PUBLIC HEALTH AND MANAGEMENT AMT, v. II, no. 3, 2009, p. 1 GENERAL ASPECTS REGARDING THE HEALTH IMPACT OF POLICIES, PROGRAMMES AND PROJECTS CARMEN DOMNARIU “Lucian Blaga” University of Sibiu Abstract: Health Assessment Policy is a structured method for assessing and improving the health consequences of projects, programmes and policies in the non-health sector. It is a multidisciplinary process combining a range of qualitative and quantitative evidence in a decision making framework. Keywords: Health Impact Assessment (HIA), policy, programme, project Rezumat: Evaluarea politicilor de sănătate este o metodă structurată privind evaluarea şi îmbunătăţirea rezultatelor proiectelor, programelor şi politicilor din alte sectoare decât cel sanitar. Este un proces multidisciplinar care combină o serie de dovezi calitative şi cantitative într-un cadru de luare a deciziilor. Cuvinte cheie: evaluarea politicilor de sănătate, politică, program, proiect It has been long accepted the fact that health and its determinants (1) are strongly influenced by the policies outside the healthcare sector, such as: transportation, regeneration projects and housing. There are countries that have recently introduced health impact assessment (HIA), with a view to try and ensure that the potential effects on health are taken into consideration. This involves identifying disbenefits and benefits to health, interpreting health risk and potential health gain and presenting this information in order to facilitate the decision making process at local level.(2) In a consensus paper, published by WHO Regional Office for Europe, health impact assessment is described as “a combination of procedures, methods and tools by which a policy, programme or project may be judged regarding its potential effects on the health state of a population and the distribution of these effects within that population”.(3) There are also other definitions proposed for health impact assessment. All of them generally agree to:(4) health gain maximization and loss minimization; • multidisciplinary, intersectorial and participatory character of HIA; • focus on health inequalities; • use both the quantitative and qualitative types; • the fact that there are four values (5) which are particularly important for HIA: - democracy, emphasizing the right of people to participate in a transparent process for the formulation, implementation and evaluation of policies that affect their life, both directly and through the elected political decision makers; - equity, emphasizing that HIA is not only interested in the aggregated impact of the assessed policy on the health of a population but also on the distribution of the impact within the local population, in terms of gender, age, ethnic background and socio-economic status; - sustainable development, emphasizing that both short term and long term, as well as more or less impacts are taken into consideration and; - ethical use of evidence, emphasizing that the use of quantitative and qualitative evidence has to be rigorous and based on different scientific disciplines and methodologies in order to get an assessment as comprehensive as possible of the expected impacts. Why do we need to develop Health Impact Assessment at local level? Social, economic and other policies in both the public and private sectors are so closely interrelated that proposed decisions in one sector may impact on the objectives and other sectors. In recognition of this, specific legal and administrative rules, procedures and methods have already been developed in many countries to assess the impacts of polices for example, on the environment, employment, economic growth or competition, on cultural and social factors, or on ethnic groups and gender. The general objective of such assessments is to improve knowledge about the potential impact of a policy or programme, inform decision-makers and affected people and facilitate adjustment of the proposed policy in order to mitigate the negative and maximize the positive impacts. Although polices in other sectors can have a considerable influence on health and the production of prevention of illness, disability or death, this has so far only been taken into consideration to a limited degree, mainly in relation to environmental and social impact assessments. Recent attempts to take a more integrated approach to health and development has put HIA high on the agenda of some governments in Europe (at national, regional and local levels), and of international organizations including WHO and World Bank. A similar PDF created with pdfFactory Pro trial version www.pdffactory.com