The HIA procedure
1. Identifying if an HIA should occur
It is not possible to carry out an HIA on every project, policy or programme. Therefore screening is used to systematically decide when to do an HIA.
Is the screening of Swedish governmental inquiries (directions to green papers) for ten principle Ministries during 2001 and 2002 (Eurohealth article vol 8 (5), p30-32, 2002/03). Within Sweden the use of screening is seen as the first step towards HIA becoming a part of the policy making process. The point at which screening occurred in the policy making process (screening governmental inquiries) was critical, and demonstrated that to influence the policy maker and policy development, HIA had to enter the decision making process as early as possible – long before any white papers were produced. Also, the inquiries were publicly available in a central place, making systematic screening feasible.
A checklist was developed that considered the possible changes in health outcomes from the proposed policy. The checklist allowed decisions to be documented for future reference. The checklist had four components, with a major focus on numbers two and three.
- Description of the policy
- Questioning whether the policy affected any of the ten selected determinants of health
- Questioning whether the policy affected the whole population or 13 selected vulnerable groups by gender
- Deciding whether the policy should undergo an HIA.
During a preliminary study of screening in Sweden, deciding whether the policy should undergo an HIA was determined by whether one or more determinants of health was affected by a proposal (step two). This preliminary study noted that it was unlikely for resources to be available to carry out the HIAs required (1/3 of all Government inquiries). Other criteria were needed to further prioritise inquiries that had the greatest potential impact on health. Questions about whether a similar HIA had been undertaken, negating the need for another, were described as useful at this point.
The Swedish experience showed that to effectively screen, an HIA core group of experts with different backgrounds was needed to discuss the screening process, and to reach consensus about whether certain inquiries should go forward for HIA.
Apart from this example above, and a few other examples around the world, in practice screening is not used often– not because it is not a good idea, but because of resource and organisational issues. Screening only works when there is organisational commitment to HIA – where management allow the time and resource to screen each project, policy or programme. Typically, the decision to carry out an HIA comes about in other ways:
- A significant project is occurring, and someone (the developer, the public, local public health, planners, etc) think an HIA would be a good idea.
- Funding is received for carrying out an HIA, and a single topic is chosen
- To do an HIA on all major issues (for example the London Mayoral Strategies).
Often, components of the screening process are used in the methods described above, but they are not systematic.