Abstract
Background
Health Impact Assessment (HIA) is promoted as a decision-informing tool by public health and governmental agencies. HIA is beneficial when carried out as part of policy ...development but is also valuable as a methodology when a policy is being implemented to identify and understand the wider health and well-being impacts of policy decisions, particularly when a decision needs to be taken rapidly to protect the population. This paper focusses on a HIA of the ‘Staying at Home and Social Distancing Policy’ or ‘lockdown’ in response to the COVID-19 pandemic in Wales conducted by the Welsh national public health institute. It describes the process and findings, captures the learning and discusses how the process has been used to better understand the wider health and well-being impacts of policy decisions beyond direct health harm. It also examines the role of public health institutes in promoting and using HIA.
Methods
A HIA was conducted following a standard HIA five step process. A literature review was undertaken alongside 15 qualitative semi-structured interviews with key stakeholders, and relevant health and demographic data were collated. The results were triangulated and analysed to form a holistic assessment of the policy decision and its impacts.
Results
A wide range of major health and well-being impacts of the lockdown in Wales were identified across the determinants of health, which included positive and negative social, economic, environmental and mental well-being impacts beyond the impact on direct health. Populations affected included children and young people, those on low incomes and women as well as those whose health has been directly impacted by COVID-19 such as older people. The work highlighted the benefit that HIA can bring in emphasizing impacts which can inform policy and shared learning with others.
Conclusion
HIA is a largely underused tool to understand the impact of policy and political decisions, particularly when a decision has been taken at speed. This case study highlights how HIA provide evidence and information for advocacy and further work by public health institutes, health agencies and policy makers.
Climate change is recognised as the biggest threat to global health of the 21st century and impacts on health and wellbeing through a range of factors. Due to this, the need to take action in order ...to protect population health and wellbeing is becoming ever more urgent.
In 2019, Public Health Wales carried out a comprehensive mixed-method Health Impact Assessment (HIA) of climate change. Unlike other risk assessments, it appraised the potential impact of climate change on health and inequalities in Wales through participatory workshops, stakeholder consultations, systematic literature reviews and case studies.
The HIA findings indicate potential impacts across the wider determinants of health and wellbeing. For example, air quality, excess heat/cold, flooding, economic productivity, infrastructure, and community resilience. A range of impacts were identified across population groups, settings, and geographical areas.
These findings can inform decision-makers to prepare for climate change plans and policies using an evidence-informed approach. The work has demonstrated the value of a HIA approach by mobilising a range of evidence through a transparent process, resulting in transferrable learning for others.
Liz Green is Consultant in Public Health, Policy and International Health / Programme Director for Health Impact Assessment at Public Health Wales. She co-authored a HIA report on the potential ...impacts from home and agile working on public health. https://whiasu.publichealthnetwork.cymru/en/hia-reports/
OBJECTIVESTo develop a Climate Change Inequality Health Impact Assessment (CCIHIA) framework for health services; to provide a systematic process for assessing potential unequal health impacts of ...climate change on vulnerable and marginalised populations and places; to support effective planning to address these impacts; and to develop contextually appropriate local strategies. Type of program: A collaborative interdisciplinary scoping research project involving two universities and two local health districts (LHDs) in New South Wales (NSW) to develop a CCIHIA framework. This work builds upon the health impact assessment (HIA) approach, which systematically assesses proposals' potential health and equity impacts by involving stakeholders in developing responses.METHODSThe project involved four main activities: understanding stakeholder requirements; conceptualising climate change vulnerability; considering the role of health services; and integrating findings into a conceptual framework.RESULTSStakeholders identified key functions that should be addressed across the framing, process and utility of the CCIHIA framework. The resulting conceptual framework outlines contexts and social stratification, the differential impacts of climate change (including factors influencing unequal impacts) and the health system's position, and also identifies key potential points of intervention.LESSONS LEARNTThe challenge of addressing the complexity of factors and resulting health impacts is reflected within the CCIHIA framework. While there are many intervention points within this framework for health services to address, many factors influencing unequal impacts are created outside the health sector's direct control. The framework's development process reflected the focus on collaboration and the interdisciplinary nature of climate change response. Ultimately, the CCIHIA framework is an assessment tool and an approach for prioritising inclusive, cross-cutting, multisector working, and problem-solving.
Assessing the positive and negative impact of policies, services and interventions on health and well-being is of great importance to public health. Health Impact Assessment (HIA) and Social Return ...on Investment (SROI) are established methodologies which assess potential effects on health and well-being, including social, economic and environmental factors, indicating synergies, and cross-over in their approach. Within this paper, we explore how HIA and SROI could complement each other to capture and account for the impact and social value of an assessed intervention or policy.
A scoping review of academic and gray literature was undertaken to identify case studies published between January 1996 and April 2019 where HIA and SROI methodologies have been used to complement each other previously. Semi-structured interviews were carried out with nine international experts from a range of regulatory and legislative contexts to gain a deeper understanding of past experiences and expertise of both HIA and SROI. A thematic analysis was undertaken on the data collected.
The scoping review identified two published reports on scenarios where HIA and SROI have both been used to assess the same intervention. Results from the interviews suggest that both methods have strengths as standalone methodologies. HIAs were noted to be well-structured in their approach, assessing health and well-being in its broadest context. SROI was noted to add value by monetizing social value, as well as capturing the social and environmental impact. Similarities of the two methods was suggested as their strong emphasis on stakeholder engagement and common shared principles. When questioned how the two methods could complement each other in practice, our results indicate the benefits of using HIA as an initial exploration of impact, potentially using SROI subsequently to monetarize social value.
HIA and SROI have many synergies in their approaches. This research suggests potential benefits when used in tandem, or combining the methods to assess impact and account for social value. Further research is needed to understand the implications of this in practice, and to understand how the results of the two methods could be used by decision-makers.
