Health Impact Assessment

from Wikipedia, the free encyclopedia

There are different translations for the English term Health Impact Assessment (HIA) in German, including: 'health impact assessment', 'health impact balance' or 'health impact assessment' (GVP). So far, none of these terms has become generally accepted. HIA is a combination of procedures, methods and tools for the prediction and assessment of positive and negative health effects on affected population groups, which can arise from projects of various kinds.

The aim of HIA is to influence decision-making processes in such a way that the health of the population is promoted and the risk of illness is reduced.

Since some of the internationally used terms for HIA are difficult to translate, HIA mainly uses English terms.

Definition and objectives of HIA

There are numerous definitions for HIA. An often used definition is that of the Gothenburg Consensus Paper of the World Health Organization (WHO):

“Health Impact Assessment is a combination of procedures, methods and tools. These can be used to estimate the effects of strategies, programs or projects on the health of a population and its distribution in the population. "

The basis for HIA is a holistic understanding of health, which is based on the concept of health determinants . According to this, almost all political decisions have an impact on health. The influence can be direct or indirect:

  • Directly , in that a decision directly affects the health of the population. For example, the construction of an airport can increase noise pollution and thus the likelihood of noise-related illnesses.
  • Indirectly , in that a measure affects the determinants of health and these in turn affect the health of the affected population. The decision to subsidize biofuels can mean that cultivated land can no longer be used for food, and so people's health is negatively affected by malnutrition.

To ensure that the relevant health determinants are taken into account, an HIA is developed and carried out by an interdisciplinary group.

Ideally, an HIA should achieve the following goals:

  1. Predict the health consequences of different courses of action before they are implemented. The severity and probability of positive and negative health effects are assessed. It examines whether the effects are direct or indirect and how they are distributed (e.g. within population groups and / or regions). Measures to reduce harm or to increase positive effects are also recommended.
  2. Decision-makers should be informed about these results in a timely and understandable manner so that they can take the information into account when making a decision. In addition to this forward-looking (prospective) procedure, HIA can also be carried out accompanying a project or looking back (retrospectively).
  3. In this way, HIA is intended to influence decision-making in strategies, programs or projects in all areas in such a way that the health of the population is improved or at least not harmed. The aim is to improve cooperation between different policy areas with the aim of promoting health and to make decision-makers more aware of the issue of health.
  4. The population affected by a strategy, a program or a project should be involved in the decision-making process and decision-making.

The stages of an HIA

An HIA goes through various development phases. In the practice of HIA, the number and the specific design of the phases vary. As a rule, a distinction is made between the following six phases:

Screening

This phase investigates whether an HIA is necessary to assess a decision. The decision for an HIA depends mainly on the political context and the available resources. It is Z. B. more likely that an HIA will be carried out in the event of controversial measures (e.g. expansion of an airport).

Screening consists of the following steps:

  • Compilation of background information (basic information about the planned measure and the affected population)
  • Determine which screening tool is appropriate.
  • Conduct a screening meeting with relevant decision-makers.
  • Decision for or against an HIA.

Scoping (setting the framework)

In the scoping phase, the essential framework conditions for the HIA are determined (e.g. resources, responsibilities and scope of the HIA). Soping is therefore one of the most important phases in the HIA process.

Scoping consists of the following steps:

  • Convocation of a steering committee
  • Set the scope for the HIA
  • Ensure the resources that are necessary to carry out the HIA
  • Creation of a project plan (schedule and responsibilities)
  • Determine which data should be used for the HIA

Assessment of the health effects

The balancing phase (also the assessment phase) is the main phase of an HIA, as this is where the essential health consequences are examined and assessed in accordance with the specifications of the scoping phase. The phase can be divided into sub-phases:

  • Precise analysis of the planned project to ensure a basic understanding of the project.
  • Creation of a population profile based on available information. This includes general information about the population (e.g. population size, age structure), information about health status (e.g. mortality, quality of life) and about health determinants (e.g. housing conditions, air quality or access to health services)
  • Collecting qualitative and quantitative data. Existing data is used or new data, mostly qualitative, is collected. Existing quantitative data can also be used for mathematical modeling. It is impractical to collect quantitative data yourself, as it is very resource-intensive.
  • In the last step, the health effects are assessed and evaluated. The potential health effects are precisely characterized on the basis of the previously collected data (e.g. affected health determinants, positive or negative effects, size of the change, probability of occurrence of the health effects and duration of the effects).

