HowtoAdvanceEquitythroughHealthImpactAssessments
APlanningandEvaluationFrameworkbytheSOPHIAEquityWorkingGroup
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TheFrameworkforEquityinHIAPracticeEquityisacorevalueofHealthImpactAssessment(HIA).1ManyHIApractitionersengageintheworktoaddresssystemic,avoidable,unjust,andunfairdifferencesbetweenpopulationgroupsinfactorsimportanttohealth.TheconceptualframeworkandtoolsinthisresourceemphasizebuildingcommunitypowerthroughthepracticeofHIAasakeyprocessforadvancingequity.Buildingcommunitypoweristheprocessbywhichcommunitiesgaincontroloverthefactorsthatshapetheirlives,includingaccesstoinformationandopportunity,decision-makers,andpolicy-making.Atruebalanceofpowerimpliesmorethantheparticipationofcommunities,butrathercommunityownershipofprocesses,planning,andactionsthatseektochangethedeterminantsofhealthequity.
Whyweneedtoemphasizebuildingcommunitypowertoadvanceequity.
Wemustachieveabalanceofpowerandfindwaystosharepowerequitablyinordertoadvancehealthequity,acknowledgingthatexistingpowerstructuresworktomaintainthestatusquoandfavorsomegroupsoverothers.Theunequaldistributionofpower—inallitsforms—isthesourceofinequitiesinsocialconditions.Researchoverthepasttwodecadesrepeatedlyshowstherelationshipbetweeninequitiesinsocioeconomicfactorssuchashousing,employmentandwages,education,andneighborhoodconditionsandinequitiesinhealthoutcomes.2,3,4,5Structural,institutional,interpersonal,andinternalizedformsofoppressionbasedonrace/ethnicity,class,gender,sexualorientation,abilityandothersocialconstructsleadtohealthinequitiesandareusedbythosewhobenefitfromretainingpower.
WhatistheroleoftheHIApractitionerincommunitypowerbuilding?
AnimportantroleoftheHIApractitioneristofacilitateaprocessthatleadstogrowingpoweramongcommunitiesfacinginequities.ConductingHIAwiththisasanexplicitgoalcanhelptobuildagencyincommunitiesfacinginequitiesandcontributetoinstitutionalreform,systemschange,andtheredistributionofpowerindecision-making.
Workingwithcommunityorganizinggroupscanhelpachievecommunityengagement.ItisachallengefortheHIApractitioneralonetoorganizetheengagementoftheimpactedcommunityduringanHIAduetovariousconstraints,includingtimelines,resources,leveloftrust,andgeographicscope.Workingthroughexistinggroupsthatdirectlyengagethosemostimpactedcanbeagoodalternative.Weconsiderworkingwithcommunityorganizinggroupstoreachthosemostimpactedbyadecisiontobeauthenticcommunityengagement.
HowtoAdvanceEquitythroughHealthImpactAssessments
APlanningandEvaluationFrameworkbytheSOPHIAEquityWorkingGroup
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Wedefineacommunityorganizinggroupasanorganizationthat6:• Helpsacommunityidentifycommonproblemsorchangetargets,mobilizeresources,
anddevelopandimplementstrategiestoreachtheircollectivegoals.• Bringspeoplewhoidentifyasbeingpartofthecommunitytogethertosolveproblems
thattheythemselvesidentify.• Workstodevelopcivicagencyamongindividualsandcommunitiestotakecontrolover
theirlivesandenvironments.HIAPractitionersmusttakeintoaccountthedecision-makingcontext.BeforebeginninganHIA,apractitionershould:• Understandthefullcontextsurroundingtheproposalunderconsiderationandwhat
othersarealreadydoingtoadvanceequity.• ConsiderthepurposeoftheHIAandtheHIAprocesswithinthiscontext.• Takeadvantageofanyauthenticcommunityengagementandpowerbuildingthatmay
alreadybeoccurringaspartoftheoveralldecision-makingprocess—bygovernmentagenciesleadingtheprocess,communityorganizinggroups,orothers.
Contextandscaleinfluenceapractitioners’approachtoandlevelofcommunityengagement.Thepractitioner’sorganizationalcontextwillinfluencetheirabilitytofocusonbuildingcommunitypowerandadditionalshiftsinpublichealthpracticesmaybenecessarytosupportafocusoncommunitypowerbuilding.Engagingandbuildingpowerincommunitiesmostimpactedbyaproposalgetsincreasinglydifficultastheproposal’sscopeincreasesfromtheneighborhoodtothefederallevel.Forexample: • Practitionersatacommunity-basednon-profitoranacademicinstitutionmayhavethe
leewaytomakebuildingcommunitypowercentraltotheirHIAwork.• PractitionersinalocalpublichealthdepartmentmayfocustheirHIApracticeonlocal
decisionsandmayhaveorbeabletoformrelationshipswithcommunitiesthatwillbemostimpacted—engagingwiththesecommunitiesislikelyalreadyrecognizedtobewithintheirpurview.
• Practitionersinstateorfederalpublichealthagenciesmaybeabletoengagedirectlywithcommunitiesfacinginequities,butarelesslikelytohavedirectorsustainedrelationshipswiththemduetotheroletheseagenciesplayandthegeographicscaletheycover.Theymayhavemoredirectandsustainedrelationshipswithadvocacygroupswhorepresentcommunities.
