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Glossary
This Glossary explains some of the terms commonly used in HIA.
HIA Menu It also explains some of the terms relevant to local government and health services in England.
Last Updated 14/7/08 JK
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Agenda 21
Reports Agenda 21 is shorthand for “The Agenda for the 21st century”. The 1992 Earth Summit held in Rio de Janeiro brought
together 175 heads of government to discuss the damage being caused to the planet through excessive use of natural
Guides & Evidence resources and the need for sustainable development. The Agenda they adopted called for the development of Local Agenda 21
(LA21) Plans. Local authorities have been given responsibility for getting LA21 started by bringing together local
Guides
organisations, business and member of the community to contribute to an Action Plan.
Evaluation
Tools for HIA
Appraisal (assessment)
Current Use
Theory Issues Appraisal or assessment follows on from the scoping stage of an HIA, where the nature, direction, size and importance of the
Policy Documents potential health impacts which have been identified are assessed using the available evidence base.
Evidence for HIA
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Glossary
Bibliography
Best Judgement
Networks & Events
Conclusive evidence of the links between, for example, socio-environmental factors and health or the effectiveness of
Links interventions is rarely available. In such cases, best judgement has to be used to decide how much weight to give to
conflicting lines of evidence and what are the most likely impacts where the evidence is incomplete.
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Best Value
Since April 2000, local councils have been required to develop Best Value performance plans and to review all their services
over a five year period. The purpose of the Best Value initiative is to encourage local authorities to develop a framework for
assessing the ways in which they deliver services and to identify ways in which service delivery can be improved. Ideally, this
is done through a series of wide ranging service reviews which incorporate service users’ and other stakeholders’ views and an
assessment of the need for services locally. In many cases, the process is seen as a possible mechanism for aligning the
councils’ activities and organisation with the priorities identified in their community strategies. Advice has been published by
IDEA, the local government improvement and development agency on how to undertake best value reviews.
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Capital investment
Funding for resources such as buildings or other “one-off” purchases such as computer hardware and software and other
office equipment.
Commissioning services
The process of identifying the need for services and making a contract or service level agreement with those able to provide
them.
Community participation
Involving the community in an activity such as the planning of projects or carrying out a HIA. There are a number of models
of community participation, some of which are outlined in the Gothenburg consensus paper on HIA.
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Community strategy
All English councils now have to produce a community strategy setting out key local priorities and proposing how the quality
of life of local residents can be improved. Local strategic partnerships usually take the lead on these in order to ensure that
the strategy is developed in partnership with local organisations and agencies rather than being produced “top down” by the
local authority.
Concurrent HIA
HIA is prospective. However the term concurrent HIA is still sometime used to describe the process of monitoring events
whilst a policy, programme or project is being implemented. This process is better described as monitoring.
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Decision making
The process of deciding which options will be chosen and implemented. An HIA should assist this process by clarifying the
health consequences of choosing each option.
Determinants of Determinants
Factors such as income, employment and community characteristics are important not only in themselves but also because
they limit what behaviour and lifestyle choices are possible. Such determinants are therefore sometimes referred to as
determinants of determinants.
Determinants of health
Determinants of health are factors which influence health status and determine health differentials or health inequalities. They
are many and varied and include, for example, biological factors, such as age, gender, ethnicity and genetic make up;
behaviour and lifestyles, such as smoking, alcohol consumption, diet and physical exercise; the physical and social
environment, including housing quality, the workplace and the wider urban and rural environment; access to health care. and
the broader economic and political setting. All of these are closely interlinked and differentials in their distribution lead to
health inequalities.
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Employment Zone
15 Employment Zones (EZs) were launched in March 2000 in areas experiencing high levels of long term unemployment in
order to help long term unemployed people get and keep work. Employment Zones pool funds for training, Employment
Service support and the equivalent of benefit to maximise flexibility and choice. The areas selected were amongst the worst
150 unitary authorities or local authority districts in Great Britain when ranked by a composite measure of the share of
unemployed claimants aged 25+ who were long term unemployed, the employment rate and the number of people
unemployed for over two years as a percentage of the working age population based on 1997 data. Participants in the EZ
schemes work with a personal adviser to establish their needs and identify any barriers preventing them from moving into
sustainable work. A costed action plan is then drawn up between adviser and participant. Once the participant has started
work, they continue to be supported to ensure that their move into employment is sustained where possible. A range of
different organisations were contracted through a tender ing process to administer the zones and their performance is
monitored and linked to the funding process.
