Professor Sally Macintyre

Director of the Medical Research Council and Public Health Sciences Unit, Glasgow

Health Impact Assessment: Making the Difference

Systematic review of area based regeneration initiatives in the UK

Little evidence of the impact of national urban regeneration on socio-economic or health outcomes.

Changes often no different from national trends.

However, some harms: Single Regeneration Budget 1996 - 1999;

deterioration in self reported health Urban programme and City Challenge;

worsening of unemployment Estate Action; increased housing costs Housing improvement in 1930s Scotland; rents

doubled, mortality rates increased (residents couldn’t afford adequate food)

Thompson et al, 2006

It is adequate to know that some intervention does good in general?

But: ‘Bike ed’ : negative association was strongest in

– Boys – Younger children– Children with parents in lower educational levels– Children lacking family members with bicycles

‘Sesame street’ benefited all children but increased the gap between fast and slow learners

Dental health promotion effective in middle class but not lower class kids

‘Sure Start’ may have adverse effects on the most vulnerable e.g. teenage mothers, workless families

Plausibility is an adequate basis for policy making?

But: Bicycle safety education will reduce bicycle accidents Lying babies on their fronts is best Supplementing diets with vitamin A will mimic good effects of

fruit and vegetables HRT will reduce CVD in postmenopausal women

Stages of HIA

Screening

Scoping

Risk assessment

Decision making

Implementation and monitoring

Health Impact Assessment feedback loop

If HIA is to be useful, it needs robust information to feed into its predictions

Need to check how HIAs compare with what actually happened

Need to bring together the HIA and evaluation fields

HIV and Evaluation

HIA: ‘any combination of procedures or methods by which a proposed policy or program may be judged as to the effects it may have on the health of the population.’

WHO 1999

Evaluation: ‘examines the outturn of a policy, programme or project against what was expected.’

HM Treasury Green Book

Evaluation: MRC SPHSU Systematic Reviews of Policy, Programmes and Projects

Health effects of new road building Urban regeneration Housing renovation Promoting walking and cycling Tobacco control programmes and their effects on social inequalities Privatisation, deregulation and state subsidies to industry

Evaluation:MRC SPHSU Evaluation of health effects of Policy, Programmes and Projects

Traffic calming Building of M74 extension Central heating initiative Sure Start Rehousing and health (Renton, Scotland wide, Glasgow) Swimming pool closure Scottish ban on smoking in enclosed public places Opening of a major new superstore Healthy living centres Closure of soft drinks factory

Hypermarket Study

New Tesco hypermarket opened November 2001 in Springburn. Comparison area Shettleston

Both had: No large supermarket Depcat 7 (levels of deprivation) 50% smoking prevalence Declining rates of male life expectancy Low levels of fruit and vegetable consumption (one-third eating fruit

daily)

The Springburn Supermarket study

Before (2001) and 1 year after (2002)

• Postal survey (2001/2002)

• Qualitative interviews (10 focus groups)

• Systematic mapping of local retailers: type, location every 6 months

s

Hypermarket Study, change from baseline

Intervention Community

Fruit (portions per day 0.09

Veg (portions per day) 0.15

F+V (portions per day) 0.29 (p=0.07)

Hypermarket Study, change from baseline

Intervention Community

Control Community

Fruit (portions per day 0.09 0.12

Veg (portions per day) 0.15 0.25

F+V (portions per day) 0.29 (p=0.07) 0.44 (p=0.003)

Hypermarket Study, change from baseline

Controlling for baseline diet, age, sex, employment and education:

No significant difference between areas in change in

fruit and/or vegetable consumption among either switchers or non switchers

Hypermarket Study, change from baseline

No significant changes in retail provision locally, although intervention area had

Greater decrease in shop vacancy rates An extension of food retail outlets A greater increase of service retail outlets

(one butcher and one greengrocer closed in control area, no closures in intervention area)

Hypermarket Study – retrospective HIA

Three classes of MPH students (45 students) Given details of the areas and the hypermarket development Given Merseyside HIA guidelines Asked to predict impacts on diet, social participation, employment

opportunities, social networks, traffic and local environmental problems

Hypermarket Study – retrospective HIA

Three classes of MPH students (45 students) Given details of the areas and the hypermarket development Given Merseyside HIA guidelines Asked to predict impacts on diet, social participation, employment

opportunities, social networks, traffic and local environmental problems Predicted

– positive impact on diet – negative impact on shops

Inequalities and HIA - conclusion

Inequalities in health and life chances are pervasive And are not always captured in aggregate data/outcomes Little is known about how best to reduce inequalities in health Health Inequalities Impact Assessment may have little data to guide

predictions Assumptions about likely impact may be wrong Need to link HIA and HIIA with systematic reviews and controlled

evaluations Closing the feedback loop – retrospective HIA

Inequalities and HIA - conclusion

Inequalities in health and life chances are pervasive And are not always captured in aggregate data/outcomes Little is known about how best to reduce inequalities in health Health Inequalities Impact Assessment may have little data to guide

predictions Assumptions about likely impact may be wrong Need to link HIA and HIIA with systematic reviews and controlled

evaluations Closing the feedback loop – retrospective HIA

With thanks to Mark Petticrew and Hilary Thomson

7th International Health Impact Assessment

Conference

Health Impact Assessment: Making the Difference

Supported by: