Evaluating the impact of equity focused health impact assessment on health service planning: three case studies

BMC Health Services Research

Lynn Kemp¹  Joanne Travaglia²  Fiona Haigh¹  Ben Harris-Roxas¹ 

[1]Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW 2052, Australia

[2]School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia

关键词: Conceptual framework;    Evaluation framework;    Impact evaluation;    Health service planning;    Health equity;    Health impact assessment;   

Others  :  1126549
DOI  :  10.1186/1472-6963-14-371

 received in 2014-02-10, accepted in 2014-08-28,  发布年份 2014

【 摘 要 】

Background

Health impact assessment has been identified internationally as a mechanism to ensure potential health impacts and health equity impacts of proposals are considered before implementation. This paper looks at the impact of three equity focused health impact assessments (EFHIAs) of health service plans on subsequent decision-making and implementation, and then utilises these findings to test and refine an existing conceptual framework for evaluating the impact and effectiveness of health impact assessments for use in relation to EFHIAs.

Methods

Case study analysis of three EFHIAs conducted on health sector plans in New South Wales, Australia. Data was drawn from 14 semi-structured interviews and the analysis of seven related documents (draft plans and EFHIA reports).

Results

The case studies showed that the EFHIAs all had some impact on the decision-making about the plans and their implementation, most clearly in relation to participants’ understandings of equity and in the development of options for modifying service plans to ensure this was addressed. The timing of the EFHIA and individual responses to the EFHIA process and its recommendations were identified as critical factors influencing the impact of the EFHIAs. Several modifications to the conceptual framework are identified, principally adding factors to recognise the role individuals play in influencing the impact and effectiveness of EFHIAs.

Conclusion

EFHIA has the potential to improve the consideration of health equity in health service planning processes, though a number of contextual and individual factors affect this. Current approaches can be strengthened by taking into account personal and organisational responses to the EFHIA process.

【 授权许可】

   
2014 Harris-Roxas et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 7.

Figure 2.

