Health impact assessment tool health promotion population health

Address for correspondence: Prof. E-mail: moc. Received Jan 14; Accepted Jan This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.

This article has been cited by other articles in PMC. Abstract Health promotion is very relevant today. Keywords: Health promotion, mainstreaming health promotion, healthy public policy, issue based approach, healthy settings. Introduction Health promotion is more relevant today than ever in addressing public health problems.

Open in a separate window. Figure 1. Health Promotion: Historical Evolution Health promotion is not a new concept. Conferences on Health Promotion Growing expectations in public health around the world prompted WHO to partner with Canada to host an international conference on Health Promotion in Figure 2. Approaches to Health Promotion Health promotion efforts can be directed toward priority health conditions involving a large population and promoting multiple interventions.

Figure 3. Examples of Health Promotion in Communicable and Non-communicable Diseases Health promotion measures are often targeted at a number of priority disease — both communicable and noncommunicable. Communicable Diseases These diseases can be adequately addressed through health promotion approach. Here is one example: Improving use of ITNs to prevent malaria: Insecticide-treated bed-nets ITNs are recommended in malaria endemic areas as a key intervention at the individual level in preventing malaria by preventing contact between mosquitoes and humans.

Cardiovascular Diseases In the early s the mortality rate from coronary heart disease was the highest in the world among men of Finland. Diabetes Mellitus Diabetes mellitus is one of the NCDs which has led to high rates of morbidity and mortality worldwide. Health Promoting Schools Health promoting schools build health into all aspects of life in school and community based on the consideration that health is essential for learning and development.

Healthy Work Places Currently, globally an estimated two million people die each year as a result of occupational accidents and work-related illnesses or injuries and million nonfatal workplace accidents result in an average of three lost workdays per casualty, as well as million new cases of work-related illness each year.

Health Promotion in India Health promotion is strongly built into the concept of all the national health programs with implementation envisaged through the primary health care system based on the principles on equitable distribution, community participation, intersectoral coordination and appropriate technology. Conclusions Today, there is a global acceptance that health and social well being are determined by a lot of factors which are outside the health system which include inequities due to socioeconomic political factors, new patterns of consumption associated with food and communication, demographic changes that affect working conditions, learning environments, family patterns, the culture and social fabric of societies; sociopolitical and economic changes, including commercialization and trade and global environmental change.

References 1. A primer for mainstreaming health promotion. Oct, [Last accessed on Apr 10]. Available from:. The urgency of health promotion. South East Asia Regional Office. The rise of chronic non-communicable diseases in southeast Asia: time for action. Commission of Social Determinants of Health.

Closing the gap in a generation: health equity through action on the social determinants of health. Terris M. Concepts of health promotion: dualities in public health theory. J Public Health Policy. Plnder L, Rootman I. WHO Geneva. World Health Forum. A prelude to health for all. Glouberman S, Millar J. Evolution of the determinants of health, health policy, and health information systems in Canada. Am J Public Health.

MacDougall H. Reinventing public health: A new perspective on the health of Canadians and its international impact. J Epidemiol Community Health. Milestones in Health Promotion, Statements in Global conferences. Shaikh Babar T. Understanding social determinants of health seeking behaviours, providing a rational framework for health policy and systems development. Website of the Global conferences on Health Promotion.

Last JM. A Dictionary of Epidemiology. The growing crisis of noncommunicable diseases in the South-East Asia Region. Mainstreaming health promotion - A practical toolkit. Influencing public nutrition for non-communicable disease prevention: from community intervention to national programme — experiences from Finland. Public Health Nutr. Healthy Settings. Healthy workplaces- a model for action. Confederation of Indian Industry. Healthy workplace in corporate sector — India. Country Health System profile: India — Health education and promotion.

Kumar S. Indians can do better at improving child survival. Support Center Support Center. External link. Since Healthy Public Policy is concerned with the health of future, as well as present generations, it must be concerned with sustaining ecosystems, which support the well-being of human populations Coles et al. Healthy public policy is clearly desirable, but two conditions have to be satisfied if it is to be produced:.

Health Impact Assessment is an approach that could assist with meeting both these prerequisites. Its purpose is to add value to the decision-making process National Assembly for Wales, It aims to assist decision makers by clarifying the various ways in which a policy could influence health and by ensuring that health considerations are not overlooked. Health Impact Assessment is primarily concerned with policies in non-health sectors such as economic, housing, law and order, transport, energy and many others since these are the areas that have the greatest potential to impact on population health Lock, Health Impact Assessment can also add to policies with an overtly health objective such as increasing taxes on tobacco by exploring the indirect health consequences, which would flow from them.

