Tools & Mechanisms
Advisory boards and committees
Advisory boards or Committees are a common structural mechanism to cover issue-based or continuous work. These have been established for this purpose, for example, in Finland and Canada. It allows for the establishment of and access to focal points, who are responsible for the work of this committee. The success of this type of mechanism is not only dependent on the people that participate in them, but also on whether their work and the conditions necessary for it are recognised at higher levels.
Human impact assessment (HUIA)
HuIA integrates both Health Impact Assessment (HIA) and Social Impact Assessment (SIA) and is used to anticipate the effect of a programme, a project or a decision on human health and welfare. It clarifies the impacts of different options and alternative solutions.
Human Impact Assessment (HuIA) is one tool that has been used with success in the Finnish context of the Healthy Cities Network and also municipal decision-making. The assessment process has been found to have opened up the municipal planning process, helping in getting various actors to commit to decisions, and in selecting the right alternative.
In Finland, over 50 HuIAs have been implemented by local social and health authorities. Given its independence from the administrative sector and from the professional and educational background of people involved, the HuIA process has proved especially useful for multicultural and multiprofessional co-operation.
Health impact assessment (HIA)
Health impact assessment (HIA) is a well-tested assessment tool that helps policy-makers anticipate how different options will affect health and so take the health consequences into account when choosing between options.
By following a systematic series of processes (see Figure 1 below) it aims to reduce the likelihood of surprises, to avoid the occurrence of unexpected negative health impacts when a policy is implemented, and to allow positive health impacts to be maximized.
Screening
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Scoping
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Risk assessment
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Decision-making
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Implementation and monitoring
Health impact assessment (HIA) has been used as an instrument for not only assessing health implications but also for helping in the process of making health implications visible and for them to be taken into serious consideration in the policy-making processes.
The scope of HIA varies from a small desk assessment of the directions of likely health impacts of the policy options, to assessments aiming at good estimates of the size of impact. The investment in HIA should be proportional to the importance of the policy decision.
According to a survey on the use of HIA in a variety of European countries, the extent of the use of HIA varies by country but is strongest in the United Kingdom.
Social impact assessment (SIA)
Social impact assessment (SIA) explicitly considers the well-being of human communities and thus differs in no important respect from HIA. It was originally derived out of environmental health impact assessment and includes the processes of analysing, monitoring and managing the intended and unintended social consequences, both positive and negative, of planned interventions (policies, programs, plans, projects) and any social change processes invoked by those interventions. Its primary purpose is to bring about a more sustainable and equitable biophysical and human environment.
Social impact assessment has likewise adopted a more democratic and participatory approach by involving more non-experts and local people in the planning and implementation of policies.
Monitoring and evaluation (M&E)
Monitoring and evaluation are crucial. While HIA and SIA are typically carried out prior to a policy, project or development, monitoring and evaluation are the follow up tools used to ensure the policy has achieved the targets set and reached the populations aimed at.
One of the outcomes of the Kuopio meeting (2006) on HiAP was to propose that statistical and research policies in public health would support the routine use of evidence in policy making, through the “development of mechanisms for adoption and adaptation in the transferability of interventions across Europe and the development of a monitoring and evaluation system to measure the mental health, social and economic outcomes of public policies, and by mapping and exchanging evidence-based practice and experiences of cross-sectoral work in national policies.”
Issue-based cross-sectoral committees and boards
Issue-based cross-sectoral committees have the strength of a problem-based approach. Actions to address obesity as a determinant of health or nutrition provide examples of issue-driven policies. These often make changes and policy discussions more concrete and enable better use of science and data.
It is often also easier to establish a structure to address a particular policy problem than for a more general policy purpose creating a more focused and policy change oriented structure for an often time-limited period of work. This type of more focused policy process may allow for better participation by different stakeholders and more specific interest groups, as well as for substance-related discussion and exchange.
Health determinants
Factors that have the most significant influence on health are called determinants of health. Health determinants include those relating to individual genetic and biological factors, individual lifestyles, the environment, culture, and societal structures and policies, though HiAP has focussed less on individual determinants and more on those social factors affected by government policies.
