Supporting health impact assessment in practice

Health impact assessment (HIA) is a process that aims to predict potential positive and negative effects of project, programme or policy proposals on health and health inequalities. It is recommended by national government and internationally. Supporting health impact assessment is one of the roles of English Public Health Observatories.The few centres in England with accredited health impact training centres have inadequate resources to meet demand. Currently, the London Health Observatory is providing the bulk of the training nationally. Some Public Health Observatories are currently investigating the preferences for support of those commissioning or conducting health impact assessment within their regions.The availability of published guidance on how to conduct health impact assessments has increased substantially over the past few years. The Department of Health has funded a research project led by the London Health Observatory to develop advice for reviewing evidence for use in health impact assessment. Completed health impact assessments can be useful resources. Evaluation of the process and impact of health impact assessment is important in order to demonstrate its usefulness and to learn lessons for the future.The focus for Public Health Observatories is to train and support others to conduct health impact assessment according to good practice, rather than undertaking health impact assessments themselves. The aim is to create sufficient skilled capacity around the country to undertake health impact assessments. The London Health Observatory plans to share its support models and to roll out a train the trainer programme nationally to enable effective local delivery of their national health impact assessment programme. (c) 2005 The Royal Institue of Public Health. Published by Elsevier Ltd. All rights reserved

A tentative step towards healthy public policy

More consistent attention to implementing healthy public policy, and amassing the evidence for it, are urgently required

A comparison of measured height and demi-span equivalent height in the assessment of body mass index among people aged 65 years and over in England

Objectives: to examine differences between measured height and demi-span equivalent height (DEH) among people aged >= 65 and investigate the impact on body mass index (BMI) of using DEH.Design and Setting: nationally representative cross-sectional sample of adults living in England.Participants: 3,346 non-institutionalised adults aged >= 65, taking part in the Health Survey for England (HSE) 2001.Measurements: height, weight and demi-span measurements were taken according to standardised HSE protocols. DEH was calculated using Basseys equation.Results: the height measurement was lower than the DEH from age group 70-74 years onwards in men and in each age group in women. No significant differences in mean DEH and measured height were found for men (0.46) or women (2.64). BMI derived from measured height did not differ significantly from BMI derived from DEH. The prevalence of underweight was lower when using measured height than when using DEH in women aged >= 65, particularly in those aged 80 years and over. The prevalence of overweight and obesity was higher using measured height than DEH in women aged >= 65.Conclusion: we confirmed in a large nationally representative sample that demi-span measurement may be a useful estimate of stature in people (particularly women) aged >= 65 for BMI calculations

Mathematical modelling of health impacts

Mathematical modelling is seldom applied to research of global measures of health or health inequalities mainly because of the lack of studies of interventions necessary to underpin modelling research

Assessing smoking status in children, adolescents and adults: cotinine cut-points revisited

Aims To reassess saliva cotinine cut-points to discriminate smoking status. Cotinine cut-points that are in use were derived from relatively small samples of smokers and non-smokers 20 or more years ago. It is possible that optimal cut-points may have changed as prevalence and exposure to passive smoking have declined. Design Cross-sectional survey of the general population, with assessment of self-reported smoking and saliva cotinine. Participants A total of 58 791 respondents aged 4 years and older in the Health Survey for England for the years 1996-2004 who provided valid saliva cotinine specimens. Measures Saliva cotinine concentrations, demographic variables, self-reported smoking, presence or absence of smoking in the home, a composite index of social disadvantage derived from occupation, housing tenure and access to a car. Findigns A cut-point of 12 ng/ml performed best overall, with specificity of 96.9% and sensitivity of 96.7% in discriminating confirmed cigarette smokers from never regular smokers. This cut-point also identified correctly 95.8% of children aged 8-15 years smoking six or more cigarettes a week. There was evidence of substantial misreport in claimed ex-smokers, especially adolescents (specificity 72.3%) and young adults aged 16-24 years (77.5%). Optimal cut-points varied by presence (18 ng/ml) or absence (5 ng/ml) of smoking in the home, and there was a gradient from 8 ng/ml to 18 ng/ml with increasing social disadvantage. Conclusions The extent of non-smokers' exposure to other people's tobacco smoke is the principal factor driving optimal cotinine cut-points. A cut-point of 12 ng/ml can be recommended for general use across the whole age range, although different cut-points may be appropriate for population subgroups and in societies with differing levels of exposure to secondhand smoke