Stateandfederalagenciescansupportcommunitypowerbuilding.WhilesomestateorfederalhealthagenciesmaybeabletobuildcommunitypowerthroughtheHIAprocess,othersmaynotbeabletodothisandcanplayalternaterolesby:• Providingtechnicalassistancetolocalhealthdepartmentsonhowtoengagethe
community.• ProvidingfundingtocommunityorganizinggroupstoengageinHIA.• Targetingresourcestoplacesorpopulationsfacingthegreatestinequities.• Strengtheninglanguageinpoliciesandfundingopportunitiesabouttherequireddegree
ofcommunityengagementforHIA.
HowtoAdvanceEquitythroughHealthImpactAssessments
APlanningandEvaluationFrameworkbytheSOPHIAEquityWorkingGroup
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ComponentsofthePlanningandEvaluationFramework
Wehaveorganizedtheframeworkintofourequity-relatedcomponents:
1. EnsuringtheHIAprocessandproductsfocusonequity.2. EnsuringtheHIAprocessbuildsthecapacityofcommunitiesfacinghealthinequitiesto
engageinfutureHIAsandindecision-makingmoregenerally.3. UsingtheHIAprocesstoshiftpowertothebenefitofcommunitiesfacinginequities.4. UsingtheHIAtoreducedhealthinequitiesandinequitiesinthesocialand
environmentaldeterminantsofhealth.ThefollowingtoolscanhelpyouplanandevaluateanHIAwiththesefourcomponentsinmindfrombeginningtoend.
WaystoUsetheFramework
WeencourageHIApractitionerstoadvancethisconceptualframeworkbyusingtheHIAEquityPlanningToolandtheHIAEquityEvaluationTool:
• UsetheHIAEquityPlanningToolthroughouttheHIAprocess,tohelpplanyourapproachtoaddressingequity.
• EvaluateacompletedHIAusingtheHIAEquityEvaluationToolasaself-reflectiveexercisetoassesshowwellyourHIAbuiltcommunitypowerandimprovedhealthinequities.
• UsetheHIAEquityEvaluationToolaspartofamorethoroughHIAevaluationprocesswithmultipledatapoints.
• UsetheHIAEquityEvaluationTooltoinformpoliciesorlegislationrelatedtoHIA.[ForPolicymakers]
TheconceptsandpracticesreflectedintheHIAEquityPlanningToolandtheHIAEquityEvaluationToolwilllikelybeusefultoadvanceequityinotherprocesses,policies,andpracticesbeyondHIA—includingHealthinAllPolicies.WeencouragethoseoutsideoftheHIAfieldtoconsiderhowthesetoolscanbeadaptedfortheiruse.
NotesManyofthemetricsintheHIAEquityEvaluationToolcanbeevaluatedsoonaftercompletionofanHIAanddecision-makingontheissueinformedbytheHIA.However,itislikelythattheanalysisofthelattermetricswillrequireadditionaltime;itoftentakestimetorealizeshiftsinpowerorreductionsininequities.Inaddition,thelastmetric—improvementsinhealthoutcomes—isaspirationalgiventhatmanydiseasesaremultifactorialandthatcausallinksbetweentheHIA,policychange,andhealthoutcomesaredifficulttovalidate.
SeeGuidanceandBestPracticesforStakeholderParticipationinHealthImpactAssessments7formanyexamplesofmeaningfulengagementateachstep.
Screening
Todo Tips
q Partnerwithcommuni/esfacinginequi/estoiden/fytheproposalonwhichyouwillconductyourHIA.
Ifyoucan’tdothis,makesuretheproposalonwhichyouchoosetoconductyourHIAisrelevanttocommuni/esfacinginequi/es.
• Askcommuni/esfacinginequi/eswhatissues,policiesand/orplansareaffec/ngtheirlivesandhealth.
• Analyzethepower,policy,andhistoricalcontextoftheprac/ceorpolicyupforanHIA,tounderstanditsrelevancetoequity.
q Meaningfullyengagecommuni/esfacinginequi/esinScreening.
• StructuretheScreeningprocesssothatcommunitymembershavetheopportunitytosubstan/allyshapedecisionsabouttheHIAtopic(e.g.,communitymembersholddecision-makingauthority).
Scoping
Todo Tips
q Includeequity-specificgoalsinyourHIAScope.• Includeatleastoneequity-specificgoal.• Developresearchques/onsandmethodsthatwillreveal
thesizeandnatureofinequi/es.
q Includeequity-specificresearchques/onsinyourHIAScope.
q Includeequity-specificmethodsinyourHIAScope.
q Meaningfullyengagecommuni/esfacinginequi/esinScoping.
• StructuretheScopingprocesssothatcommunitymembershavetheopportunitytosubstan/allyshapetheHIAgoals,researchques/ons,andmethods(e.g.,communitymembersholddecision-makingauthority).
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HIAEquityPlanningToolHowtoAdvanceEquitythroughHealthImpactAssessments
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Assessment
Todo Tips
q Analyzethedistribu/onofopportuni/esforhealthylivingandhealthoutcomesacrosspopula/ons.
• Quan/ta/velyassessdispropor/onateimpactsandpoten/alcumula/veimpactsoncommuni/esfacinginequi/es.
• Conductfocusgroupsand/orsurveyswithcommuni/esfacinginequi/es.
q Usethecommunityknowledgeandexperienceasevidence.
q Meaningfullyengagecommuni/esfacinginequi/es.• Usecommunitypar/cipatorymethodstoinclude
membersofcommuni/esfacinginequi/esindatacollec/on,forexample.