【 参考文献 】

• [1]Harris-Roxas B, Viliani F, Bond A, Cave B, Divall M, Furu P, Harris P, Soeberg M, Wernham A, Winkler M: Health Impact Assessment: The state of the art. Impact Assessment Proj Appraisal 2012, 30(1):43-52.
• [2]National Research Council: Improving Health in the United States: The Role of Health Impact Assessment. Washington DC: National Academies Press; 2011.
• [3]Wismar M, Blau J, Ernst K, Elliott E, Golby A, Van Herten L, Lavin T, Stricka M, Williams G: Implementing and Institutionalizing Health Impact Assessment in Europe. In Health in All Policies: Prospects and potentials. Edited by Ståhl T, Wismar M, Ollila E, Lahtinen E, Leppo K. Helsinki: Ministry of Social Affairs and Health; 2006:231-252.
• [4]Kemm J: Past Achievement, Current Understanding and Future Progress in Health Impact Assessment. Oxford: Oxford University Press; 2013.
• [5]Birley M: Health Impact Assessment: Principles and practice. London: Routledge; 2011.
• [6]ECHP: Gothenburg Consensus Paper on Health Impact Assessment: Main concepts and suggested approach. Brussels: European Centre for Health Policy, WHO Regional Office for Europe 1999.
• [7]Cave B, Curtis S: Developing a practical guide to assess the potential health impact of urban regeneration schemes. Promot Educ 2001, 8(1):12-16.
• [8]enHealth: Health Impact Assessment Guidelines. Canberra: National Public Health Partnership, Commonwealth Department of Health and Aged Care; 2001.
• [9]Scott-Samuel A, Birley M, Ardern K: The Merseyside Guidelines for Health Impact Assessment. 2nd edition. Liverpool: International Health Impact Assessment Consortium (IMPACT); 2001.
• [10]Harris P, Harris-Roxas B, Harris E, Kemp L: Health Impact Assessment: A practical guide. Sydney: UNSW Research Centre for Primary Health Care and Equity and NSW Health; 2007.
• [11]Mindell JS, Boltong A, Forde I: A Review of Health Impact Assessment Frameworks. Public Health 2008, 122(11):1177-1187.
• [12]Bhatia R, Farhang L, Gaydos M, Gilhuly K, Harris-Roxas B, Heller J, Lee M, McLaughlin J, Orenstein M, Seto E, St-Pierre L, Tamburrini A, Wernham A, Wier M: Practice Standards for Health Impact Assessment (Version 1). Oakland CA: North American HIA Practice Standards Working Group; 2009.
• [13]Vohra S, Amo-Danso G, Ball J: Health impact assessment and its role in shaping government policy-making: the use of health impact assessment at the national policy level in England. In Integrating health impact assessment with the policy process. Edited by O’Mullane M. Oxford: Oxford University Press; 2013:76-87.
• [14]Douglas MJ, Scott-Samuel A: Addressing Health Inequalities in Health Impact Assessment. JECH 2001, 55(7):450-451.
• [15]Mahoney M, Simpson S, Harris E, Aldrich R, Stewart Williams J: Equity Focused Health Impact Assessment Framework. Newcastle: Australasian Collaboration for Health Equity Impact Assessment; 2004.
• [16]Harris-Roxas B, Simpson S, Harris E: Equity Focused Health Impact Assessment: A literature review. Sydney: CHETRE on behalf of the Australasian Collaboration for Health Equity Impact Assessment; 2004.
• [17]Sukkumnoed D, Kessomboon P, Nusaraporn K, Nuntavorakarn S, Sabrum N: Health Impact Assessment Training Manual: A learning tool for healthy communities and society in Thailand, Southeast Asia, and beyond. Bangkok: Research and Development Program on Healthy Public Policy and Health Impact Assessment, Health Systems Research Institute; 2007.
• [18]Simpson S, Harris E, Harris-Roxas B: Health Impact Assessment: An introduction to the what, why and how. Health Promot J Austr 2004, 15(2):162-167.
• [19]Quigley R, den Broeder L, Furu P, Bond A, Cave B, Bos R: Health Impact Assessment International Best Practice Principles. Edited by Fargo USA, Special Publication Series Number 5 edn. International Association for Impact Assessment; 2006.
• [20]Ravn AK, Nicolaisen H, Linnrose K, Folkersen MW, Kraemer SRJ, Gulis G: Screening tool development for health impact assessment of large administrative structural changes. Scand J Public Health 2008, 36(8):789-794.
