Abstract
Highly participatory local health impact assessment processes can be used to identify and encourage practices and policies that promote health. They also foster community learning that can increase a community's capacity to improve local conditions for a healthier community. This chapter examines a Community-Driven form of Health Impact Assessment (CHIA) practiced in rural Nova Scotia, Canada since 1997. Experience suggests that informal learning in these processes is often transformative; ordinary citizens learn to identify factors that influence their health, to think beyond the illness problems of individuals, and to consider how programs and policies can weaken or support community health. They learn that that they can identify directions for future action that will safeguard the health of their community.
TopThe Healthy Public Policy And Health Impact Assessment Context
Successive global health promotion agreements, most notably the Ottawa Charter for Health Promotion (WHO, 1986) and the Jakarta Declaration on Health Promotion into the 21st Century (WHO, 1997), have advocated building healthy public policy as a key action front for global health development. A healthy public policy is a policy that increases the health and wellbeing of those individuals and communities that it affects (Kemm, 2001). It is oriented to the future state of health, to multiple small-scale solutions, and to the involvement of individuals and the local community in those solutions (Hancock, 1985; Mittelmark, 2001). The emphasis is on refocusing a preoccupation in public policy with the existing sick care system, to a focus on creating health (Hancock & Minkler, 2002). The development of healthy public policy relies heavily on adult learning; it recognizes that people know a great deal about what affects their health, and can be involved in planning action to improve individual and community health and wellbeing (Coady, 2009). A recent report of the World Health Organization’s Commission on the Social Determinants of Health (WHO, 2008) reinforces that healthy public policy—focused on improving the circumstances in which people are born, grow, live, work, and age—is now more important than ever.
Key Terms in this Chapter
Qualitative Evidence: Information which reflects the feelings, thoughts, meanings and understandings of people in order to gain understanding about why and how a situation is unfolding as it is.
District Health Authority (DHA): The administrative unit mandated by the Nova Scotia Health Authorities Act (2001) AU31: The in-text citation "Authorities Act (2001)" is not in the reference list. Please correct the citation, add the reference to the list, or delete the citation. to govern, plan, manage, monitor, evaluate and deliver health services in each of the nine Nova Scotia health districts. Two-thirds of the board of directors of each DHA is comprised of people nominated by Community Health Boards in the district.
Determinants of Health: The range of personal, social, economic and environmental factors which determine the health status of individuals and populations.
Population Health Approach: Addresses the entire range of individual and collective factors that determine health – and the interactions among them. Population health strategies are designed to affect whole groups or ‘populations’ of people. The goals of a population health approach are to maintain and improve the health status of the entire population and to reduce inequities in health status between populations groups.
Quantitative Evidence: Numerical information to estimate or measure the magnitude (size) of something.
Community Health Impact Assessment (CHIA): A strategy to increase public understanding of the broad determinants of health and to bring the health concerns of the public forward in discussions of public policy.
Evidence Based Decision-Making: The use of current best evidence, both qualitative and quantitative, in making policy. When used in combination with good reasoning, it answers the question: “Why did you decide that?”
Scotia Health Authorities Act: CHBs develop annual “community health plans” for submission to the District Health Authority. These plans include recommended priorities for the delivery of community-based health services and a list of initiatives recommended for the improvement of the health of the community.
Health Impact Assessment (HIA): Any combination of procedures or methods by which a proposed program or policy may be judged as to the effect(s) it may have on the health of the population.
Community Health Board (CHB): A voluntary, community-based board regulated by the Nova.
Community Health Impact Assessment Tool (CHIAT): A resource (document, checklist, or other means) created by a community to facilitate the systematic undertaking of a community health impact assessment.
Healthy Public Policy: Public policy that is characterized by an explicit concern for health and equity, and by accountability for health impact. It aims to create a supportive environment to enable people to lead healthy lives.
Health Promotion: The process of enabling people to increase control over the determinants of health and thereby improve their health. Participation is essential to sustain health promotion action.