What makes health impact assessments successful? Factors contributing to effectiveness in Australia and New Zealand

Abstract

BackgroundWhile many guidelines explain how to conduct Health Impact Assessments (HIAs), less is known about the factors that determine the extent to which HIAs affect health considerations in the decision making process. We investigated which factors are associated with increased or reduced effectiveness of HIAs in changing decisions and in the implementation of policies, programs or projects. This study builds on and tests the Harris and Harris-Roxas’ conceptual framework for evaluating HIA effectiveness, which emphasises context, process and output as key domains.MethodsWe reviewed 55 HIA reports in Australia and New Zealand from 2005 to 2009 and conducted surveys and interviews for 48 of these HIAs. Eleven detailed case studies were undertaken using document review and stakeholder interviews. Case study participants were selected through purposeful and snowball sampling. The data were analysed by thematic content analysis. Findings were synthesised and mapped against the conceptual framework. A stakeholder forum was utilised to test face validity and practical adequacy of the findings.ResultsWe found that some features of HIA are essential, such as the stepwise but flexible process, and evidence based approach. Non-essential features that can enhance the impact of HIAs include capacity and experience; ‘right person right level’; involvement of decision-makers and communities; and relationships and partnerships. There are contextual factors outside of HIA such as fit with planning and decision making context, broader global context and unanticipated events, and shared values and goals that may influence a HIA. Crosscutting factors include proactive positioning, and time and timeliness. These all operate within complex open systems, involving multiple decision-makers, levels of decision-making, and points of influence. The Harris and Harris-Roxas framework was generally supported.ConclusionWe have confirmed previously identified factors influencing effectiveness of HIA and identified new factors such as proactive positioning. Our findings challenge some presumptions about ‘right’ timing for HIA and the rationality and linearity of decision-making processes. The influence of right timing on decision making needs to be seen within the context of other factors such as proactive positioning. This research can help HIA practitioners and researchers understand and identify what can be enhanced within the HIA process. Practitioners can adapt the flexible HIA process to accommodate the external contextual factors identified in this report.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2319-8) contains supplementary material, which is available to authorized users.

A Brief History of Health Impact Assessment in the United States

“…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).…”

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

“…Davenport et al (32) reported on all HIAs identified in multiple databases as of 2004. The other reports purposefully selected HIAs from large databases by using criteria such as having “some potential for effectiveness” (35): reflecting diversity in sector, geography, timing, effectiveness, and funding (31,33): or relating to the agency’s mission (34). HIAs were examined from such sectors as land use, transportation, housing, agriculture, energy, health services, and waste management.…”

A community grounded HIA: The benefits of conducting a HIA during the Airds Bradbury Estate Redevelopment

“…For example Kearney (Kearney, 2004) in an evaluation of community participation in a regenerartion HIA found that "The results suggest that there may be a large gap between professional rhetoric and the reality of community participation, and that barriers to community participation in HIA may be substantial and institutionalised" Community participation is often considered as a central practice for effective HIAs (den Broeder, Uiters, ten Have, Wagemakers, & Schuit, 2017;Mahoney, Potter, & Marsh, 2007). The presence of local residential involvement and contribution in HIAs has been shown to have a positive impact on the success of projects from development through to implementation (Chadderton, Elliott, Hacking, Shepherd, & Williams, 2012;Chilaka, 2015;den Broeder et al, 2017;Elliott & Williams, 2008;Haigh et al, 2015;Wright, Parry, & Mathers, 2005). However, community participation is often hard to establish, and also for it to be best managed within the timeframes and expectations of policy making, which can make a truly collaborative HIA process a challenge to attain (Chadderton et al, 2012;Parry & Wright, 2003).…”

“…Although engaging community members in HIAs is standard good practice, evaluations of HIAs have found variation in levels of community engagement and community perspectives are often missing or limited to providing evidence in the identification stage (Haigh et al, 2015;Schuchter, Bhatia, Corburn, & Seto, 2014).This similar to the consideration of equity in HIA, where equity is a core value and expected to be considered all HIAs however in reality is often missed or superficially considered (Povall, Haigh, Abrahams, & Scott-Samuel, 2013). Similar to the Equity Focussed HIA approach developed in Australia (Simpson, Mahoney, Harris, Aldrich, & Stewart-Williams, 2005) we felt that it would be useful to adopt an HIA approach that was explicitly grounded in the community.…”