Strengthening Health, Wellbeing and Equity: Embedding Policy-Level HIA in New Zealand
Signal, Louise, Langford, Barbara, Quigley, Rob, Ward, Martin, Social Policy Journal of New Zealand
Policy-level health impact assessment (HIA) is a formal approach for assessing the impact of policies on health, wellbeing and equity. HIA is used by policymakers across government and by those who may be affected by policy. This paper outlines efforts to embed HIA in New Zealand, including development of an HIA guide for New Zealand, training to support its use and the promotion of HIA to key government agencies. It briefly presents three New Zealand HIA case studies. The paper reviews the uptake of HIA in New Zealand and identifies a range of factors (including awareness of the role and potential value of HIA, training in HIA, access to HIA expertise, political and managerial support for HIA, resourcing and statutory recognition) that influence whether agencies undertake HIA. The paper then discusses the future of HIA in New Zealand, identifying the need for legislation to encourage HIA, the value of embedding HIA in policy processes and the importance of a dedicated HIA support unit. The paper concludes that considerable progress has been made at this initial stage of embedding HIA and that the approach has an important contribution to make in strengthening health, wellbeing and equity in policymaking in New Zealand.
Policy agencies are increasingly recognising the influence their policies may have on the health and wellbeing of the population, and the impacts of the interaction of these policies with those of other sectors. The complex nature of these interactions makes it clear that a collective response is needed to ensure health improvement and a reduction of health inequalities. New ways of working across sectors are needed to find solutions, with new tools to assist the process. Health impact assessment (HIA) is one such tool, which is based on the recognition that the health and wellbeing of people and communities are greatly influenced by factors that lie outside the health sector, in areas such as housing, employment or urban design. It is a tool that can be applied at the "project" level (e.g. when a new road is being built in a particular community), but this paper focuses on the policy level (e.g. urban design, housing assistance policy, environmental policy).
Policy-level HIA provides formal tools to assess the impact of policies on health, wellbeing and equity. HIA can be used by policymakers in central, regional and local government in areas such as housing, urban planning and employment; by health policymakers; and by those who may be affected by policy. A New Zealand model for HIA has been developed and training is available. Policy-level HIAs have been undertaken in New Zealand with very positive results. This paper outlines efforts to embed HIA in New Zealand. It presents three New Zealand case studies, discusses the effect of HIA on policymaking and concludes with consideration of the future of HIA in New Zealand.
HIA is a practical way to ensure that health, wellbeing and equity are considered as part of policy development in all sectors. It is defined as "a combination of procedures, methods and tools by which a policy, program or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population (European Centre for Health Policy 1999). It helps facilitate policymaking that is based on evidence and focused on outcomes, and encourages collaboration between a range of sectors and stakeholders. It is best undertaken when there are policy alternatives being considered and before commitment has been made (see Figure 1). However, it can be undertaken or revisited when revising or evaluating policy.
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In theory, good policy analysis should consider all the relevant beneficial or adverse effects of policy options, both direct and indirect. In practice, however, the impacts of policies on health, wellbeing and equity are often not explicitly or even implicitly considered by sectors outside health, and certainly not in any formalised way. …