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From the Editor’s Desk Welcome to the twenty-first issue of the approach, where people and organisations HIA eNews. In this issue we look at build- learn about HIA through practical experiing capacity for HIA. ence. Our work on HIA at the Centre for Health Equity Training, Research and Evaluation (CHETRE) has had a strong focus on building the capacity of health and other sectors to undertake HIAs. This hasn’t always been easy. HIA is a field that many people feel comfortable speaking about in abstract terms. Fewer people are actually brave and entrepreneurial enough to undertake HIAs. Working with other groups and stakeholders can be confronting and often involves reconciling competing views and ideas.
In addition to reporting on the independent evaluation of the NSW HIA Project ,this issue showcases some of the other HIA capacity building initiatives that are being pursued internationally. As HIA continues to grow we need to ensure that capacity isn’t outstripped by demand for HIA’s use. As a field we need to recognise that here is no latent capacity to undertake HIAs - we need to take responsibility for building it ourselves. Elizabeth Harris Director, CHETRE
We have been very fortunate in New South Wales to have the support of Area Health Services and the NSW Department of Health to develop HIA’s use. This has enabled us to pursue a learning by doing
What is Capacity Building? Capacity building is a term that is commonly used but what does it actually mean? In essence it’s about improving the abilities and performance of organisations, groups and individuals. It can be seen as: ♦
♦
♦
a means to an end, e.g. getting others to take responsibility for programs or activities; an end in itself, e.g. improving the capacity of organisation to solve problems and respond to change; and a process, e.g. where building the capacity of individuals and groups is a normal and expected part of good practice (NSW Health 2001).
Capacity building is not simply a top-down approach, nor is it solely focused on workforce or individual development.
Issue 21 November 2008 Inside this issue: Independent Evaluation of Phase 3 of the NSW HIA Project
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Developing Capacity and 3 Capability for HIA in the North East Region of England Capacity Building and HIA in New Zealand
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Capacity Building for HIA in 6 European Union New Member States and Pre-Accession Countries
Ben Harris-Roxas CHETRE, Part of the Centre for Primary Health Care & Equity
Upcoming HIA Training
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What’s New?
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The Framework for Building Capacity to Improve Health (NSW Health 2001) outlines five action areas for capacity building: ♦
organisational development
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workforce development
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resource allocation
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partnerships
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leadership
It is important that we recognise that building capacity for HIA doesn't just involve training people to do HIAs - it also has implications for how we should conduct HIAs and work with other organisations. For more information on capacity building go to www.health.nsw.gov.au/public-health/ health-promotion/capacity-building
Centre for Health Equity Training Research and Evaluation Part of the Centre for Primary Health Care and Equity
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NSW Health Impact Assessment Project
Independent Evaluation of Phase 3 of the NSW HIA Project Fiona Byrne, CHETRE Part of the UNSW Centre for Primary Health Care and Equity
“The learning-bydoing approach adopted by the project is regarded as practical, informative and highly effective.”
Evaluation Summary tinyurl.com/6efz8e Complete Evaluation tinyurl.com/6hfxw5.
