Plenary 4Chair: Alex Scott-Samuel

Health Impact Assessment: Making the Difference

Beverlea Frowen

Head of Health, Social Care and Well Being, Welsh Local Government Association

Health Impact Assessment: Making the Difference

Beverlea Frowen

DirectorSocial Services and Health Improvement

The Dragon’s Health: Breathing new life

Welsh Reflections on Healthy Public Policy

• Policy landscape• Key Drivers for Health Improvement• What Local Government is doing• Opportunities for the future

Policy Landscape

1.Twin Track approach- strong recognition of the value of ‘prevention’ and Local Governments role

2.Statutory duty to co-operate between NHS and LG

3.Public Sector collaboration not competition

Where has local government has come from..

Punch, 1852

• Wales: A Better Country

−“health & wealth creation at the heart of policy making”

• Health Challenge Wales

−Themes AND ‘any/every thing’ else

• Health, Social Care & Well-being Strategies

−Rebalancing prevention/promotion and treatment/care

• WLGA Approach

−Principles for health improvement and a support team

Policy & Structures at work…

Key actions progressing the agenda

• A new language for local government- creating the right environment

• Making the agenda more manageable

• Dedicated Health & Well-being Team

• Jointly launched HIA guidance in Nov ‘04

• Route to Health Improvement – May ‘06

The Route to Health Improvement

An organisational development package based on Five Key Features of a Health Improving Council

Health improvement is an integral part of all Council’s activity

1. Corporate Culture

2. Policy Development supports the core commitment to improve health

3. Collaboration brings added value to the

health improvement effort

4. Capacity totake forward theagenda is strengthened

5. Governance andPerformance Management

ensures healthy public policy

Keeping it simple – a new language

Life Circumstance

s

LifestyleShared Care

Improving & safeguarding the health of the most vulnerable people in society

Tackling the economic, social & environmental issues that impact on well-being

Encouraging & supporting

healthy attitudes and behaviour

Source: WLGA Route to Health Improvement.

HIA in ‘The Route toHealth Improvement’

“Health Impact Assessment…is used appropriately as part of

policy and decision making processes and in doing so builds partnerships

and fosters greater awareness of the collective impact of our actions”

Making linkages and learning

• Electronic database of notable practice• Self assessment framework and matrix of

three thresholds of status• Spearhead sites (building on learning zone

concept)• Stronger links to community planning• International network of collaborative

effort??

Three levels of preparedness

• Capacity - Leading the way..

• Members use community leadership role to drive health improvement

• Workforce and development planning focuses on health improvement

• Employees across the organisation have the appropriate knowledge, skills & attitudes for health improvement

-‘We don’t do health’

Three levels of preparedness

• Capacity – Getting there..• Awareness growing of potential to use

community leadership role

• Some employees in key positions understand the issues

• Health improvement is a side issue amongst roles and responsibilities and work force recruitment

Three levels of preparedness

• Capacity – Starting out..

• The community leadership role and community planning needs further development

• Health not a feature of organisational ‘psyche’

• Dominance of NHS to lead agenda

Where next for healthy public policy in Wales?

Councils acknowledged by all as health improvement agencies and in doing

so they are maximising the full potential of their roles and

resources

In the horizon

• Beecham Review

• Local Government white paper

• Changing relationships betweenCentral and Local Government

• NHS secondary care reforms

• New Funding regimes

The following have the potential to enhance our efforts or put the skids on some of it!

A final observation…

“inequalities in health are the most fundamental inequalities of all there is no greater inequality than being dead and being alive” Frank Dobson

Thank you for listening have a good second day and good luck with your efforts!

beverlea.frowen@wlga.gov.uk

Beverlea FrowenDirector,

Social Services & Health Improvement

Mary Mahoney

Senior Lecturer and Coordinator, Deakin University, Australia

Health Impact Assessment: Making the Difference

‘When all the ducks line up’ Healthy Public Policy in Victoria

Mary Mahoney, Coordinator

This presentation will…

Map the territory – healthy public policy in

Victoria and the role of HIA

Introduce the context specific drivers for HIA

Model the attributes for ‘sustainable HIA’

Explore the threats to ‘the ducks’

Mapping – the political scene

3 levels of government - federal, state and local each with differing responsibilities

Each state and territory differs so it is not possible to generalise between states

Federal government is liberal (i.e. conservative), and all states are Labor

Local government in Victoria - amalgamations in 1993 moving from 210 to 79

Mapping – Origins of Impact Assessment

Project-focused Impact Assessment Prediction of impacts of a proposed development on the environment with social and health IA as integral processes

Origins: EIA → SIA → EHIA → Policy applications

Strategic planning and policy makingTypes: PIA + SEA + (P)HIA

Discrete applications IA types used for different purposes and driven by different needs in each context

Examples: SIA in LG

Mapping - Victorian policy context

State government level: All government agendas must reflect the Triple

Bottom Line principles of economic, environmental, social accountability

Whole of government focus on spatial disadvantage and health inequalities through Neighbourhood Renewal program

Increased emphasis on the social through A Fairer Victoria framework and the new state government Department of Victorian Communities.

