The effectiveness of health impact assessment in influencing decision-making in Australia and New Zealand 2005–2009

Abstract

BackgroundHealth Impact Assessment (HIA) involves assessing how proposals may alter the determinants of health prior to implementation and recommends changes to enhance positive and mitigate negative impacts. HIAs growing use needs to be supported by a strong evidence base, both to validate the value of its application and to make its application more robust. We have carried out the first systematic empirical study of the influence of HIA on decision-making and implementation of proposals in Australia and New Zealand. This paper focuses on identifying whether and how HIAs changed decision-making and implementation and impacts that participants report following involvement in HIAs.MethodsWe used a two-step process first surveying 55 HIAs followed by 11 in-depth case studies. Data gathering methods included questionnaires with follow-up interview, semi-structured interviews and document collation. We carried out deductive and inductive qualitative content analyses of interview transcripts and documents as well as simple descriptive statistics.ResultsWe found that most HIAs are effective in some way. HIAs are often directly effective in changing, influencing, broadening areas considered and in some cases having immediate impact on decisions. Even when HIAs are reported to have no direct effect on a decision they are often still effective in influencing decision-making processes and the stakeholders involved in them. HIA participants identify changes in relationships, improved understanding of the determinants of health and positive working relationships as major and sustainable impacts of their involvement.ConclusionsThis study clearly demonstrates direct and indirect effectiveness of HIA influencing decision making in Australia and New Zealand. We recommend that public health leaders and policy makers should be confident in promoting the use of HIA and investing in building capacity to undertake high quality HIAs. New findings about the value HIA stakeholders put on indirect impacts such as learning and relationship building suggest HIA has a role both as a technical tool that makes predictions of potential impacts of a policy, program or project and as a mechanism for developing relationships with and influencing other sectors. Accordingly when evaluating the effectiveness of HIAs we need to look beyond the direct impacts on decisions.

A Brief History of Health Impact Assessment in the United States

“…The largest impact evaluation conducted in the US included detail case studies of 23 HIAs and concluded that "HIAs are a useful tool to promote public health because they can influence decisions in non-health-related sectors, strengthen cross-sector collaborations, and raise awareness of health issues among decision makers" (Bourcier, 2015). Findings from this study were similar to those from HIA evaluations conducted in Europe (Davenport, 2006;Wismar, 2007) and in Australia (Haigh, 2013). Several studies have specifically documented facilitators and barriers to successful HIAs (Davenport, 2006;Bourcier, 2015: Haigh, 2015Dannenberg, 2016 (Pollack, 2015).…”

An Evaluation of Health Impact Assessments in the United States, 2011–2014

“…This report adds to the growing literature on the evaluation of HIAs as a field (6–13). Study strengths include the decision maker perspective on impact and which elements make HIA more influential and useful, its relatively large and diverse sample size, and the resources to gather data from multiple perspectives.…”

“…A process evaluation of 55 HIAs in Australia and New Zealand found that 65% of the reports that used a standard report review package were adequate (12). An impact evaluation of 11 of those 55 HIAs found most were effective, usually by directly influencing the decision process of nonhealth-related policymakers or raising stakeholder awareness of health issues (13). …”

Effectiveness of Health Impact Assessments: A Synthesis of Data From Five Impact Evaluation Reports

“…Wismar et al (35) proposed 4 categories of effectiveness: direct (leads to changes in decision), general (raises awareness but no specific changes are made in decision), opportunistic (favorable decision would have been made anyway), and ineffective (HIA ignored in decision). Haigh et al (36) found these categories difficult to use because different aspects of a single HIA may fall into multiple categories, and judging whether an HIA impact fit into a category often needed a graded characterization rather than a yes-or-no decision.…”