers can then separately think about the implications and recommendations? Other issues relevant to your local or organisational setting
Page 13
Methodology Question Answer Depending on what HIA model you chose in scoping, will you use a quantitative, qualitative or mixed approach? Why?
What health evidence and research sources will you use? What sources won’t you be able to use? Why?
Current evidence on health needs (public health, local authority, etc) Research review evidence on health impacts
Will you do an informal ‘windscreen’ or ‘walkabout’ observation of the geographical area and community?
Will your HIA include a formal consultation of professional and community stakeholders? Why? What method/s are you thinking of using?
Baseline Assessment Page 14
Question Answer What are the characteristics of the local people – age, gender, ethnicity?
What is the health situation like of local people?
What is the social situation like?
What is the economic situation like?
What is the local environment like?
Baseline Assessment contd… Page 15
Question Answer
What health & social care services are there in the area/ serving local people?
What voluntary sector and charity services are there?
What retail, shopping and banking services are there?
What culture and leisure services are there e.g. cinemas, theatres, sports centres?
What urban/rural regeneration or other area or health improvement programmes are there?
Policy context (and policy evidence) Question Answer Page 16
What international policies does the proposal link into?
Which parts of these policies does the proposal follow and which parts does it ignore? What are the reasons for this?
What national/regional policies does the proposal link into?
Which parts of these policies does the proposal follow and which parts does it ignore? What are the reasons for this?
What local policies does the proposal link into?
Which parts of these policies does the proposal follow and which parts does it ignore? What are the reasons for this?
Page 17
Page 18
6. What is Analysis?
Page 19
genetic effects
sex
sexual behaviour
noise
vibration public & environmental health services
soil qualit y
waste management
working condition s income
Personal circumstances means of transport education
substance misuse
air quality
natural resources
social contact
Determinants of
Health & Wellbeing
civic design
green space
prescriptio n drugs
family relationships
employment status
water quality
Environment
natural hazards
alcohol
Lifestyle leisure activities
smell
smoking
exercise
Biological factors
age
housing tenure
housing conditions
land use & planning
community participation
social support
peer pressure
Social influences discrimination
fear of discrimination
crime & anti-social behaviour
fear of crime & anti-social behaviour
research & technological development business activity availability of employment
Economic conditions
quality of employmen t
job creation distribution of incomes
availability of training
Adapted from ‘Rapid Health Impact Assessment: a guide to research’ by Amanda Harris, Mar 2002
voluntary & charity groups health & social care services shops and banking services public Page 20 transport
childcare
community facilities
Availability & access workplaces, employment opportunities advice & services services
leisure facilities housing education & training
Health appraisal – rapid Yes, No, Not Sure
adapted from the British Columbia HIA model as described by Erica Ison in Resources for HIA, 2000
If Yes, is the health impact likely to be positive or negative (+/-)?
Who or what people or group(s) will this impact potentially affect?
How is the impact likely to occur? How do you know this?
If the impacts are negative
What possible mitigation measure(s) would reduce the negative affects?
Will the proposal affect the creation and distribution of income or wealth levels? Will the proposal affect employment opportunities? Will the proposal affect learning opportunities? Will the proposal create healthier beginnings for children? Will the proposal affect the number and quality of personal connections? Will the proposal affect crime and safety? Will the proposal affect people’s ability to influence their lives and locality? Will the proposal affect the local environment?
Health effects and pathways of impact
adapted from the Westminster Toolkit: Health and Wellbeing, 2004
Page 21
Impact
Employment
Effects on health and wellbeing
Pathway of impact
Leads to poverty and a reduction in personal and social esteem. Poverty excludes people from: • • • •
being able to afford quality and variety of foods engaging in opportunities for leisure and physical recreation enhancing their education and learning having warm and comfortable homes
If the impacts are negative
What possible mitigation measure(s) would reduce the negative effects?
Through reducing employment opportunities, affecting there social and welfare entitlements, affecting the viability of the organisations they work for, reducing their opportunities for education and training, reducing their ability to travel and access
Ensuring that existing employment, education, training, amenities and public transport are not reduced.
Construction work that causes vibration and subsidence in existing homes.
Ensuring housing meets ‘decent homes’ standards especially social housing.
Poor maintenance of social housing.
Building more cheap and affordable homes.
Homes where large families live in overcrowded conditions.
Improving the access to housing maintenance services.
Direct changes to an education or training programme e.g. closure of a school and move to a new one.
Ensure that existing education and training opportunities are not reduced or affected.
Increasing and promoting the range of employment, education, training, amenities, public transport and welfare.