Recommenda@ons
Todo Tips
q Ensureyourrecommenda/onsfocusonmi/ga/ngnega/veimpactsandmaximizingposi/veimpactsoncommuni/esfacinginequi/es.
• Recommenda/onsshouldtargetimpactsoncommuni/esfacinginequi/esatthesame/measpromo/nghealthimprovementsfortheen/regreatercommunity.
• Communitypriori/esshouldbereflectedintherecommenda/ons.
q Ensureyourrecommenda/onsareresponsivetotheconcernsofcommuni/esfacinginequi/es.
q Meaningfullyengagecommuni/esfacinginequi/es.
• Structuretheprocessofdevelopingrecommenda/onssothatcommunitymembershavetheopportunitytosubstan/allyshaperecommenda/onsandpriori/es(e.g.,communitymembersholddecision-makingauthority).
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HIAEquityPlanningToolHowtoAdvanceEquitythroughHealthImpactAssessments
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Repor@ng
Todo Tips
q Disseminatethefindingsandrecommenda/onsincommuni/esfacinginequi/es. • Translatefindingsandrecommenda/onsintorelevant
languagesandmediaformats(e.g.,socialmedia).• Traincommunityleaderstocommunicatefindingsand
recommenda/onsontheirownbehalftopolicymakersandothercommunitymembers.
q Supportmembersofcommuni/esfacinginequi/estodisseminatethefindingsandrecommenda/ons.
q Usearangeofculturallyandlinguis/callyappropriatemediaandplaUormstodisseminatefindingsandrecommenda/ons.
q Meaningfullyengagecommuni/esfacinginequi/es.• Membersofcommuni/esfacinginequi/esshouldpresent
HIAfindingstothemediaanddecision-makers,forexample.
MonitoringandEvalua@on
Todo Tips
q Ensurethemonitoringandevalua/onplanassessequityimpacts. • Iden/fythosewithposi/onalpowerwhomusttakeac/on,be
heldaccountable,andreportbacktothecommunityifnega/veequityimpactsarefoundduringmonitoringandevalua/on.
q Ensurethemonitoringandevalua/onplanincludeaccountabilitymechanisms.
q Meaningfullyengagecommuni/esfacinginequi/es.
• Promotecommunitymemberdecision-makingauthorityandresponsibilityformonitoring.
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HIAEquityPlanningToolHowtoAdvanceEquitythroughHealthImpactAssessments
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Opportuni@esforIncreasingHealthEquityinHIAPurposeandIntent
Opportuni@es Tips
q UsetheHIAprocesstobuildknowledgeandawarenessofdecision-makingprocessesamongcommuni/esfacinginequi/es.
• Provideleadershiptrainingformembersofcommuni/esfacinginequi/esaspartoftheHIAprocess.
• Buildunderstandingamongmembersofcommuni/esfacinginequi/esofac/onresearchandhowitcanbeusedtomakechange.
• Buildtheskillsofcommunitymemberstoanalyzethepower,policy,andhistoricalcontextofdecisions.
q UsetheHIAprocesstobuildthecapacityofcommuni/esfacinginequi/estoinfluencedecision-makingprocesses,suchastheabilitytoplan,fundraise,andtakeac/onwithinthedecision-makingcontext.
q UsetheHIAprocesstoincreasetheinfluencecommuni/esfacinginequi/eshaveoverdecisions,policies,partnerships,ins/tu/ons,andsystemsthataffecttheirlives.
UsetheHIAprocessto:• ShiYtheculturewithinins/tu/onsandamong
communi/essothattheyconsidercommunitydataandknowledgeasevidence.
• Buildorstrengthenalliancesbetweenorganiza/onsthatareaddressinginequi/esintheirwork.
• Createopportuni/esformembersofcommuni/esfacinginequi/estohaveaseatatdecision-makingtables.
q UsetheHIAprocesstochangegovernmentagenciesandotherins/tu/onssotheyaremoreawareofinequi/esandmoretransparent,inclusive,responsive,and/orcollabora/ve.
UsetheHIAprocessto:• Changeagencyoversight,forexampletoincludea
CommunityAdvisoryBoard.• Createnewgovernmentoffices,suchasanOfficeof
HealthEquity.• Changethemissionofagovernmentagency.
HIAEquityPlanningToolHowtoAdvanceEquitythroughHealthImpactAssessments
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Outcome1:TheHIAprocessandproductfocusonequity
Metric1.a DataCollec@onMethods InterviewQues@ons
ProposalanalyzedintheHIAwasiden@fiedand/orrelevanttocommuni@esfacinginequi@es.
Ø InterviewswithHIAprac//oner
Ø Interviewswithcommunitypar/cipants
Ø HIAReport
• Whowasinvolvediniden/fyingtheproposalanalyzedintheHIA?• Weremembersofthecommunitythatwouldbeimpactedby
theproposalinvolvediniden/fyingthisasapoten/alHIAtopic?• Ifnot,didthecommunityhaveconcernsaboutissuesthatwere
relevanttothisproposal?• Ifnot,howwasthisHIArelevanttocommuni/esfacing
inequi/es?Howwasthisdetermined?• WasthisproposalofinteresttotheleadHIAprac//oner(s)andnot
ofinterestorrelevanttothecommunity?• Wasananalysisconductedtounderstandhowthedecisionbeing
analyzedforthisHIAfitintothelargerpolicy-makingcontextandhowtheHIAcouldbeusedtoadvanceequitymorebroadly?
