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Health Impact Assessments can be carried out on
policies, programs, and specific projects. These may be at a national,
regional, district or a very local level. They can be carried out for
a number of reasons, for example, to appraise a number of options, to
lobby for particular outcomes, to bring decision makers and/or users together,
and to develop an evidence base.
HIA's can also take place at different times:
- as part of the project or policy development process. These are prospective
assessments, carried out before significant decisions and actions
have been taken on a policy or project and designed to ensure that positive
health impacts are maximised and negative impacts minimised.·
- whilst a policy, programme or project is being implemented. Concurrent
assessments can provide an opportunity to "tweak"
the operation and delivery of a program, policy or project to enhance
health outcomes and to generate data and evidence that might not be
available once the activity has ended.
- after a programme or project has been completed. A retrospective
assessment can be used to calculate benefits against spend
and inform the development of future plans and programs.
In addition to time, HIA's can also vary by the
scale of resources available. Resources can include evidence, skills,
information, expertise, funding, and time.
- A rapid assessment can be done in half a day by
a group of informed people using their judgement. Any evidence used
will be from existing sources, such as local authority and health statistics
or local evaluations and from the experiences of those making the assessment.
Information will be needed on which groups of people are being targeted
for the assessment (young, old, ethnic minorities, men between 50 and
65 etc) and on the design and operation of the policy, program or project
being assessed. A rapid HIA can “score” a number of options
for their health impact and help to identify gaps and ways to improve
health outcomes at little cost. One of the outcomes of rapid appraisal
may be recognition of the need for a more substantial assessment.
- An intermediate assessment uses readily accessible
and routinely collected data but can also involve a literature search
for appropriate evidence and indicators. This work may be combined with
a workshop for interested parties that uses and/or sets the specification
for the data collected.
- A comprehensive assessment tends to require the
collection of new data, significant involvement and consultation with
a wide range of stakeholders, systematic reviews of existing evidence
and secondary analysis of existing data. “Control” populations
may also be used. The process can take several months, require specialist
skills, and demand significant resources.
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