This blog post is part of a series on the 12th International Health Impact Assessment conference which I attended in August in Quebec City. In Part 1 I gave an overview on HIA in case you – like me - are new to HIA (Health Impact Assessment). In this post, I'll try to answer the question "What's in it for me?" (with the 'it' being conducting an HIA) by exploring the themes that emerged over the course of the 7 plenary sessions/ keynote presentations and 6 concurrent sessions that I attended. These three themes, which really speak to the outcomes and benefits of conducting an HIA, are:
• Collaboration and expanded social networks
• Community engagement/participation
• Address health through non-health policies/programs
HIA provides opportunities for collaboration with sectors/organizations/people that may not have worked together previously. The process of conducting an HIA can build mutually respectful relationship and establish common language. While many of us work with partners in various sectors, HIA can take intersectoral collaboration to concrete action. HIA can be a way to build social networks by establishing new relationship and collaborations amongst people whose work addresses similar issues, but have not worked together (or even spoken to each before). For example, Rajiv Bhatia from the San Francisco Department of Public Health shared that in his city, the planning and education sectors did not have a working relationship until an HIA was conducted. The HIA brought the two sectors together and through the project, they established a relationship that carried on after the HIA was completed into future projects and planning.
HIA provides opportunities for community engagement and participation and gives communities a voice in matters that deeply affect them. In Thailand, conducting an HIA on "potentially harmful projects" is required by the Constitution and the National Health Act guarantees the right of citizens to participate in the process. In this way, HIA is a tool that gives people power- and a voice- in policy making. In Oakland California, the Change Lab conducted an HIA received a community participation grant to conduct an HIA regarding the placement of a transit.
As I talked about in my first blog post, HIA provides a framework to address health though non-health policies/programs. This gives the health sector an opportunity to influence strategies, policies and programs that affect health but are directed by other sectors. A note of caution here: that there is often seen to be a push-pull relationship between health and other sectors whereby health "pulls" other sectors into "our" territory and "pushes" those sectors to do work which they may see as the work of the health sectors. This can often evolve into a tug-of-war between health and other sectors. Danny Broderick, from South Australia, advised us to "drop the rope" and instead of attempting to pull sectors into our territory, move into the territory of the other sectors. This theme was echoed and referred to throughout the conference.
A final reason to conduct an HIA is this: it works. In New Zealand, nearly 50 HIAs have been conducted on a variety of strategies and policies. 17 were evaluated and 24 were included in a meta-analysis which showed that HIA does work. The majority of the recommendations made in the HIAs were accepted by the local council/government: this is the dream of those of us who work in policy development! When asked "What does HIA achieve?" Robert Quigley, who has worked in HIA in New Zealand, the UK and Australia, answered that HIA:
• informs and changes the proposal
• alters the proposal development process
• informs and changes the work of other sectors
• develops knowledge and skills of HIA and the social determinants of health
• develops technical, methodological, consultative, partnership development and community engagement skills of those conducting and involved in the HIA
As Francois Benoit, from the National Collaborating Centre for Healthy Public Policy noted, HIA is a WIN WIN WIN: a win for public health, for policy makers and for the community.
I'll wrap up this blog post by quote Robert Quigley again: you don't have to be an expert at HIA at the start. You'll build capacity along the way. Just get out and do one!
Stay tuned for the last blog post in this series: HIA Part 3: What's in a name?