• [21]Vohra S: International perspective on health impact assessment in urban settings. N S W Public Health Bull 2007, 18(9–10):152-154.
• [22]Povall S, Haigh F, Abrahams D, Scott-Samuel A: Health Equity Impact Assessment: Project Report. Liverpool: IMPACT, University of Liverpool; 2010.
• [23]Gunther S: A rapid review of enhancing the equity focus on policy orientated Health Impact Assessment. Birmingham: Equity Action: EU Joint Action on Health Inequalities; 2011.
• [24]WHO: Closing the Gap in a Generation: Health equity through action on the social determinants of health. Geneva: Commission on the Social Determinants of Health, World Health Organization; 2008.
• [25]PHAC: Crossing Sectors: Experiences in intersectoral action, public policy and health. Ottawa: Public Health Agency of Canada; 2007.
• [26]Bro Taf Health Authority: Health Inequalities Impact Assessment Rapid Appraisal Guidelines and Tool. Cardiff: Bro Taf Health Authority; 1999.
• [27]Lester C, Temple M: Rapid Collaborative Health Impact Assessment: A three-meeting process. Public Health 2004, 118(3):218-224.
• [28]Haber R: Health Equiy Impact Assessment: A Primer. Toronto: Wellesley Institute; 2011.
• [29]Kickbusch I, Buckett K: Implementing Health in All Policies: Adelaide 2010. Adelaide: Department of Health, Government of South Australia; 2010.
• [30]WHO & SA Government: Adelaide Statement on Health in All Policies: Moving towards a shared governance for health and wellbeing. Geneva: World Health Organization and South Australian Government; 2010.
• [31]Signal L, Martin J, Cram F, Robson B: Health Equity Assessment Tool: A user’s guide. Wellington: New Zealand Ministry of Health; 2008.
• [32]Dahlgren G, Whitehead M: Levelling up (part 2): a discussion paper on European strategies for tackling social inequities in health. Copenhagen: WHO Regional Office for Europe; 2006.
• [33]Gunning C, Harris P, Mallett J: Assessing the health equity impacts of regional land-use plan making: An equity focussed health impact assessment of alternative patterns of development of the Whitsunday Hinterland and Mackay Regional Plan, Australia. Environ Impact Assess Rev 2011, 31(4):415-419.
• [34]Wells VL, Gillham KE, Licata M, Kempton AM: An Equity Focused Social Impact Assessment of the Lower Hunter Regional Strategy. NSW Public Health Bull 2007, 18:166-168.
• [35]Snyder J, Wagler M, Lkhagvasuren O, Laing L, Davison C, Janes C: An equity tool for health impact assessments: Reflections from Mongolia. Environ Impact Assess Rev 2012, 34:83-91.
• [36]Povall S, Haigh F, Abrahams D, Scott-Samuel A: Health equity impact assessment. Health Promotion International 2013. accepted in 2013 - in press, available as online first
• [37]Wellesley Institute: Equity Impact Assessment. Toronto: Wellesley Institute; 2013. http://www.wellesleyinstitute.com/our-work/healthcare/healthequity/heath-equity-impact-assessment/ webcite
• [38]Barnes R: Equity and Health Impact Assessment Seminar Report, Manchester 16–17 June. Liverpool: Liverpool Public Health Observatory; 2000.
• [39]Pauly B, MacDonald M, O’Briain W, Hancock T, Perkin K, Martin W, Zeisser C, Lowen C, Wallace B, Beveridge R, Cusack E, Riishede J: Health Equity Tools. Victoria, BC: ELPH Research Team, University of Victoria; 2013.
• [40]Orenstein M, Rondeau K: Scan of health equity impact assessment tools. Calgary: Habitat Health Impact Consulting, prepared for the Strategic Initiatives and Innovations Directorate, Public Health Agency of Canada; 2009.
• [41]Mannheimer LN, Gulis G, Lehto J, Östlin P: Introducing Health Impact Assessment: an analysis of political and administrative intersectoral working methods. Eur J Pub Health 2007, 17(5):526-531.
• [42]WHO: World Health Report 2008: Primary health care - Now more than ever. Geneva: World Health Organization; 2008.