It also increases their •
difficulties in travelling and therefore accessing other services and amenities
•
levels of stress
All leading to poorer physical growth and development, reduced immunity to disease and reduced physical and mental health wellbeing. •
Housing
Poor housing that is damp, cold with poorly maintained water, electric and gas appliances has an effect on physical growth and development, reduced immunity to infections and mental health and wellbeing. •
Education
Affects all age groups but greatest effects on older people, those with disabilities and children.
Access to education improves the life chances and opportunities of people in terms of access to employment, uptake of health promotion and disease prevention information and being able to articulate need and hence access services more effectively. •
Impact
Affects all age groups but greatest effects on those already on low incomes, those with disabilities and children.
Affects all age groups but greatest effects on children and young people.
Effects on health and wellbeing
Pathway of impact
Page 22
Increase educational opportunities.
Disruption to access to an education or training facility or disruption of their ability to deliver e.g. construction.
If the impacts are negative
What possible mitigation measure(s) would reduce the negative effects?
Transport
Can lead to traffic which leads to poorer outdoor air quality which in turn leads to respiratory problems. •
Affects all age groups but greatest effects on those with preexisting chronic illnesses and children.
New roads, greater flows of traffic because of new or denser housing developments, greater flows of heavy traffic because of new or expanded business/ industrial facilities.
Can lead to improved access to services and amenities e.g. health and social care, parks, leisure centres, etc. which leads to increased health and wellbeing. Increased opportunities for business expansion leading to more employment opportunities. •
Crime and safety
Actual experience of crime causes stress and physical injury which reduces physical and mental health and wellbeing.
Access to health and social care services
Social cohesion and capital
Environment
Ensure that residential and outdoor play areas are not built near roads with heavy motor traffic. Increase public transport provision wherever possible.
Affects all age groups but greatest effects on older people, those with disabilities and those with very young children.
Fear of crime causes stress which reduces immunity to disease and mental wellbeing.
•
Reduce the outdoor air pollution caused by motor vehicles and industrial factories.
Affects all age groups but fear of crime greatest among women.
Construction and changes in a locality can bring in new people and new routines in a community which can make crime easier to commit and less easy to notice. Buildings that do not have natural surveillance from neighbours can create isolated areas where crime can occur without being noticed.
Reduced access to health services leads to ill-health becoming worse, less amenable to treatment and more likely to lead to a permanent physical or mental impairment. Reduced access to social care services leads to stable chronic conditions becoming worse and the loss of independent living skills which in turn lead to greater physical and mental impairment.
Disruption to or reduction of public transport – buses, tube trains, trams, cycle routes, pedestrian paths, etc.
Disruption and reduction in the quality of the social relationships and social networks that local people and communities have can lead to feeling isolated and excluded which in turn can lead to depression and poor mental wellbeing. It can also make individual more vulnerable to crime and to reduce their access to health and social care services.
An proposal that is disliked and not wanted by the community.
Dirty and poor quality built environments as well as little or poor quality green space have a negative effect on mental wellbeing.
Reduction in street cleaning amenities and park officers, etc.
Health appraisal – detailed
Improve local people’s relationships with the Police. Build neighbourhood community networks e.g. neighbour-hood watch. Ensure schools, youth facilities and others are brought together to develop a collaborative strategy.
Appropriate planning and communication about disruption to access. Ensuring alternatives are developed.
Closure of local facilities or disruption during a move to a new facility.
An proposal that benefits some people at the expense of others.
adapted from the East London and Merseyside HIA models
Page 23
Use ‘designing out crime’ building design principles.
Ensuring that there is acceptance of an proposal by local people and affected groups. Ensuring that everyone benefits and those that don’t are compensated.
Ensuring that green space is looked after and managed.
What are the potential effects on …..?
Themes
Will the change be +/for people’s health?
What stakeholder/s are likely to be affected?
When is the impact likely to occur (start, during or end of the proposal)
infectious diseases
e.g. TB, measles, food poisoning, salmonella, BSE, SARS
non-infectious/ chronic diseases e.g. heart disease, cancer,
accidents & physical injuries
mental health & wellbeing
Health appraisal – detailed contd…
Page 24
EVIDENCE OF IMPACT EVIDENCE OF IMPACT - TYPE
- SOURCE
(reports, reviews, surveys, experiences)
(agency, institution, expert, community)
Mitigations (how can the negative impacts be reduced)
Enhancements
What are the potential effects on …..?
Themes
Will the change be +/for people’s health?
What stakeholder/s are likely to be affected?
