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Health Inequalities Impact Assessment Answers to Frequently Asked Questions

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Health Inequalities Impact Assessment Answers to Frequently Asked Questions Part 2 Health inequalities impact assessment Answers to frequently asked questions 1 Authors We are happy to consider requests Debbie Sigerson, Project Manager for other languages or formats. and Pauline Craig, Head of Equality Please contact 0131 314 5300 or email NHS Health Scotland [email protected] Acknowledgments Thanks to the following individuals and organisations for contributions and comments: Martin Hayward, Equality and Human Rights Commission; Kavita Chetty, Scottish Human Rights Commission; Ieva Morrison, Scottish Government Equality Unit; Emma Ashman, Scottish Health Council; Margaret Douglas, NHS Lothian; Katy Hetherington, Jo Marwaha and Arma Sayed, Equality Team, NHS Health Scotland; other Committed to excellence NHS Health Scotland teams (Evidence 2012 for Action, Learning and Workforce Development, Programme Design and Delivery) Published by NHS Health Scotland Picture credits 1 South Gyle Crescent Front cover and pages 5, 14, 23, 29 Edinburgh EH12 9EB © Photofusion © NHS Health Scotland 2014 Pages 27, 33 © NHS Health Scotland All rights reserved. Material contained in Page 31 © iStockphoto.com this publication may not be reproduced in whole or part without prior permission of NHS Health Scotland (or other copyright owners). While every effort is made to ensure that the information given here is accurate, no legal responsibility is accepted for any errors, omissions or misleading statements. NHS Health Scotland is a WHO Collaborating Centre for Health Promotion and Public Health Development. Aims of this guide 2 Key messages 3 Contents Part 1 Why? 1 What is HIIA? 5 4 What makes HIIA different to equality impact assessment? 8 2 Who can use HIIA? 6 5 Why focus on health inequalities? 9 3 What legal duties are there for impact assessments? 7 6 Why include human rights? 12 Part 2 How? 7 How do I carry out a HIIA? 14 • F: What type of evidence should I gather and when? 17 • A: When? 14 • G: Who should I invite? 20 • B: On which plans and policies? 14 • H: How do I report a HIIA? 20 • C: Who should lead a HIIA? 15 • I: What happens after the HIIA? 21 • D: What are the steps? 15 • E: How long is it likely to take? 17 8 What makes a good impact assessment? 21 9 Who scrutinises impact assessments? 22 Part 3 In practice 10 What support is available to guide me B: Influencing development of the Public through the process? 23 Bodies (Joint Working) (Scotland) Bill 11 Completed and ongoing HIIAs 25 C: Tailoring the delivery of the Walk Once a Week (WoW) Project 12 Case studies: D: Influencing a decision to move office A: Informing the relocation of primary care sites, NHS Health Scotland services, Fife References 34 Further reading 36 Aims of this guide This guide answers the most commonly asked questions about why and how to conduct a health inequalities impact assessment (HIIA). The questions are commonly posed by individuals getting to grips with HIIA. The answers are drawn from the experience of staff conducting HIIAs during the piloting phase in 20101 and during the use of the tool during 2011–13. The advice builds on the full HIIA guidance, which has more detail to refer to as you plan your HIIA.2 2 Part 2 Key messages 1 The main aim of HIIA is to 4 HIIA offers an integrated strengthen the contribution approach to impact assessment, of policies and plans to encompassing legally protected reducing health inequalities characteristics, wider population by improving equity of access groups, the social determinants to the intervention, ensuring of health and human rights: non-discriminatory practice and acting on the social — HIIA includes but goes determinants of health. beyond equality impact assessment. It meets the legal 2 Any public sector agency with a requirement to conduct an contribution to reducing health impact assessment of Section inequalities can use the tool. 149 of the Equality Act 20103 (the public sector equality 3 HIIA informs action and duty), and the Equality transparent decision making Act 2010 (Specific Duties) and should be conducted at a (Scotland) Regulations 2012.4 point in policy development or planning when there is scope to — HIIA helps to raise questions make changes as a result of the about how the proposed assessment. policy will impact on the fundamental causes, wider environmental influences and individual experiences of health inequalities. 3 — The PANEL principle of 7 HIIA should be carried out Participation, Accountability, by individuals with project Non-discrimination and management, facilitation equality, Empowerment and research skills and final and Legality can be used to reports should be scrutinised by stimulate discussion and committees or senior managers action on everyone’s right to approving any new policy or plan. achieve the highest attainable standard of health. 8 Support and guidance for HIIA and equality impact assessment 5 There are six steps in is available from NHS Health the process which can be Scotland, the Equality and Human incorporated into existing Rights Commission, the Scottish impact assessment systems: Human Rights Commission and preparation, scoping, peer support networks. prioritisation, appraisal, making recommendations and taking action. 