This précis of the independent evaluation has been prepared by CHETRE. For a copy of the evaluation summary report please go to tinyurl.com/6efz8e or the complete evaluation report can be downloaded from tinyurl.com/6hfxw5. The New South Wales Health Impact Assessment (HIA) Project has taken a phased approach. Phase One (2002-2003) focused on raising awareness, exploring the feasibility of HIA in the New South Wales context and identifying areas where capacity needed to be developed. The second Phase (2003-2005) involved developing a formal HIA communication strategy and conducting assessments with a number of developmental HIA sites using the “learning by doing” approach. The purpose of Phase Three (2005-2007) was to integrate HIA into the NSW health system as a tool to improve internal planning and decision making, to build capacity within the health system and as a means to engage external partners on initiatives which influence health outcomes. An independent evaluation of Phase Three of the Project was conducted in 2008 by Quigley and Watts Ltd, New Zealand. The evaluation used a mixed method qualitative design, which included three case studies, 19 key informant interviews and document analysis. The report presents the outcomes of Phase Three under five capacity building domains: workforce development; resource development; partnership develop-
ment; leadership development and organisational development. Workforce Development The evaluation found that there has been a significant impact on workforce development at the Area Health Service level. This has been achieved through increasing staff awareness and understanding of HIA. Many staff members in Area Health Services have received HIA training and those who have been trained have been involved in undertaking at least one HIA in their Area. The learning-by-doing approach adopted by the project is regarded as practical, informative and highly effective. The report notes that workforce development has been less obvious at the Departmental level, in part because of the limited number of HIAs that have been conducted by the Department of Health and the organisational changes that have taken place. Resource Development The successful practical application of HIA was attributed in part to the provision of a wide range of resources from CHETRE in the form of training, help desk expertise, support, reliability, informa-
tion resources. The learningby-doing training was viewed as being important for building capacity within health and in partner organisations. Partnership Development The consolidation of previously existing relationships, the development of new partnerships, and working in a collaborative way with external organisations, were regarded as a key achievement arising from the project. Similarly, engagement with other sections within the health system, such as Environmental Health, Public Health, Health Promotion and Health Service Planning, was also noted as an important achievement. The HIA process was attributed with having provided a purpose and focus for partnerships. The development of collaborative relationships between Area Health Services and local councils was noted as a key achievement. Leadership Development Having “champions” at a high level and strong leadership within Area Health Services has contributed to the achievements of the HIA Project. Staff members who have undertaken HIA training were recognised as being effective advocates for
More than 250 people have been trained in HIA as part of the NSW HIA Project, and more than 20 HIAs have been conducted
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Independent Evaluation of Phase 3 of the NSW HIA Project Cont. HIA within their organisations. Importantly, HIAs use within Area Health Services has been endorsement by their Chief Executives and this has allowed those at the second tier of management to provide effective leadership. Organisational Development Findings from the document analysis indicated that HIA has been included within key strategic documents including the State Health Plan and the NSW Population Health Plan, however, the inclusion has been described as “aspirational” and not yet operationalised. Area Health Services have included HIA within internal documents (such as service level
agreements, business plans, activity reports, work plans, performance agreements, job descriptions) within Population Health and/or Health Promotion or Health Development Divisions. In some Area Health Services, HIA has been incorporated into plan-
ning processes, included in urban planning and land release, has impacted on local government environmental and social plans, and used by local councils and other organisations.
Several events have been organised as part of the NSW HIA Project, including a conference attended by 190 people in 2007
Developing Capacity and Capability for HIA in the North East Region of England Balsam Ahmad Institute of Health & Society, Newcastle University, Newcastle upon Tyne UK balsam.ahmad@newcastle.ac.uk David Chappel North East Public Health Observatory, Wolfson Research Institute, Stockton on Tees UK