Some definitions of Health Impact Assessment specifically exclude consideration of policies in the health sector, but this is neither necessary nor helpful. While the development of Health Impact Assessment has been strongly influenced by Environmental Impact Assessment Joffe and Sutcliffe, , the Healthy Public Policy movement has played an equally important role in shaping its growth.

The health interests of Americans will be better served if the impacts of policies, affecting health important aspects of environments and patterns of living, were assessed Milio, Her notion that the question of how policies would impact on health had to be considered became an implicit part of all subsequent discussion of Healthy Public Policy. The term Health Impact Assessment is relatively new but the ideas underlying it are not.

Policy makers have always intended outcomes for their policies and frequently those outcomes embraced improvement in the health and well-being of populations. It is common practice for decision-making bodies to require policy proposals to list the implications for one or more of the following: women, ethnic minority groups, people with disabilities, children, the environment and so on. These are all examples of limited impact assessment. Interest in the consequences of policy is not new, but Health Impact Assessment should make the exploration of these consequences more systematic.

Prediction of consequences is frequently contentious. No policy proponent argues that their policy proposal is unhealthy, and most claim that their policy will, directly or indirectly, increase the overall well-being of the community. For most policies the influence on health is indirect, and often through several pathways that may act in conflicting directions. For example, closure of a factory may benefit health by reducing emission of pollutants and increasing the financial viability of competing producers, while at the same time damaging health by making the factory workforce unemployed.

Such conflicting health consequences are features of most policies and require trade-offs to reach optimal decisions. Numerous examples may be quoted of policies being both advocated and condemned on health grounds.

Economic adjustment policies may have beneficial effects of increasing macroeconomic stability and growth, and encouraging better use of natural resources through pricing policies. These benefits have to be set against the harm of adverse effects on income distribution of vulnerable groups, resulting from greater reliance on market mechanisms Warford, Policies to discourage smoking were initially opposed on the grounds that they would reduce exchequer income and thereby the ability to provide health and welfare services Pollock, Reducing tobacco sales has been opposed on the grounds that it would increase unemployment but Godfrey et al.

Health Impact Assessment claims to assist policy making by identifying the different paths through which health may be benefited or harmed, and by estimating the balance of harm and benefit. By assessing the relative importance of impacts through different routes it provides information to help the trade-offs which are inherent in all policy making.

Policy making is complicated because the harmful and beneficial impacts usually fall on different groups. A new railway line may bring considerable health benefit to those who travel on it or send their products along it, but those who live close to it and suffer increased noise may experience only harm. At the very least, utilization of resources for one purpose means that those resources cannot be used for another purpose, which might have benefited a different section of the community Drummond and Stoddart, Adequate Health Impact Assessment describes not only the nature and size of health impacts but also the sectors of the community on which each impact falls.

It thus offers guidance on how policies may be expected to increase or decrease health inequalities. Some have called for the development of a separate Health Inequalities Impact Assessment Acheson, ; Lester et al. The prediction in Health Impact Assessment must be evidence based. Predictions are widely used to inform decision making in other fields. Economists predict, with varying degrees of accuracy, the effect of fiscal measures on trade and economic well-being, and the effect of price and income on sales of products such as cigarettes and alcoholic beverages.

Climatologists predict the effect of energy policy on future climatic conditions. Transport planners predict the effect of road and railway developments on traffic, mobility and quality of life. Urban planners predict the effect of the built environment on quality of life for urban residents. Risk assessment engineers predict the likelihood of catastrophic events in safety-critical structures such as aeroplanes, chemical plants and atomic power stations.

The epidemiological model of exposure level and dose—response curve USEPA, has been used extensively to predict the effects of chemical and physical agents on selected health outcomes.

The range of outcomes death, physical disease to which this approach has been applied is limited, but there is no theoretical reason why it should not be extended to other outcomes and other agents.

The model could be applied to outcomes that are highly relevant to Healthy Public Policy such as mental distress and even positive health and well-being. Equally, determinants of health such as unemployment, social networks and housing quality could be covered in these models as well as the physico-chemical agents. Epidemiological models have already been used to predict the future incidence of selected diseases such as mesothelioma in European countries Peto et al. Reliance on either approach to the exclusion of the other is likely to produce an incomplete and misleading assessment.

Evidence from interviews with key informants, focus groups, opinion surveys and other ways of tapping informal knowledge should be used to produce better Health Impact Assessment. Policy analysts may not be able to describe system behaviour with equations, but can base predictions on experience of similar policies in comparable settings.

However, teasing out the connections between interventions and their sequelae note sequelae are not necessarily consequences is notoriously difficult Chapman, Where there are no precedents, predictions may be based on theory derived from observation and experience. Scenario modelling is another approach by which the future consequences of policies may be predicted Ziglio, Policy impact assessment, like policy evaluation Fischer, , has to take place at several levels.