When is the impact likely to occur (start, during or end of the proposal)
housing & accommodation
education & learning
employment & economy
transport & connections
Health appraisal – detailed contd…
Page 25
EVIDENCE OF IMPACT EVIDENCE OF IMPACT - TYPE
- SOURCE
(reports, reviews, surveys, experiences)
(agency, institution, expert, community)
Mitigations (how can the negative impacts be reduced)
Enhancements
What are the potential effects on …..?
Themes
Will the change be +/for people’s health?
What stakeholder/s are likely to be affected?
When is the impact likely to occur (start, during or end of the proposal)
crime & safety
social capital & community cohesion
health & social care services
retail shops and other amenities
Health appraisal – detailed contd…
Page 26
EVIDENCE OF IMPACT EVIDENCE OF IMPACT - TYPE
- SOURCE
(reports, reviews, surveys, experiences)
(agency, institution, expert, community)
Mitigations (how can the negative impacts be reduced)
Enhancements
What are the potential effects on …..?
Themes
Will the change be +/for people’s health?
What stakeholder/s are likely to be affected?
When is the impact likely to occur (start, during or end of the proposal)
culture & leisure
lifestyle & daily routines
energy & waste
land & spatial
Page 27
EVIDENCE OF IMPACT EVIDENCE OF IMPACT - TYPE
- SOURCE
(reports, reviews, surveys, experiences)
(agency, institution, expert, community)
Mitigations (how can the negative impacts be reduced)
Enhancements
Blank Page for Notes
Page 28
Evaluating the evidence Assess how strong the evidence of positive or negative health impacts is likely to be by answering as honestly as you can the following questions.
Answers showing the evidence is more likely to be of good quality
To your knowledge
Answers showing the evidence is less likely to be of good quality
Research Yes
Does the evidence for each impact come from more than one source?
No
Yes
Is the evidence for each impact of more than one type (i.e. both quantitative and qualitative and/or a range of quantitative and qualitative studies/reports)?
No
Yes
Has some or all the evidence for each impact been reviewed by other research experts (peer-reviewed and/or published)
No
No
Is the evidence for each clear and consistent or are there areas of ambiguity and differences of emphasis in the different types and sources of evidence?
Yes
Yes
Is there broad consensus among front-line experienced experts and professionals that the impacts can/do occur in these kinds of proposals? Is there broad consensus among experienced front-line experts and professionals that the evidence for each impact is sound?
Front-line experts and professionals
Yes
No No
Lay publics Yes
Is there broad consensus among resident and communities who have experienced the impacts (lay experts) that these impacts can/do occur in these kinds of proposals?
No
Yes
Is there broad consensus among the public (non-experts) that the evidence for each impact is sound?
No
Assessors/Evaluators Yes
Do the assessors/evaluators of the evidence of impact have experience and expertise in reviewing health and social care evidence?
No
Social Context No
More likely =
Is there current heightened public concern and/ or local, regional or national political issues surrounding some or all the impacts?
TOTAL
Page 29
Yes
Less likely =
Page 30
7. What is Consultation?
Page 31
7.1 Who to consult? Write down the key individuals and groups you have consulted in the past.
Stakeholder
Why did you want to consult them?
Page 32
7.2 How to consult? Write down the key methods you have used to consult these individuals and groups.
What methods have you used to talk to them?
Page 33
Page 34
Page 35
8. Developing a Consultation Plan
Page 36
Consultation plan What group/s of people is the proposal aimed at? ………………………………………………………………………………………………………… ………………………………………………………………………………………………………… What group/s of people does the proposal not target or exclude from benefiting? ………………………………………………………………………………………………………… ………………………………………………………………………………………………………… What public, voluntary and private sector organisations will the proposal benefit or work with? ………………………………………………………………………………………………………… ………………………………………………………………………………………………………… What public, voluntary and private sector organisations will the proposal not benefit or work with? ………………………………………………………………………………………………………… ………………………………………………………………………………………………………… What do other influential stakeholders think e.g. journalists, local politicians, professional groups? ………………………………………………………………………………………………………… …………………………………………………………………………………………………………
What is the overall aims/objectives of the consultation? ………………………………………………………………………………………………………… ………………………………………………………………………………………………………… ………………………………………………………………………………………………………… ………………………………………………………………………………………………………… Page 37
…………………………………………………………………………………………………………
Page 38
Consultation plan Aim of consultation
Key issues to be discussed
Stakeholder
Public
Consultation plan contd… Page 39
Consultation method/s
Potential difficulties in doing the consultation
Options
Aim of consultation
Key issues to be discussed
Stakeholder
Professionals
Page 40
Consultation method/s
Potential difficulties in doing the consultation
Options
9. Consultation Role Play Exercise
Page 41
Stakeholder Consultation Meeting The occasion The scene is a stakeholder consultation meeting to discuss the implications of the proposed developments/projects.
