Health Impact Assessment in the New Zealand Policy Context
Signal, Louise, Durham, Gillian, Social Policy Journal of New Zealand
Assessing the health impact of policy outside the health sector is a key part of public health policy making. Policy makers use health impact assessment to improve, promote and protect the health of populations. This paper defines health impact assessment and provides justification for the use of formal health impact assessment tools. The New Zealand policy-making process and the mechanisms currently used within the public sector to assess health impact in New Zealand are discussed. Examples in the public domain from recent public policy making are used to illustrate the discussion. The paper then examines the opportunities that exist for public sector public health policy advisers assessing the health impact of policy in other sectors, given that policy can be a fiercely contested domain, and considers why the generic mechanisms are insufficient to achieve optimal influence. The supports needed for the successful application of formal tools, and the obstacles that exist, are analysed.
Health impact assessment (HIA) has been 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). We view it as a means to ensure healthy public policy -- that is, as a means of putting health on the agenda of policy makers across government, assisting them to be aware of the health consequences of their decisions.
There is support for HIA internationally and in New Zealand. There has been increasing international interest (Lewis 2000, Scottish Needs Assessment Programme 2000). The Commission of the European Union has included HIA in its work (Commission of the European Communities 1995). In 1998, the UK Government proposed that "major new government policies should be assessed for their impact on health" (Secretary of State for Health 1998).
An early attempt to use HIA in New Zealand occurred at the Public Health Commission with the production of A Guide to Health Impact Assessment (Public Health Commission 1995). This guide for public health services focused on HIA only in relation to environmental issues. Subsequently, during consultation on the strategic direction for public health in 1996/97, it was proposed by the Ministry of Health that HIA be implemented at a high level across government, possibly at the Cabinet level in a similar way to Treasury compliance requirements. It was suggested that a formal HIA tool should be developed in cooperation with other sectors (Ministry of Health 1997b). Strong support was received for this proposal.
More recently, the National Health Committee (NHC) has proposed the adoption of HIA (Lewis 2000). This recommendation has emerged from the NHC's work on inequalities in health. The Committee has recognised the very real potential HIA has for addressing the health impacts of the determinants of health.
Further, the recently released draft New Zealand Health Strategy acknowledges the need to address the determinants of health and the important role the health sector has to play in intersectoral action to promote health (Minister of Health 2000). It argues that this role includes "assessing relevant public policies for their impact on health and health inequalities". The first goal is "a healthy social environment". The first objective under this goal is "to assess all public policies for their impact on health and health inequalities" (Minister of Health 2000:10). Clearly, there is support for HIA in New Zealand, but what does it actually involve and why is it needed?
WHAT IS HIA?
HIA provides formal tools to enable us to identify both direct and indirect impacts on health. It is a structured way of bringing together evaluation, partnership working, public consultation, and available evidence for more explicit decision making (Lock 2000:13961397). …