• DidtheHIAprocessandproductsreflectanunderstandingofthepower,policyandhistoricalcontextofthedecisions?
Score(circleone) Examplesofhigh-scoringac@vi@es
NotatallTheproposalisnotofinterestorrelevanttothecommunity.
TosomeextentTheproposalwasiden/fiedbyHIAprac//onerasbeingrelevanttocommuni/esfacinginequi/es.
VeryTheproposalwaspriori/zedbycommuni/esfacinginequi/esasbeingimportantfortheirhealth.
² HIAprac//oneraskedcommunityfacinginequitywhatpolicyorplantheythoughtwouldhaveanimpactontheirhealthandproceededwiththatastheHIAtopic.
² HIAprac//oneraskedcommunityfacinginequitywhattheirmainhealthconcernswere,iden/fiedanHIAtopicbasedonthat,andgainedcommunitysupportformovingforwardwiththeHIA.
² HIAprac//oneranalyzedthepower,policy,andhistoricalcontextofthedecisiontounderstanditsrelevanceforequity.
Notes
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HIAEquityEvalua@onToolHowtoAdvanceEquitythroughHealthImpactAssessments
Outcome1:TheHIAprocessandproductfocusonequity
Metric1.b DataCollec@onMethods InterviewQues@ons
TheHIAscope—includinggoals,researchques@ons,andmethods—clearlyaddressesequity.
Ø HIAReport
OrØ InterviewwithHIA
prac//onerandcommunitypar/cipantsifgoals,researchques/ons,andmethodsarenotincludedintheHIAreport
• WhatweretheHIAgoalsandresearchques/ons?• IftheHIAgoalsand/orresearchques/onsdon’tmen/onequity:did
thegoalsandresearchques/onsconsiderequity?Whichinequi/eswereaddressed?
• Didyourresearchmethodsaddressequity?Ifso,how?
Score(circleone) Examplesofhigh-scoringac@vi@es
NotatallNo.
TosomeextentScopeincludesequity-relatedgoals,ques/ons,ormethods.
VeryScopeincludesequity-relatedgoals,ques/ons,andmethods.
² AtleastoneoftheprimarygoalsoftheHIAistoassessequityimpacts,whetherornotthetermequityisused.
² Researchques/onscallforfocusoncommuni/esfacinginequi/es.
Notes
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HIAEquityEvalua@onToolHowtoAdvanceEquitythroughHealthImpactAssessments
Outcome1:TheHIAprocessandproductfocusonequity
Metric1.c DataCollec@onMethods
Distribu@onofhealthandequityimpactsacrossthepopula@onwereanalyzed(e.g.,exis@ngcondi@ons,impactsonspecificpopula@onspredicted)[email protected]@lizedcommunityknowledgeandexperienceasevidence.
Ø HIAReport
Score(circleone) Examplesofhigh-scoringac@vi@es
NotatallDistribu/onofimpactsnotassessedandcommunityknowledge/experiencenotincluded.
TosomeextentDistribu/onofimpactsassessedorcommunityknowledge/experienceincluded.
VeryDistribu/onofimpactsassessedandcommunityknowledge/experienceincluded.
² Quan/ta/veassessmentofdispropor/onateimpacts(andpoten/alcumula/veimpacts)oncommuni/esfacinginequi/esincludedintheHIA.
² Focusgroupsand/orsurveysconductedincommuni/esfacinginequi/es.
Notes
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HIAEquityEvalua@onToolHowtoAdvanceEquitythroughHealthImpactAssessments
Outcome1:TheHIAprocessandproductfocusonequity
Metric1.d DataCollec@onMethods InterviewQues@ons
Recommenda@onsfocusonimpactstocommuni@esfacinginequi@esandareresponsivetocommunityconcerns.
Ø HIAReportØ InterviewswiththeHIA
prac//onerØ Interviewswithcommunity
par/cipants
• Didtherecommenda/onsfocusonequityimpactsand/or
impactstocommuni/esfacinginequi/es?Ifso,how?• Didthecommuni/esfacinginequi/eshaveinputintothe
recommenda/ons?Ifso,canyoudescribetheprocessforcollec/ngandintegra/ngcommunityinput?
• Doanyoftherecommenda/onsreflectspecificinputfromcommuni/esfacinginequi/es?Ifso,how?
Score(circleone) Examplesofhigh-scoringac@vi@es
NotatallRecommenda/onsdonotaddressissuesrelatedtoequity.
TosomeextentRecommenda/onsaddressequityimpacts.
VeryRecommenda/onsaddressequityimpactsandareresponsivetocommunityconcerns.
² Keyrecommenda/onsfocusonimpactstothosefacinginequi/es,notjustonimprovingoverallpopula/onhealth
² Recommenda/onsreflectcommunitypriori/es
Notes
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HIAEquityEvalua@onToolHowtoAdvanceEquitythroughHealthImpactAssessments
Outcome1:TheHIAprocessandproductfocusonequity
Metric1.e DataCollec@onMethods InterviewQues@ons
Findingsandrecommenda@onsweredisseminatedinandbycommuni@esfacinginequi@esusingarangeofculturallyandlinguis@callyappropriatemediaandplaZorms.
Ø InterviewswiththeHIAprac//oner
Ø Interviewswithcommunitypar/cipants
Ø Reviewofcommunica/ons(e.g.,summarydocuments,resul/ngmedia)
• Werefindingsdisseminatedtothecommuni/esfacing
inequi/es?Ifso,how?Bywhom/whatformat?Doyouhaveanyideahowmanypeoplereceivedorreadthem?Howdoyouknowpeoplereceived/readthem?
