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Health Equity Impact Assessment: a Primer. By Rebecca Harber, Wellesley Institute.
This report explores Health Equity Impact Assessment (HEIA) as a promising tool for equity-focused planning. The author notes that inequalities in health remain pervasive in Ontario and world wide. While acknowledging that the roots of these disparities lie in social determinants of health, she suggests that the health system can either mediate the impact of these root causes of ill health or serve to widen health disparities if access and quality of healthcare are not equitable.
HEIA is a tool used to analyze a new program or policy’s potential impact on health disparities and/or on health disadvantaged populations. It is an adaptation of the more well known Health Impact Assessment (HIA), with an explicit focus on equity.
While there are a variety of specific HEIA tools available, they generally follow five steps:
- Screening: Does the program have the potential to impact health disparities or health disadvantaged groups? If yes, then HEIA is appropriate.
- Scoping: What populations or groups might be affected by the program?
- Impact Assessment: Consider the impacts of the program/policy, both positive and negative, for each population affected. Consider cumulative effects.
- Develop a Strategy: Recommend on how to mitigate negative effects and build on positive ones.
- Monitoring and Evaluation: Follow up with the program. An evaluation built in from the start, with indicators, data collection and community input helps to figure out what works and why.
HEIA has been used in Wales, New Zealand, Australia, the United Kingdom and Canada (Ontario). Its use has been advocated by the World Health Organization Commission on the Social Determinants of Health. HEIA has been used in a variety of fields, from the health system, to regional land-use planning, to road construction. Harber notes that while HEIA has been used in a variety of settings, there has been little documentation of their impacts on policy and program development and implementation. A limited number evaluations have found HEIAs to be successful in identifying unintended impacts of planning, improving relationships and collaboration among different sectors, and have prompted decision-makers to consider equity concerns.
Harber notes that meaningful application of HEIA is possible in a context where there is an awareness of equity as an issue, support to use the HEIA tool, and a clear goal for its use. In addition, because HEIA’s purpose is to consider impacts on a community, that community’s involvement and input is a key part of HEIA. Barriers to the use of HEIA include conflict over participants’ different values, the difficulty for participants to identify negative consequences of their own programs, lack of capacity to perform a HEIA, and the significant amount of time required to perform one.
The author notes that HEIA’s potential lies beyond generating specific recommendations for a policy or program; it also serves to get people together and makes equity a mainstream concern in planning.
This short (3 pages of text) report would be useful for anyone considering conducting a HEIA, whether as an organization to aid decision-making, by an outside group to influence decision-making, by potentially affected communities to voice their concerns, or collaboratively by a variety of stakeholders. The report concludes with a list of resources to provide information about HEIA, as well as specific HEIA tools, frameworks and templates.
Review by Debbie Rawson
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Thursday, 17 May 2012 