The aim of this study was to map current capacity and capability to undertake HIA in the North East region, England and write a strategy for development. The North East Public Health Observatory (NEPHO), the regional health intelligence organisation, commissioned the Public Health Research Group at the University of Newcastle to undertake the study which started in August 2005 and lasted until December 2005. Detailed findings of this study appeared in a report published in May 2006 (Ahmad et al., 2006) and in a paper published in Public Health (Ahmad et al, 2008). In this article we revisit some of the main findings of this mapping study more than two years after the publication. We also briefly describe the current status of HIA practice in the North East region. We defined capacity as the existence of sufficient human resources in the North East region with the necessary knowledge and experience in HIA to meet the current demand for HIA activities (Ahmad et al., 2006). We found a reasonable cohort of profes-
sionals in the North East region who received training in HIA. Many of those are based in primary care trusts (PCTs - responsible in England for the health of the local population) with some based at local authorities (responsible for most other issues including planning), academia or regional organisations (Regional Assembly, Environment Agency) (Ahmad et al., 2006). Most of the training in HIA was conducted by trainers from other regions (e.g. London Health Observatory, IMPACT, Liverpool and WHO for local authority professionals as part of the Healthy City Network). One gap in training identified by the study was the lack of coordination among the five regional universities in their HIA training syllabus at postgraduate courses and lack of availability outside of full masters’ level courses. However, more coordination between the regional universities on HIA training is expected after the establishment of the Centre for Translational Research in Public Health. The centre is collaboration between all five North East universities together with National Health Service, local
and regional government and other public, private and voluntary organisations (see http://www.ncl.ac.uk/ ihs/ctrph/about.htm). We defined capability as the ability to use the current resources (human and financial) efficiently and effectively to meet the current and future demand for HIA (Ahmad et al., 2006). HIA practice in the region remains ad hoc. It consists primarily of screening and rapid appraisal activities. Recent examples of completed rapid appraisals in HIA include “HIA of the Regional Housing Strategy” and “HIA of the impact of 2012 London Olympics on the North East” (see http:// www.nepho.org.uk). Key informants interviewed in this project identified a number of factors that may enable the use of HIA in the decision-making processes within their organizations. These include amongst others the presence of a leading regional organisation that could strategically guide HIA capacity building and practice and the integration of HIA with existing organisa-
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NSW Health Impact Assessment Project
Developing Capacity and Capability for HIA in the North East Region of England Cont. “Respondents... were concerned that were HIA to be made a statutory requirement they did not have the capacity to deliver what the guidance implied health organisations should provide.”
tional structures (Ahmad et al, 2008). The presence of an organisation who leads on HIA development at the regional level remains a gap until present although NEPHO is seen by many as the one regional organisation with a significant role in HIA. Integration of HIA within organisational structures can take many forms. It can involve a high level organisational commitment to HIA by adopting an approach that results in integrating HIA practice in an organisation’s
policies and strategies (e.g. the Greater London Authority, Ahmad et al., 2008). It can also involve creating special HIA posts at the organisational level. So far, there is very limited integration of HIA within the policy of stakeholder organisations in the North East Region. In our study, we found only one post in HIA in the region created at Durham County Council (Policy Officer, Health Improvement). However, we learnt that limited HIA work was done as part of this post and the post no longer exists in that form. The Department of Health’s ‘Draft guidance on health in strategic environmental assessment’ (Williams and Fisher, 2008) is an attempt by the government to embed HIA into policy making. It is yet to be seen whether HIA will be a statutory requirement in strategic environmental assessment (SEA). Respondents to the consultation in the North East Region were concerned that, were HIA to be made a statutory requirement, they did not have the capacity to deliver what the guidance implied health organisations should provide. Nevertheless, should this be the case there might be an incentive for health organisations (mainly PCTs) to build their capacity in HIA or possibly contract consultants to do
The North East region of England
HIA on their behalf, as in the case of the statutory tool ‘Integrated Pollution Prevention and Control’ (Ahmad et al., 2005). Note The views presented in this article are those of the authors and do not represent those of any organisation. References Ahmad B, Pless-Mulloli T, White M. Developing capacity and capability for HIA in the North East Region. A mapping study and strategy document. North East Public Health Observatory; 2006. Ahmad B, Chappel D, PlessMulloli T, White M. Enabling factors and barriers for the use of health impact assessment in decision-making processes, Public Health, 2008; 122, 452–457 Ahmad B, Pless-Mulloli T, Vizard K. HIA and pollution prevention and control: what they can learn from each other. Environmental Impact Assess Review 2005; 25:714–22. Williams C, Fisher P. Draft guidance on health in strategic environmental assessment: A consultation. Department of Health; 2008. http://www.dh.gov.uk/en/ Consultations/ Closedconsultations/
