Health Impact Assessment

Sustainable management of urban pollution: an integrated approach

by Giovanni Leonardi

Overview of sources of information on health and social effects of flooding

by Giovanni Leonardi

page 40

International perspective on health impact assessment in urban settings

by Salim Vohra

New International Consensus on Health Impact Assessment

by Salim Vohra

Health Aspects in EIA

by Salim Vohra

Impact of outdoor air pollution on the health of London’s children

by Giovanni Leonardi

Chemical Hazards and Poisons Report, Sept 2005
UK Health Protection Agency
page 32

Development of a framework for integrated health impact analysis of geoenvironmental pollution

by Giovanni Leonardi

‘Bridging health and foreign policy: the role of health impact assessments’

by Colin McInnes

With Kelley Lee, Alan Ingram, Karen Lock. Bulletin of the World Health Organisation, Vol. 85, No. 3 (March 2007)

Health impact assessment (HIA) is an important tool for exploring the intersection between health and foreign... more Health impact assessment (HIA) is an important tool for exploring the intersection between health and foreign policy,
offering a useful analytical approach to increase positive health impacts and minimize negative impacts. Numerous subject areas have brought health and foreign policy together. Yet further opportunities exist for HIA to address a broader range of health impacts that otherwise may not be seen as relevant to foreign policy. HIA may also improve the quality of scientific evidence available to policymakers. The Framework Convention on Tobacco Control offers lessons for the strategic use of HIA. However, HIA alone is limited in influencing these decision-making processes, notably when issues diverge from other core concerns such as economics and security. In such cases, HIA is an important tool to be used alongside the mobilization of key constituencies and public support.

Equity Focused Health Impact Assessment – A Step Forward or Two Steps Backwards

by Jordan Panayotov

Health impact assessment has the potential to address health inequalities and to provide recommendations to reduce... more Health impact assessment has the potential to address health inequalities and to provide recommendations to reduce these. Do we need to mention this specifically in the name of the assessment in order to do it, for example, shall we use “health equity impact assessment” or “equity focused health impact assessment”? Will a new name help the goal to reduce health inequalities?

Key words: Equity Focused Health Impact Assessment, Health Equity Impact Assessment

Suggested citation: Panayotov J., "Equity Focused Health Impact Assessment - A Step Forward or Two Steps Backwards", ICARE, 11 January 2011

[see also "EU Joint Action on Health Inequalities", very useful Report available here: www.apho.org.uk/resource/view.aspx?RID=103815 . The Report notes that "there was a consensus that HIA should be the only term used with other terms not being appropriate and that a HIA is incomplete if it does not consider equity impacts within its process"]

Evidence in Public Health and Health Impact Assessment (The Role of Panayotov Matrix)

by Jordan Panayotov

When making decisions for allocating limited resources people use evidence in order to have certainty about achieving... more When making decisions for allocating limited resources people use evidence in order to have certainty about achieving intended result in relation to predetermined goal. Different interventions to choose between are nothing more than means for getting the desired outcome. It should be clear to everyone that, although that a population is sum of individuals, achieving highest attainable health for an individual and for whole population is not the same thing. While the evidence that an intervention achieves the desired outcome for an individual can be unambiguous and usually can be replicated at any local context, the evidence for interventions implemented to populations is often weak, equivocal, inconclusive and even controversial. Why identical interventions implemented to populations achieve different results to different groups of this population? Why replicating successful intervention delivers poor result in other cases? Since public health is about populations, it is about distribution of the benefit within these populations, therefore ultimately it’s about who-gets-what from an intervention. Distribution of the benefit should not be confused with distribution of the population, which is normal distribution with bell-shape. The former impacts the shape of the later. Average data alone has very limited informative value for decision makers in order to make the right choices for interventions implemented to whole populations. For any intervention implemented to populations the distribution of the benefit within the population is the most important factor, which affects both average health status and health inequalities. There are eight different possible combinations of distribution of the benefit from an intervention defined in Panayotov Matrix, which lead to very different outcomes for average health status and health inequalities. Therefore, no matter whether improving the health is primary objective (in public health) or not (in health impact assessment), the evidence that an intervention “works” becomes relative, depending on replicating the same combination of distribution of the benefit.
Key words: Evidence-Based Policy, Health Impact Assessment,
Social Determinants of Health, Health Inequalities, Health Disparities, Decision-Making, Average Health Status

Suggested Citation: Panayotov J., "Evidence in Public Health and Health Impact Assessment (The Role of Panayotov Matrix)", ICARE, 01 February 2009

Public Health and Average Health Status: Do Health Inequalities Matter? (Panayotov Matrix)

by Jordan Panayotov

[ Presented on several international forums since October 2004 ]

Any policy, program or intervention is decision for resource allocation. Whatever intervention is implemented there... more Any policy, program or intervention is decision for resource allocation. Whatever intervention is implemented there are winners - people who benefit of it, and losers - people who benefit less or nothing at all, or are even worse off compared to their previous situation. Therefore there are always opposing interests – who will benefit more. Choices, or prioritizing competing demands, are inevitable, since resources are limited and less than the needs. However, maximizing individuals' health is not the same as maximizing health of whole populations, although that population is sum of individuals. Having losers de facto means that some claims of the recipients are declined. The question is:
“Which claims will be declined?” and more importantly:
“On what basis some claims will be declined?”

Around the world decision-makers are puzzled – What is best for improving health of populations: increasing average health status, or decreasing health inequalities? Is there interdependence between health gain and health equity? This article is about theoretical investigation of the correlation between average health status and health inequalities. How they relate one to another, why they relate the way it is observed empirically, how would different interventions impact them? Focusing on improvement in average health status can mask widening of health inequalities. This situation, where health gain and health equity are not interdependent, has supporters, as it complies with Kaldor-Hicks criterion for efficiency. However, does it comply with declared by the society ethics that people, irrespective of their personal characteristics, are of equal value? The right of an individual to the highest attainable health should not be achieved by denying this right to others. Therefore different approach is needed when allocating resources in public health.

This article provides a useful tool for researchers, decision-makers and local practitioners to: explain and analyse empirical findings; make predictions about future developments of average health status and health inequalities; make proper choices for policies, programs and interventions in line with the goals of WHO and public health.

Key words: Health Inequalities, Evidence-Based Policy, Social Determinants of Health, Health Impact Assessment, Priority Setting, Decision-Making, Average Health Status, Health Disparities

Suggested Citation: Panayotov J., "Public Health and Average Health Status: Do Health Inequalities Matter? (Panayotov Matrix)", ICARE, 08 August 2008