Step 2 - Scoping
Determining the Scope of Your Health Impact Assessment
An Introduction to the Scoping Step
by Sarah Simpson
Health impact assessment is only one method for
measuring health impact and is generally defined by five specific steps.
In this section, we look at the second step of HIA, scoping - providing an
overview of the purpose, suggested strategies and expected outcomes from
scoping.
The purpose of this step is to determine the
scope of the work to be undertaken, what's included and excluded based on
the time and resource constraints that apply to the proposal under
consideration. This includes consideration of issues such as:
- whether the HIA should be rapid (eg. desk top audit), intermediate (eg. health impact statement) or comprehensive
- the definition of health and health outcomes to be considered
- what kinds of evidence will be gathered and how will it be assessed
- the range of stakeholders who need to be engaged
- mechanisms for making recommendations.
Usually a Steering Committee/Group is established between the screening and scoping
steps to oversee the conduct and progress of the HIA. The Steering
Committee can be as large or as small as required - eg. it may only be 3
or 4 people. Also when the Steering Group is considering the range of
stakeholders who need to be engaged in the HIA they may make a decision to
invite other stakeholders to join the Group. Sometimes however, the
timeframe for the conduct of the HIA will determine the level and type of
participation and engagement.
The manuals on HIA present a wide variety of
ways in which scoping can be undertaken - some are extremely detailed,
involving scoping tools and others are less so (some HIA manuals combine
the screening and scoping steps). A list of some of the HIA manuals is
included at the end of this article. Whatever approach is selected for
scoping the HIA it's important for the Steering Group to:
- Agree on the definition of health to be applied
- Agree on the type of HIA to be undertaken
- Agree on what counts as "evidence"
- Develop the methods and processes for collecting the information on potential health impact
- Agree on the criteria and/or a process for the decision making step
- Agree on the principles that underpin the HIA
The main outcome of the scoping step is an
outline of how the HIA will be conducted and how the results will be
assessed. A written protocol setting out the conduct of the HIA should
usually be developed. As part of the scoping step a matrix that reflects
the agreed definition of health, criteria for assessing the health impact
and then weighting it for significance may also have been developed.
In effect the scoping step sets the scene of
the HIA, making the assumptions on which decisions will be based transparent. Being thorough in the scoping of the HIA is important
because it could save time, work and resources further on in the HIA
process. For example, it's important that by the decision-making stage of
the HIA to have an agreed process for negotiating "trade offs" and for
areas where there is disagreement.
The section on the forms of HIA
provides an overview of what's involved in each of the
three different levels of HIA - rapid, intermediate and comprehensive.
This information can be used by a Steering Committee to decide on the
type of HIA to be undertaken, which is an important part of the scoping
step.
See the section on tools for HIA for more
information on this stage.
by Ben Harris-Roxas
Key Questions in Scoping a HIA
Rapid Appraisal
Health Impact Statement
Comprehensive Health Impact Assessment
References
The introduction to scoping emphasises the importance of getting the scope of a HIA
right. This process throws up a major question for those undertaking
a HIA: now that we've screened the proposal what sort of assessment do
we undertake? The table
below shows how difficult it can be to disentangle the issues of
desired information and the methods you have at your disposal to get
it.
One of the most overwhelming aspects of taking on a HIA is the proliferation of
terms used to describe types of health impact assessments -
statements, checklists, rapid appraisals, audits, analyses and
reviews. These are usually grouped into categories according the
timeframe and resources available.
What follows is an account of the three different kinds of HIA
identified in the Phase 1
NSW HIA Project report where the level of HIA may be
related to the level of investment and potential health impacts.