• Werethefindingscommunicatedinawaythatwasunderstandabletomanypeopleinthecommunity?Howdoyouknow?
• Werecommuni/esfacinginequi/esinvolvedinthedevelopmentofdissemina/onproducts,ordetermina/onofkeyaudiencesandcommunica/onoutlets?Ifso,how?
Score(circleone) Examplesofhigh-scoringac@vi@es
NotatallNodissemina/oninorbycommuni/esfacinginequi/es.
TosomeextentDissemina/onoccursinorbycommuni/esfacinginequi/es.
VeryDissemina/onoccursinandbycommuni/esfacinginequi/eswithappropriatemediaandplaUorms.
² Findingsandrecommenda/onstranslatedintorelevantlanguagesandmediaformats(e.g.,socialmedia)anddistributed
² Communityleaderscommunicatefindingsontheirownbehalftopolicymakersandothercommunitymembers
Notes
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HIAEquityEvalua@onToolHowtoAdvanceEquitythroughHealthImpactAssessments
Outcome1:TheHIAprocessandproductfocusonequity
Metric1.f DataCollec@onMethods
Monitoringandevalua@on(M&E)planincludedcleargoalstomonitorequityimpactsover@meandanaccountabilitymechanism(i.e.,accountabilitytriggers,ac@ons,andresponsiblepar@es)toaddressadverseimpactsthatmayarise.
Ø HIAreportØ Monitoringandevalua/onplan(M&Eplan)
Score(circleone) Examplesofhigh-scoringac@vi@es
NotatallEquityimpactsnotincludedinM&Eplan
TosomeextentEquityimpactsincludedinM&Eplan
VeryEquityimpactsincludedinM&Eplanandaccountabilitymechanismsputinplace.
² DuringM&E,ifnega/veequityimpactsarefound,decision-makersareresponsibleforimplemen/nganimprovementplanandrepor/ngbacktothecommunity.
Notes
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HIAEquityEvalua@onToolHowtoAdvanceEquitythroughHealthImpactAssessments
Outcome2:TheHIAprocessbuiltthecapacityandabilityofcommuni@esfacinghealthinequi@estoengageinfutureHIAsanddecision-makingmoregenerally.
Metric2.a DataCollec@onMethods InterviewQues@ons
Communi@esfacinginequi@esleadoraremeaningfullyinvolvedineachstepoftheHIA.
Ø InterviewwithHIAprac//oner
Ø Interviewwithcommunitypar/cipants
• Werecommuni/esfacinginequi/esmeaningfullyengagedineachstepoftheHIA?Ifyes,canyoudescribehowforeachstep?Canyoudescribetherangeortypesofcommunitystakeholderswhopar/cipatedineachstepofthisHIA?
Score(circleone) Examplesofhigh-scoringac@vi@es
NotatallNoinvolvementofcommuni/esfacinginequi/es
TosomeextentCommuni/esfacinginequi/esmeaningfullyengagedinsome,butnotall,HIAsteps
VeryCommuni/esfacinginequi/esmeaningfullyengagedinallHIAsteps
² SeeGuidanceandBestPrac7cesforStakeholderPar7cipa7oninHealthImpactAssessments(referencedabove)formanyexamplesofmeaningfulengagementateachstep.
² Forexample,inthescopingstagethiscouldincludecommuni/esfacinginequi/eshavingdecision-makingauthorityoverthefinalScope;intheassessmentstagethiscouldincludeu/lizingcommunitypar/cipatorymethods.
Notes
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HIAEquityEvalua@onToolHowtoAdvanceEquitythroughHealthImpactAssessments
Outcome2:TheHIAprocessbuiltthecapacityandabilityofcommuni@esfacinghealthinequi@estoengageinfutureHIAsanddecision-makingmoregenerally.
Metric2.b DataCollec@onMethods InterviewQues@ons
AsaresultoftheHIA,communi@esfacinginequi@eshaveincreasedknowledgeandawarenessofdecision-makingprocesses,anda\ainedgreatercapacitytoinfluencedecision-makingprocesses,includingabilitytoplan,organize,fundraise,andtakeac@onwithinthedecision-makingcontext
Ø InterviewwithHIAprac//oner
Ø Interviewwithcommunitypar/cipants
• What,ifanything,isdifferentforthecommuni/esfacinginequi/es,asaresultoftheHIA?Forexample,werethere:• Anychangesinknowledgeorawarenessofdecision-making
processes?Pleasedescribespecifically.Whatdoyouseeorhearthattellsyouthereissuchachange?Specificexamples?
• Anychangesintheabilityofthecommunitytoplan,organize,fundraise,ortakeac/ononfuturesimilardecisions?Whatdoyouseeorhearthattellsyouthereissuchachange?Specificexamplesofanystepstaken?
• AsapartoftheHIAprocess,werecommuni/esfacinginequi/esmeaningfullyengagedtounderstandthepower,policy,andhistoricalcontextoftheproposeddecision?
• Werethereanychangesinorganiza/onalcultureorprac/cesaroundcommunitymemberpar/cipa/onintheproposal/decisionthatwasthetargetofthisHIA?WhataboutfordecisionsbeyondthetargetofthisHIA?