The same determinants typically influence a multitude of health issues and major diseases. It is notable that even changing individual lifestyles is, at times, beyond the ability of the individuals themselves; a change often needs supporting policies that make healthy lifestyles a viable option.
The HiAP approach considers the impacts of other policies on health through health determinants when the policies of all sectors are being planned, when decisions between various policy options are being made, and when implementation strategies are being designed.
It also examines the impacts of existing policies. The ultimate aim is to enhance evidence-informed policy-making by clarifying for decision-makers the links between policies and interventions, health determinants and the consequent health outcomes.
Social determinants of health
Social determinants of health refer to the social conditions in which people live, work, study, shop and play. Tackling the social determinants of health does not automatically address health inequalities; hence an explicit focus on health inequalities is required. When inequalities in health are monitored at local level, this is mainly by geographic area. It is only if health status is related to social determinants like income, education or employment, for example, that policy- makers can understand the need for HiAP.
Good quality public information on health outcomes and determinants, on their trends, as well as on ways in which health determinants can be affected is needed. It is important that essential population health data remain under public domain so that evidence-based policy-making remains a viable option.
Knowledge base
HiAP requires a knowledge base both within the administration and as part of public health research. Articulation of HiAP as well as discussions with other sectors are likely to be meaningful only if the proponents of this approach know what they are doing. Furthermore, in taking the approach further there is a need for appropriate research and analytical capacities to be utilised for assessment and the articulation of concerns. This goes beyond mere epidemiological surveillance, as all sectors do not have equivalent policy contexts. This implies a capacity to use not only public health, but also legal, economic, health and public policy expertise. There is not necessarily a need for substantial in-house research, analysis and data sets, but rather a capacity to draw together knowledge from different sources and backgrounds.
Policy briefing
Policy briefs, fact sheets, statements and other mechanisms are one type of means to articulate health in All Policies -related concerns further. They can contribute to committee work or act to highlight emerging issues or particularly important aspects in policy-making. These can be geared towards those who work in other sectors, making decision-makers accountable for the policies made or for policy capitulation and decision-making more broadly, so that these are communicated also to interested citizens.
Expert reviews
Expert reviews are increasingly used as part of policy-making. They are used often when issues are complex or when it is desired that a particular viewpoint be included in the decision-making process. Expert reviews can also be used as external assessments for policy dialogue. Expert reviews do not usually include broader participatory processes.
Use of case studies
Case studies and studies with a focus on specific issues can be used to contribute to policy-level assessments and processes in bringing concrete aspects and more substantive discussions to policy-making. They are also useful for participatory approaches. However, case studies may not be representative or sufficiently comprehensive to provide a useful reference point for assessing policies.
Public healtt reports
Understanding health implications in national-level policy-making and political support for the proper consideration of those implications can be enhanced, for example, by parliamentary public health and public health policy reporting.
Involvement of the various sectoral bodies in the preparation of such public health reports can further enhance understanding of the effects of other policies on health determinants and ultimately on health in relation to other sectoral bodies. This type of reporting can be done on various levels of policy making, including the EU level and the local level.
Intersectoral committees
Partnership and alliance building is essential for integrating HiAP. Many countries have chosen to use permanent intersectoral committees to prepare, implement and follow up on HiAP. More contemporary intersectoral bodies have also been formed on specific problems, issues or policy proposals. Other intersectoral mechanisms include formal consultation, for example, in the form of requests for formal statements over policy proposals, as well as more informal mechanisms and contacts.
National policy stands
Formulating responses to EU-level policy proposals at national level in intersectoral and political arenas is extremely important as the policy mandates and perspectives may differ on the one hand between the various sectors at Community level and on the other at national level. As regards HiAP at country level, it is not least at national level that the health perspectives need to be integrated in terms of the national stands on the various policy proposals.
Collaboration mechanisms
Changes in policy making forums have presented increasing challenges to those looking to improve population health by integrating health into the policy making of other sectors.
While several overarching policy themes already cut across government sectors - health equity, poverty reduction, social inclusion, social protection, gender equality, activation, economic growth and development - policy makers are still seeking effective collaborative mechanisms for achieving better policy coherence across sectors.
