An introduction to a generic Health Impact Assessment Methodology - PDF document

An introduction to a generic Health Impact Assessment Methodology Debbie Abrahams, International Health Impact Assessment Consortium, University of Liverpool

Presentation Overview • Overview of HIA procedure and methods • Examples from HIA practice

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Screening 1 • A quick assessment of the health effects of a policy • Identifies policies that may need HIA

Screening 2 Target area and population Will the following neighbourhood be Yes/No/Unsure Extent affected Qualitative description affected by the proposal: (Very significant = 1; very insignificant = 5) 1 2 3 4 5 Alt Valley? City Centre? Eastern Link? North Liverpool? South Central? South Liverpool? South Suburbs? City-wide? Will the following population groups be Yes/No/Unsure Extent affected Qualitative description affected by the proposal: (Very significant = 1; very insignificant = 5) 1 2 3 4 5 All population groups? Black communities? Asian communities? Irish communities? Refugees and asylum seekers? Infants and young children (under 5s)? Children (5-15)? Young people (16-24)? Adults (25-64)? Older people (65+)? Women? Men? People with mental health problems? People with disabilities? People with learning difficulties?

Scoping 1 • Agree the detailed design and plan, e.g.: – Aim/objectives – Methods – Geographical boundaries – Units of analysis – Outputs • Terms of Reference & Steering Group • Scoping report – Data map – Document map – Stakeholder map

Scoping 2 • FV - DoH, FV Steering Group reps, Access & Diversity Officer, HIA assessment team • EES - DWP, DfES, DTI, DoH, HDA, TUC, CBI, EOC, CRE, UCL, EFILWC, HIA assessment team • BIA – BIA plc, SHA, PCTs, LAs, BIA Consultative Committee, HIA assessment team

Scoping 3 Stakeholder map Stakeholder/Key Stakeholders/Key Contacts informant Category Informants Community - population Households in following Households/Groups in wards via: proximal to development 4 SMBC wards: BIA Consultative Committee Bickenhill, Elmdon, Solihull Community & Economic Meriden, Knowle Regeneration Team, Solihull CVS, Solihull Ward councilors Potential groups identified: Masterplan consultation attendees, Knowle Society, Lions, Rotary Clubs, Community Associations, Neighbourhood Forums, Tenants Groups (W)

Policy Analysis 1 • Context setting • Audit and analysis of key documents • Analysis criteria: – Policy development – Policy intent – Policy implementation – Health in policy planning

Policy Analysis 2 • Example from ‘Our health our care our say’ HIA: – Audit and analysis of over 20 official documents, including: • OHOCOS and associated documents • Independence, well being & choice (DH, 2005), NSF for Children, Young People & Maternity Services (DH, 2004a), Choosing Health (DH, 2004b) • Caring about Carers: A National Strategy for Carers (DH, 1999) … • The Children Act 2004, Every Child Matters (DfES, 2004)

Profiling 1 • Context setting • Informed by policy analysis • Continuing process • Involves secondary data

Profiling 2

Qualitative and Quantitative Data Collection 1 • Literature reviews: – Sources, searching, strength/hierarchy of evidence – Reviews of interventions, e.g., housing, transport – Examples of searches

Qualitative and Quantitative Data Collection 2 • Participatory, qualitative approaches: – Defines perceptions, opinions, values, providing insight and understanding – Involves identifying stakeholders – Defining a sample frame and engaging – Designing and applying tools, e.g., in semi-structured interviews, focus groups – Analysing the data, e.g., content analysis using NVIVO

Qualitative and Quantitative Qualitative and Quantitative Data Collection 3 Data Collection 2 • Example from FV HIA: • Sample methods - purposive/snowball automotive manufacturers (development), stratified, random different socio- economic groups (operation) • Focus groups, semi-structured interviews • Question guides for each sample group (generation of themes informed by policy analysis) • Content analysis of transcripts using NVIVO

Impact Analysis • Characterisation of evidence: – Health Impacts – health determinants and health outcomes – Direction – positive or negative – Scale – severity and where possible size of population – Likelihood – definite, probable, possible, speculative – Latency – short, medium, long-term

Impact Analysis and Prioritisation • Models • Matrices • Mathematical modelling & health economics • Transparent synthesis of evidence • Delphi, consensus building methods and tools • Prioritisation criteria

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Scenario building in FV HIA • Three scenarios (2000-2029) – A (no policies), – B (UK, EC policies), – C (UK, EC, FV policies) • Estimate changes in key health determinants – air pollutants (PM 10 ) – road traffic accidents • Consensus panel, email discussion group with FV Steering Group and Thematic Groups to generate values for scenario C

Consensus panel in FV HIA 2010 1 2010 2 Health Determinant 2020 Air pollutant emissions per year (kT): PM 10 s 10.1 0.15% 0.25% Road traffic accidents (1000s): Serious injuries 21 0.18% 0.55% Fatalities 2 0.03% 0.1% 1 Forecasts from Transport 2010 2 Added positive effect of the FV strategy on Transport 2010

Health impacts of Scenario C using ARMADA model 60000 Total reduction in mortality over period 2000 - 2029 40000 Decreas e in m ortality 20000 0 -20000 RTA – Underlying Other – Underlying RTA – Underlying + FVI Other – Underlying + FVI -40000 0 95 Age

Mathematical modelling of FV impacts using ARMADA model Base Figures 2000 -2029 - Road Deaths, Serious Injuries & Hospital Admissions from Air Pollution Scenario A B C Position remains Implementation Implementation as at 2000 of UK & EU of Policies + FVI Transport Policies Deaths 87,530 52,906 52,887 Serious Injuries 1,092,467 648,112 646,124 First Hospital Admissions for 17,831,237 17,753,250 17,729,778 Respiratory / Cardio Vascular

Economic analysis of FV impacts using ‘Willingness to Pay’ estimates Total NHS Costs 2000 -2029 for First Hospital Stays for Serious Injuries & Hospital Admissions Scenario A B C Position Implementation Implementati remains as at of UK & EU on of Policies 2000 Transport + FVI Policies Total £7,166,533,829 £7,030,007,211 £7,022,277,279 Serious Injuries £353,718,195 £241,104,240 £240,617,603 First Hospital Admissions for £6,812,815,634 £6,788,902,971 £6,781,659,675 Respiratory / Cardio Vascular All costs discounted at 6%

Modelling noise impacts in BIA HIA: annoyance 70000 60000 50000 S e rio u s a n n o y a n c e n o is e 5 4 L A e q 40000 ext no ext baseline 30000 20000 10000 0 2006 2012 2022 2030 Year

Modelling noise impacts in BIA HIA: sleep disturbance 9000 ext 8000 no ext baseline 7000 6000 highly disturbed sleep 5000 4000 3000 2000 1000 0 2006 2012 2022 2030 year