Score(circleone) Examplesofhigh-scoringac@vi@es
NotatallNoincreaseinknowledgeorawarenessofdecision-makingprocesses
TosomeextentCommuni/esfacinginequi/esacquiredknowledgeandawareness
VeryCommuni/esfacinginequi/esacquiredknowledge,awareness,andgreatercapacitytotakeac/on
² HIAprocessinvolvedleadershiptrainingformembersofcommuni/esfacinginequi/es
² HIAconductedinsuchawayastoincreaseunderstandingofac/onresearchasatoolforcommunitychange
² Communitymembershaveabekerunderstandingofhowtoanalyzethepower,policy,andhistoricalcontextofdecisions.
Notes
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HIAEquityEvalua@onToolHowtoAdvanceEquitythroughHealthImpactAssessments
Outcome3:TheHIAresultedinashi^inpowerbenefi@ngcommuni@esfacinginequi@es.
Metric3.a DataCollec@onMethods InterviewQues@ons
Communi@esthatfaceinequi@eshaveincreasedinfluenceoverdecisions,policies,partnerships,ins@tu@onsandsystemsthataffecttheirlives.
Ø Interviewswithdecision-makers
Ø Interviewswithcommunitypar/cipants
Ø Addi/onalcheck-insforupdatesover/mewithcommunitypar/cipants
• Didcommunitymembershaveanincreasedinfluenceoverdecisions,policies,partnerships,ins/tu/ons,orsystemsthatwerethetargetofthisHIA?Ifso,howdoyouknow?Canyoudescribethechangeininfluence?• Hascommunitypar/cipa/onindecision-makingincreased,asaresultofthis
HIA?Ifyes,howdoyouknow?Canyoudescribethatpar/cipa/on?• Didtheins/tu/onsandcommuni/eschangetheirideasaboutwhatis
consideredvalidevidenceordata?Canyougiveexamples?• Werecommunitymembersinvitedtopar/cipateinfutureplanningordecision-
makingeffortsonthisissue?• Wastheremutuallearningthatresultedinaculturechangebothwithin
communi/esandins/tu/onsaboutconsideringcommunityconcernsindecision-making?
• Didpar/cipa/ngcommuni/eshaveanincreasedabilitytoinfluencedecisions,policies,partnerships,ins/tu/ons,orsystemsthataffecttheirlivesbeyondthetargetofthisHIA?Ifyes,canyougiveexamplesofwheretheyhavebeenabletoincreasetheirsphereofinfluenceandpower?• Forexample,werecommunitymembersinvitedtositonCommunityAdvisory
Boards,councils,workgroups,orothervenuesthatwouldgivetheminfluenceinotherspheresorsectorsbeyondthespecifictargetofthisHIA?
Score(circleone,ifdataisavailable) Examplesofhigh-scoringac@vi@es
NotatallNoincreasedabilitytoinfluence
TosomeextentIndividualsandgroupshadincreasedinfluenceoverthedecisionthatwasthefocusoftheHIA
VeryIndividualsandgroupshaveincreasedinfluenceoverabroadrangeofdecisionsandsystemsthataffecttheirlives
² AshiYinculturebothwithinins/tu/onsandamongcommuni/esaboutwhatisconsideredevidence(i.e.,communitydataorknowledgeas"expert"andvalidevidence)
² Membersofcommuni/esfacinginequi/esgetinvitedtothedecision-makingtable
Notes
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HIAEquityEvalua@onToolHowtoAdvanceEquitythroughHealthImpactAssessments
Outcome3:TheHIAresultedinashi^inpowerbenefi@ngcommuni@esfacinginequi@es.
Metric3.b DataCollec@onMethods InterviewQues@ons
Governmentandins@tu@onsaremoretransparent,inclusive,responsive,and/orcollabora@ve.
Ø Interviewswithdecision-makers
Ø Interviewswithcommunitypar/cipants
Ø Addi/onalcheck-insforupdatesover/mewithcommunitypar/cipants
Ø Reviewofpublicdocuments
• What,ifanything,isdifferentforgovernmentandins/tu/ons,asaresultoftheHIA?Werethereanychangesinadministra/veprac/cesthatmakethemmoretransparent,inclusive,responsive,orcollabora/vewiththecommunityfacinginequi/es?Ifyes,canyougivesomeexamples?• Forexample,isaddressinginequi/esanewpartoftheins/tu/on’s
statedmissionorgoals?• Wereanynewresourcesassignedtoaddresshealthorequity,suchasa
newoffice,staffperson,orprogram?• Willtheins/tu/onassessandmonitorthestatusofhealthinequi/es
over/me,measuredbyindicatorscreatedwithinputfromcommuni/esfacinginequi/es?And,ifso,arethererequiredac/onsifinequi/espersist?
• Wasthereanimprovementinhowaccessibledataistothecommunity?• Iscommunityoutreachbytheins/tu/onbekernowthanitwasbeforethe
HIA?Whatisdifferent?Whatdoyouseeorhearthattellsyouitisbeker?
Score(circleone,ifdataisavailable) Examplesofhigh-scoringac@vi@es
NotatallNoincreaseinins/tu/onaltransparencyorinclusiveness
TosomeextentIns/tu/onsmoretransparentandinclusive
VeryAsystems-levelchangehasbeenimplementedthatallowsforsustainedinfluence
² Changeinins/tu/onaldesign,suchasCommunityAdvisoryBoards,newofficesofHealthEquity,orintegra/onofequityintoallmissions
Notes
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HIAEquityEvalua@onToolHowtoAdvanceEquitythroughHealthImpactAssessments
Outcome4:TheHIAcontributedtochangesthatreducedhealthinequi@esandinequi@esinthesocialandenvironmentaldeterminantsofhealth.