Mapping - Victorian policy context

State level legislative requirement The Environment Effects Act (1978) for

the Department of Human Services to review all Works Approvals to ensure that public health is not endangered by any proposal. If DHS objects to the application Environment Protection Agency must refuse the application.

Mapping - Victorian policy context

Local government level: Health Act (1958) legislated a requirement for all

council to produce Municipal Public Health Plans (MPHP)

Local Government Act (2003) requires Council Plans to be prepared focused on the quality, sustainability, prosperity

Planning and Environment Act 1987 requires Municipal Strategic Statements linked to objectives for land use and development

Mapping - Supportive partnerships

Key partnerships between Government departments e.g. housing, public health,

infrastructure, sustainability and environment VicHealth Planning Institute of Australia (PIA) Municipal Association (MAV) Local government association (VLGA) Heart Foundation Cancer Council Victorian Council of Social Services

Mapping – supportive frameworks

Environments for Health Planning Framework - A practical guide to assist in the integration of

public health considerations into council’s broader planning responsibilities

Underpinned by principles of leading communities to better health and environmental dimensions of health i.e. built, social, economic and natural environments

Mapping – supportive frameworks

Other examples Leading the Way

introducing the social model of health to councillors Healthy by Design

resource for planners for designing liveable and healthy communities

VicLanes resource for LG on people’s health promoting behaviour by

location Safer by Design Guidelines

planning and design of safer communities Good practice funding

to support elements of MPHPs

Mapping - Implications for HIA

Status quo +: enhancing HIA in EIA but adding a specific HIA protocol developed and assessed by health sector

Checklist approach: specialist HIA using equity audits, RIS approaches and rapid appraisals

Strategic placement of HIA in decision-making: high level applications across government

Combined approaches: incorporating A, B & C Human or Sustainability: new whole of government

application with multiple methodologies (Source: HIA Forum, Melbourne, 2002)

Drivers for HIA – important features

In seeking to introduce HIA it was important to exploit all opportunities for formal mechanisms to

address the role of health in development argue for legislative status capitalise on existing strengths within the system build on existing goodwill, informal networks,

champions, community concerns, and changes occurring

develop a common agreement about language build on current guidelines to produce comprehensive,

well supported processes for all to use urge for improved access to evidence

Context specific drivers for HIA

Ranging from formal to less formal including: the need to comply with formally-required

processes the growing imperative to take health into

account in planning a growing awareness of the complexity of the

problems and the need for diverse solutions the growing awareness of the need to work

together Awareness of gaps within existing approaches

Context specific drivers cont’d

Comparisons between councils/departments Innovative practices emerging from within

government which provided examples for others

Availability of resources to support and encourage change (and dissemination)

Publicity about the potential role of HIA (timely, accessible, relevant and flexible)

Impetus to regenerate other forms of HIA in the light of new enthusiasm about its use in policy contexts

Progress in Victoria

Ministerial push for expanding HIA in Review of Health Act

Inclusion in further roll out of Neighbourhood Renewal programs

Funding for capacity building and demonstration projects across the state

Use in non-health sector and health care services

Integrated options under discussion Funded positions within government ‘Grass roots’ interest and commitment

Attributes for an effective and sustained use of HIA in HPP

Supportive agendas of government √

Appropriate organisational structures √

Realistic legislative requirements √

Enabling planning frameworks √

Willingness to adopt a social model of health √

Preparedness to adopt innovative approaches to planning √

Commitment by professionals to principles of HPP √

Desire to create a different future for the population through flexible policy and planning processes

√

Opportunities for intersectoral working across government √

In the Victorian context

It has been crucial to blend top-down support with bottom-up impetus, capacity building and driving

It has been less important to have legislative requirements than grass roots acceptance of the need for HIA and the value it can bring to current working practices

Threats to the ducks

HIA turning into a passing fad HIA seen as panacea delivering more than it can Unrealistic expectations about how quickly a new

process can be introduced HIA as an idea not an action Change of focus of the state government

With thanks …

for the chance to tell this story and close the loop to the key people who have guided our development to the people who have made available key papers,

and reports or developed websites which have permitted a sharing of knowledge

for the collegiality within the HIA network

So overall what does the Victorian situation actually look like?