Develop and write recommendations for the HIA report

In this phase, the results of the assessment phase are summarized and recommendations for action to deal with the health consequences are developed. The recommendations for action are aimed at minimizing negative health consequences or intensifying positive consequences. Recommendations can be made for monitoring health impacts. The written report must be forwarded to the decision-makers in a suitable form and in good time, i.e. before the final decision on a measure is made.

Decision making

The decision-making phase is the responsibility of the decision-makers. A good HIA report can support decision-makers in this phase and show them options for action.

Evaluation of the HIA and monitoring of the health effects

In this phase, the HIA process is evaluated in order to learn from successes and mistakes for future HIAs. The health consequences resulting from the action taken should be monitored so that countermeasures can be taken if necessary.

HIA forms

Depending on the available resources, the planning context and the time frame, it must be decided in the scoping phase how detailed an HIA should be. Usually a distinction is made between three main forms of HIA, but there are also intermediate forms.

A desk HIA is a brief study of the health consequences of a project. Existing knowledge, e.g. B. used from other HIAs. The processing time is usually a few days to weeks and is usually carried out by one person.

More comprehensive is the standard or intermediate HIA . The investigation of possible health effects is more extensive. Existing evidence is examined in detail and experts and those affected are involved in the HIA process.

The comprehensive HIA is an intensive study of possible health effects over a long period of time (e.g. 6–12 months). In addition to the examinations performed in a standard HIA, new information can also be gathered through surveys and measurements (e.g. through surveys and measurements). With the scope of an HIA, the consumption of resources increases, but generally also the quality of the results.

Ethical values ​​of HIA and their implementation

According to the Göteborg consensus paper of the WHO , an HIA report should take into account four basic ethical principles: the ethical benefit of evidence, sustainability, participation and equity. Experience from implemented HIA shows that the implementation of these principles is not easy.

Ethical use of evidence

The predictions made in an HIA are based on causal models. For each option that is examined in an HIA, predictions are made as to how strongly and in which direction (health-promoting vs. harmful to health) and through which intermediate steps health will be influenced. The basis for these predictions is the available evidence that must be compiled and evaluated for an HIA report in the accounting phase.

An HIA report typically draws the available evidence from the following sources:

  • Published scientific findings (e.g. articles in scientific magazines, review articles or gray literature )
  • Locally available data (e.g. statistical data on the population of interest)
  • Information from people involved (e.g. from workshops with affected groups and decision-makers, interviews, etc.)

In this context, the ethical use of evidence means that the information sources used correspond to the highest scientific standard as far as possible. Clear criteria should be formulated and used to select and evaluate the available information. All available information should be considered, even if it is inconsistent.

The implementation of this principle is associated with the following problems in practice:

  • The political decisions, programs or projects to be evaluated are often very complex interventions that can have a wide range of effects on health determinants.
  • Often there is a lack of scientific knowledge about the connection between interventions, the possible influences on health determinants and the resulting health consequences.
  • Many stakeholders with different goals are involved in an HIA. Proponents of a project will handle information that reveals negative health effects of the project differently than its opponents.
  • HIA must fit into decision-making processes, which means that there are often very few time, financial and human resources available for an HIA.
  • Decision-makers demand verifiable, conclusive information, even when little information is available.

sustainability

The Göteborg consensus paper of the WHO understands sustainability to mean that short-term and long-term effects as well as direct and indirect effects of measures should be examined in an HIA. Such extensive reports are rare. The cause is, on the one hand, the lack of knowledge about long-term and indirect effects of various factors on health and health determinants. On the other hand, HIA reports that examine many effects over the long term are extremely resource-intensive (in terms of time, personnel and finances).

participation

According to the WHO , stakeholders affected by the HIA should be involved in the HIA process when formulating, implementing and evaluating measures.