Metric4.a DataCollec@onMethods
TheHIAinfluencedthesocialandenvironmentaldeterminantsofhealthwithinthecommunityandadecreaseddifferen@alinthesedeterminantsbetweencommuni@esfacinginequi@esandothercommuni@es.
Ø Monitoringofdatarelatedtothedeterminantsofhealth(e.g.,fromgovernmentagencies)uponcomple/onoftheHIA
Score(circleone,ifdataisavailable) Examplesofhigh-scoringac@vi@es
NotatallNochangeindeterminants
TosomeextentCommuni/esfacinginequi/esexperienceimprovementsinhealthdeterminants
VeryCommuni/esfacinginequi/esrealizeimprovementsinhealthdeterminantsandclosethegaponinequi/es
² DeterminantsofhealththatwerethefocusoftheHIAareimprovedincommuni/esfacinginequi/esatafasterratethaninthegeneralpopula/on
Notes
18
HIAEquityEvalua@onToolHowtoAdvanceEquitythroughHealthImpactAssessments
Outcome4:TheHIAcontributedtochangesthatreducedhealthinequi@esandinequi@esinthesocialandenvironmentaldeterminantsofhealth.
Metric4.b DataCollec@onMethods
TheHIAinfluencedphysical,mental,andsocialhealthissueswithinthecommunityandadecreaseddifferen@alinthesehealthoutcomesbetweencommuni@esfacinginequi@esandothercommuni@es.
Ø Monitoringofdatarelatedtothedeterminantsofhealth(e.g.,fromgovernmentagencies)uponcomple/onoftheHIA
Score(circleone,ifdataisavailable) Examplesofhigh-scoringac@vi@es
NotatallNochangeinhealthoutcomes
TosomeextentCommuni/esfacinginequi/esexperienceimprovementsinhealthoutcomes
VeryCommuni/esfacinginequi/esrealizeimprovementsinhealthoutcomesandminimizehealthdispari/es
² HealthoutcomesthatwerethefocusoftheHIAareimprovedincommuni/esfacinginequi/esatafasterratethaninthegeneralpopula/on
Notes
19
HIAEquityEvalua@onToolHowtoAdvanceEquitythroughHealthImpactAssessments
HowtoAdvanceEquitythroughHealthImpactAssessments
APlanningandEvaluationFrameworkbytheSOPHIAEquityWorkingGroup
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KeyDefinitionsEquityAsMargaretWhiteheadwrotein1992:“Equityinhealthimpliesthatideallyeveryoneshouldhaveafairopportunitytoattaintheirfullhealthpotentialand,morepragmatically,thatnoneshouldbedisadvantagedfromachievingthispotential,ifitcanbeavoided.”PaulaBravemanaddsthat“equityinhealthistheabsenceofsystematicdisparitiesinhealth(orinthemajorsocialdeterminantsofhealth)betweengroupswithdifferentlevelsofunderlyingsocialadvantageordisadvantage,namelywealth,powerorprestige.”8
CommunitiesfacinginequitiesThistermwaschosentodescribecommunitiesthatarefacingimpactsofadecisionwithimplicationsforequity,andthatmayhavehistoricallyfacednegativeimpactsfrompreviousdecisions.Manyphraseshavebeenusedtodescribesimilarpopulationssuchasvulnerableorsociallydisadvantaged.Communityadvocateshavepointedoutissueswiththesephrases,includingthatcommunitiesthemselvesmaynotidentifywiththeseterms.HealthInequityvs.HealthDisparityPopulationswithinasocietycanhavedisparatehealthoutcomes.Somedisparitiesaretobeexpected—arthritis,forexample,ismorecommonamongseniors.Thesedifferencesarecommonlycalledhealthdisparities.
Otherdifferences,mostoftenbetweenpopulationsthathavevaryinglevelsofpowerandaccesstoopportunity,maybesystemic,avoidable,unfairorunjust.Forexample,peopleinalow-incomecommunityofcolorinonepartofacitymayhavelowerlifeexpectancythanmoreaffluentpeopleinaseparatepartofthesamecity.Thesedifferencesarecommonlycalledhealthinequities.PowerPowerisdefinedasthepotentialtoshapeourlivesandtheworldaroundus.Therearemultipleformsofpower,9including:
• Influencingdecision-makingdirectlybyorganizingpeopleandresources.• Influencingwhatisonthepoliticalagendabybuildinganinfrastructureof
organizations.• Influencingideologyandworldviewbychangingthepublicnarrative.