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Capacity Building and HIA in New Zealand Paula Hawley-Evans and Matt Soeberg HIA Support Unit, New Zealand Ministry of Health matt_soeberg@moh.govt.nz
New Zealand’s HIA Support Unit was established in August 2007, and is based in the Office of the Director of Public Health at the Ministry of Health. Its main focus is to contribute to improving health outcomes and reducing health inequalities in New Zealand by embedding health impact assessment (HIA) approaches into public policy development at central and local government levels. Our baseline of HIA activity, as at July 2007, showed that approx 145 people had been trained in HIA during the two years prior to the Unit’s establishment, but that this did not translate into actual HIAs, with only 7 completed and written up. It was agreed therefore that our priorities should be creating capacity and building the evidence base on
HIA. We adopted the New South Wales ‘Building Capacity to Improve Health Framework’, which outlines 5 action areas: organisational change, workforce development, resource allocation, partnership and leadership. The table below summarises these actions. In New Zealand we are fortunate to have strong Cabinet level support for HIA, a dedicated Unit and a ‘critical mass of people now trained in HIA’. The Learning by Doing approach has been helpful in encouraging a shift from training to doing HIAs. Over the past year, since the Unit was set up, a further 7 HIAs have been completed and several more are underway. What the Unit has provided is some dedicated support
Building Capacity Organisational Change
and funding. This has been useful, but even more important is the organisational support from District Health Boards and partner agencies such as local authorities to take part in HIAs, and that they see the tool as valuable to achieving their aims and objectives. Therefore, as a Unit we have agreed to continue to prioritise creating capacity and building the evidence base on HIA across the five areas outlined. For more information visit our website www.moh.govt.nz/ hiasupportunit or contact Paula Hawley-Evans or Matt Soeberg on 0064 (4) 816 2837/2672.
Action to Date 2007/08
• HIA within the Government’s policy wheel guidance • Raising awareness of HIA and the tools available, bi-monthly HIA enewsletter, website, leaflet etc. • Public Health Bill 2007 includes enabling clauses on HIA • Review of the Public Health Handbook for District Health Boards is to include provisions for HIA
Workforce Development
• Agreement to pilot HIA training within Ministry of Health • Support to Whanau Ora HIA (Maori health focused tool) 10 half day Advocacy and 5 X 2 day training sessions held across the country • Provision of tailored HIA training courses in specific areas of the country and University of Otago Summer School HIA introductory and advanced courses
Resource Allocation
• Learning by Doing HIA Fund for District Health Boards • Round 1 (2007/08) - supported 5 HIAs including an impact evaluation of Christchurch Urban Development Strategy
Partnership
• Round 2 (2008/09) - a further 7 proposals have been agreed. • New posts in District Health Boards developed dedicated to HIA • Developing partnerships with key agencies such as the Ministry of Transport. Co-funding a research project on the use of HIA in transport planning for 2008/09 • Presentations to central and local government agencies on HIA • Setting up a HIA Reference Group for the Unit
Leadership
• • • •
Providing advice and guidance on HIA Undertaking peer reviews on completed HIAs Dissemination of good practice Organising a Practitioners Network Workshop – 45 people sharing their work and learning from each other’s experiences
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NSW Health Impact Assessment Project
Capacity Building for HIA in European Union New Member States and Pre-Accession Countries Gabriel Gulis University of Southern Denmark, Esbjerg, Denmark ggulis@health.sdu.dk
The aim of the Health Impact Assessment in New Member States and Accession Countries (HIA-NMAC) project has been to establish and expand capacities for HIA in partner countries. The project has been supported by a grant from the European Commission and has included HIA case studies, methodological development and local level implementation. A series of workshops were conducted in participant countries with an aim to train professionals in HIA. At the project kick-off meeting it was agreed that the main target group for the HIA training will be non-public health people first and public health practitioners second. The workshops provided an excellent opportunity for informal discussion with different level decision makers, public health and non-public health experts. The workshops also provided an opportunity to develop the training modules. Power Point slides of training modules are available to project partners in countries where workshops were conducted. The final modules are also posted on the pro-
ject webpage nmac.sdu.dk).