Epidemiology is a particularly powerful tool at the level of verification, which uses technical and analytical approaches to determine the probability that the policy will achieve its stated objectives. Other disciplines have more to offer at the higher discourse levels of impact analysis to answer questions such as will the policy objectives be relevant to the problem situational validation , will the policy have instrumental value for the health of society as a whole societal vindication and will the fundamental ideology of the policy be compatible with health social choice?

All approaches have in common that predictions are based on knowledge of, and extrapolation from, previous events. Information on the web of causation and the size and direction of different impacts can be derived from studying the consequences of decisions, which have already been implemented, or events, which have already occurred. This gives better understanding of how systems react, which can be used to make better predictions for future policy.

The study of consequences of policies that have been implemented is usually referred to as retrospective Health Impact Assessment, although it could equally be described as an evaluation, despite the claims of some Milner and Marples, that these are distinct activities.

All prediction involves uncertainty and policy makers need to be informed of the confidence that they can attach to predictions. Other types of uncertainty, such as whether a particular factor is causally linked to a particular health outcome or whether one population will react similarly to another, can only be described on crude ordinal scales very certain, fairly certain, fairly uncertain, very uncertain. Frequently, one is concerned with the indirect consequences of policy, where the unpredictability of complex systems and chaos theory suggest that any predictions will be very uncertain.

If health promoters are to influence policy making and if Health Impact Assessment is to be of use to policy makers, one has to understand the nature of the policy-making process. Definitions of policy are elusive. De Leeuw De Leeuw, quotes Blum's definition of policy as:.

A long term, continuously used, standing decision by which more specific proposals are judged for acceptability in terms of means to be employed, ends to be pursued and time frame in which these proposals will have to fit. Ham Ham, suggests that policy is even more diffuse, and says:. A policy … consists of a web of decisions and actions that allocate … values. He notes that policies arise from a web of decisions and actions rather than a single decision, that decision without action does not make a policy, and that non-decision making and inaction are often important in policy genesis.

It is therefore unsurprising that policy formulation is rarely a simple rational deductive process in which a series of sequential steps are taken to attain a given objective. Much more often policy formulation is incremental, consisting of no more than marginal adjustments to existing policies and structures.

The outcomes were quite similar in each community. Other determinants identified were healthy child development, lifelong learning, lifestyle practices, physical environment, safety and security, social support, stable incomes and good health services. The CHIATs also pointed to factors thought to be key in building healthy and sustainable communities.

These included: good communication; community involvement; local control; opportunities for leadership development; confidence in one's community; coordination and cooperation in service delivery; ethics, values and spirituality; and respect for one's culture and history. The key lessons learned through the PATH experience are very likely applicable to other communities. The highly participatory process helped many people shift thinking beyond the illness problems of individuals to consideration of how programmes and policies could support or weaken community health.

In all three communities, the process brought to light local socio-economic inequalities and illuminated community capacity and control to improve conditions for a healthier community. PATH illustrates some core principles for community health impact assessment, and these are very consistent with community development strategies that have proven value Mittelmark, ; Restrepo, PATH is a particularly good example of how ordinary citizens can have a place at the very heart of local decision-making, with the CHIAT process as a central element for positive change.

PATH is of course not the answer for all communities. Some communities need processes to evaluate specific proposals, for example road-building projects, public safety issues or educational policies.

Community health impact assessment need not take place at the community level, as in PATH, but could be focused in settings such as schools and workplaces. This paper makes the claim that a key activity required to promote healthy policy-making at the local level is health impact assessment.

Highly participatory local health impact assessment can be used to identify negative health impacts that call for policy responses, and to identify and encourage practices and policies that promote health.

Socially responsible decision-making for improved equity-in-health is stimulated by community-level health impact assessment because it is a practical tool to help communities come to grips with local conditions that need changing if better health for all is to be realized. Healthy Cities is a strong and growing movement that has long recognized the importance of systematic assessment of the health impact of local policies.

The Milan Declaration is quite specific on this point, stating participants' pledges to:. Follow-up on the good intentions expressed in public declarations is, however, not easy. Frankish et al. The main lessons appear to be that highly complex approaches to health impact assessment are self-defeating, and that in any case there is no uniform way to conduct assessment.

Relatively simple approaches, tailored in each instance to local circumstances, are called for. Healthy Cities and similar movements focused on villages, islands, prisons and hospitals among others!

It is urged here that both within Healthy Cities and outside, the development of practical approaches to community health impact assessment should have a place high on the health promotion agenda in the coming period. This paper is a revised and substantially shortened version of a technical report prepared in cooperation with the World Health Organization, in support of the 5th Global Conference on Health Promotion: Bridging the Gap, Mexico, 5—9 June, Egeland, G.

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