Health equity impact assessment

Abstract

The World Health Organization's Commission on Social Determinants of Health has called for 'health equity impact assessments' of all economic agreements, market regulation and public policies. We carried out an international study to clarify if existing health impact assessment (HIA) methods are adequate for the task of global health equity assessments. We triangulated data from a scoping review of the international literature, in-depth interviews with health equity and HIA experts and an international stakeholder workshop. We found that equity is not addressed adequately in HIAs for a variety of reasons, including inadequate guidance, absence of definitions, poor data and evidence, perceived lack of methods and tools and practitioner unwillingness or inability to address values like fairness and social justice. Current methods can address immediate, 'downstream' factors, but not the root causes of inequity. Extending HIAs to cover macro policy and global equity issues will require new tools to address macroeconomic policies, historical roots of inequities and upstream causes like power imbalances. More sensitive, participatory methods are also required. There is, however, no need for the development of a completely new methodology.

Report of an equity-focused health impact assessment of a proposed universal parenting program in Manitoba

“…25,26 We decided to use an established equity-focused HIA framework 27 to guide the impact assessment process, in order to ensure that equity was considered at every stage. This EfHIA framework consists of several phases: screening (determining the suitability of a proposed policy or program); scoping (including establishing terms of reference [ToR], clarifying dimensions of equity, and data collection planning); impact identification and assessment (literature search, consultation with key stakeholders and target population, weighting and synthesis of evidence, identification of potential inequitable impacts); recommendations (to policy/program proponent for mitigating or avoiding inequitable impacts); and monitoring and evaluation of uptake of EfHIA recommendations.…”

The relevance of work-related learning for vulnerable groups. Dutch case study of a Health Impact Assessment with equity focus

“…Health equity implies the absence of avoidable health inequalities [8]. It is known that health inequalities are closely related to unemployment, low income, low educational level and unfavourable working conditions [9].…”

“…A HIAef involves the complementary and structured application of the HIA methodology to determine the potential differential and distributional impacts of a policy or practice on the health of the population and on certain groups within that population, as well as whether the differential impacts are inequitable [1,8]. Similar instruments are Equity-Focus Health Impact Assessment or the Health Equity Assessment Tool [12,13].…”

Interventions interactives dans les médias sociaux visant à promouvoir l’équité en matière de santé : vue d’ensemble des examens

“…Idéalement, cet outil sert plutôt à éclairer la planification et l'élaboration d'interventions, et la consultation et l'engagement avec les communautés touchées y sont essentiels 38 .…”