What makes health impact assessments successful? Factors contributing to effectiveness in Australia and New Zealand

Background: While many guidelines explain how to conduct Health Impact Assessments (HIAs), less is known about the factors that determine the extent to which HIAs affect health considerations in the decision making process. We investigated which factors are associated with increased or reduced effectiveness of HIAs in changing decisions and in the implementation of policies, programs or projects. This study builds on and tests the Harris and Harris-Roxas' conceptual framework for evaluating HIA effectiveness, which emphasises context, process and output as key domains. Methods: We reviewed 55 HIA reports in Australia and New Zealand from 2005 to 2009 and conducted surveys and interviews for 48 of these HIAs. Eleven detailed case studies were undertaken using document review and stakeholder interviews. Case study participants were selected through purposeful and snowball sampling. The data were analysed by thematic content analysis. Findings were synthesised and mapped against the conceptual framework. A stakeholder forum was utilised to test face validity and practical adequacy of the findings. Results: We found that some features of HIA are essential, such as the stepwise but flexible process, and evidence based approach. Non-essential features that can enhance the impact of HIAs include capacity and experience; 'right person right level'; involvement of decision-makers and communities; and relationships and partnerships. There are contextual factors outside of HIA such as fit with planning and decision making context, broader global context and unanticipated events, and shared values and goals that may influence a HIA. Crosscutting factors include proactive positioning, and time and timeliness. These all operate within complex open systems, involving multiple decision-makers, levels of decision-making, and points of influence. The Harris and Harris-Roxas framework was generally supported. Conclusion: We have confirmed previously identified factors influencing effectiveness of HIA and identified new factors such as proactive positioning. Our findings challenge some presumptions about 'right' timing for HIA and the rationality and linearity of decision-making processes. The influence of right timing on decision making needs to be seen within the context of other factors such as proactive positioning. This research can help HIA practitioners and researchers understand and identify what can be enhanced within the HIA process. Practitioners can adapt the flexible HIA process to accommodate the external contextual factors identified in this report

Health in All Urban Policy: City Services through the Prism of Health

In April, 2014, the City of Richmond, California, became one of the first and only municipalities in the USA to adopt a Health in All Policies (HiAP) ordinance and strategy. HiAP is increasingly recognized as an important method for ensuring policy making outside the health sector addresses the determinants of health and social equity. A central challenge facing HiAP is how to integrate community knowledge and health equity considerations into the agendas of policymakers who have not previously considered health as their responsibility or view the value of such an approach. In Richmond, the HiAP strategy has an explicit focus on equity and guides city services from budgeting to built and social environment programs. We describe the evolution of Richmond’s HiAP strategy and its content. We highlight how this urban HiAP was the result of the coproduction of science policy. Coproduction includes participatory processes where different public stakeholders, scientific experts, and government sector leaders come together to jointly generate policy goals, health equity metrics, and policy drafting and implementation strategies. We conclude with some insights for how city governments might consider HiAP as an approach to achieve “targeted universalism,” or the idea that general population health goals can be achieved by targeting actions and improvements for specific vulnerable groups and places

Het belang van een 'lenige geest'. Agendering van integrale actie voor een Gezonde Stad

Contains fulltext : 145047.pdf (publisher's version ) (Closed access)In dit artikel staat de vraag centraal hoe draagvlak onder stakeholders voor integrale actie voor gezondheid tot stand komt. Daartoe hebben we in samenwerking met de provincie Noord-Brabant een responsieve evaluatie opgezet waarin 32 gemeentelijke ambtenaren van verschillende beleidsterreinen bevraagd zijn op hun percepties van een Gezonde Stad, en hun ervaringen met het agenderen van integrale actie. Percepties van een Gezonde Stad leveren een beeld op van een duurzame stad met een gezond vestigingsklimaat voor talentvolle ondernemers en werknemers, die in de openbare ruimte ontmoetingen faciliteert tussen verschillende sociale groepen, en bewegen en sporten aantrekkelijk maakt. Ondanks raakvlakken onderhouden de ambtelijke stakeholders geen beleidsmatige relaties met de gezondheidssector. Bij het agenderen van integrale initiatieven hebben ambtenaren vooral geleerd van wat er niet werkt: een activistische benadering, het uitsluitend vertrouwen op wetenschappelijke ‘bewijs’ of op de morele superioriteit van gezondheid. Een belangrijke agenderingsstrategie van ambtenaren bestaat uit het mobiliseren van externe invloedrijke actoren. Daarnaast lijkt de ontwikkeling van ‘lenigheid van geest’ van belang: de persoonlijke attitude om gegeven de institutionele kokers en verantwoordingsregels flexibel te kunnen opereren. Dat contrasteert met het top down concept van IGB. Een pragmatisch-flexibel concept als ‘adaptieve integrale actie’ lijkt ons voorlopig een beter passend concept voor de analyse en versterking van gezondheidsbevordering en bescherming. ----------------------------------------------------------------------------------------------------------------- The importance of flexible mindset. Setting the agenda for integrated action on a Healthy City. In this article we question how support among stakeholders for integrated action on health is built and maintained. In collaboration with health policy advisors at the province of North-Brabant and an independent professional dialogue facilitator we set up a responsive evaluation among 32 municipal policy officers from different policy domains, addressing their perceptions of a Healthy City and their experiences in agendasetting of integrated action in general. Perceptions consist of a ‘sustainable’ city with a ‘healthy climate for settlement of talented entrepreneurs and skilled labour force’, which facilitates ‘interactions between different social groups’, and attracts citizens to ‘engage in physical exercise and sports’. Despite the overlap in perceptions, policy officers do not maintain structural relationships with the health policy officer nor health services. Policy officers involved in integrated action on other topics have mostly learned from experience that which did not work: an activitst approach, relying solely on scientific evidence, or on the moral superiority of health over other policy topics. An important agendasetting strategy familiar to all policy officers consists of mobilising external influential actors. Furthermore, it seems crucial to develop a flexible mindset: the personal attitude and capacity –given the institutional pillarisation of policy sectors and accountability regimes– to operate in an adaptive and supportive manner. This contrasts with the top down concept of integrated health policy. The pragmatic and flexible concept of adaptive integrated action seems to be a more suitable concept for analysing and strengthening integrated health-related action. Keywords: responsive evaluation, integrated action, province North Brabant, Healthy City7 p

The impact of two Los Angeles County Teen Courts on youth recidivism: comparing two informal probation programs

OBJECTIVE: This study sought to examine the impact of two Teen Courts operating in Los Angeles County, a juvenile justice system diversion program in which youth are judged by their peers and given restorative sentences to complete during a period of supervision. METHODS: A quasi-experimental design was used to compare youth who participated in Teen Court (n=112) to youth who participated in another diversion program administered by the Probation Department (the 654 Contract program) (n=194). Administrative data were abstracted from Probation records for all youth who participated in these programs between January 1, 2012 and June 20, 2014. Logistic and survival models were used to examine differences in recidivism - measured as whether the minor had any subsequent arrest or arrests for which the charge was filed. RESULTS: Comparison group participants had higher rates of recidivism than Teen Court participants, after controlling for age, gender, race/ethnicity, and risk level. While the magnitude of the program effects were fairly consistent across model specifications (odd ratios comparing Teen Court [referent] to school-based 654 Contract ranging from 1.95 to 3.07, hazard ratios ranging from 1.62 to 2.27), differences were not statistically significant in all scenarios. CONCLUSIONS: While this study provides modest support for the positive impact of Teen Court, additional research is needed to better understand how juvenile diversion programs can improve youth outcomes