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Environmental impact assessment (EIA) is a well developed discipline, both in terms of theory and practice.Its origins lie in
the US National Environmental Policy Acts of 1969. In the same way that HIA explores the effect of policies, programmes and
projects on health, EIA does the same in terms of environmental effects. In many countries, including those of the European
Union, there is a statutory requirement for EIA to be undertaken under certain circumstances. The rules vary from country to
country but generally EIA should lead to the abandonment or modification of proposals which are likely to have any significant
adverse effects on the environment. There are numerous definitions of EIA, including the following:-
an assessment of the impact of a planned activity on the environment
the process of evaluating the likely environmental consequences of a proposed major action significantly affecting the
natural and man-made environment
a technique and a process by which information about the environmental effects of a project is collected, both by the
developer and from other sources, and taken into account by the planning authority in forming their judgements about
whether the development should go ahead
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Equity Audit
An investigation of the inequalities of health and whether the distribution of services within that area relates to those
inequalities. The audit will make recommendations as to how policies might be changed or services redirected to decrease
inequity.
Equity in health
The key idea of equity is fairness. Equity in health is the absence of health inequity. Equity implies that everyone should have
a fair opportunity to attain their full health potential and, more pragmatically, that no one should be unfairly disadvantaged
from achieving this potential if it can be avoided. More succinctly, equity is concerned with creating equal opportunities for
health and with bringing health differentials down to the lowest possible level.
Equity is part of the basic values system of HIA. HIA explores and addresses health inequities in health wherever possible.
Evaluation
Evaluation involves making a judgement as to how successful (or otherwise) a project, programme or policy has been.
Success is commonly measured as the extent to which the project has met its original objectives but good and bad aspects
not mentioned in the objectives may also need to be considered. Both the “process” (activities) and “outcomes” (what is
produced, for example in terms of changes in the health of those targeted by the project) can be monitored and evaluated.
Process evaluation is particularly important for understanding why a project programme or policy failed or succeeded and
seeing how it can be improved in future. In the past an evaluation was sometimes called a retrospective HIA.
Evidence base
The evidence base refers to the body of information, drawn from routine statistical analyses, published studies, “grey”
literature, views of key informants and experts and views of residents and stakeholders. Evidence from the literature and
other sources tells us something about what is already known about how different factors affect health. For example, in the
field of housing and health there are a number of studies which demonstrate the links between damp and cold housing and
respiratory disease and, increasingly, the links between high quality housing and quality of life).
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Health gain
Improvement in health status.
Health impact
A health impact can be positive or negative.
A positive health impact occurs when good health is promoted or health is improved or harm to health is prevented. For
example, having a sense of control over one’s life and having choices is known to have a beneficial effect on mental health
and well being, making people feel “healthier”.
A negative health impact is the opposite and occurs when health is harmed. For example, working in unhygienic or unsafe
conditions or spending a lot of time in an area with poor air quality is likely to have an adverse effect on physical health
status.
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Health Inequalities Impact Assessment (HIIA)
The term Health Inequalities Impact Assessment is sometimes used for an assessment which places particular emphasis on
reducing health inequalites. One could argue that every HIA should have an emphasis on reducing health inequalities in which
case the term HIIA is redundant.
Some health inequalities are attributable to biological variations or free choice. For example the longer life expectancy of a
young person compared to an older person or the greaer risk of injury in someone who choses hang gliding as a hobby
compared to someone who does not. In these examples of inequality it is not possible or unacceptable to change the health
determinants and so there is no inequity.
On the other hand some inequalities are attributable to the external environment and conditions mainly outside the control of
the individuals concerned. For example the shorter life expectancy in people from manual social classes as opposed to those
from non manual a social classes or the higher infant mortaliy in residents of some areas compared to residents in other
areas. In these examples the uneven distribution of health may be unnecessary and avoidable and therefore unjust and
unfair. They are therefore examples of inequity.
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Impact assessment
Impact assessment is about judging the effect that a policy or activity will have on people or places. It has been defined as
the “prediction or estimation of the consequences of a current or proposed action”.
Inequalities audit
See Equity Audit.
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consulted on IPPC. There are around 7,000 sites affected across the country and the types of activity which are covered by
the regulations include the energy, metals, oil, chemical and waste management industries, paper production, food production
and some intensive livestock rearing.