The participation of interest groups can have advantages for the HIA process:

  • Participation in decision-making improves the transparency of the decision-making process.
  • Relevant knowledge of those involved can be used for HIA.
  • Participation can sensitize interested interest groups to health problems, encourage them to solve these problems and thereby enable social learning.
  • The participation process can help defuse conflicts between interest groups.

However, participation is not easy to implement. Transparency is not always desired, especially at the beginning of planning, and is difficult to implement, since options for action must first be discussed independently before plans are made public. In addition, full participation of all interest groups is hardly possible with limited time, human and financial resources.

In the practice of HIA, participation is mainly used when evaluating projects at the local level. Most often, the results of an HIA are made available to the population or the opinions of those affected and experts are incorporated into the creation of the HIA report. Participation in the decision, for or against a measure, does not usually take place.

justice

At HIA, fairness means that not only key figures are presented. Rather, the distribution of health effects in the population should be based on gender, age, ethnic background and socio-economic status . HIA can contribute to equity by identifying those who experience negative and positive health effects and making recommendations on how to evenly distribute those health effects across the population. A detailed analysis of the health effects with regard to specific population groups can be very resource-intensive and demanding, and suitable data are not always available. Such analyzes are therefore rarely found in HIA reports.

Modeling and key figures in an HIA

Due to the lack of evidence, HIA is currently using more qualitative methods . However, quantitative methods and, in this context, key figures are also increasingly used.

Quantitative analyzes can be descriptive or predictive in HIA. Models can be developed to predict health effects on different population groups . The basis for the models are assumptions about causal chains of effects between the intervention and the resulting health consequences. Various measures can be calculated as the result of a model. These can estimate the extent and probability of positive and negative health effects.

In the context of such models, key figures (such as QALY or DALY ) can be calculated. Key figures are suitable because many health determinants are often affected by measures and the resulting health effects must be compared. Key figures summarize health gains and losses as a measure. You may be morbidity - and mortality outcomes are considered. In this way, key figures enable the effects of various risk factors to be directly compared. They can also be linked to economic values. Which means that monetary costs and profits can also be compared directly. Because of this easy comparability, such key figures are very popular with decision-makers.

However, in the case of key figures and the results of models, there is a risk that the complex relationships that are hidden behind the calculations are neglected. In addition, not all effects on health determinants can be quantified due to a lack of scientific knowledge. Therefore, the variability of the results and the method behind the calculation must be shown and appropriately communicated to the decision-makers.

There are many potential consequences of a measure or decision that cannot be quantified, due to a lack of resources, scientific evidence or because they cannot be ascertained using quantitative methods. However, this information can be very important for an HIA. Therefore, both quantitative and qualitative methods should be used equally.

The development of HIA

Health Impact Assessment in its current form began in the mid-1980s. This is where the first political demands arose in various countries to take account of health effects in the development of policies, programs, plans and projects. In 1996, the article Health Impact Assessment: an idea whose time has come was published in the British Medical Journal by Scott-Samuel A., in which Health Impact Assessment (HIA) was mentioned for the first time in its current form. In 1999 the Gothenburg consensus paper was drawn up, in which the current definition of Health Impact Assessment was formulated. Then the World Health Organization Europe (WHO) and other organizations began promoting the development of HIA. In Agenda 21 of UNCED, the WHO programs “Health for All” (HFA) and “Health 21” and the national programs “Environment and Health” (NEHAPs) the implementation of HIA in politics is required. The assessment of health effects that can arise through measures should be anchored in legislation and put into practice. In the Treaty of Amsterdam , Chapter 152 (1999), health in the European Union is redefined as the focus of European integration. According to this, a high level of health protection must be guaranteed in the definition and implementation of community policies, programs, plans and projects.

