JK PUBLIC HEALTH CONSULTING

HIA as an intersectoral governance structure

John KemmGranada

15/4/2011

JK PUBLIC HEALTH CONSULTING

The problem

• HIA or a similar process is essential if HIAP is to be a reality.

• HIA has the potential to support policy consistency in government

• Very few governments make much use of HIA in policy making.

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Why is HIA not used?

Demand barriers• Health unimportant• Health not business

of our department• Unaware of HIA• Don’ t believe HIA

can help

Supply barriers• Lack of leadership• Too busy (impact

assessment fatigue)• Lack knowledge of

health and HIA• Lack of support

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Ken ClarkeMinister of Health 1982-85On evaluation of NHS reforms

“I do not want academics crawling all over my reforms”

Cited in Robinson R Introduction to Evaluating the NHS reforms King’s Fund 1994

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Overcoming demand barriers

• Public commitment• Recognise health is only one of many issues• Leadership from government centre

- not department of health • Briefing ministers and civil servants on health• Briefing ministers and civil servants on HIA

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What about making HIA legally required ?

• Legislation only works when generally accepted.

• Danger of tokenism• Need to ensure understanding, support and

capacity in place before legislation.

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Supply barriers

Who will undertake HIA?• Civil servants in department originating policy–May not be sufficiently independent

• Bodies commissioned outside government–May not sufficiently understand policy

context

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Reducing the work load

• Integrated impact assessment• Parallel impact assessment and policy

development• HIA support units and easily available (?

online) guidance

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Integrated Impact Assessment

FOR• Efficient use of time• Reduces bureaucratic

work load• Balances different

policy objectives• Opportunity for trading

and alliances

AGAINST• Risk of tick-box exercise• Inadequate coverage of

any issue

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JK PUBLIC HEALTH CONSULTING

Parallel HIA & Policy makingPropose Options

Consider Health Impacts

Revise Options

Finalise Options

HIA

Make Decision

Propose and finalise Options

Assess options with HIA

Consider HIA

Make Decision

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Quality assurance of HIA

• Procedural checklists• Peer review• Ministerial sign-off• Public scrutiny

• Judicial review• Accreditation

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http://www.ialibrary.berr.gov.uk/

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Ten Steps to increase use of HIA• Make public commitment• Identify senior figure to lead • Require use of HIA (?legislation)• Train civil servants to understand health & HIA• Establish HIA support unit• Ensure consultation can inform HIA• Cooordinate health with other impact assessments• Make considering health part of policy development• Decide for each policy if HIA is required• Require minister to publish HIA