International definition of Health Impact Assessment

In an attempt to connect and standardise individual HIA initiatives into a unified effort, in 1999 the WHO European Centre for Health Policy (ECHP) focused on developing a common understanding of HIA. The resulting “Gothenburg Consensus Paper” (ECHP 1999) defined HIA as follows:

„Health Impact Assessment is a combination of procedures, methods and tools by which a policy, program or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population” (ECHP 1999).

National definition of Health Impact Assessment

Based on the “Gothenburg Consensus Paper” the GÖG/ÖBIG defines HIA as follows:

„Health Impact Assessment is a systematic process to analyse und evaluate planned policy initiatives in view of their possible positive and negative effects on health as well as the distribution of these effects within the population. HIA is designed to inform policy decisions and promote Health in All Policies.” (GÖG 2010)

Main values and fundamental principles of HIA

As stated in the "Gothenburg Consensus Paper", HIA is based on the following central values:

Democracy
Emphasizing participation of the population in a transparent process of decision-making when the policies affect their lives and health.
Equity
Differentiated collection of data and consideration of possible health effects on different population groups. Goal: To contribute to the reduction of (health-status and social) inequality.
Sustainable development
Consideration of short- and long-term health impacts, as well as direct and indirect effects on health.
Ethical use of evidence
Objective and rigorous use of qualitative and quantitative evidence, based on different scientific disciplines and methodologies.

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Health determinants concept

Heath determinants can be understood as the personal, social, economic or environmental factors that either positively or negatively influence the health status of individuals or entire communities. (See figure: ‘Health determinants rainbow’) This model, from the social sciences, is the foundational concept for the majority of HIA models (See, for example: European Policy Health Impact Assessment, EPHIA).

Determinanten-Regenbogen
Figure: Health determinants “rainbow”
Source: GÖG/FGÖ, based on Dahlgren and Whitehead (1991)
Description of Health in All Policies

Health in All Policies (HiAP) aims for the integration of health with the specific goals and priorities of all other policy sectors.

When consideration of health takes place only within the health sector, efforts to achieve health goals often fall short. Therefore, health aspects and health effects must be considered in all policy fields. This approach can also have advantages for other sectors, as demonstrated by scientific evidence (e.g., economic growth).

Policies with negative health consequences burden the health systems and the broader economy. Efforts to compensate for negative health effects through interventions in the healthcare sector are usually not very efficient and are often expensive (Wismar et al. 2006).

HiAP and HIA are inextricably linked: HIA cannot be established without acceptance of HiAP. Also, HIA is a fitting instrument for the concrete implementation of HiAP. In the ideal case, HiAP and HIA can be mutually supportive in that the activities in both areas and the results of such activities can serve to promote the general acceptance of the foundational ideas of both.

Health in All Policies

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Description of health promotion

According to the Ottawa Charter of the WHO, health promotion is a process of empowering people to exercise greater control over the determinants that affect own health and thereby also improve their health.

More concretely, this includes activities and programs that help people improve their health. Health promotion takes place in various settings of daily life such as the workplace, residential environments or at school. The settings have an important influence on health.

Health promotion activities aim to change individual behaviours or to affect structural change. However, efforts towards structural change are usually rarely found in practice.

HIA can be used as an instrument for structural change and support the creation of health-promoting living conditions. As with HiAP, HIA can contribute to the effort to move the spotlight away from individual lifestyle factors and specific diseases, and rather focus on social factors and a broader structural understanding of health. (Hyssälä 2006).

Gesundheitsförderung
Description of health inequalities

‘Health inequalities’ refers to the gap in health status between different population groups. The study of health inequalities considers the interactions between socioeconomic factors and health.

A 35-year old male university graduate in Austria can expect to live until he is 81.4 years old, according to calculations by Statistics Austria. However, a man of the same age with only a compulsory education can statistically expect to live 6.2 years less; he has a life expectancy of only 75.2 years. Among women, the gap is somewhat narrower (84.4 vs. 81.6 years). (http://gesundesleben.at/zusammenleben/fakten/warum-armut-krank-macht)

Measures to reduce health inequalities should contribute to an improved health status of the affected population groups and to increased health equality. (See, for example: CSDH 2008)

In Austria, 52 per cent of women with only compulsory education are overweight or obese. Among university graduates, only 28 per cent. (http://gesundesleben.at/zusammenleben/fakten/warum-armut-krank-macht)

Equality is a central value of HIA and the consideration of social and health-status inequalities has an important place in the implementation of HIA. HIA can also contribute to the reduction of health inequalities.

Health Inequalities