Strengthening health, wellbeing and equity: embedding policy-level HIA in New Zealand.

• Author: Signal, Louise
• Position: Health impact assessment

Abstract

Policy-level health impact assessment (HIA) is a formal approach for assessing the impact of policies on health, wellbeing and equity. HIA is used by policymakers across government and by those who may be affected by policy. This paper outlines efforts to embed HIA in New Zealand, including development of an HIA guide for New Zealand, training to support its use and the promotion of HIA to key government agencies. It briefly presents three New Zealand HIA case studies. The paper reviews the uptake of HIA in New Zealand and identifies a range of factors (including awareness of the role and potential value of HIA, training in HIA, access to HIA expertise, political and managerial support for HIA, resourcing and statutory recognition) that influence whether agencies undertake HIA. The paper then discusses the future of HIA in New Zealand, identifying the need for legislation to encourage HIA, the value of embedding HIA in policy processes and the importance of a dedicated HIA support unit. The paper concludes that considerable progress has been made at this initial stage of embedding HIA and that the approach has an important contribution to make in strengthening health, wellbeing and equity in policymaking in New Zealand.

INTRODUCTION

Policy agencies are increasingly recognising the influence their policies may have on the health and wellbeing of the population, and the impacts of the interaction of these policies with those of other sectors. The complex nature of these interactions makes it clear that a collective response is needed to ensure health improvement and a reduction of health inequalities. New ways of working across sectors are needed to find solutions, with new tools to assist the process. Health impact assessment (HIA) is one such tool, which is based on the recognition that the health and wellbeing of people and communities are greatly influenced by factors that lie outside the health sector, in areas such as housing, employment or urban design. It is a tool that can be applied at the "project" level (e.g. when a new road is being built in a particular community), but this paper focuses on the policy level (e.g. urban design, housing assistance policy, environmental policy).

Policy-level HIA provides formal tools to assess the impact of policies on health, wellbeing and equity. HIA can be used by policymakers in central, regional and local government in areas such as housing, urban planning and employment; by health policymakers; and by those who may be affected by policy. A New Zealand model for HIA has been developed and training is available. Policy-level HIAs have been undertaken in New Zealand with very positive results. This paper outlines efforts to embed HIA in New Zealand. It presents three New Zealand case studies, discusses the effect of HIA on policymaking and concludes with consideration of the future of HIA in New Zealand.

HIA DEFINED

HIA is a practical way to ensure that health, wellbeing and equity are considered as part of policy development in all sectors. It is defined as "a combination of procedures, methods and tools by which a policy, program 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 (European Centre for Health Policy 1999). It helps facilitate policymaking that is based on evidence and focused on outcomes, and encourages collaboration between a range of sectors and stakeholders. It is best undertaken when there are policy alternatives being considered and before commitment has been made (see Figure 1). However, it can be undertaken or revisited when revising or evaluating policy.

[FIGURE 1 OMITTED]

In theory, good policy analysis should consider all the relevant beneficial or adverse effects of policy options, both direct and indirect. In practice, however, the impacts of policies on health, wellbeing and equity are often not explicitly or even implicitly considered by sectors outside health, and certainly not in any formalised way. HIA enables these sectors to consider the wider impact of their policy on health, wellbeing and equity. It provides a systematic way to consider impacts, something not always possible in the typically pressured context of policymaking. This in turn promotes greater transparency in policymaking (Signal and Durham 2000). Policy HIA takes place in a complex political and administrative environment. It is not intended to make health, wellbeing and equity considerations paramount over other concerns; merely to raise their profile on the policy agenda.

THE STRATEGY OF EMBEDDING HIA

There has been a deliberate strategy to embed policy-level HIA in New Zealand. A number of factors have been important in getting policy-level HIA onto the policy agenda. Key among these were advice to the Minister of Health from the National Health Committee about the value of HIA (National Health Committee 1998), the support of a new government for HIA, and specific government policy regarding HIA. In 2000 The New Zealand Health Strategy, the overarching strategy for health in New Zealand, included as its first objective to "assess public policies for their impact on health and health inequalities" (Minister of Health 2000).

In 2004 the Public Health Advisory Committee (PHAC), a sub-committee of the National Health Committee, published A Guide to Health Impact Assessment: A Policy Tool for New Zealand (Public Health Advisory Committee 2004) to facilitate policy-level HIA in New Zealand. It was developed with the support of the PHAC secretariat, an external advisory group and international peer reviewers. The guide was drafted and then trialled on two case studies, one an HIA of a review of public transport funding policy and the other on the patenting of human DNA. It was modified as a result of these trials and launched in March 2004 at an HIA symposium. The guide has since been revised based on feedback from users and comments received by people attending HIA training (Public Health Advisory Committee 2005).

At the request of the Minister of Health at that time, PHAC promoted HIA in central and local government. At the central government level, PHAC has funded HIA seminars and screening workshops within agencies. Where these took place outside the health sector, the focus was on increasing the agencies' understanding of the wider determinants of health, often by selecting policies currently under development to screen their impact on health, and by making explicit links between the policies of the agency and health outcomes. In some cases, links were made with legislative responsibilities of the agency, showing how HIA could assist in meeting their responsibilities; for example, public health requirements of the New Zealand Land Transport Act 2003. Seminars and screening workshops that have taken place in the health sector focused on the methodology, the entry points for HIA in other agencies and "hands-on" practical examples.

Promotion to local authorities was largely in response to requests for assistance, often as a result of local government and public health unit attendance at HIA training workshops. However, a close relationship was developed with Local Government New Zealand, which provided an avenue for contact with local authorities. It...