Building in Equity
Health Impact Assessment is a structured method to assess the potential health impacts of proposed policies and practices. When applied correctly, health impact assessments make it possible for staff to strengthen the health-enhancing elements of a plan, and minimize the aspects that may be harmful to health. As a result, health impact assessment (HIA) has been described as a promising practice to reduce inequities in health. HIA’s have been used widely by public health practitioners.
Equity-focused health impact assessments (EfHIA) go one step further; they help decision makers determine whether a proposed policy or practice has the potential to create greater disparity by either not reaching people who are disadvantaged, or by inadvertently increasing their disadvantage. The EfHIA method
- identifies the needs of disadvantaged populations,
- encourages discussion,
- identifies ways that an initiative could result in greater inequities, and
- sets the stage for the development of effective, targeted programs
The Wellesley Institute in Toronto has worked collaboratively with Toronto Public Health and other community partners to use the EfHIA process to bring an equity perspective to projects such as casino development. Following the EfHIA of a proposed casino project, the Institute made a compelling argument that the casino would likely result in poorer health for seniors, new Canadians, young people, and people living in poverty.
According to Bob Gardner (former Director, Policy, at the Wellesley Institute), equity focused health impact assessments can be powerful if used appropriately. He notes that although some people think EfHIAs always slow down decision making, the assessment can be conducted rapidly (e.g. a desktop check) to ensure policy decisions consider the root causes of differences and do not perpetuate or cause unintended negative health outcomes. It facilitates and supports targeting within universal programs, and considers the social determinants of health and the true social and financial costs of decisions.
EfHIA has the potential to make health care more equitable by
- injecting population health thinking into policy debates.
- encouraging community groups and government departments to consider equity in their decision making processes
- encouraging decision makers to consider the true social and financial costs of decisions
- supporting the design of equity-based interventions that favour targeting within universalism
EfHIA can contribute to the development of cross-sectoral collaborations with people who, together, have the potential to fundamentally change policy decisions. EfHIA tools provide an opportunity for people from diverse sectors to begin those conversations.
The experience of the Wellesley Institute provides a good examples of how Health Impact Assessments can be useful to assess the impact of proposals (either policy or specific practice) at the general population level while at the same time addressing the underlying social and economic determinants of health and resulting health inequities.
Please visit the NCCDH Resource Library for related materials, including:
- Introduction to health impact assessment (HIA) of public policies – online course, NCCHPP 2012
- Cross-country analysis of the institutionalization of health impact assessment, WHO 2013
- Health equity impact assessment (HEIA) - online course, CAMH 2012
- Health equity impact assessment (HEIA) tool, Ontario 2012
We would like to hear from you! What have your successes been in using health impact assessment as a practice to improve health equity? What resources do you find helpful? Please send your ideas and examples to Lesley Dyck, Knowledge Translation Specialist.
With thanks to Helena Wall and the late Bob Gardner for their help in preparing this story. For more information on the work of the Wellesley Institute, please visit our database of health equity champions.