Institutionalizing health impact assessment in London as a public health tool for increasing synergy between policies in other areas

Objectives: To describe the background to the inclusion of health impact assessment (HIA) in the development process for the London mayoral strategies, the HIA processes developed, how these evolved, and the role of HIA in identifying synergies between and conflicting priorities of different strategies.Study design: Case series.Methods: Early HIAs had just a few weeks for the whole HIA process. A rapid appraisal approach was developed. Stages included: scoping, reviewing published evidence, a stakeholder workshop, drafting a report, review of the report by the London Health Commission, and submission of the final report to the Mayor. The process evolved as more assessments were conducted. More recently, an integrated impact assessment (IIA) method has been developed that fuses the key aspects of this HIA method with sustainability assessment, strategic environmental assessment and equalities assessment.Results: Whilst some of the early strategy drafts encompassed some elements of health, health was not a priority. Conducting HIAs was important both to ensure that the strategies reflected health concerns and to raise awareness about health and its determinants within the Greater London Authority (GLA). HIA recommendations were useful for identifying synergies and conflicts between strategies. HIA can be successfully integrated into other impact assessment processes.Conclusions: The HIAs ensured that health became more integral to the strategies and increased understanding of determinants of health and how the GLA impacts on health and health inequalities. Inclusion of HIA within IIA ensures that health and health inequalities impacts are considered robustly within statutory impact assessments. (C) 2010 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved

What do we need for robust and quantitative health impact assessment?

Health impact assessment (HIA) aims to make the health consequences of decisions explicit. Decision-makers need to know that the conclusions of HIA are robust. Quantified estimates of potential health impacts may be more influential but there are a number of concerns. First, not everything that can be quantified is important. Second, not everything that is being quantified at present should be, if this cannot be done robustly. Finally, not everything that is important can be quantified; rigorous qualitative HIA will still be needed for a thorough assessment. This paper presents the first published attempt to provide practical guidance on what is required to perform robust, quantitative HIA. Initial steps include profiling the affected populations, obtaining evidence from for postulated impacts, and determining how differences in subgoups' exposures and suscepibilities affect impacts. Using epidemiological evidence for HIA is different from carrying out a new study. Key steps in quantifying impacts are mapping the causal pathway, selecting appropriate outcome measures and selecting or developing a statistical model. Evidence from different sources is needed. For many health impacts, evidence of an effect may be scarce and estimates of the size and nature of the relationship may be inadequate. Assumptions and uncertainties must therefore be explicit. Modelled data can sometimes be tested against empirical data but sensitivity analyses are crucial. When scientific problems occur, discontinuing the study is not an option, as HIA is usually intended to inform real decisions. Both qualitative and quantitative elements of HIA must be performed robustly to be of value

The impact of private sector provision on equitable provision of coronary revascularisation

Objective: To investigate the impact of including private sector data on assessments of equity of coronary revascularisation provision using NHS data only. Design: Analyses of Hospital Episodes Statistics and private sector data by age, sex, and PCT of residence. For each PCT, the share of London's total population and revascularisations (all admissions, NHS-funded, and privately-funded admissions) were calculated. GINI coefficients were derived to provide an index of inequality across sub-populations, with parametric bootstrapping to estimate confidence intervals. Setting: London Participants London residents undergoing coronary revascularisation April 2001 - December 2003. Intervention Coronary artery bypass graft or angioplasty Main outcome measures: Directly-standardised revascularisation rates, GINI coefficients. Results: NHS-funded age-standardised revascularisation rates varied from 95.2 to 193.9 per 100,000 and privately funded procedures from 7.6 to 57.6. Although the age distribution did not vary by funding, the proportion of revascularisations among women that were privately funded (11.0%) was lower than among men (17.0%). Privately funded rates were highest in PCTs with the lowest death rates (p=0.053). NHS-funded admission rates were not related to deprivation nor age-standardised deaths rates from coronary heart disease. Privately-funded admission rates were lower in more deprived PCTs. NHS provision was significantly more egalitarian (Gini coefficient 0.12) than the private sector (0.35). Including all procedures was significantly less equal (0.13) than NHS funded care alone. Conclusion: Private provision exacerbates geographical inequalities. Those responsible for commissioning care for defined populations must have access to consistent data on provision of treatment wherever it takes place