Implementation of HIA in Germany

In Germany, HIA elements have been introduced since the 1980s primarily through environmental impact assessments (EIA). In 1990 the health aspect in the law on environmental impact assessment (UVPG) becomes mandatory in § 2 . The human being comes first as a protected asset. In implementation, the health aspect was and is often insufficiently covered in the EIA. In some federal states, e.g. B. North Rhine-Westphalia and Hamburg, HIAs have started at regional level if a measure can have an impact on the health of the population groups affected.

International implementation of HIA

The general implementation of HIA began in the late 1990s. The main initiators were mainly the WHO and the UN. With the demand for a greater consideration of health in the implementation of policies, projects, programs and planning, HIA has established itself in the various countries. In Europe, North America, Australia and New Zealand, HIA is used more or less regularly in politics at the local, regional and national level. In many countries, HIA has become a routine measure on large projects. In the less developed countries, too, HIA is being used more and more frequently for risk assessment, especially to reduce infectious diseases such as B. Malaria and Tuberculosis.

Implementation in Great Britain

In Great Britain z. B. in the construction of airports as well as in various development measures within and outside of the health sector HIAs carried out. The British Medical Association published Guidelines for Conducting HIA in 1995, combining HIA and Environmental Impact Assessment. In 1998 the British government set out HIA as a key policy in the Green Paper: "Our healthier nation: a contract for the nation" . This decision was renewed in 1999 in the White Paper: “Saving lives our healthier nation” . In 1998 the first Health Impact Assessment Conference took place in Liverpool. Scotland and Wales have developed their own HIA policies since 1998 and published their own guidelines for implementing HIAs. Northern Ireland started HIA in 1997.

Implementation in the Netherlands

In the Netherlands, various major projects such as B. the expansion of Schiphol Airport near Amsterdam carried out a combination of HIA and Environmental Impact Assessment.

Implementation in Sweden

In 1995 the Swedish government made a move to implement Health Impact Assessment in politics. Health issues were put on the political agenda to reduce social and health inequalities. In 1998, HIA was introduced at the political level.

Implementation in Australia and New Zealand

In Australia and New Zealand, HIA has long been implemented at all political levels - national, regional and local. HIA is used here as part of the Environmental Impact Assessment (EIA) and the potential effects of chemical and biological substances or physical and social influences on the affected population groups under the new conditions are examined over a certain period of time. The introduction of HIA in New Zealand was publicly requested in 1991, and guidelines for Health Impact Assessment were published in 1995.

Implementation in developing countries

In the less developed countries, the implementation of HIA has become established through the United African Harare Declaration. HIA is used to record and assess the risk of infection, vector-associated and chronic diseases and to record water and sanitation.

Other types of impact assessment

The integrated impact assessment is a combination of different impact assessments to assess measures. An attempt is made to combine the focal points of the various impact assessments. The strategic environmental assessment (SEA) has many characteristics of an integrated impact assessment. Social Impact Assessment, Environmental Impact Assessment and / or Gender Impact Assessment are often combined with one another, so that the resulting recommendations for action reflect the needs of all population groups involved as far as possible. In Germany, Health Technology Assessment (HTA) is better known as HIA. Like HIA, HTA should evaluate the short and long-term effects of a measure on a scientific basis and using scientific methods in an interdisciplinary manner. The main difference is that HTA is limited to evaluating technologies in the context of health policy. HIA, on the other hand, also deals with the effects of measures outside of health policy.

See also

literature

  • John Kemm, Jayne Parry: Health impact assessment . Ed .: John Kemm, Jayne Parry, Stephen Palmer. Oxford University Press, Oxford 2004, ISBN 0-19-852629-6 (standard work on HIA with a basic introduction and examples of HIAs that have already been carried out).
  • John Kemm: Health impact assessment: an aid to political decision-making . In: Scandinavian journal of public health . tape 36 , 2008, p. 785-788 .
  • John Kemm: Perspectives on health impact assessment . In: Bulletin of the World Health Organization . tape 81 , no. 2 , 2003 ( online [accessed December 20, 2009]).
  • J. Parry, E. Scully: Health impact assessment and the consideration of health inequalities . In: Journal of Public Health Medicine . tape 25 , 2003, p. 243-245 .
  • Julia Nowacki: Profitability analysis in the context of health impact assessments . Ed .: lögd. Bielefeld 2003 ( PDF [accessed December 20, 2009]).
  • Thimo Ståhl, Matthias Wismar, Ollila Eeva, Eero Lahtinen, Kimmo Leppo: Health in All Policies . Helsinki 2006 ( PDF [accessed January 10, 2010] report with a focus chapter on the development of HIA in Europe).
  • Matthias Wismar: The effectiveness of health impact assessment . Ed .: World Health Organization. Copenhagen 2007, p. 291 ( PDF [accessed on January 10, 2010] Report on the effects of HIA in countries using HIA).

