Evaluating the impact of equity focused health impact assessment on health service planning: three case studies

Abstract

BackgroundHealth impact assessment has been identified internationally as a mechanism to ensure potential health impacts and health equity impacts of proposals are considered before implementation. This paper looks at the impact of three equity focused health impact assessments (EFHIAs) of health service plans on subsequent decision-making and implementation, and then utilises these findings to test and refine an existing conceptual framework for evaluating the impact and effectiveness of health impact assessments for use in relation to EFHIAs.MethodsCase study analysis of three EFHIAs conducted on health sector plans in New South Wales, Australia. Data was drawn from 14 semi-structured interviews and the analysis of seven related documents (draft plans and EFHIA reports).ResultsThe case studies showed that the EFHIAs all had some impact on the decision-making about the plans and their implementation, most clearly in relation to participants’ understandings of equity and in the development of options for modifying service plans to ensure this was addressed. The timing of the EFHIA and individual responses to the EFHIA process and its recommendations were identified as critical factors influencing the impact of the EFHIAs. Several modifications to the conceptual framework are identified, principally adding factors to recognise the role individuals play in influencing the impact and effectiveness of EFHIAs.ConclusionEFHIA has the potential to improve the consideration of health equity in health service planning processes, though a number of contextual and individual factors affect this. Current approaches can be strengthened by taking into account personal and organisational responses to the EFHIA process.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6963-14-371) contains supplementary material, which is available to authorized users.

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

“…Promoting equity and reducing health disparities are often cited as major reasons for conducting an HIA (43,44,49). Equity may have improved as a result of some HIAs examined in this study, but no reports explicitly documented changes in equity or the factors contributing to reduced inequities.…”

Short-Term Solutions to a Long-Term Challenge: Rethinking Disaster Recovery Planning to Reduce Vulnerabilities and Inequities

“…Assessing equity impacts aids the development of recommendations on how to mitigate any negative impacts and maximize positive impacts and how to improve programs or services to be more responsive to specific populations. Case studies have shown that equity impact assessments can change decisions, enhance plan content, and improve plan implementation [106,110]. However, the assessment must be conducted in a timely manner prior to a plan's completion and have a clear definition of the scope, purpose, underpinning values, and what is hoped to be learned [111].…”

“…However, the assessment must be conducted in a timely manner prior to a plan's completion and have a clear definition of the scope, purpose, underpinning values, and what is hoped to be learned [111]. A shared understanding and agreement about the purpose of the assessment is needed at an early stage to ensure that decision makers and planners engage in a meaningful learning of equity issues that leads to the integration of changes to planning activities, rather than generating a separate plan [110,112].…”

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“…Se sustenta en la democracia, la equidad, el desarrollo sostenible y la unificación del uso ético de la evidencia. En esta misma línea, la EIS es de carácter predictivo (32) y por lo tanto ayuda a la toma de decisiones y a la aplicación de las propuestas mediante el desarrollo de recomendaciones basadas en la evidencia para maximizar los efectos positivos sobre la salud y reducir al mínimo los efectos negativos (31,(33)(34)(35). La EIS se fundamenta en los principios de la política pública saludable recogida en la Carta de Ottawa y en conceptos de la ciencia política, de allí que se sustenta en un modelo de salud holístico que trasciende el modelo biomédico e incluye los determinantes sociales de la salud (32,(36)(37)(38).…”