The impact and effectiveness of equity focused health impact assessment in health service planning

This ebook looks at the use of equity focused health impact assessment (EFHIA) on health service plans. It examines: What are the direct and indirect impacts of EFHIAs conducted on health sector plans? Does EFHIA improve the consideration of equity in the development and implementation of health sector plans? How does EFHIA improve the consideration of equity in health planning? This ebook describes the use and evolution of health impact assessment (HIA) and EFHIA internationally and in Australia, how it has been used in relation to health service plans, examines its effectiveness and impacts on decision-making and implementation and examines several EFHIAs using case study and interpretive description methodologies. This research shows that EFHIA has the potential to have both direct and indirect impacts on health service planning. These impacts are influenced by a broad range of factors however. The case studies in this ebook show that engagement with the EFHIA process and the extent to which EFHIA is regarded as a broader learning process are important factors that mediate the extent to which EFHIAs influence subsequent activities. This research suggests that it is not possible to adequately describe the full range of impacts of EFHIA on decision-making and implementation without looking at perceptions about EFHIA’s effectiveness, in particular the perceptions of those involved in the EFHIA and those responsible for acting on its recommendations. These perceptions change over time, suggesting that future research on the effectiveness of HIA should look at the mechanisms by which this change occurs. The ebook makes two theoretical contributions in the form of (i) a typology for HIAs and (ii) a conceptual framework for evaluating the impact and effectiveness of HIAs. This conceptual framework is tested for its applicability and refined. The ebook and the accompanying publications were written to fulfil the requirements for a Doctor of Philosophy in Public Health at the University of New South Wales

What do General Practitioners want from Specialist Alcohol and Other Drugs Services? A Qualitative Study of NSW Metropolitan GPs

Alcohol and other drug (AOD) use is common in Australia with significant health and community impacts. General practitioners (GP) often see people with AOD use; however, there is little research to understand how specialist AOD services could assist GPs in the management of patients with AOD issues. Methods. Thirty-five GPs working in general practice in a metropolitan area in Sydney in New South Wales, Australia, participated in one of three focus groups. The groups were recorded, transcribed and thematically analysed. Results. The five themes raised by participants were: GP personal agency and interest in AOD issues; GP education and training gaps; improving pathways between GP and specialist AOD services; easier access to AOD specialist advice; and improving access to collaborative care for patients with complex AOD presentations. Participants requested education on screening, assessing, managing AOD issues, focused on alcohol, stimulants and high-risk prescription medicines. They suggested better referral processes, discharge summaries and care planning for complex presentations. Participants wanted easy access to specialist advice and suggested collaborative care assisted by experienced AOD liaison nurses. Discussion and Conclusions. Australia has several existing programs; online referral pathways and specialist phone advice, that address some of the issues raised. Unfortunately, many participants were not aware of these. GP education must be supported by multiple processes, including durable referral pathways, ready access to local specialist advice, clear communication (including patient attendance and a treatment plan), care planning and written summaries

A rapid equity focused health impact assessment of a policy implementation plan: An Australian case study and impact evaluation

<p>Abstract</p> <p>Background</p> <p>Equity focused health impact assessments (EFHIAs), or health equity impact assessments, are being increasingly promoted internationally as a mechanism for enhancing the consideration of health equity in the development of policies, programs and projects. Despite this there are relatively few examples of examples of completed EFHIAs available. This paper presents a case study of a rapid EFHIA that was conducted in Australia on a health promotion policy implementation plan. It briefly describes the process and findings of the EFHIA and evaluates the impact on decision-making and implementation.</p> <p>Methods</p> <p>The rapid EFHIA was undertaken in four days, drawing on an expert panel and limited review of the literature. A process evaluation was undertaken by email one month after the EFHIA was completed. An impact evaluation was undertaken two years later based on five semi-structured interviews with members of the EFHIA working group and policy officers and managers responsible for implementing the plan. A cost estimation was conducted by the EFHIA working group.</p> <p>Findings</p> <p>The EFHIA made both general and specific recommendations about how the health equity impacts of the policy implementation plan could be improved. The impact evaluation identified changes to development and implementation that occurred as a result of the EFHIA, though there was disagreement about the extent to which changes could be attributed solely to the EFHIA. Those responsible considered the recommendations of the EFHIA in the next versions of their ABHI implementation plans. Factors that influenced the impact of the EFHIA included consolidating understandings of equity, enabling discussion of alternatives, and differing understandings of the purpose of the EFHIA. The EFHIA cost US$4,036 to undertake.</p> <p>Conclusions</p> <p>This EFHIA was conducted in a short timeframe using relatively few resources. It had some reported impacts on the development of the implementation plan and enhanced overall consideration of health equity. This case highlights some of the factors and preconditions that may maximise the impact of future EFHIAs on decision-making and implementation.</p

