Evaluations of health impact assessments (HIAs) have highlighted its potential impacts on decision-making, implementation and broader factors such as intersectoral collaboration (Harris-Roxas et al. 2011, Harris-Roxas et al. 2012b, Wismar et al. 2007). Tensions often arise between stakeholders about the outcomes of HIAs however. Studies that have looked at this have found that there are:
- Often disagreements between stakeholders about the perceived purpose of the HIA and what form it should take (Harris-Roxas et al. 2012a, Harris-Roxas & Harris 2011); and
- The perception that an HIA’s recommendations could have been identified through normal planning and implementation processes and that the HIA didn’t necessarily have to be conducted (Harris-Roxas et al. 2011). In other words, that an HIA’s recommendations are “common sense”.
These two issues, about the perceived purpose of HIA and the “common sense” nature of HIAs’ recommendations, lie at the heart of any discussion of the HIA effectiveness. These issues have also been under-explored in the literature to date.
This plenary will present initial findings from a study that looked at two decision-support equity-focused HIAs of similar health sector proposals (local health service obesity prevention and treatment service plans) longitudinally. This involved conducting 23 semi-structured interviews with key stakeholders before, during and after the HIAs, and document reviews. One of the HIAs was completed while the other one was screened and determined to be unnecessary. This study is unique in relation to HIA to the authors’ knowledge, because it looks at expectations and perceptions of effectiveness before and after the HIAs were completed. It also compares two similar planning situations, one in which an HIA was conducted and one in which the HIA was screened out.
The study’s findings highlight that while many of the recommendations and distal impacts of an HIA (Harris-Roxas & Harris 2012) could notionally be anticipated through common sense analysis, in practice they are rarely foreseen. A similar phenomenon has been demonstrated in other fields such as organisational psychology and management (Orrell 2007, Watts 2011). This study also highlights the critical role that learning plays in impact assessment practice (Morgan 2012, Bond & Pope 2012). This learning takes three forms: technical, conceptual and participatory (Harris & Harris-Roxas 2010, Glasbergen 1999). Learning may also take place at individual, organisational and social levels.
This suggests that “common sense” is anything but common in the real world of planning and decision-making, and for good reasons. What seems obvious in hindsight is rarely apparent in advance. HIA, as a structured process for looking at under-considered impacts, has an important role to play in moving beyond common sense towards broader learning and more nuanced analyses of alternatives.
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