• [43]Lock K, Gabrijelcic-Blenkus M, Martuzzi M, Otorepec P, Kuhar A, Robertson A, Wallace P, Dora C, Maucec Zakotnic J: Conducting an HIA of the Effect of Accession to the European Union on National Agriculture and Food Policy in Slovenia. Environ Impact Assess Rev 2004, 24:2.
• [44]Lock K, McKee M: Health Impact Assessment: Assessing opportunities and barriers to intersectoral health improvement in an expanded European Union. J Epidemiol Community Health 2005, 59(5):356-360.
• [45]Puska P, Ståhl T: Health in All Policies - The Finnish Initiative: Background, principles and current issues. Annu Rev Public Health 2010, 31(1):315-328.
• [46]WHO: Ottawa Charter on Health Promotion. Geneva: World Health Organization; 1986.
• [47]Fell G, Haroon S: Learning from a Rapid Health Impact Assessment of a Proposed Maternity Service Reconfiguration in the English NHS. BMC Public Health 2008, 8:138. BioMed Central Full Text
• [48]Maxwell ML: A health impact assessment of the Liverpool Hospital redevelopment. N S W Public Health Bull 2007, 18(9–10):172-173.
• [49]Ali S, O’Callaghan V, Middleton JD, Little R: A Prospective Mini Health Impact Assessment of the ‘Towards 2010’ Programme in Sandwell and West Birmingham in the West Midlands. Public Health 2007, 121(6):469-481.
• [50]Simpson S, Mahoney M, Harris E, Aldrich R, Stewart-Williams J: Equity-Focused Health Impact Assessment: A tool to assist policy makers in addressing health inequalities. Environ Impact Assess Rev 2005, 25(7–8):772-782.
• [51]Douglas CH, Higgins A, Dabbs C, Walbank M: Health Impact Assessment for the Sustainable Futures of Salford. JECH 2004, 58:642-648.
• [52]Maxwell M, Harris P, Peters S, Thornell M, D’Souza L: A health impact assessment on the construction phase of a major hospital redevelopment. Aust Health Rev 2008, 32(3):509-519.
• [53]Harris-Roxas B, Harris E: Differing Forms, Differing Purposes: A Typology of Health Impact Assessment. Environ Impact Assess Rev 2011, 31(4):396-403.
• [54]NSW Health: NSW Health and Equity Statement: In All Fairness. Sydney: New South Wales Department of Health; 2004.
• [55]Harris-Roxas B, Harris P, Harris E, Kemp L: A Rapid Equity Focused Health Impact Assessment of a Policy Implementation Plan: An Australian case study and impact evaluation. Int J Equity Health 2011, 10:6. BioMed Central Full Text
• [56]Bond A, Pope J: The State of the Art of Impact Assessment in 2012. Impact Assessment Proj Appraisal 2012, 30(1):1-4.
• [57]Fehr R, Hurley F, Mekel OC, Mackenbach JP: Quantitative health impact assessment: Taking stock and moving forward. JECH 2012, 66(12):1088-1091.
• [58]Ali S, O’Callaghan V, Middleton JD, Little R: The challenges of evaluating a health impact assessment. Critical Public Health 2009, 19(2):171-180.
• [59]Bond A, Cashmore M, Cobb D, Lovell A, Taylor L: Evaluation in Impact Assessment Areas Other Than HIA. London: National Institute for Health and Clinical Excellence; 2005.
• [60]Cashmore M, Gwilliam R, Morgan R, Cobb D, Bond A: The Interminable Issue of Effectiveness: Substantive purposes, outcomes and research challenges in the advancement of environmental impact assessment theory. Impact Assessment Proj Appraisal 2004, 22(4):295-310.
• [61]UNEP: Environmental Impact Assessment Training Resource Manual. Geneva: United Nations Environment Program; 2002.
• [62]Weinstein MC, Skinner JA: Comparative Effectiveness and Health Care Spending — Implications for Reform. N Engl J Med 2010, 362(5):460-465.
• [63]Tamburrini A, Gilhuly K, Harris-Roxas B: Enhancing benefits in health impact assessment through stakeholder consultation. Impact Assessment Proj Appraisal 2011, 29(3):195-204.
• [64]Mathias K, Harris-Roxas B: Process and Impact Evaluation of the Greater Christchurch Urban Development Strategy Health Impact Assessment. BMC Public Health 2009, 9(1):97. BioMed Central Full Text
• [65]Parry JM, Kemm JR: Criteria for use in the evaluation of health impact assessments. Public Health 2005, 119(12):1122-1129.
• [66]Abdel Aziz M: Evaluation of the Finningley Airport Health Impact Assessment. Birmingham: 5th UK and Ireland Health Impact Assessment Conference; 2003.