CommunityengagementCommunityengagementistheprocessofincludingmembersofcommunitiesfacinginequitiesandothercommunitiesintheHIAprocess.Engagementcantakevariousforms:informing,consulting,involving,collaborating,orempowering.10
HowtoAdvanceEquitythroughHealthImpactAssessments
APlanningandEvaluationFrameworkbytheSOPHIAEquityWorkingGroup
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AboutThisFrameworkEquityisacorevalueofHealthImpactAssessment(HIA).11ManyHIApractitionersengageintheworktoaddresssystemic,avoidable,unjust,andunfairdifferencesinfactorsimportanttohealthbetweenpopulationgroups.Therearemanycompellingmoral,economic,andhealthargumentsforprioritizingandincorporatingequityintoHIApractice.HIApractitionersandevaluatorshavefoundthatmanyHIAscouldbeimprovedbytakingamoreintentionalandthoroughapproachtoaddressingequityimpacts12andhavesoughttoremedythisthroughnewtools13andguidance.1415AclearframeworkforplanninganHIAandevaluatingthedegreetowhichanHIAsuccessfullyincorporatedequityhasnotbeenavailable,thoughsuchaframeworkcouldhelpguideHIApractitionersandevaluators,aswellasequityadvocates.SuchaframeworkwouldalsoprovidemoredetailtotheHIAPracticeStandards16regardingtheincorporationofequityintoHIApractice.Withthisinmind,theSOPHIAEquityWorkingGroupcollaboratedinaconsensusprocesstodevelopEquityMetricsforHealthImpactAssessment,Version1,whichwasreleasedin2014.Manyoftheoriginalauthorsreconvenedin2016tosolicitinputfrompractitionersandotherusers,andthenincorporatedthisfeedbacktoevolvetheframeworkpresentedhereasVersion2.Formoreinformationpleasecontactanyoftheauthors:EmilyBourcier:[email protected]:[email protected]:[email protected]:[email protected]:tina@raimiassociates.comHowtoAdvanceEquityThroughHealthImpactAssessments:APlanningandEvaluationFrameworkwasdevelopedwithfundingfromtheHealthImpactProject,acollaborationoftheRobertWoodJohnsonFoundationandThePewCharitableTrusts.
HowtoAdvanceEquitythroughHealthImpactAssessments
APlanningandEvaluationFrameworkbytheSOPHIAEquityWorkingGroup
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References1QuigleyR,denBroederL,FuruP,BondA,CaveB,andBosR.(2006).HealthImpactAssessment,InternationalAssociationforImpactAssessment,InternationalBestPracticePrinciples.SpecialpublicationseriesNo.5.Availableat:http://www.iaia.org/publicdocuments/special-publications/SP5.pdf2Krieger,N.(1994).Epidemiologyandthewebofcausation:Hasanyoneseenthespider?SocialScience&Medicine,39(7),887-903.3Marmot,M,&Wilkinson,RG(Eds.).(1999).Socialdeterminantsofhealth.Oxford,U.K.:OxfordUniversityPress.4Williams,DR,Costa,MV,Odunlami,AO,&Mohammed,SA.(2008).Movingupstream:Howinterventionsthataddressthesocialdeterminantsofhealthcanimprovehealthandreducedisparities.JournalofPublicHealthManagementandPractice,14(Suppl),S8-17.5CommissionontheSocialDeterminantsofHealth.(2008).Closingthegapinageneration:Healthequitythroughactiononthesocialdeterminantsofhealth.FinalReportoftheCommissiononSocialDeterminantsofHealth.Geneva,Switzerland:WorldHealthOrganization.6Minkler,M.(2012).CommunityOrganizingandCommunityBuildingforHealthandWelfare.NewJersey:RutgersUniversityPress.7StakeholderParticipationWorkingGroupofthe2010HIAintheAmericasWorkshop.(2011).GuidanceandBestPracticesforStakeholderParticipationinHealthImpactAssessment.Oakland,CA.Availableat:https://sophia.wildapricot.org/resources/Documents/guide-for-stakeholder-participation.pdf8Braveman, P, and Gruskin, S. (2003). Defining equity in health. J Epidemiol Community Health 2003; 57:254–258.9Healey,RandHinson,S.PowerandSocialChange.Availableat:http://www.strategicpractice.org/system/files/power_and_social_change.pdf10InternationalAssociationforPublicParticipation(2007).IAP2SpectrumofPublicParticipation.Availableat:http://c.ymcdn.com/sites/www.iap2.org/resource/resmgr/imported/IAP2%20Spectrum_vertical.pdf11QuigleyR,denBroederL,FuruP,BondA,CaveB,andBosR.(2006).HealthImpactAssessment,InternationalAssociationforImpactAssessment,InternationalBestPracticePrinciples.SpecialpublicationseriesNo.5.Availableat:http://www.iaia.org/publicdocuments/special-publications/SP5.pdf12Harris-RoxasB,SimpsonS,andHarrisE.(2004).EquityFocusedHealthImpactAssessment:Aliteraturereview.Sydney:CHETREonbehalfoftheAustralasianCollaborationforHealthEquityImpactAssessment.Availableat:http://www.healthimpactproject.org/resources/document/Harris-Roxas_B_2004_Equity_Focused_HIA.pdf13See,forexample:Harris-Roxas,BF,HarrisPJ,andKempLA.(2011).Arapidequityfocusedhealthimpactassessmentofapolicyimplementationplan:AnAustraliancasestudyandimpactevaluation.IntJEquityHealth.10:6.14HellerJ,MalekafzaliS,TodmanL,andWierM.(2013).PromotingEquityThroughthePracticeofHealthImpactAssessment.Availableat:http://www.humanimpact.org/component/jdownloads/finish/9/29415TheSOPHIAEquityWorkgroup(2016).CommunicatingAboutEquityinHealthImpactAssessment:AGuideforPractitioners.Availableat:https://sophia.wildapricot.org/resources/Documents/Communicating_Equity_in_HIA_Final.pdf16BhatiaR,FarhangL,HellerJ,LeeM,OrensteinM,RichardsonMandWernhamA.(2014).MinimumElementsandPracticeStandardsforHealthImpactAssessment,Version3.Availableat:https://sophia.wildapricot.org/resources/Documents/HIA-Practice-Standards-September-2014.pdf
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