On April 11, 2008, in Toronto, the NCCHPP and Toronto Public Health co-hosted a workshop on HIA, with thirty of the City of Toronto's public health team in attendance. The goal of the meeting was to share thoughts on HIA within the municipality and to test the search tool that had been used to identify the city's projects that could be subject of health impact assessments. Sarah Curtis presented, among other things, the CMO Model (Context-Mechanism-Outcome) to frame an effects analysis approach. Also presenting at the workshop were Dr. David McKeown, Medical Officer of Health for the City of Toronto, and Ronald Macfarlane, (Supervisor, Environmental Health Assessment and Policy, Toronto Public Health)
The Day's Principal Messages:
From Dr. David McKeown
- Ontario is a favourable context for the practice of HIA at the municipal level: public health teams are situated within the municipalities
- HIA is more than a tool, its application requires the participation of decision-makers outside of the health sector
- It is important to consider the effects on health differentiated according to different groups
From Ronald Macfarlane
- HIA applies well to municipal jurisdictions like Toronto;
- It allows the consideration to go as far as social, physical and health infrastructures;
- HIA arises from the fact that health is not well accounted for by other impact assessment approaches (e.g. environmental, social etc.) Also, the concept of sustainable development does not include health;
- An important element in the search and framing phases is the level of public preoccupation with the project. The more that this is elevated, the more the necessity of an HIA is important;
- What makes HIA special is the emphasis placed upon inequalities, the highlighting of participative processes (population and steering committees); these are targets as much as are maximizing positive effects and minimizing negative effects;
- It is necessary to be vigilant with respect to cumulative effects. An analysis could conclude that effects are minor, but such effects repeated many times could have an important impact;
- An important experience is underway: HIA is deeply integrated within a solid waste management study.
From Sarah Curtis
- HIA is based on a social model of health;
- It is important to go from there to the process itself and to ask questions together in order to better understand the complexity
- The CMO Model (context, mechanisms, outcomes) is relevant for appreciating social interventions;
- This model is inspired by Pawson's approach (realist evaluation cycle), which was itself inspired by a theory of change. This approach allows us to question ourselves about the theories and hypotheses underlying the proposed changes, and to identify the logical framework for evaluation;
- Different models of HIA according to the situation: see the Belfast examples using a combination of methods according to projects: desktop, close consultation with employees, participative sessions, community HIA;
- The four challenges, as much for practice as for research, are: considering evidence, considering opinions, to come to contribute to a better-informed understanding, and to come to propose adjustments that will improve the proposal;
- Among the difficulties associated with the challenge of evidence: how to make recommendations while there are so many uncertainties with respect to the effects and their magnitude;
- The difficulties associated with the challenge of opinions: the representation of groups, the unequal capacities of participants to interact, how to proceed without consensus, ? Does the participative process really allow us to improve the power and capacities of citizens to improve policies?
- HIA requires collaborative efforts to change practices and to develop new capacities.
A video showing the presentations of Sarah Curtis, Ronald Macfarlane and Dr. David McKeown will soon be available on our site.