Key Questions in Scoping a HIA
| When? | Prospective? Retrospective? Concurrent? |
| Limited to? | Boundaries: spatial, jurisdictional and temporal? |
| How? | Checklist? Rapid Appraisal? Focused analysis? Extensive Assessment? Post-hoc evaluation? |
| Degree of Detail? | Specific? Exhaustive? Cursory? |
| Who? | In-house? 'Experts'? Independent party? |
| HIA on its own? | Or combined with other assessments, such as environmental impact assessment? Impact on whom? Focus on health inequalities and equity? Population as a whole? How to weigh different impacts in different areas (e.g. rural/urban)? |
| For whom? | Target audience: decision-makers, general public or others? |
| Involvement of stakeholders? | Should the process be more consultative? Will it increase ownership of the assessment's outcomes? Will the stakeholders be able to provide information to guide the HIA? |
| Where is the data? | Existing evidence? Official/routinely collected data? Specifically collected data? |
| Definitions | How is health defined? How is equity defined? |
Rapid appraisal
involves the structured assessment of the health impact of a policy,
program or project by an individual or small number of stakeholders.
It may involve sharing existing knowledge or checklist approaches to
reviewing potential health impacts. Rapid appraisals are typically
carried out with minimal resourcing within a shorter timeframe. The
benefits of rapid appraisal are that it allows the consideration of a
broad range of interrelated health issues within a shortened period
and resource constraints. This is linked to its most cited weakness,
namely that it is at risk of being superficial and insufficiently
flexible. As such it may fail to add substantial value to the
planning process.
Many guidelines for rapid health impact appraisal have been developed, both
in Australia and overseas:
Bro Taff Health Authority Health Inequality Impact Assessment: Rapid
Appraisal Tool
Health Impact Assessment: A Screening Tool for the Greater London
Authority
An impact statement involves a closer scrutiny of the proposed policy,
program or project. It typically includes greater stakeholder
engagement but typically doesn't involve extensive data collection.
It involves more time and resources than rapid assessment and is often
done by a group or panel rather than an individual. Methodologies
employed may often include literature and policy reviews, interviews
or stakeholder surveys. This approach's strengths lie in its more
comprehensive nature. It is often criticised, as many "middle"
approaches are, for not being detailed enough on the one hand and for
being too labour intensive on the other.
Guidelines for impact statements are more varied and less directive than those
developed for rapid appraisals, reflecting a more diverse approach:
NSW Health Aboriginal Health Impact Statement
Swedish
Government Guide to Health Impact Analysis
Comprehensive Health Impact Assessment
A comprehensive health impact assessment is done primarily to ensure that not only are health impacts considered but that the beneficial impacts are maximised and that they are distributed equitably. Generally a comprehensive HIA is undertaken when there are thought to be:
- potentially significant health impacts on a small number of people;
- a high level of investment that may be recurrent; or
- potential health impacts on a large number of people andwhere it was felt that more evidence needed to be collected before an assessment could be made.
Comprehensive HIAs are intensive and often require additional data
from diverse sources. This level of assessment is rarely done
in-house but usually by commissioning consultants or academics.
This approach's strengths lie in its more comprehensive nature and scope
for rich, detailed analysis. Its main weakness is that it requires a
substantial investment of time and resources, not only on the part of
those undertaking the HIA but also of the stakeholders involved.
enHealth Health Impact Assessment Guidelines
It's important to realise that though both articles on scoping in this issue present
different aspects of scoping neither are exhaustive. The real world
factors that affect scoping, such as the political context, often play
a greater role in determining the scope of a HIA than formal processes
of deliberation.
See the section on tools for HIA for
more information on this stage.
1.
European Centre for Health Policy.
Gothenburg Consensus Paper: health impact assessment main concepts and
suggested approach. Brussels: WHO Regional Office for Europe,
1999.
2.
Environmental Health Assessment Services.
Canadian Handbook on Health Impact Assessment. Ottawa: Health
Canada, 1999.
3.
Health Development Agency.
Stage Two: deciding how to undertake an HIA in a given context
(scoping): UK National Health Service, updated November 14,
accessed November 17 2003.
4.
Mcintyre L, Petticrew M.
Methods of Health Impact Assessment: a literature review.
Glasgow: MRC Social & Public Health Sciences Unit, 1999.
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