A framework for preferred practices in conducting culturally competent health research in a multicultural society

Background: Improving the health and well-being of the whole population requires that health inequities be addressed. In an era of unprecedented international migration, meeting the health care needs of growing multicultural or multiethnic societies presents major challenges for health care systems and for health researchers. Considerable literature exists on the methodological and ethical difficulties of conducting research in a cross-cultural context; however, there is a need for a framework to guide health research in multicultural societies. Methods: The framework was informed by “research on research” that we have undertaken in community and primary health care settings in Sydney, Australia. Case studies are presented as illustrative examples. Results: We present a framework for preferred practices in conducting health research that is culturally informed, high-quality, safe, and actionable. Conclusions: The framework is not intended to be universal, however many of its aspects will have relevance for health research generally. Application of the framework for preferred practices could potentially make health research more culturally competent, thus enabling enhanced policies, programmes and practices to better meet population health needs. The framework needs to be further tested and refined in different contexts

Environmental assessment and health impact assessment

HIA and EA are approaches and processes that support better, healthier, and more sustainable policy development and decisionmaking. When undertaken well, and when valued and applied, they can also help to support better, more informed, transparent and democratic policy development and decision- making processes. However, they are not a panacea; rather, they constitute one important piece of the policy development and decision- making puzzle. Public health practitioners need to increase their knowledge and understanding of EA and HIA. They should improve their links with EA and HIA specialists. They also need to proactively and consistently undertake and commission assessments of health either within EA or as stand alone HIAs. Public health practitioners would also do well to oversee and scrutinize the scope of work for, and the findings of, EAs and HIAs that are commissioned and undertaken by others in the localities in which they work. By doing so, public health practitioners can help to advance the agenda of improving health for all by acting on the upstream determinants of health and bringing together key actors across society

Ontological foundations of urban health policy ideas: the case of planning Sydney’s Western Parkland City

This case study examines the ontological backgrounds of urban health policy ideas in planning the Western Parkland City, a large-scale regional development project in Sydney, Australia. Using an empirical approach, the study identifies seven key urban health policy ideas and analyses the nature of these ideas using urban health ontological frameworks. The dominant ontological paradigms appear as the medical-industrial and urban health science paradigms with strong alignment with the sustainable urban development and healthy urban planning research traditions. Additionally, the dominant ideas adopt a view of systems that is complicated more than complex, favour change driven by structure rather than agency, and involve perspectives that transcend across multiple scales. These findings highlight the importance of recognising the influence of paradigms in shaping policies and the need for transdisciplinary approach to policymaking

Health Impact Assessment: A practical guide

Health Impact Assessment (A) Assesses plans, project, program or policies before they are implemented. (B) Predicts the health impacts of these proposals, including: (i) assessing the severity and likelihood of the identified positive and negative impacts; (ii) determining whether these are direct or indirect impacts, and (iii) assessing the distribution of impacts. (C) Recommends mitigation measures: (i) to maximise positive health impacts and minimise negative health impacts; and (ii) engage decision makers so that they consider health impacts and the determinants of health in their deliberations. This guide focuses on established steps or stages of HIA: screening, scoping, identification, assessment, decision-making and recommendations, and evaluation and follow-up