December 2003
Healthy communities matter

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EHJ December 2003, pages 368-370

Health impact assessment is being used as a tool in the regeneration of Liverpool through improved services and more responsive service delivery. EHJ talks to Rob Faulkner about the initiative

Health impact assessment (HIA) has been defined in many different ways by many different people. While each of the numerous definitions are similar, there is, according to the World Health Organisation (WHO), no one "correct definition". Rather, differences occur through the emphasis given to particular components of the approach to HIA. The WHO defines HIA as "a combination of procedures, methods and tools by which a policy or project may be judged as to its potential effects on the health of a population and the distribution of those effects within the population".1

While HIA is a relatively new approach to the evaluation of public policy, in recent years various initiatives have pressed the importance of developing HIA as a tool across the UK. A number of national policies and programmes have endorsed HIA, including:

  • the NHS plan;
  • New Deal for Communities; and
  • Saving lives - our healthier nation.

At local level, HIA has a potential contribution to make to a wide range of initiatives, including:2

  • neighbourhood renewal;
  • community strategies;
  • local and regional transport and land use plans;
  • health improvement and modernisation plans;
  • integrated pollution prevention control regulations;
  • regeneration initiatives; and
  • the new power for councils to promote the wellbeing of communities.

Much of the focus locally for HIA is undoubtedly in urban regeneration or renewal initiatives designed to tackle inequality and social exclusion. In Liverpool, the environmental health and trading standards service is leading the way with its commitment to help guide and support the introduction of HIA across 20 service areas in Liverpool City Council's regeneration portfolio.

Andy Hull, head of service for environmental health and trading standards, and Rob Faulkner, principal environmental health officer, have between them devised a practical tool that will help steer these individual service areas in the right direction. As Mr Hull points out, "this is about changing culture, moving away from the traditional way of delivering services and scrutinising the delivery of each service".

The hardest part in any attempt at culture change is getting the co-operation of those who will be affected by that change. HIA is not an easy concept to understand and initial reactions usually involve the asking of questions such as: "What is in it for me?" or "What are the resource implications?". As Mr Faulkner says, "it is about identifying evidenced-based recommendations that help a service to redesign or develop its operational activities/programmes or policies, so that positive health impacts are maximised and negative impacts on health, wellbeing and inequalities are minimised".

With these thoughts in mind, Mr Faulkner and Mr Hull together considered all the available options and decided that a rapid assessment approach was the best way to get people involved and thinking about the concept of health when devising strategies for the delivery of existing or new innovative services. "The rapid assessment method involves minimal time and resource implications for the individual service areas and in terms of self-commitment to the process, time could be allocated to supporting the change," proclaims Mr Faulkner.

The rapid assessment tool consists of a high quality, eight- page brochure, which has been supported in its development by the Liverpool Central Primary Care Trust and the Liverpool Public Health Observatory, a covering letter and a simple six-step questionnaire aimed at helping to guide a service area through the process. The HIA brochure is written in an accessible style and is the result of hours of research that aims to answer fundamental questions such as: "Why should I get involved?"; "What are the benefits for me?"; and "What is its purpose?".

"Achieving 'buy in' is critical to the process," says Mr Faulkner, "and to help reach the goal that all 20 service areas carry out a rapid health impact assessment." Both officers have teamed up with the regeneration portfolio business management unit and Liverpool Central Primary Care Trust to offer a fully committed advice and guidance service.

It is intended that there will be a phased three-tier approach. Services will be required to identify three key operational activities, policies or programmes, the first of which will be assessed for health impacts by the environmental health department and the primary care trusts. The second choice will be a hands-on assessment in partnership with the individual service area. Finally, the third operational activities/policies or programmes chosen will be assessed by the management team of the individual service area.

It is hoped that by the time the third assessment is completed each individual service area will begin to consider other areas of service delivery that may benefit from a health impact assessment. "This is not intended to be a quick fix short-term process," continues Mr Faulkner. "There is commitment from the city council and primary care trust to long-term planning and to ensuring health impact assessment becomes embedded into the business planning processes of all environmental services."

The public health section of Liverpool University has recently shown an interest in working in partnership with Liverpool CC on this project. "They have secured funding for a two and a half year programme to promote HIA," explains Mr Faulkner. "Part of their role will be to offer free training sessions to business managers as part of the learning process and hopefully this will help link the concept of HIA to the practical tool that has been developed."

References

  1. European Centre for Health Policy, WHO Regional Office for Europe (1999) Health impact assessment: main concepts and suggested approach. Brussels: WHO.
  2. Health Development Agency, Why use health impact assessment?, http://www.hiagateway.org.uk

For further information on the work being done in Liverpool, contact Rob Faulkner, principal environmental health officer, Liverpool environmental health and trading standards, 1st Floor, Kingsway House, Hatton Garden, Liverpool, L69 3DY. Tel: 0151 225 4707, Fax: 0151 225 4024 or email: Rob.Faulkner@liverpool.gov.uk

Copies of the rapid assessment tool brochure are available from Rob Faulkner on tel: 0151 225 4707.

What they say...

"Environmental health practitioners have a major role to play in improving the nations health and reducing health inequalities alongside NHS professionals." Professor Liam Donaldson, chief medical officer (2001)

"The way change is managed and the appropriateness of the approach adopted, are likely to have major implications for the way people experience change and their perceptions of the outcomes. It is therefore important to show strong leadership and commitment to the change process and develop a change plan that ensures change will be fully effected." Bernard Burns (2000)

"Environmental health is seen as playing a key role in local authority community health and wellbeing strategies and actively contributing to the public health agenda of NHS primary care trusts." Gray et al (2002)

 

What the Government says...

"We need to ensure that in all areas of government policy making the actions that flow from our policies will contribute to our goals of improving the health of the population and reducing inequality. So we have decided that major new government policies should be assessed for their impact on health. The assessment process is important because it acknowledges for the first time the relationship between health and the impact of government policy generally. We intend to make health impact assessment a part of the routine practice of policy making in government."

The white paper, Saving lives - our healthier nation (1999)

"There is increasing national and international recognition of health impact assessment (HIA) as a valuable tool to support efforts to improve health and reduce health inequalities. The Government is committed to promoting HIA at national, regional and local levels to inform development of policy, strategy, programmes and projects. HIA also fits well with the Government's approaches to support and encourage wider involvement and engagement of multi-sector partners and communities, and to ensure that decisions are informed by the best available evidence."

http://www.sustainable-development.gov.uk/sdig/integrating/04.htm