Web links

Individual evidence

  1. ↑ a b c d e What is HIA? Introduction and overview . In: JR Kemm, Jayne Parry, Stephen Palmer (Eds.): Health impact assessment: concepts, theory, techniques, and applications . Oxford University Press, Oxford / New York 2004, ISBN 0-19-852629-6 , pp. 1-13 .
  2. ↑ a b c d e WHO Regional Office for Europe and European Center for Health Policy: Health Impact Assessment. (PDF) Archived from the original on October 21, 2003 ; accessed on January 18, 2010 (English).
  3. ↑ a b c d e f g John Kemm: Health impact assessment: an aid to political decision-making . In: Scandinavian journal of public health . tape 36 , 2008, Sp. 785-788 .
  4. ↑ a b c d e f g h i j k l P. Harris, B. Harris-Roxas, E. Harris, L. Kemp: Health Impact Assessment: A Practical Guide. (No longer available online.) 2007, archived from the original on October 30, 2009 ; Retrieved on November 5, 2009 (English, easy-to-understand guidelines for creating an HIA report). Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.hiaconnect.edu.au
  5. ^ A b John Kemm: Perspectives on health impact assessment . In: Bulletin of the World Health Organization . tape 81 , no. 6 , 2003, p. 387 (English, online [accessed March 27, 2010]).
  6. ↑ Reiner Banken: Health impact assessment: how to start the process and make it last . In: Bulletin of the World Health Organization . tape 81 , no. 6 . Helsinki 2006, p. 389 (English, PDF [accessed March 27, 2010] Document gives a good introduction to the subject of HIA and the development of HIA).
  7. ↑ a b c d European Policy Health Impact Assessment: Health Compatibility of European Policy Decisions . (PDF; 1.1 MB) Retrieved January 12, 2010 .
  8. ↑ EnHealth: Health Impact Assessment Guidelines. (PDF) (No longer available online.) Commonwealth of Australia, archived from the original on October 13, 2009 ; accessed on January 12, 2010 (English). Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / enhealth.nphp.gov.au
  9. ↑ a b c d e f g h i Julia Blau, Ernst Kelly u. a .: The use of health impact assessment across Europe . In: Health in All Policies . Finnish Ministry of Social Affairs and Health, Helsinki 2006, p. 209–230 ( PDF [accessed on March 27, 2010] Provides a very good overview of HIA practice in Europe.).
  10. ^ A b c d John Kemm: Health impact assessment and Health in All Policies . In: Health in all Policies . Finnish Ministry of Social Affairs and Health, Helsinki 2006, ISBN 952-00-1964-2 , p. 189–204 (English, PDF [accessed March 27, 2010] Document gives a good introduction to the subject of HIA.).
  11. ↑ a b J Mindell, A Boaz et al. a .: A Guide to Reviewing Evidence for use in Health Impact Assessment . London Health Observatory, London 2006 ( PDF [accessed March 27, 2010] Guide to Researching Data for an HIA Report).
  12. ↑ a b c d e f Brian L. Cole, Jonathan E. Fielding: Health impact assessment: a tool to help policy makers understand health beyond health care . In: Annual review of public health . tape 28 , 2007, pp. 393–412 (Illuminated HIA from an American perspective.).
  13. ↑ J Mindell, A Boaz et al. a .: Enhancing the evidence base for health impact assessment . In: Journal of epidemiology and community health . tape 58 , no. 7 , 2004, p. 546–551 (article discusses the challenges of compiling the existing evidence for an HIA).