(see
www.hia-
♦ ♦
An evaluation was conducted immediately after the internet-based workshop. An important issue identified was language. Handouts were provided, often in the national language. A clear finding of the project is that countries should be encouraged to develop their own language teaching materials. Amongst countries participating in the project these already exist, though many other European countries do not have these resources currently available. In interesting case is Poland, where a Polish language HIA web site has been created.
♦
There were significant differences between participating countries in terms of levels of pre-existing awareness of HIA. The workshop evaluations also highlighted the substantial organisational challenges that more widespread use of HIA will entail (see Table 1). Participants identified the following needs to conduct HIA in future in their respective countries:
♦ ♦
Further education and training Legal and regulatory requirements to support HIA’s use Technical support, including a software to assist analysis of health impacts Methodological support and HIA guidelines Financial support
Despite many achievements of the project, there are issues to be discussed critically and addressed in future. Firstly, there is as a need for systematic, long term training and experience exchange forum for all interested on HIA both as research and practice. Except in the UK, where a series of annual conferences on HIA are being organized for 9 years (last 5 years as international) there is no such forum in Europe. There are individual and rather scattered HIA training courses but no systematic training or experience exchange forums exists. With respect to this issue the language barrier has to be taken seriously, especially with respect to new member states of EU. Cost issues are also relevant to consider while discussing participation in systematic training and experience exchange forums. Internet based distance learning or discussion forums in similar ways as tested with our workshop in Denmark might create a good option within relatively short timeframes and resources. However, the most appropriate action to propose seems to be establishment of a systematic “summer-winter school series”. Secondly, the issue of general public health training needs to be addressed. In all of participating countries participants came to workshops with very strong knowledge of basic public health, medicine, epidemiology and other, mostly medical, disciplines. During the workshops, it was realised that an understanding based on the broad determinants of health was missing.
Project Website http://www.hia-nmac.sdu.dk/
The issue of legal undertakings and
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regulations clearly requires independent and detailed research. There are countries where HIA is already legally required by different legislation (either a public health, health protection law, or within EIA) .However, there are also countries with no legal requirement for HIA. There is no evidence at what extent to which models works better. Taking in account the value base of HIA and a variety of methodological approaches, stakeholders involved in HIA one obvious question is ‘what should be legally required and from whom?’ Technical and methodological supports are the two issues mentioned by participants as important requirements for successful implementation of HIA. It was not the aim of our project to develop national guidelines or technical tools. However, as shown from our experience, participants successfully learned to develop their own screening tools and use them in practice. Again, the best way to support development of country- and languagespecific technical and methodological tools will be the establishment of systematic experience exchange forum on HIA within the EU as discussed above. Last, but not least, the issue of financial support. After breaking capacity building and implementation down into relatively small elements, the same has to be done with financial support. More funding needs to address training and experience exchange issues. Both international and national funding is required, as experience exchange in particular must be done internationally. Methodological and technical tool development needs more national funding as both should be linked to a country’s political, cultural and social context.
Table 1: Issues reported to be relevant to the use of HIA Do you think a rapid screening activity is sufficient in routine work? Do you think all cases coming to the desk of an administrator should be subjected to screening? Do you think HIA should be legally required?