The stakeholders The following stakeholders are represented at the meeting
Residents
Media
Private Developer
Local Authority
Health Agency
Existing Businesses
Local Voluntary Group
The issues Each stakeholder sees things from a range of perspectives, have different priorities and see a lot to gain and lose. Some issues are described in the prompts below. You may identify other and more interesting issues that you would like to bring up.
The task Each stakeholder group has 15 minutes to think through what the key issues are for them before the meeting starts. The meeting will be chaired and facilitated by a community development and stakeholder engagement officer from one of the local district authorities (the trainers).
The agenda 1. Introductions (going round the table with each stakeholder group saying who they are and why they are here). 2. Each stakeholder then tells the others what their key concerns/ objections are (max 3min) 3. A round table discussion ensues with the group aiming to reach some consensus on the way forward and how key objections and issues can/ should be dealt with. 4. Five key recommendations on what should be done next are developed by the group as a whole.
Page 42
Blank Page for Notes
Page 43
Page 44
10. Key Conclusions, Mitigations and Enhancements
Page 45
Key conclusions IMPLEMENTATION OR CONSTRUCTION PHASE Question Answer What are the key potential positive impacts?
What are the key potential negative impacts?
What groups are likely to be affected positively? How? Will this widen existing health inequalities?
What groups are likely to be affected negatively? How? Will this widen existing health inequalities?
How strong is the evidence for the positive effects? Do the affected communities agree?
How strong is the evidence for the negative effects? Do the affected communities agree?
Key conclusions contd… Page 46
OPERATION OR WORKING PHASE (short & long term) Question Answer What are the key potential positive impacts? - short term - long term
What are the key potential negative impacts? - short term - long term
What groups are likely to be affected positively? How? Will this widen existing health inequalities?
What groups are likely to be affected negatively? How? Will this widen existing health inequalities?
How strong is the evidence for the positive effects? Do the affected communities agree?
How strong is the evidence for the negative effects? Do the affected communities agree?
Key conclusions contd… Page 47
END OF PROPOSAL PHASE Question Answer What are the key potential positive impacts?
What are the key potential negative impacts?
What groups are likely to be affected positively? How? Will this widen existing health inequalities?
What groups are likely to be affected negatively? How? Will this widen existing health inequalities?
How strong is the evidence for the positive effects? Do the affected communities agree?
How strong is the evidence for the negative effects? Do the affected communities agree?
Page 48
Mitigation and enhancement Question Answer What are the key options to reduce (mitigate) the potential negative impacts for each stage:
implementation/ construction phase operation/ working phase (short & long term) end of proposal phase
What are the key options to increase (enhance) the positive impacts?
implementation/ construction phase operation/ working phase (short & long term) end of proposal phase
Page 49
Page 50
11. What is Monitoring and Evaluation?
Page 51
11.1 Outputs What health and wellbeing (or other) outputs are you currently measuring in your work ?
Area
Output
Why?
Diseases
Crime
Employment
Education
Transport
Housing
Health & social care services
Social capital
Culture & leisure
Quality of life
Page 52
11.2 Outcomes What health and wellbeing (or other) outcomes are you currently measuring in your work ?
Area
Outcome
Why?
Diseases
Crime
Employment
Education
Transport
Housing
Health & social care services
Social capital
Culture & leisure
Quality of life
Page 53
Page 54
Monitoring and evaluation Question Answer What monitoring processes will you put in place to ensure that negative health effects are reduced? What indicators will you use?
What monitoring processes will you put in place to ensure that positive health effects are enhanced? What indicators will you use?
How will you evaluate the proposal in terms of health outputs and health outcomes? - process evaluation - impact evaluation - outcome evaluation
Page 55
Process evaluation Did the proposal have explicit values to guide its design and implementation and what were they? ……………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………… To what extent did the proposal work to these values? ……………………………………………………………………………………………………………………………… If the proposal did not have explicit values what values should have been used to guide the design and implementation and to what extent did the proposal work to these values? ……………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………………
Impact evaluation What were the objectives of the proposal in the short term? ……………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………… To what extent did it achieve those objectives? What enhanced and what hindered the achievement of those objectives? ……………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………… Were these the right objectives for the proposal? ……………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………………
Outcome evaluation What were the objectives of the proposal in the long term? ……………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………… To what extent did it achieve those objectives? What enhanced and what hindered the achievement of those objectives? ……………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………… Were these the right objectives for the proposal? ………………………………………………………………………………………………………………………………
Page 56
………………………………………………………………………………………………………………………………
Page 57
12. What can we do? What should we do?
Page 58
Upstreamers versus Downstreamers
“Once upon a time in a land far, far away. Villagers living in a village on the banks of a river began to find drowning people being washed away by the river and calling out for help.