  14. ↑ John Kemm: What is HIA and why might it be useful? In: The effectiveness of health impact assessment . World Health Organization Regional Office for Europe, Copenhagen 2007, p. 3–14 ( PDF [accessed on March 27, 2010] provides an overview of HIA and its benefits.).
  15. ↑ a b c d e f g E. O'Connel, F. Hurley: A review of the strengths and weaknesses of quantitative methods used; in health impact assessment . In: Public Health . tape 123 , no. 4 , 2009, p. 306-310 .
  16. ^ J. Mindell, A. Hansell et al: What do we need for robust, quantitative health impact assessment? In: Journal of Public Health Medicine . tape 23 , no. 3 , 2001, p. 173-178 .
  17. ↑ John Kemm, Jayne Parry: Future directions for HIA . In: John Kemm, Jayne Parry et al. (Eds.): Health impact assessment . Oxford University Press, Oxford, S. 412-417 .
  18. ^ A b c John Kemm, Jayne Parry: The development of HIA . In: John Kemm, Jayne Parry, Stephen Palmer (Eds.): Health impact assessment . Oxford Univ. Press, Oxford 2004, ISBN 0-19-852629-6 , pp. 15-23 .
  19. ^ Julia Nowacki: Profitability Analysis in the context of Health Impact Assessments . Ed .: lögd. Bielefeld 2003 ( PDF [accessed April 19, 2010]). PDF ( Memento of the original dated November 1, 2004 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.  @1@ 2Template: Webachiv / IABot / www.loegd.nrw.de
  20. ↑ Treaty of Amsterdam amending the Treaty on European Union, the Treaties establishing the European Communities and some related legal acts , accessed on April 19, 2010
  21. ↑ R. Fehr, O. Mekel. R. Welteke: The German perspective . In: John Kemm, Jayne Parry, Stephen Palmer (Eds.): Health impact assessment . Oxford Univ. Press, Oxford 2004, ISBN 0-19-852629-6 , pp. 253-265 .
  22. ^ A b S. Vohra: International perspective on health impact assessment in urban settings . In: New South Wales public health bulletin . No. 18 , 2007, p. 152-154 .
  23. ^ A b c Scott-Samuel et al .: The Merseyside Guidelines for Health Impact Assessment . Ed .: The International Health Impact Assessment Consortium. 2007, p. 20 .
  24. ↑ K. Lock: Health impact assessment . In: British Medical Journal . No. 320 , 2000, pp. 1395-1398 .
  25. ^ EW Roscam Abbing: HIA and national policy in the Netherlands . In: John Kemm, Jayne Parry, Stephen Palmer (Eds.): Health impact assessment . Oxford Univ. Press, Oxford 2004, ISBN 0-19-852629-6 , pp. 177-189 .
  26. ↑ K. Berensson: HIA at the lotal level in Sweden . In: John Kemm, Jayne Parry, Stephen Palmer (Eds.): Health impact assessment . Oxford Univ. Press, Oxford 2004, ISBN 0-19-852629-6 , pp. 213-222 .
  27. ^ JSF Wright: HIA in Australia . In: John Kemm, Jayne Parry, Stephen Palmer (Eds.): Health impact assessment . Oxford Univ. Press, Oxford 2004, ISBN 0-19-852629-6 , pp. 223-234 .
  28. ^ A b M. Birley: HIA in developing countries . In: John Kemm, Jayne Parry, Stephen Palmer (Eds.): Health impact assessment . Oxford Univ. Press, Oxford 2004, ISBN 0-19-852629-6 , pp. 363-374 .
  29. ^ The HIA Gate. (No longer available online.) Archived from the original on July 9, 2015 ; Retrieved April 19, 2010 (English). Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.apho.org.uk
  30. ↑ a b M. Perleth: Basics and principles of Health Technology Assessment (HTA) . In: M. Perleth and R. Busse (Eds.): Health Technology Assessment . MWV Medizinisch-Wissenschaftliche Verlags-Gesellschaft, Berlin 2008, p. 1-21 .