Building Capacityfor HIA

Health Impact Assessment ColloquiumBondi, 9th December 2005

Ben Harris-Roxas & Patrick Harris

The Centre for Health EquityTraining, Research and Evaluation (CHETRE)

Centre for Health EquityTraining, Research & Evaluation

Context for NSW HIA Project

• NSW Health and Equity Statement: In All Fairness

• CEO’s concern with two strategies:– Rapid appraisals– Health impact assessment

from an inequalities perspective

NSW HIA Project:A Phased Approach

• Phase 1 (2002-3)– Awareness raising & exploration

• Phase 2 (2003-2004)– Expanded awareness & early adoption

• Phase 3 (2005-2008)– Implementation of HIA– Moving towards institutionalising the

consideration of health impacts– Working more with other sectors on ‘health’

impacts

Phase 1: What we did

• 2 x one day workshops with range of NSW Health staff– Introduction to HIA– Exploring pros & cons of HIA

• Review of literature

• Establishment of HIA e-News

Phase 1: Findings

• Clarity needed in:

– Scope of HIA

– Triggers

– Who

• Anxiety about talking rather than acting

Issues arising from Phase 1

• Regulatory or Developmental

• Tight or Broad Health Focus

• Health or Non-Health Developments

• Triggers: where is the value add?

• Scientific or Decision Making Tool

• Valuing Evidence• Prospective,

Retrospective or Concurrent

Phase 1: Take Home Messages

• LISTEN

• Remember the roots of HIA

• Engage others

• Be cautious – maybe it’s not something we want to do

• SLOWLY, SLOWLY

Stages of organisational change

• Building on awareness

• Moving towards adoption

• Getting read for implementation

And …

• Institutionalisation

Capacity Building Framework

Source: NSW Health. A Framework for Building Capacity to Improve health. Sydney: New South Wales Department of Health, 2001.

Organisational Development

Workforce Development

Resource Allocation

Partnerships

Leadership

• Infrastructure

• Sustainability

• ProblemSolving

CONTEXT

Build Capacity

Phase 2: What We Did

• 5 Developmental Sites– Undertook HIAs on health

proposals– CHETRE training & support

• Strategic Engagement– GWSHUDG– Steering Committee

• Communication– HIA E-News ongoing– HIA Connect est

Phase 2 pioneers

The focus of their HIAs

• Social marketing campaign for chronic disease prevention

• Transport for Health Policy Framework

• Foreshore development plan

• Services delivery plan for health promotion

• Innovative aged care program

A mix of skills & backgrounds

• Health promotion

• Clinical

• Allied health

• Policy

• Epidemiology

• Planning

• Some with post-graduate quals, e.g. MPHs

What did we (the team) do?

• Help-desk• Site visits

– Before– Towards the end of the HIA– One afterwards

• Ongoing support & assistance– Stg Committee for Illawarra HIA– Reviewing reports – Assessment & decision-making

stages

About learning by doing:

“It’s great if we have organisational commitment.”

“It is a very appropriate approach to adopt for this subject matter. It mobilises resources for real work, rather than theory.”

chetre.med.unsw.edu.au

2004 Developmental Sites

“Best way to learn - but time consuming”

“Takes time, needs digesting”

Learning by Doing

• We’re committed to doing HIA rather than just talking about it

• To build technical knowledge and practical expertise in HIA

• To identify structural and contextual uses and impediments

• Need an active & structured process of support for sites

• Builds a cohort of advocates for HIA

chetre.med.unsw.edu.au

Phase 2: Some Learnings

• Need to be able to do HIA:– Rapidly (but may be difficult when

learning)– on bigger projects/proposals

• Learning by doing builds confidence

• An active & structured approach to future developmental HIA sites:

– Screening & scoping etc reports– Participant observers

Phase 3• 3 Year Project• Key Features:

– 2 x Developmental Sites– Develop HIA Manual for NSW– Develop Masters Module on HIA– Liaison & Engagement– Introduction to HIA for Senior Staff– Continue E-News & HIA Connect– Colloquium and conference– Special Issue of NSW Public Health

Bulletin (and further dissemination)– PHO Placements

Phase 3: Context

• NSW Health – a system in stress– Area Health Service mergers– Departmental restructure &

cutbacks– Potential for no takers for HIA

• Urban development aplenty in Sydney metro & regional NSW

• National and International context of interest in PA, urban form and prevention of CDs – search for interventions (HIA?)

Phase 3: What’s Happening?

• 8 months into it• Call for developmental HIA sites for

2005– 6 HIAs Underway– Overwhelming response– HIA gaining ground– Questions are different

• Health and Urban Development Workshop

• 2006 Developmental Sites• Expanding communication strategy

Outcomes to Date

• Larger assessments• Assessing Impacts Project – PHO

Placement at CHETRE• Discussion Paper on Impact

Assessment for NSW Health Futures Planning

• Engagement with enHealth, environmental health sectors – learning where we can

• HIA Blog

Concluding Thoughts

• Context makes a difference• A phased approach has worked for

us (so far…)• Worthwhile beginning ‘in-house’

before branching out• HIA – a useful tool, a conversation

starter …• Need to start integrating,

implementing & institutionalising• Pre-Screening?

Acknowledgements

• 2004Developmental Sites– Centre for Chronic Disease Prevention and Health

Advancement– IAHS– MNCASH– Primary Health and Community Partnerships Branch– MWAHS

• 2005 Developmental Sites– HNEAHS, Premier’s Dept & Hunter RCMG– GSAHS & Palerang Council– WSAHS, Dept of Housing and Parramatta City Council– NCAHS– NSCCAHS– Greater Western Sydney HUD group

• Steering Committee• CCDPHA• SEIAHS

chetre.med.unsw.edu.au

More Information

HIA Connecthttp://chetre.med.unsw.edu.au/hia

chetre.med.unsw.edu.au

What Capacity Might be Required?

• Individual level – Personal qualities, knowledge, skills,

resources, partnerships

• Organisational Level– Policies, processes procedures, partnerships,

leadership, knowledge, skills

• System Level– Values, ideology, economics, politics

What capacity would be required in your organisation/work?

Source: Bowen S, Zwi A. Pathways to evidence Infomred Policy and Practice: A framework for action, Plos Medicine 2(7), e1166 doi:10.1371/journal.pmed.0020166

Who Could/Should Be Doing HIA?

• Who has the capacity to do HIA?

• How could/should we be developing this?

• How could we achieve this?

• Challenges• Opportunities• Ways forward

Get Involved!