Question topics covered in a rapid HIA workshop

Rob Quigley, Director, Quigley and Watts Ltd

rob@quigleyandwatts.co.nz

Background

• Information collection in the appraisal stage can use many methods

• One is a rapid appraisal workshop, where information is provided to stakeholders beforehand and during the workshop, and then information is collected from them.

• With limited time, which questions are asked?• What key features are present in many tools?

Assessing the positive and negative impacts.

• A feature of all tools:• The impact assessment matrix and the Merseyside

guidelines have a separate column for each;• Ison’s RAT and PHACs determinants and

inequalities matrices asks if the impact is positive, negative or neutral.

• Some don’t mention the words ‘positive or negative’, just ‘identify the impact’ or something similar (PPP; HEAT, Health Lens).

Addressing inequalities• Most tools are explicit about this, with a question

something like:– ‘what are the potential effects on inequalties (Health Lens)– Are there differential impacts on particular groups (Determinants

matrix; impact matrix)– Focusing on Maori (PPP);– Focusing on inequalities (inequalities matrix; HEAT)– Whom will it affect, the whole community or various groups

(Ison’s RAT)– Who is most advantaged and how; who will benefit most (HEAT)– For Merseyside Guidelines, it’s in the supporting documentation

only

Evidence

• Some don’t ask about this (Health Lens; PPP; impact matrix; HEAT; Merseyside)

• Others ask it in a roundabout way – identify any measurable indicators; How measurable is the impact; (determinants matrix, inequalities matrix,

• Explicit – what is the basis for identifying this impact: evidence base, experience base, personal experience (Isons RAT)

Mediating factors

• Not covered in the Health Lens, PPP, inequalities matrix, impact matrix,

• Included in determinants matrix (what external factors may interact with the policy being assessed?)

• Included in Ison’s RAT (which of the factors affecting health/determinants are key to mediating that impact)

• What are the determinants of this inequality (HEAT)

The principles of the Treaty of Waitangi

• Included in the Health Lens (How will the proposal address the principles of partnership, participation and protection)

• Included in HEAT (How will you address the Treaty of Waitangi in the context of the NZ Public Health and Disability Act 2000)

• Not in the determinants matrix, Ison’s RAT or Merseyside

• The sole purpose of the four PPP questions• Ethnicity is included in the inequalities matrix• Impact on Maori has it’s own row in the impact matrix

Scale of impact

• Not included in Health Lens, determinants matrix, PPP, inequalities matrix, merseyside, HEAT.

• Sole purpose of the impact matrix – likelihood, severity/significance, number affected, time to take effect, measurability of impact.

• Included in Ison’s RAT – magnitude, frequency, time of occurrence, point of occurrence, likelihood, severity/benefit

Recommendations

• Not covered in determinants matrix, PPP, inequalities, Merseyside.

• How will the unintended consequences be addressed (Health Lens)

• Where/how will you intervene to tackle this issue? (HEAT)

• Possible actions to enhance positive or diminish negative impacts (Impact matrix)

• Whole section in Ison’s RAT

A scenario

• Imagine you are running a rapid appraisal workshop with multiple stakeholders – community, policy writers, public health experts, other stakeholders.

• You have 4.5 hours in total, of which much of the time is taken up in introducing the policy, the evidence and describing the population affected

• You have about three hours left for small group or plenary session work

Questions to consider for each determinant:

How is the proposed Arts Centre likely to affect this determinant of health?i. Will this impact on health directly, or will it affect

health (indirectly) after affecting other factors in a pathway leading to [poor health?]

ii. What is the existing evidence for the answers you have given above– e.g. past experience, facts, research & existing data sources

Possible enhancements/mitigation

iii. Will the impact affect some Youth more than others? Who will benefit/suffer most? Will inequalities increase or decrease?

iv. What key factors might encourage or prevent the health impact?

v. What recommendations do you suggest? Who are the recommendations directed at?