6 Timely planning, meaningful involvement of stakeholders, evidence-informed assessment of impacts and taking proportionate action characterise a good quality assessment. 4 Part 2 Part 1 Why? 1 What is HIIA? Health inequalities impact assessment (HIIA) provides a systematic way to consider how a policy or plan may affect people differently. The findings can inform the policy’s development and implementation. The term ‘policy’ will be used throughout this guide, encompassing any programme, service or plan subject to an impact assessment. HIIA is a tool which offers an integrated approach to impact assessment, drawing on methodology from health impact assessment (HIA),5 equality impact assessment and human rights impact assessment.6 Scotland is unique in our integration of human rights into equality and HIA processes. Internationally, HIA is the main approach featuring in published literature although Australia has ‘equity focused health impact assessment’, which the Commission on Social Determinants of Health proposes should be institutionalised.7 5 People are not defined by any single characteristic. A narrow focus on one aspect of an individual’s or group’s identity may work to hinder understanding and responding to the reality of people’s lives and experiences. HIIA therefore encourages consideration of the intersections of different potential impacts on individuals and communities, as illustrated opposite. The tool was developed following a recommendation in Equally Well8 and was piloted in 2010 with NHS Boards and the Scottish Government. The HIIA approach has been used with policy and service development in Scottish Government, local and national Health Boards and some third sector agencies since its launch in November 2011. 2 Who can use HIIA? Any policy-maker or planner in the public, third or enterprise sectors can use HIIA. The tool can be used by agencies required to eliminate discrimination, advance equality, foster good relations, reduce health inequalities and enhance human rights and can be applied to any policy or plan. Part 3: Putting it into practice includes case studies and a list of completed and ongoing HIIAs in a range of organisations, facilitated by NHS Health Scotland. 6 PartPart 21 What legal duties are there 3 for impact assessments? Public bodies have a legal duty to conduct an equality impact assessment. HIIA includes equality impact assessment and therefore satisfies this legal requirement if it considers how a new or revised policy will: • eliminate unlawful discrimination, harassment and victimisation and other prohibited conduct • advance equality of opportunity between people who share a relevant protected characteristic and those who do not • foster good relations between people who share a protected characteristic and those who do not. These are the three requirements of the Public Sector Equality Duty of the Equality Act 2010.3 Scotland’s specific equality duties to support better performance of the Public Sector Equality Duty of the Equality Act 20104 state impact assessments must: • consider relevant evidence – from formal peer reviewed research to informal feedback from community engagement, relating to persons who share a protected characteristic (including any received from those persons) • not be ignored – public bodies must, in developing a policy or practice, take account of the results of any assessment made by it • be published – within a reasonable period, and in a manner accessible to the public. Examples of legal cases show occasions where authorities have failed to conduct an impact assessment early enough and as a result decisions have had to be reversed.9 7 What makes HIIA 4 different to equality impact assessment? Equality impact assessment (EqIA) focuses on considering impacts on people covered by the nine protected characteristics included in the Equality Act 2010. These are: age; sex; disability; gender reassignment; pregnancy and maternity; marriage and civil partnership; race; religion or belief; and sexual orientation. In addition to these, HIIA considers other population groups who are vulnerable to unfair differences in health outcomes (such as people in different socio-economic groups, those involved in the criminal justice system, those living in remote/rural locations) and the social determinants of health (for example, employment and education). The HIIA approach draws on health impact assessment (HIA) methodology, which includes consideration of the social determinants of health. HIA has been used to influence policies in a wide range of sectors, such as housing and transport.10 HIIA also considers potential impacts on human rights, which is not usually included in EqIA. There is growing interest in Scotland for integrating consideration of human rights into impact assessment processes (such as City of Edinburgh Council, 201211) and some local and national bodies routinely consider socio-economic status in their EqIAs, for example, NHS Greater Glasgow & Clyde.
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