The final speaker of the Policy Network conference was Erica Ison. She's an independent Health Impact Assessment specialist.
Many councils and other agencies already undertake assessments of environmental impact (required by law) or sustainability or social impact during the options evaluation stage of major projects. Health impact assessments (HIA) are not required but may become more of a feature as local government - along with partners - takes a leading role in ensuring healthier communities overall and reducing health inequalities within communities.
Erica mostly talked about some of the main theory around HIA - and a bit about the methodology. A robust HIA can't be done in a day, but you can conduct one using only already available data and even if you don't conduct a full HIA - you can take an HIA approach for your options appraisal - at least taking account of effects of health on the community.
The Mayor of London has already made the political commitment to conduct HIA for his London programmes and these are undertaken by the London Health Commission - an independent agency.
There is a web resource for HIA - who's done them, techniques and approaches. I don't have the URL now, but I'll look for it when I get a chance. Apparently you can search on "HIA gateway" - and the resource is hosted on the NICE website.
Personally, I think there are some interesting issues around HIA and on the concept of reducing health inequalities generally. For example, if the health of the population as a whole increased, but improved for some groups more than others (in a way that increased the disparity of outcomes), but everyone was at least somewhat better off, would that be wrong? What if that were the least worst solution?
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I attended a workshop run by Amelia Cookson from the Local Government Information Unit (LGIU).
A number of interesting issues were raised - and the LGA/IDeA new performance framework was also cited in a positive way. One of the policy ideas that caught my eye was a written constitution or compact to settle the argument about separation of powers between central and local. As an American, this seems quite natural to me - though it's not as if a written arrangement settles the matter for good. State and federal government, and state and local still have their wrangles and disputes. There are still boundary issues and squabbles over money, but state and local government are far more autonomous.
The idea of a written British constitution may not be popular - but the LGIU aren't the only ones to raise it. David Cameron, Conservative party leader, has pushed out the notion of a British Bill of Rights. It might be worth noting that the US Bill of Rights that has served us pretty well (withstanding even the destructive instincts of some executive administrations) was lifted almost word for word from the English Bill of Rights from 1692 (err...don't quote me on the date).
Another thing Amelia mentioned was using performance management as a political tool to achieve the democratic mandate. I think she felt PM was little used by politicians and certainly not used particularly often or well by backbench politicians.
Through the PMMI project we tried to provide a tool for councillors through A Councillor's Guide to PM. It was written by a councillor (Malcolm Grimston, LB Wandsworth). You can find it at www.idea.gov.uk/performance
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Finally, I'm writing this on the train which has folks standing in the aisles and vestibules. It is PACKED with central government economists who have also been on a conference in Nottingham. Just imagine - if this train were to crash... It might well be the end of dismal government forecasts for some time to come.
If there's no economist to make a forecast - does that mean nothing will happen?
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"For example, if the health of the population as a whole increased, but improved for some groups more than others (in a way that increased the disparity of outcomes), but everyone was at least somewhat better off, would that be wrong? What if that were the least worst solution?"
This is the classic problem of health promotion, i.e. that it disproportionately advantages the already advantaged. In a sense it might not matter - people are living longer healthier lives on average, right?
The problem is that in New South Wales, the part of Australia I live in, in 1983 the rate of potentially avoidable deaths was 432.5 per 100,000 people in the poorest quintile and 309.9 in the richest. There has been a marked drop over the period to 2002 with the rates falling to 207.3 and 135.4 respectively. Even though these gains have been substantial it now means that the difference between the poor and the rich now accounts for 34.6% of the overall rate of avoidable deaths, rather than the 28.3% it was in 1983(NSW Chief Health Officer's Report 2004).
This is a little complicated to explain in text, this graph is easier to understand.
There will always be differences in health outcomes but there's a danger in thinking that the excesses of this ditribution are unavoidable - as if it was simply the Pareto distribution in practice. I think HIA's usefulness comes from its potential to ensure that benefits are maximised and distributed equitably, helping to avoid a situation where we regard the healthiest getting proportionally healthier as simply being unavoidable.
But that's just my view. I'm glad you found Erica's speech thought-provoking.
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