Making the case for investing in preventative public health by illustrating not only the health impact but the social, economic and environmental value of Public Health Institutes is imperative. This ...is captured by the concept of Social Value, which when measured, demonstrates the combined intersectoral value of public health. There is currently insufficient research and evidence to show the social value of Public Health Institutes and their work across the life course, population groups and settings, in order to make the case for more investment.
During July 2021, a quantitative online self-administered questionnaire was conducted across international networks. Semi-structured interviews were also carried out with nine representatives to gain a deeper understanding. A thematic analysis was undertaken on the data collected.
In total, 82.3% (
= 14) were aware of the terminology of social value and 58.8% (
= 10) were aware of the economic method of Social Return on Investment. However, only two Institutes reported capturing social and community impacts within their economic analysis and only 41.2% (
= 7) currently capture or measure the social value of their actions. Interviews and survey responses indicate a lack of resources, skills and buy-in from political powers. Finally, 76.5% (
= 12) wanted to do more to understand and measure wider outcomes and impact of their actions. It was noted this can be achieved through enhancing political will, developing a community of best practice and tools.
This research can inform future work to understand how to measure the holistic social value of Public Health Institutes, in order to strengthen institutional capacity and impact, as well as to achieve a more equitable society, and a more sustainable health system and economy, making the case for investing in public health, as we recover from COVID-19.
Hold On Green, Liz
Fourth genre,
10/2019, Letnik:
21, Številka:
2
Journal Article
Green shares her experience of working in a residential rehab. In a single year, hundreds of souls passed through the facility where she worked, which housed 25 women at a time. It was an all-female ...residential rehab in an aging house in New Orleans LA, a neighborhood of rundown Victorians and lush, sheltering oaks. They referred to residents as "clients" or "the Ladies." Clients had come to them from mental hospitals, shelters, and detox, from living under the Claiborne Avenue overpass. Some stayed barely 24 hours.
The food environment has taken on much of the impact of the COVID-19 pandemic. Evidence shows people's relationship and access to the food environment is a determinant of their health and wellbeing, ...and in relation to prevalence of chronic and non-communicable diseases. The spatial planning system forms part of a whole systems action in shaping the environment in a way that maximises population health gain. While these practices have had varying degrees of success, the sudden introduction and spread of COVID-19, and the responses to it, has forced us to re-examine the utility of current planning practice, particularly the impact on inequalities. In this commentary we aim to explore the post-pandemic role of spatial planning as a mechanism for improving public health by highlight a whole system perspective on the food environment, referring to experiences in Wales as a case study, and concluding with observation on future consumer trends around access to food.
In June 2016, the UK voted to leave the European Union (EU) in a process known as Brexit, which is surrounded by political and social uncertainty. We aimed to assess the potential impact of Brexit on ...Wales.
Using health impact assessment methodology steered by a Strategic Advisory Group, we did a comprehensive mixed-method health impact assessment between July 2, 2018, and Jan 21, 2019. We searched MEDLINE, Embase, and Proquest databases using the well-established PICO (population, intervention, comparator, and outcome) framework used in evidence-based practice to frame and answer a health-care related question, to identify peer-reviewed literature published after January 2016, on the potential impact of Brexit on health and the economy. We supplemented the search with a review of grey literature on direct impacts, such as the environment, health care, and EU funding. Additionally, we held a stakeholder workshop including cross-sectoral representation such as housing, environmental health and planning, qualitative interviews with policy leads, and developed a community health profile using recognised data sources (eg, the National Survey for Wales) to understand the different population groups. The findings were analysed, synthesized, and collated into a published report.
The health impact assessment identified considerable potential impacts across the wider determinants of health, including effects across vulnerable population groups, mental wellbeing, and geographical areas in Wales that receive EU funding. Trade agreements, changing relationships with EU agencies, uncertainty, and loss of regulatory alignment were identified as key pathways for health impacts. For example, trade agreements can improve the supply and choice of food, but can also result in trade liberalisation and increased imports of highly-processed foods. Another example is the impact on food safety due to workforce challenges (ie, the low number of certificating officers at abattoirs who are UK-national citizens).
Since Brexit is yet to occur, the impacts identified are potential. Although this assessment was done over a short period of time, the findings have been beneficial in informing decision makers to prepare for Brexit using an evidence-informed approach. This work highlights the value of a health impact assessment approach to unprecedented events by mobilising a wide range of evidence through a transparent process, resulting in transferrable learning for others.
Public Health Wales.
Abstract
Health Impact Assessment is a key approach used internationally to identify positive or negative impacts of policies, plans and proposals on health and well-being. In 2020, HIAs were ...undertaken in Scotland and Wales to identify the potential health and well-being impacts of the ‘stay at home’ and physical distancing measures implemented at the start of the coronavirus disease (COVID-19) pandemic. There is sparse evidence evaluating whether the impacts predicted in HIAs occur following policy implementation. This paper evaluates the impacts anticipated in the COVID-19 HIAs against actual observed trends. The processes undertaken were compared and predicted impacts were tabulated by population groups and main determinants of health. Routine data and literature evidence were collated to compare predicted and observed impacts. Nearly all health impacts anticipated in both HIAs have occurred in the direction predicted. There have been significant adverse impacts through multiple direct and indirect pathways including loss of income, social isolation, disruption to education and services, and psychosocial effects. This research demonstrates the value of prediction in impact assessment and fills a gap in the literature by comparing the predicted impacts identified within the HIAs with observed trends. Post-COVID-19 recovery should centre health and well-being within future policies and decisions. Processes like HIA can support this as part of a ‘health in all policies’ approach to improve the health and well-being of populations.
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