• [67]Close N: Alconbury Airfield Development Health Impact Assessment Evaluation Report. Cambridge: Cambridgeshire Health Authority; 2001.
• [68]Wismar M, Blau J, Ernst K, Figueras J: The Effectiveness of Health Impact Assessment: Scope and limitations of supporting decision-making in Europe. Copenhagen: European Observatory on Health Systems and Policies, World Health Organization; 2007.
• [69]Blau J, Ernst K, Wismar M, Baro F, Blenkus MG, Von Bremen K, Fehr R, Gulis G, Kauppinen T, Mekel O, Nelimarkka K, Perttilä K, Scagnetti N, Sprenger M, Stegeman I, Welteke R: The use of HIA across Europe. In The Effectiveness of Health Impact Assessment: Scope and limitations of supporting decision-making in Europe. Edited by Wismar M, Blau J, Ernst K, Figueras J. Copenhagen, Denmark: World Health Organization Regional Office for Europe, on behalf of the European Observatory on Health Systems and Policies; 2007:37-55.
• [70]Wismar M: The Effectiveness of Health Impact Assessment. Eurohealth 2004, 10(3–4):41-43.
• [71]Molnár Á, Ádám B, Antova T, Bosak L, Dimitrov P, Mileva H, Pekarcikova J, Zurlyte I, Gulis G, Ádány R, Kósa K: Health impact assessment of Roma housing policies in Central and Eastern Europe: A comparative analysis. Environ Impact Assess Rev 2012, 33(1):7-14.
• [72]Ward M: Health Impact Assessment in New Zealand: Experience at a policy level. Wellington: Public Health Advisory Committee; 2006.
• [73]O’Mullane M, Quinlivan A: Health Impact Assessment (HIA) in Ireland and the role of local government. Environ Impact Assess Rev 2012, 32(1):181-186.
• [74]Harris-Roxas B, Harris E: The Impact and Effectiveness of Health Impact Assessment: A conceptual framework. Environ Impact Assess Rev 2013, 42:51-59.
• [75]Kraemer SR, Gulis G: How do experts define relevance criteria when initiating Health Impact Assessments of national policies? Scand J Public Health 2014, 42(1):18-24.
• [76]Dannenberg AL, Bhatia R, Cole BL, Heaton SK, Feldman JD, Rutt CD: Use of Health Impact Assessment in the US: 27 Case Studies, 1999–2007. Am J Prev Med 2008, 34(3):241-256.
• [77]Cunningham R, Signal L, Bowers S: Evaluating Health Impact Assessments in New Zealand. Wellington: New Zealand Ministry of Health; 2011.
• [78]Bekker M: The Politics of Healthy Policies: Redesigning health impact assessment to to integrate health in public policy. Delft: Eburon Uitgeverij B.V.; 2007.
• [79]Lester C, Griffiths S, Smith K, Lowe G: Priority Setting with Health Inequality Impact Assessment. Public Health 2001, 115(4):272-276.
• [80]Foley M: Future arrangements for governance of NSW Health: Report of the Director-General. Sydney: NSW Health; 2011.
• [81]DOHA: About National Health Reform. Canberra: Australian Government Department of Health and Ageing; 2012. https://www.coag.gov.au/health_and_ageing webcite
• [82]Kingdom J: Agendas, Alternatives and Public Policies. 2nd edition. New York: Addison, Wesley, Longman; 1995.
• [83]Edward N: The Triumph of Hope Over Experience. London: NHS Confederation; 2011.
• [84]Braithwaite J, Westbrook J, Iedema R: Restructuring as gratification. J R Soc Med 2005, 98(12):542-544.
• [85]Morgan D, Astolfi R: Health Spending Growth at Zero: Which countries, which sectors are most affected? OECD Health Working Papers No. 60. Paris: Organisation for Economic Cooperation and Development; 2012.
• [86]Thorne S: Interpretive Description. Walnut Creek, California: Left Coast Press; 2008.
• [87]Thorne S, Kirkham SR, O’Flynn-Magee K: The Analytic Challenge in Interpretive Description. Int J Qual Methods 2004, 3:1.
• [88]Yin RK: Case Study Research: Design and Methods. 3rd edition. Thousand Oaks: Sage; 2002.
• [89]Shadish W, Cook T, Campbell D: Experimental and quasi-experimental designs for generalized causal inference. Boston: Houghton Mifflin Company; 2002.
• [90]Barbour R: Checklists for improving rigour in qualitative research: a case of the tail wagging the dog? BMJ 2001, 322(7294):1115-1117.
