Journal of Public Health Medicine 23:173-178 (2001)
© 2001 Faculty of Public Health Medicine of the Royal Colleges of Physicians of the United Kingdom
Debate |
What do we need for robust, quantitative health impact assessment?
Jennifer Mindell1
Anna Hansell1
David Morrison2
Margaret Douglas3
Michael Joffe1
1 Department of Epidemiology and Public Health, Imperial College, St Mary's Campus, Norfolk Place, London W2 1PG
2 MRC Social and Public Health Sciences Unit, 4 Lilybank Gardens, Glasgow G12 8RZ
3 Lothian Health, Deaconess House, 148 Pleasance, Edinburgh EH8 9RG
Health impact assessment (HIA) aims to make the health consequences of decisions explicit. Decision-makers need to know that the conclusions of HIA are robust. Quantified estimates of potential health impacts may be more influential but there are a number of concerns. First, not everything that can be quantified is important. Second, not everything that is being quantified at present should be, if this cannot be done robustly. Finally, not everything that is important can be quantified: rigorous qualitative HIA will still be needed for a thorough assessment. This paper presents the first published attempt to provide practical guidance on what is required to perform robust, quantitative HIA. Initial steps include profiling the affected populations, obtaining evidence for postulated impacts, and determining how differences in subgroups' exposures and susceptibilities affect impacts. Using epidemiological evidence for HIA is different from carrying out a new study. Key steps in quantifying impacts are mapping the causal pathway, selecting appropriate outcome measures and selecting or developing a statistical model. Evidence from different sources is needed. For many health impacts, evidence of an effect may be scarce and estimates of the size and nature of the relationship may be inadequate. Assumptions and uncertainties must therefore be explicit. Modelled data can sometimes be tested against empirical data but sensitivity analyses are crucial. When scientific problems occur, discontinuing the study is not an option, as HIA is usually intended to inform real decisions. Both qualitative and quantitative elements of HIA must be performed robustly to be of value.
Keywords: health impact assessment, public policy, quantitative, reproducibility of results
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