HIA is based on the theory of health determinants, which recognizes that well-being is determined by a wide range of economic, social and environmental factors, by heredity and medical intervention. The intended HIA procedure represents a new approach to the evaluation of all cantonal policies in order to assess their potential health impacts and to improve the quality of governmental decisions, through recommendations to enhance predicted positive health impacts and minimize negative ones.
Issue and description of the problem Ticino is one of the twenty-six Cantons of the Swiss Confederation and is located in the southernmost part of the country. Ticino covers an area of 2812 km2 and almost 350'000 people live in this region. The mission of the Ticino health service is promoting health and prevention of noncommunicable disease among the population, particularly on four main topics: physical activity, alcohol abuse, smoking and overweight. However, the small size of the area and the consequent limited availability of resources pose several challenges. Firstly there is an issue in terms of the representativeness of the data but equally there are difficulties in terms of the effectiveness of the decision-making process. Intervention In order to seek to improve both these aspects, a framework encompassing the whole process from data collection to visualization is under development. It is anticipated that this will improve the capability to provide a reliable representation of the region's health data and issues together with a set of relevant tools to assist decision making. Lessons learned Throughout the data collection, the small sample size issue is being addressed by integrating different data sources and looking for correlations among them. In order to define real community health needs, the focus is on epidemiological analysis and multivariate models to try to identify the most relevant characteristics of the respective target. Finally, in order to help decision-makers to take policy decisions and communicate these effectively, the epidemiological results are being represented using visualization models coming from different scientific fields such as extending health promotion on social media (Facebook). It is planned that such initiatives will aid the collection of new data on population needs, monitor feedback on specific topics and targeting the right segment of population.
This article is intended to be an initial report on the experiences gained while using HIA. Although it is provisional and pragmatic, it ought to provide useful elements for comparison with other territorial situations, both Swiss and foreign. The large differences between the three cantonal political-institutional contexts probably explain the profound differences in the way that HIA processes were introduced in each canton. Nevertheless, the article - through the concept of institutionalization - seeks to identify supracantonal elements. Finally, by presenting HIA implementation methods in different Cantons, it endeavours to demonstrate the existence of a common matrix in the Swiss context beyond the differences arising from the actual political-institutional situations linked to them.
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