1. As a villager what 3 things would you do in the short term?
Short term options 1
2
3
Questions 1. Why did you choose the options that you did? ……………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………
2. Did you use any criteria if so what were they? ……………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………
Page 59
2. What 3 things would you or could you do in the long term?
Long term options 1
2
3
Questions 3. Why did you choose the options that you did? ……………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………
4. Did you use any criteria if so what were they? ……………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………
Page 60
Recommendations Question Answer What key recommendations emerge from your assessment?
Should the proposal go ahead? How should the proposal be taken forward so that it is provides the greatest health benefits? Which mitigation and enhancement options will local people and/or other key stakeholders find most acceptable?
Page 61
Blank Page for Notes
Page 62
13. To Do of Not to Do That is the Question?
Page 63
On the horns of an ethical dilemma or two! The following are amalgamations of real life situations faced by HIA practitioners during the course of planning, implementing and writing up a HIA.
Case
1
You are asked to undertake a rapid HIA which the client – a local authority wants to keep confidential for their use only on an issue of local community concern. However as part of the HIA you have talked to many local residents who will be affected by the proposal and who have expressed a strong desire to read the report.
2
You are asked to undertake a HIA to help in a planning inquiry - involving legal representation - to present a case that one development option is better than another for a private sector developer. The client wishes to present the best case possible for the positive health benefits of their case.
3
You are doing an HIA on a new proposed proposal and are asked to identify only the positives to help support the business case for the proposal to be funded by a national government department.
4
You are asked to undertake a HIA on the siting of a mobile phone transmitter mast on a run-down council estate. This has upset and angered many local residents especially those with children who are opposed to the siting. The income from the mast siting will be used to refurbish the estate.
5
You have presented your HIA statement/report and while some aspects of the recommendations have been actioned many of the key issues have not been taken forward or even discussed. You are keen to help to move forward the programme but other organisational priorities and the uncertainty around when and if the proposal will go ahead has made the HIA less pertinent and relevant to the organisation.
Page 64
Page 65
What’s the key ethical dilemma is involved here?
How would you resolve this and what would the likely consequences of your decision be?
Page 66
HIA evaluation Question Answer What was the proposal that was assessed?
What type of HIA did you undertake? What HIA model/method did you use? Why? What were the costs (financial, human, time) involved and could these have been better spent elsewhere?
Did you use a wide range of evidence sources to make the assessment and did they inform the HIA’s recommendations?
Were health inequalities assessed and if so how were they assessed? How were recommendations formulated and prioritised? What factors influenced this decision-making process?
Were decision-makers involved and engaged in the process and if so how was this done? What were their expectations and were they fulfilled?
Were the recommendations delivered in a form and within a timescale that was relevant and appropriate to decision makers?
What did the steering group, consultees and others involved in the HIA think about the HIA process and the method used?
HIA evaluation contd… Page 67
Question Answer
Were all or some of the recommendations accepted and implemented by the decision makers? What factors contributed to their acceptance or rejection?
Were the aim and objectives of the HIA met?
What other impacts were associated with the HIA? - improved partnership working, - raising the profile of local health needs and putting health on partner agencies’ agendas, - organisational development - new ways of working within and across the organisations involved
(Adapted from the Health Development Agency Learning from Practice Bulletin ‘Evaluating Health Impact Assessment’ by Taylor, L., Gowman, N., Quigley, R. 2003.)
Page 68
Centre for Health Impact Assessment, Institute of Occupational Medicine Research House Business Centre, Fraser Road, Perivale, Middlesex. UB6 7AQ Tel: 020 8537 3491/2
Fax: 020 8537 3493
Website: www.iom-world.org
Related Documents
Iom Chia Hia Training Course Workbook (2008)
October 2019 7
Iom Chia Hia Training Course Workbook _2008
October 2019 6
Iom Chia Hia Reader 2005-2007
October 2019 3
Iom Chia Hia Reader 2005-2007
October 2019 3
Course Workbook
July 2020 16
Hia
October 2019 5More Documents from ""
Trumpington Meadows - Hia Scoping Paper - Draft
October 2019 2
Trumping Ton Meadows Hia Report - Final
October 2019 6
Newport City Council Hia Tool
May 2020 3
Iom Chia Hia Reader 2005-2007
October 2019 3