Methodology: Phases and Procedures

HIA can be divided into five sequential phases: 1. Scanning or screening to determine whether an HIA should be conducted; 2. Scoping to outline the specific focus of the HIA and methodologies to be used; 3. Profiling; 4. Impact assessment to analyze relevant evidence in order to make qualitative and quantitative assessments of potential health impacts; 5. Report preparation to synthesize the results and communicate them to target audiences (e.g. policy-makers and stakeholders).

1. Scanning/Screening

Purpose
To assess the suitability of HIA for a given policy proposal in order to decide whether or not to proceed with the HIA. The purpose of scanning is to identify current or emerging policy proposals for which an HIA might produce useful information. A useful metaphor is 'winnowing'-sifting through the chaff of countless policy proposals to identify those that might have significant health impacts and for which HIA might contribute valuable information to the policy-making process. Screening, on the other hand, starts with just one policy proposal, not many, and aims to determine the suitability of HIA for that proposal, and culminating in a decision on whether or not to proceed with the HIA.

Analytical Steps
1. Define the policy, program or project to be analyzed.

2. Review criteria for selection (including general HIA screening criteria and additional criteria relevant to a particular program, locale, etc).

3. Complete and discuss screening tools (checklists, etc.)

4. Make a preliminary assessment on whether to proceed with HIA.

5. Review decision with stakeholders.

Product
A brief preliminary assessment on the feasibility and value of an HIA

2. Scoping

Purpose
To outline the impacts, an explicit model describing how the proposed policy may impact health determinants and health-related outcomes, methodological approach, expected challenges and resources needs for impact analysis.

Analytical Steps
1. Consult policy-makers, stakeholders, experts and research literature to assess and describe the:

1. proposed policy;
2. population affected;
3. immediate, intended effects;
4. health-related secondary and side effects;
5. pathways through which the proposed policy or program is expected to affect health outcomes and intermediate outcomes (i.e. determinants of health);

2. Determine methodologies to be used and set boundaries for the proposed HIA to maximize the efficient use of resources for producing the most salient and valuable information.

Product
An outline for the impact analysis, including data on the relevant baseline characteristics of the target population

3. Profiling

Purpose
To describe key aspects of the health status and demographics of the population that can act as a baseline against which possible health impacts can be assessed.

Analytical Steps
1. Compile a profile of the areas and communities likely to be affected by the project using available socio-demographic and health data and information from key informants (Scott-Samuel et al, 2001).

2. Describe key aspects of the health status and general make-up of the population, particularly in relation to factors that are believed to be susceptible to change or that may act a as indicators of anticipated health impact(s) (Commonwealth Department of Health and Aged Care, 2001).

3. Assess the nature and characteristics of groups whose health could be enhanced or placed at risk by the project efforts. Vulnerable and disadvantaged groups require special consideration (Scott-Samuel et al, 2001).

Product
A comprehensive description of the socio-demographic and health profile of a community or population.

4. Impact assessment

Purpose
To identify the positive and negative health impacts of the proposal.

Analytical Steps
1. Assess qualitative evidence pertaining to each of the links in the causal chain(s) linking the policy with putative health outcomes.

2. If possible, use evidence from the literature to construct quantitative models and estimate potential health effects and their likelihood.

3. Conduct cost analyses when feasible and appropriate.

Product
1. A brief summary and assessment of literature, expert opinion, etc.

2. Impact estimates, including probable direction, magnitude, distribution and likelihood.

5. Report preparation

Purpose
To produce a coherent, usable synthesis of findings from the analysis.

Analytical Steps
1. Document the quantitative and qualitative findings from the preceding steps of the HIA

2. Prepare a summary of the findings for policy-makers.

The end product
A comprehensive HIA report for target audiences (e.g. policy-makers). The report(s) should include a brief summary as well as a more complete report that provides detailed information about the findings, methodologies, and underlying assumptions.