Health Impact Assessment: An Overview of the Process

1. Health Impact Assessment: An Overview of the Process Rajiv Bhatia, MD, MPH San Francisco Department of Public Health

2. The “Typical” HIA Process Methods Rajiv Bhatia, MD, MPH Alaska Health Impact Assessment Training 2008

3. The Actual Approach to HIA Will Vary • Voluntary vs. Regulatory • Independent vs. Integrated HIA/EIA/SIA • Expert-driven vs. Participatory • State of Evidence & Methodology • Timeframe • Resources Rajiv Bhatia, MD, MPH Alaska Health Impact Assessment Training 2008

4. Screening: Establishing the Need for and Value of an HIA • Screening is a critical first step to ensure the relevance of HIA • For a screening, one must: • Understand regulatory requirements for HIA • Identify potential impacts about the decision and alternatives on health • Decide whether a HIA is feasible, timely, and provides added value. • Evaluate the “openness” of the decision making process • Identify users and uses for the HIA Rajiv Bhatia, MD, MPH Alaska Health Impact Assessment Training 2008

5. Scoping: Creating a Work plan for the HIA • Decision alternatives subject to analysis; • Geographical & temporal boundaries; • Populations and Subgroups; • Health issues and impacts; • Research questions & analytic methods; • Timeframe and resources; • Roles of researchers and stakeholders Rajiv Bhatia, MD, MPH Alaska Health Impact Assessment Training 2008

6. Assessment: Analyzing and Judging Impacts • Profile health and health conditions in an affected population and place • Review existing research and evidence • Collect and analyze data (e.g., surveys) • Apply quantitative or qualitative forecasting methods • Make judgments about health impacts and their significance • Identify feasible mitigations and alternatives Rajiv Bhatia, MD, MPH Alaska Health Impact Assessment Training 2008

7. Tips for Assessment • Many research methods are on the shelf • Impact predictions are informed judgments • It is not always possible or necessary to quantify effects • Use complimentary approaches • Be cautious with generalizations • Acknowledge uncertainties • Consider consensus approaches • Researchers have biases - solicit critiques of findings • Identify research needs Rajiv Bhatia, MD, MPH Alaska Health Impact Assessment Training 2008

8. What is a Significant Impact • Criteria for Significance • Intensity (magnitude, rate of change) • Spatial and temporal extent • Cumulative impact • Distributional impact • Degree of Certainty • Reversibility / permanence • Ability to mitigate Rajiv Bhatia, MD, MPH Alaska Health Impact Assessment Training 2008

9. Developing Significance Criteria • Significant broadly means unacceptable • Not all Significance Criteria will be Legal standards • Good Significance Criteria : • Involve an explicit and transparent process • Are logical and supported by evidence • Consider trade-offs • Consider context • Consider equity Rajiv Bhatia, MD, MPH Alaska Health Impact Assessment Training 2008

10. Reporting: Getting the word out • A written HIA report usually forms the basis of communications • Regulations and the decision-making process may direct of inform communication needs and format • Elements of a communication plan • Key messages • Audiences (stakeholders, decision-makers, communicators) • Media (letters, reports, fact sheets, press releases) Rajiv Bhatia, MD, MPH Alaska Health Impact Assessment Training 2008

11. Tips for Reporting • Prioritize findings and recommendations into clear succinct messages • Develop communication materials for advocates, opinion leaders, and the media • Good public participation is the key to effective translation Rajiv Bhatia, MD, MPH Alaska Health Impact Assessment Training 2008

12. Tasks in Monitoring: Tracking the Outcomes of Decisions • Define outcomes, indicators, and methods for long term monitoring • Identify a lead individual or organization to conduct monitoring • Commit resources to monitoring • Decide how to report monitoring outcomes to decision makers and HIA stakeholders Rajiv Bhatia, MD, MPH Alaska Health Impact Assessment Training 2008

13. Monitoring in Impact Assessment: Usually Unfinished Business • Monitoring supports adaptive management • Monitoring can validate HIA methods and provide data for future HIAs • Monitoring can serve “watchdog” duties on decision agreements and mitigations • Experience with HIA monitoring is limited • Monitoring impacts on health outcomes in the short term is unrealistic Rajiv Bhatia, MD, MPH Alaska Health Impact Assessment Training 2008