% Yes 49.5% 60.3% 58.8%
References Hawe P, King L, Noort M, Jordens C, Lloyd B: Indicators to help with capacity building in health promotion, NSW Health Department, Sydney, 2000 Project Partners Nur Aksakal, Didem Evci, Gazi University, Ankara, Turkey Ingrida Zurlyte, State Environmental Health Center, Vilnius, Lithuania Joanna Kobza, Medical University of Silesia, Katowice, Poland Hristina Mileva, Ministry of Health of Bulgaria, Sofia, Bulgaria Jarmila Pekarcikova, Daniela Marcinkova, Trnava University, Trnava, Slovak Republic Roza Adany, Balazs Adam, University of Debrecen, Debrecen, Hungary Marco Martuzzi, WHO Regional Office for Europe, ECEH Rome, Italy
Upcoming HIA Training 3 Day HIA Training 25-27 February 2009, Sydney CHETRE is holding a three day HIA training workshop in Sydney in February, bringing together HIA practitioners and Master of Public Health students. The cost for the training is $990 and places are limited. To register your interest in the event please email b.harris-roxas @unsw.edu.au
1 Day Introductory HIA Training for NSW Health Staff 15 December 2008, Sydney CHETRE is holding a one day training workshop on HIA. The audience for the training is people who have had no exposure to HIA. The workshop will The event is free for NSW Health staff though places are limited. To register your interest please email b.harris-roxas@unsw.edu.au
Past HIA training
What’s New? Publications and Events Journal Articles
Furnee CA, Groot W, van den Brink HM (2008)The Health Effects of Education: A metaanalysis, European Journal of Public Health, 18(4): 417-421. doi:10.1093/eurpub/ ckn028 Fell G, Haroon S (2008) Learning from a Rapid Health Impact Assessment of a Proposed Maternity Service Reconfiguration in the English NHS, BMC Public Health, 8(138) doi:10.1186/1471-2458-8-138 Curtis S (2008) How Can We Address Health Inequality Through Healthy Public Policy in Europe?, European Urban and Regional Studies, 15(4): 293-305. doi:10.1177/0969776408095106 Clickable links!
Reports
WHO (2008) World Health Report 2008: Primary health care - Now more than ever, World Health Organization: Geneva. ISBN 9 7892 4156 3734. http://www.who.int/entity/whr/2008/whr08_en.pdf Brennan Ramirez LK, Baker EA, Metzler M (2008) Promoting Health Equity: A resource to help communities address social determinants of health, Social Determinants of Health Work Group, Centers for Disease Control and Prevention, US Department of Health and Human Services: Atlanta. http://www.cdc.gov/nccdphp/dach/chaps/pdf/ SDOHworkbook.pdf WHO (2008) Closing the Gap in a Generation: Health equity through action on the social determinants of health, Commission on the Social Determinants of Health, World Health Organization: Geneva. ISBN 9 7892 4156 3703. http://whqlibdoc.who.int/publications/2008/9789241563703_eng.pdf PHAC & WHO (2008) Health Equity Through Intersectoral Action: An analysis of 18 country case studies, Public Health Agency of Canada and the the World Health Organization: Ottawa. ISBN 9 7806 6248 8279. http://www.phac-aspc.gc.ca/publicat/2008/hetia18-esgai18/pdf/hetia18-esgai18eng.pdf Paradies Y, Harris R, Anderson I (2008) The Impact of Racism on Indigenous Health in Australia and Aotearoa: Towards a research agenda: Darwin. http://www.crcah.org.au/publications/downloads/Racism-Report.pdf Higgins C, Lavin T, Metcalfe O (2008) Health Impacts of Education: A review, Institute of Public Health in Ireland: Dublin. ISBN 9 7809 5595 9813. http://www.publichealth.ie/files/file/Health%20Impacts%20of%20Education.pdf
Upcoming Conferences
8-10 December 2008 HIA2008 2nd Asia Pacific HIA Conference Chiang Mai, Thailand http://www.hia2008chiangmai.com 23-29 May 2009 Impact Assessment and Human Wellbeing (IAIA09) Accra, Ghana http://www.iaia.org/modx/index.php?id=442
NSW HIA eNews Disclaimer The NSW HIA Project is funded by the NSW Department of Health. Views expressed here are not necessarily those of the NSW Department of Health. This newsletter is brought to you by the Healthy Public Policy Program at the Centre for Health Equity Training, Research and Evaluation (CHETRE), part of the UNSW Research Centre for Primary Health Care and Equity. Content within this newsletter was accurate at the time of publication.
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