Intermediate HIA
An intermediate HIA is less intensive than a comprehensive HIA and more intensive than a Rapid HIA. It may combine a
workshop with key stakeholders followed by desk based work to build up a more detailed picture of the potential health
impacts than those which would be identified during a rapid or “mini” HIA. It may involve a limited literature search, usually
non-systematic, and is mostly reliant on routine, readily available data.
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to prepare and implement a community strategy for the area
to bring together local plans, partnerships and initiatives
to work with local authorities in developing local public service agreements (PSAs)
to develop and deliver a local neighbourhood renewal strategy.
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Monitoring
Monitoring is the process of keeping track of events. For example, the monitoring of a project may involve counting the
number of people coming into contact with it over a period of time or recording the way in which the project is administered
and developed. Monitoring is often an important part of evaluation.
Multidisciplinary
HIA is not the preserve of any one disciplinary group. Instead, it draws on the experience and expertise of a wide range of
“stakeholders”, who are involved throughout the process. These may include professionals with knowledge relevant to the
issues being addressed, key decision makers, relevant voluntary organisations and – perhaps most importantly –
representatives of the communities whose lives will be affected by the policy.
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mental health
coronary heart disease
older people
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diabetes
renal services
children’s services
neurological conditions
Usually one new framework is published each year. Each NSF is developed with the assistance of an external reference group
which brings together health professionals, service users and carers, health service managers, partner agencies, and other
advocates.
Neighbourhood
The term neighbourhood usually refers to a local area which is defined in some way physically (for example, an estate or an
area bounded by major roads) or by people’s perceptions of what constitutes their local area. Neighbourhoods are usually
fairly small. For example, neighbourhoods designated for New Deal for Communities funding were usually made up of around
4,000 households or around 10,000 people.
Neighbourhood renewal
Neighbourhood renewal is the term commonly used when referring to the regeneration of local areas. At national
governmental level in England there is a Neighbourhood Renewal Unit charged with coordinating and promoting
neighbourhood renewal in the most disadvantaged areas of the country. The Neighbourhood Renewal Fund from 2001 to 2008
provided funds to support local renewal and regeneration porjects in 88 of the most deprived local authorities. The
programme has now been replaced by the Local Area Agreement programme.
poor job prospects
high levels of crime
educational under-achievement
poor health
problems with housing and physical environment
There were 39 New deal for Communities Partnerships but the programme has now been subsumed into the Local Area
Agreement programme.
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Outcomes
The effect the process has had on the people targeted by it. These might include, for example, changes in disease frequency,
self-perceived health status or changes in the distribution of health determinants, or factors which are known to affect their
health, well-being and quality of life.
Outputs
The products of the process. These might include, for example, how many people a project has affected, their ages and ethnic
groups or the number of meetings held and the ways in which the findings of the project are disseminated.
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Partnership
A group of people or organisations brought together with a common purpose such as developing a regeneration programme or
undertaking .
Policy
There are various definitions of policy:-
deliberate plan of action to guide decisions and achieve rational outcomes
a definite course or method of action selected from among alternatives in light of given conditions to guide and
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determine present and future decisions
the process by which governments (or organisations or individuals) translate their political vision into programmes and
actions to deliver outcome - desired changes in the real world
Policies can result in acting or not acting and may be explicitly stated or merely implicit. Where a policy is to be the subject of
an HIA it needs to be fairly well defined and explicit. National governments create policies to influence (produce change or
prevent change) conditions affecting their countries. Local government similar have policies intended to influence conditions
for their own populations. other organisations and individuals can similarly have policies to guide actions and activities.
For example, “Saving Lives: Our Healthier Nation” can be seen as a national health policy aimed at improving the health of
the population of England, reducing health inequalities and setting objectives and targets which can be used to monitor
progress towards the policy’s overall goal or aims.
Process
A course of action or series of activities.
Programme
The term programme usually refers to a group of activities which are designed to be implemented in order to reach policy
objectives. For example, Choosing Health lists various bundles of activities or programmes each of which is concerned with a
particular health problem such as health inequalities, smoking, obesity, sexual health, mental health and alcohol.
Project
A project is a discrete piece of work addressing a single issue with a pre-set time limit. Examples of a project might be
building a new road, building a bridge, regenerating an area of a town, building a new health centre, a scheme to provide
money to private landlords in order to bring their rented properties up to housing fitness standards and so on.
