In Leicester, as part of my role with the Health Action Zone, and in my present role, I have completed the following Health Impact Assessments HIA into the Leicester Local Transport Plan HIA into the proposed Braunstone Sports Centre HIA into the Leicester LIFT project Development of a HIA screening tool for the Leicester Local Strategic Partnership.
1. The decision to carry out a HIA should have ownership at a high level, because if there is no “high level” ownership of the HIA.
- The HIA can become an “add on” rather than central to the policy or project, and does not have a major influence on the project or policy development.
- It is likely that resources may not be available to evaluate whether or not actions recommended by the HIA, if implemented, have been effective in addressing inequalities.
- Learning from the HIA is not communicated within the organisation and “best practice” is not developed.
2. The person who has the responsibility for carrying out the HIA should be central to the project. HIAs in Leicester have been carried out with sympathetic individuals in order to influence the focus of their projects. However, finding the resource to take forward the findings from the HIAs often “slips of the agenda” as other service related priorities take priority. Also, if the person carrying out the HIA is external to the process and moves on once it is complete, there is no impetus for ensuring that the HIA findings are implemented, and evaluation methodologies are not put in place. For this reason, it is preferable to find the resources to employ an HIA specialist or to train individuals from within the organisation on how to carry out the HIA.
3. Health Impact Assessment can be resource intensive. HIA takes up resources in terms of time and staff commitment. The scope of the HIA should be clearly defined to match the resources available. For example, if it is only possible to carry out a “desk top” exercise then the limitations of the procedure should be made clear. Even a rapid HIA requires resources in terms of researching the evidence base and ensuring that all of the right people are around the table.
4. If a rapid HIA is carried out, it is important to either include community research to inform the HIA, or to carry out research in the community following the HIA to validate the findings. So often, community representatives are asked to take part in rapid HIAs and are tasked, unfairly, with providing the views of very diverse communities.
5. The HIA model needs to be flexible, particularly if it is carried out at a local community level. In particular, it is important to fit with those models of consultation already used by the community and to build on research and networks already available. If possible, local people should be trained to carry out consultation, or community members should be used who already have skills in this area.
6. HIA is a good tool for enabling partnership working. It encourages partners to think about the impact that their policies and programmes may have on inequalities, and the potential impact that decisions about their area of work may have on the work of other partners.
7. It is important to identify other partner agendas and not to be too precious about the term “health”. Often, this term alienates partners who are only familiar with the medical model. It may be possible to link in with the environmental or regeneration agendas. However, it is important to ensure that the focus on inequalities remains. Often environmental or integrated appraisal tools do not explore the impact of a policy or project on vulnerable populations.
8. For an HIA to be properly integrated into a policy or project – it needs to be prospective. A concurrent HIA can only assess what has started to go wrong (or right) in terms of addressing inequalities and attempt to patch up mistakes. This is often resource intensive. Also, if the HIA is to be evaluated effectively, these mechanisms need to be integrated into the process from the beginning. A retrospective HIA can only be a learning process, and suggest.
Final Point– Many of the suggestions above are resource intensive in terms of staffing time and finance. However, I strongly believe that HIA should be used as a tool to address inequalities, and should contribute to building up evidence of what works. If this is to be the case, then they should be properly resourced and evaluated, and be informed by community research.The views expressed in the practitioners’ personal experience reports are those of the author, and do not necessarily reflect the views of the HIA Gateway team or the National Institute for Health and Clinical Excellence (NICE)