• [91]Tongco M: Purposive sampling as a tool for informant selection. Ethnobotany Res Appl 2007, 5:147-158.
• [92]Tong A, Sainsbury P, Craig J: Consolidated Criteria for Reporting Qualitative Research (COREQ): A 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007, 19(6):349-357.
• [93]Clark J: How to peer review a qualitative manuscript. In Peer Review in Health Sciences. Edited by Godlee F, Jefferson T. London: BMJ Books; 2003:219-235.
• [94]QSR: NVivo. 9th edition. Melbourne: QSR International; 2012.
• [95]Richards L: Handling Qualitative Data: A practical guide. London: Sage; 2005.
• [96]Boeije H: A purposeful approach to the constant comparative method in the analysis of qualitative interviews. Qual Quant 2002, 36(4):391-409.
• [97]Rapley T: Exploring Documents. In Doing Conversation, Discourse and Document Analysis. Edited by Rapley T. London: Sage; 2007:111-124.
• [98]Holliday A: Doing and writing qualitative research. Mountain View, California: Sage Publications; 2007.
• [99]Sandelowski M: Using Qualitative Research. Qual Health Res 2004, 14(10):1366-1386.
• [100]Bazeley P: Qualitative Data Analysis with NVivo. London: Sage; 2007.
• [101]Poland B, Krupa G, McCall D: Settings for Health Promotion: An Analytic Framework to Guide Intervention Design and Implementation. Health Promot Pract 2009, 10(4):505-516.
• [102]HIA Blog: Good for Kids. Good for Life Equity Focused HIA Wins Minister’s Award for Aboriginal Health. Sydney: International Association for Impact Assessment Health Section; http://healthimpactassessment.blogspot.com.au/2008/07/good-for-kids-good-for-life-equity.html webcite
• [103]Abbott T: Media Release: Better Health For All Australians. In Edited by Ageing MfHa. 2006.
• [104]NSW Health: Aboriginal Health Impact Statement and Guidelines: Incorporating Aboriginal health needs and interests in health policies and programs. Sydney: NSW Health; 2003.
• [105]Signal L, Soeberg M, Quigley R: Health impact assessment in local government: A New Zealand case study. In Integrating Health Impact Assessment into the Policy Process: Lessons and Experiences from around the World. 1st edition. Edited by O’Mullane M. Oxford: Oxford University Press; 2013:109-118.
• [106]Glasbergen P, Biermann F, Mol APJ: Partnerships, Governance and Sustainable Development: Reflections on theory and practice. Cheltenham UK: Edward Elgar; 2007.
• [107]Glasbergen P: Learning to Manage the Environment. In Democracy and the Environment: Problems and Prospects. Edited by Lafferty W, Meadowcroft J. Cheltenham: Edward Elgar; 1999:175-193.
• [108]Farris R, Will J, Khavjou O, Finkelstein E: Beyond Effectiveness: Evaluating the Public Health Impact of the WISEWOMAN Program. Am J Public Health 2007, 97(4):641-647.
• [109]Pencheon D: Oxford handbook of public health practice. Oxford: Oxford University Press; 2001.
• [110]Harris E, Harris-Roxas B, Harris P, Kemp L: “Learning by Doing”: Building Workforce Capacity to undertake HIA - An Australian case study. In Integrating Health Impact Assessment into the Policy Process: Lessons and Experiences from around the World. Edited by O’Mullane M. Oxford: Oxford University Press; 2013. accepted, in press
• [111]Haigh F, Harris E, Ng Chok H, Baum F, Harris-Roxas B, Kemp L, Spickett J, Keleher H, Morgan R, Harris M, Wendel A, Dannenberg A: Characteristics of health impact assessments reported in Australia and New Zealand 2005–2009. Aust N Z J Public Health 2013, 37(6):534-546.
• [112]Orrell D: The Future of Everything: The science of prediction. New York: Basic Books; 2007.
• [113]Fiorino DJ: Environmental Policy As Learning: A new view of an old landscape. Public Adm Rev 2001, 61(3):322-334.
• [114]Muro M, Jeffrey P: A Critical Review of the Theory and Application of Social Learning in Participatory Natural Resource Management Processes. J Environ Plan Manag 2008, 51(3):325-344.
• [115]Harris E, Harris-Roxas B: Health in All Policies: A pathway for thinking about our broader societal goals. Public Health Bulletin South Australia 2010, 7(2):43-46.