Prospective HIA
All HIA is prospective since it involves predicting how a project programme or policy will effect health. The term prospective
HIA is therefore unhelpful.
HIA takes account of the quantitative, “scientific” evidence where it can be found but also recognises the importance of
qualitative information, which will include the opinions, experience and expectations of those people most directly affected by
the proposed project, programme or policy. HIA tries to balance the various types of evidence.
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Regeneration
Regeneration is a broad concept used to describe a wide variety of measures that are designed to revive disadvantaged
(mainly urban) areas. This might include
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modifying the physical environment
altering lifestyles
improving leisure opportunities
enhancing the training and employment prospects of local residents
reducing stress, anxiety and fear
strengthening control over people's lives and fostering empowerment
improving access to public services
enhancing relationships between local residents and public sector agencies.
Since the second world war there have been many regeneration initiatives and many inner city areas have been “regenerated”
more than once.
Resource allocation
The process of deciding what is needed to carry out an activity and providing for those needs. This can include making
provision for financial resources (money), capital resources (such as buildings and computer hardware) and staff resources
(including the number of staff needed and the skill mix required).
Retrospective HIA
The term retrospective HIA was used to describe studying the effects of a project, programme or policy after it had been
implemented or the effect of an unintended event after it had occurred. This activity is better described as evaluation and the
term retrospective HIA is unhelpful.
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Scoping
Scoping refers to the process of planning the HIA It will involve identifying the potential health impacts of a policy,
programme or project and drawing a logic map before they are further investigated, deciding what types of evidence will be
used, what areas of literature need to be reviewed, how (and if) participation will be arranged and who are the key
stakeholders (those with expert knowledge of the project, those involved and those potentially affected).
Screening
In relation to HIA, screening refers to an initial step taken in order to determine whether a policy, programme or project
should be subject to a HIA. The criteria used for this process may include, for example, the size of any possible health
impacts, the size and cost of the activity in question and the degree of concern among those who might br affected.
Steering group
A group of people brought together to oversee a piece of work such as a HIA. Typically, a steering group might be made up of
representatives of relevant professional groups, key stautory agencies and the local community and its terms of reference
might include
overseeing development and progress of the work
agreeing the methodological framework and timescales
providing an input of local knowledge and information
acting as a bridge between partners
facilitating the implementation of the assessment's recommendations
helping to assimilate and disseminate the emerging lessons.
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development requires that a strategic approach to the environment be adopted. SEA is by European legislation for certain
projects and the European legislation has been incorporated into UK and other national legisaltion.
Currently there are 10 SHAs which replaced the 30 smaller SHA created in the NHS reorganisation of April 2002 by merging
the 95 previous health authorities.
Strategy
The term strategy usually refers to a series of broad lines of action intended to achieve a set of goals and targets set out
within a policy or programme. For example, Choosing Health laid out broad priorities for improving health and broad
approaches to be taken in order to achieve them.
Sure Start
Sure Start is a government funded programme in England designed to improve services for young children and their families.
It encourages statutory services, voluntary organisations and community groups to work together to provide services, and to
ask local people what services they want. Its overall aim is to improve the health and well being of children so that they are
ready to flourish when they start school and to identify children who need help at an earlier stage so that professional help
can be given as soon as possible. Part of this process involves helping children’s social and emotional development by
supporting the early bonding of children and their parents as well as improving children’s ability to learn by encouraging play
and improving language skills.
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Toolkit
The term toolkit is generally held to mean an information resource including, for example, routinely available data which may
be required for quantifying potential health impacts, a compilation of literature on health determinants or a template for
organising a HIA or parts of the HIA process such as a workshop for key stakeholders.
Working group
In contrast to a steering group, a working group convened for the purpose of carrying out usually consists of those charged
with carrying out the work on a day to day basis. Typically it might include people with a range of complementary public
health skills such as project management, epidemiology, statistical analysis and presentation, questionnaire design and
community development.
Workshops
Workshops involve bringing together a group of people for a specific purpose. In HIA this might include, for example,
identifying key stakeholders’ health concerns in relation to the policy, programme or project being addressed, identifying
sources of current knowledge in relation to the evidence base or training staff in HIA techniques. Workshops are usually
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structured in some way with a mixture of presentations and “hands on” participative work.
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