Akademik Veri Yönetim Sistemi
Baran Aksakal F. N., Gulis G.(Yürütücü), Kiraz E. D. E., Aycan S., İlhan M. N., Özkan S.
AB Destekli Diğer Projeler, 2006 - 2008
Executive summary
Work Package leader:
Gabriel Gulis, University of Southern Denmark, Esbjerg, Denmark
Health impact assessment in new member states and accession and pre-accession countries” (HIA-NMAC) project were to:
1. Consolidate HIA networks in Eastern Europe
2. Strengthen HIA capacity in acceding and candidate countries
3. Design, initiate, pilot and carry out parallel case studies in HIA
of various sectors
4. Progress methodology of incorporating socio-economic health
determinants into HIA
5. Develop guidelines to introduce HIA on local level
The following summary describes briefly the achievements
of the project in five aim areas:
1. Consolidate HIA networks in Eastern Europe
a. As the WP 2 report mentions, before NMAC project there were
scattered HIA training and review activities done in Lithuania, Hungary ad
Slovakia. Their impact is clearly visible in starting level of workshop
participants and existing knowledge in these countries. The HIA-NMAC project
expanded this network to Malta, Turkey, Slovenia, Poland and Bulgaria as of the
new member states and accession countries and furthermore included Italy and
Denmark.
b. The new, consolidated network presents its strengths in case study work
package reports as well as in methodological and implementation work packages.
2. Strengthen HIA capacity in acceding and candidate countries
a. About 450 public health and non-public health experts were trained
direct during the workshops in 6 countries; in addition to this number some of
the countries included HIA lessons to regular public health curriculum, post
graduate training of public health experts and a full set of training documents
has been developed and translated to national languages.
b. National internet sites were launched in Poland, Lithuania, Denmark
and are under preparation in other partner countries
3. Design, initiate, pilot and carry out parallel case studies in HIA
of various sectors
a. Policy level HIAs on wine policies, dietary fibre policies, tourism
and recreational water policies and vulnerable population policies were
conducted in 9 countries providing all together 17 national HIA case studies
b. Although the quality and completeness of national case studies
varies in general,
i.
significant knowledge has been
produced on policy level HIA
ii.
pre-screening has been introduced and tested to help with
selection of the most significant document for a retrospective HIA on policy
level A tool for pre-screening has been developed and used in most of the case
studies (see individual reports). Although our case studies were retrospective,
pre –screening might help also in prospective HIA to define a kind of entry
criteria.
iii.
detailed schemes to describe
all stakeholders, elements, steps, populations and determinants were developed
within 3 out of four case study areas. These schemes help not only to conduct
HIA (relevant for different steps of HIA methodology), but also to describe,
analyze and plan public health work in general
iv.
the schemes developed in case
studies reflect the difference between
policy level and project level HIA. Policy level HIA needs more detailed
analysis of context, external links of policies, elements of policies, and
linkage to different legal documents. In contrast to project level, in policy
level HIA usually all major determinants of health are influenced making the
risk appraisal part extremely complex and hard to do
v.
case study results show no
difference between new and old member states in terms of problem and
difficulties encountered during research
vi.
policy level HIA due to issues
mentioned in point “iv.” requires rather large steering committee involving
many different stakeholders; it is therefore time and resource consuming to
organize large steering committee meetings. In NMAC case studies partners used
a method of structured interviewing of steering committee members combined with
meetings. This method proved to work well (see individual case study reports).
vii.
due to complexity of policy
level HIA it is rather complicated to describe in detail the link from a policy
through determinants of health and risk factors to a single health outcome.
Therefore policy level HIA might be expected to assess the impact rather on
determinant of health or risk factor level as on health outcome level
viii.
recommendations toward
monitoring of real impacts have been made in each case study
ix.
the case studies identified a
new role/function of HIA; HIA can help public health decision makers to
identify gaps in existing data and indicator systems
x.
detailed final reports of case
studies (work package 3, 4, 5, 7) are part of this final technical report
xi.
the results of NMAC case
studies prove that personnel capacity to conduct HIA in participating countries
has been developed
4. Progress methodology of incorporating socio-economic health
determinants into HIA
a. A place for inclusion of socio-economic determinants into HIA has
been identified and described in work package 6; the final report is included
in this technical report.
b. A review of available indicators for socio-economic determinants was
completed within the work package
c. The work package 6 developed and pilot tested a framework for three
different levels of inclusion of socio-economic determinants into HIA using
case studies developed within HIA-NMAC project
5. Develop guidelines to introduce HIA on local level
a. Early discussion of the work package group disclosed that
understanding and meaning of local level across participating countries is very
different. Consequently the roles, rights and responsibilities of local level
decision makers differ substantially across participating countries and Europe
in general. This made development of one set of guidelines impossible. This
issue is described in work package reports by providing tables from partner
countries.
b. However, a possibility to produce recommendations for development of
such guidelines within a country was found possible and completed within the
work package
c. Politicians, administrators and civil servants provided useful
information via a coordinated interview process in participating countries for
development of recommendations presented in final report of WP8
As an added value of the project the project team
suggests cross-cutting, main issues to consider if a decision making unit
(municipality, region, district, country, state, country, transnational group)
would like to consider introduction of HIA. These points address the barriers
and opportunities to introduce HIA as observed in work package 2 and 8. We
suggests to present them as a HIA introduction tool (checklist):
a. Does public health training in your country (any other relevant
unit) included the determinants of health theory, intersectorality, risk
management principles and impact assessment principles?
b. Is there a “culture” or “atmosphere” for discussion and consensus
based intersectoral work including principle, of transparency and
participation?
c. Is there an agency that can take the leader role on introduction of
HIA and furthermore provide training and help with risk appraisal part of HIA?
d. Are there data source available to support conduct of HIA,
especially risk appraisal?
e. Is it clear in the society whether the HIA method should be
introduced on regulatory base or rather value base?
f.
Is it clear in the society how
the HIA method fit to other existing intersectoral impact assessment and policy
making tools, methods?
g. Is there a clear implementation plan for HIA describing roles of all
stakeholders, variables and processes on the bases of implementation theory?