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Glossary

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Glossary

This Glossary explains some of the terms commonly used in HIA.

It also explains some of the terms relevant to local government and health services in England.

Last Updated 14/7/08 JK

Agenda 21

Agenda 21 is shorthand for “The Agenda for the 21st century”. The 1992 Earth Summit held in Rio de Janeiro brought

together 175 heads of government to discuss the damage being caused to the planet through excessive use of natural

resources and the need for sustainable development. The Agenda they adopted called for the development of Local Age

(LA21) Plans. Local authorities have been given responsibility for getting LA21 started by bringing together local

organisations, business and member of the community to contribute to an Action Plan.

Appraisal (assessment)

Appraisal or assessment follows on from the scoping stage of an HIA, where the nature, direction, size and importance

potential health impacts which have been identified are assessed using the available evidence base.

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Best Judgement

Conclusive evidence of the links between, for example, socio-environmental factors and health or the effectiveness of

interventions is rarely available. In such cases, best judgement has to be used to decide how much weight to give to

conflicting lines of evidence and what are the most likely impacts where the evidence is incomplete.

Best Value

Since April 2000, local councils have been required to develop Best Value performance plans and to review all their serv

over a five year period. The purpose of the Best Value initiative is to encourage local authorities to develop a frameworkassessing the ways in which they deliver services and to identify ways in which service delivery can be improved. Ideall

is done through a series of wide ranging service reviews which incorporate service users’ and other stakeholders’ views

assessment of the need for services locally. In many cases, the process is seen as a possible mechanism for aligning th

councils’ activities and organisation with the priorities identified in their community strategies. Advice has been publish

IDEA, the local government improvement and development agency on how to undertake best value reviews.

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Capital investment

Funding for resources such as buildings or other “one-off” purchases such as computer hardware and software and otheoffice equipment.

Commissioning services

The process of identifying the need for services and making a contract or service level agreement with those able to prothem.

Community participation

Involving the community in an activity such as the planning of projects or carrying out a HIA. There are a number of mo

of community participation, some of which are outlined in the Gothenburg consensus paper on HIA.

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Community strategy

All English councils now have to produce a community strategy setting out key local priorities and proposing how the qu

of life of local residents can be improved. Local strategic partnerships usually take the lead on these in order to ensure

the strategy is developed in partnership with local organisations and agencies rather than being produced “top down” b

local authority.

Comprehensive (maxi) HIA

A comprehensive or “maxi” HIA is the most detailed and rigorous from of HIA. It involves much more than either a rapi

intermediate HIA. It usually involves the participation of the full range of stakeholders, an extensive literature search,

secondary analysis of existing data and the collection of new data.

Concurrent HIA

HIA is prospective. However the term concurrent HIA is still sometime used to describe the process of monitoring event

whilst a policy, programme or project is being implemented. This process is better described as monitoring.

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Decision making

The process of deciding which options will be chosen and implemented. An HIA should assist this process by clarifying t

health consequences of choosing each option.

Determinants of Determinants

Factors such as income, employment and community characteristics are important not only in themselves but also beca

they limit what behaviour and lifestyle choices are possible. Such determinants are therefore sometimes referred to as

determinants of determinants.

Determinants of health

Determinants of health are factors which influence health status and determine health differentials or health inequalities

are many and varied and include, for example, biological factors, such as age, gender, ethnicity and genetic make up;

behaviour and lifestyles, such as smoking, alcohol consumption, diet and physical exercise; the physical and social

environment, including housing quality, the workplace and the wider urban and rural environment; access to health car

the broader economic and political setting. All of these are closely interlinked and differentials in their distribution lead t

health inequalities.

Disadvantaged / vulnerable / marginalized groups

These terms are applied to groups of people who, due to factors usually considered outside their control, do not have th

same opportunities as other, more fortunate groups in society. Examples might include unemployed people, refugees a

others who are socially excluded.

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Economic impact assessment

Economic impact assessment involves exploring and identifying the ways in which the economy in general, or local econcircumstances in particular, will be affected by a policy, programme or project.

Employment Zone15 Employment Zones (EZs) were launched in March 2000 in areas experiencing high levels of long term unemploymen

order to help long term unemployed people get and keep work. Employment Zones pool funds for training, Employment

Service support and the equivalent of benefit to maximise flexibility and choice. The areas selected were amongst the w

150 unitary authorities or local authority districts in Great Britain when ranked by a composite measure of the share of

unemployed claimants aged 25+ who were long term unemployed, the employment rate and the number of people

unemployed for over two years as a percentage of the working age population based on 1997 data. Participants in the schemes work with a personal adviser to establish their needs and identify any barriers preventing them from moving in

sustainable work. A costed action plan is then drawn up between adviser and participant. Once the participant has start

work, they continue to be supported to ensure that their move into employment is sustained where possible. A range of

different organisations were contracted through a tender ing process to administer the zones and their performance is

monitored and linked to the funding process.

Environmental impact assessment




Environmental impact assessment (EIA) is a well developed discipline, both in terms of theory and practice.Its origins li

the US National Environmental Policy Acts of 1969. In the same way that HIA explores the effect of policies, programme

projects on health, EIA does the same in terms of environmental effects. In many countries, including those of the Euro

Union, there is a statutory requirement for EIA to be undertaken under certain circumstances. The rules vary from coun

country but generally EIA should lead to the abandonment or modification of proposals which are likely to have any sign

adverse effects on the environment. There are numerous definitions of EIA, including the following:-

an assessment of the impact of a planned activity on the environment the process of evaluating the likely environmental consequences of a proposed major action significantly affectin

natural and man-made environment

a technique and a process by which information about the environmental effects of a project is collected, both by

developer and from other sources, and taken into account by the planning authority in forming their judgements

whether the development should go ahead

.

Equity Audit

An investigation of the inequalities of health and whether the distribution of services within that area relates to those

inequalities. The audit will make recommendations as to how policies might be changed or services redirected to decrea

inequity.

Equity in health

The key idea of equity is fairness. Equity in health is the absence of health inequity. Equity implies that everyone shoul

a fair opportunity to attain their full health potential and, more pragmatically, that no one should be unfairly disadvanta

from achieving this potential if it can be avoided. More succinctly, equity is concerned with creating equal opportunities

health and with bringing health differentials down to the lowest possible level.

Equity is part of the basic values system of HIA. HIA explores and addresses health inequities in health wherever possib

Evaluation

Evaluation involves making a judgement as to how successful (or otherwise) a project, programme or policy has been.

Success is commonly measured as the extent to which the project has met its original objectives but good and bad aspe

not mentioned in the objectives may also need to be considered. Both the “process” (activities) and “outcomes” (what i

produced, for example in terms of changes in the health of those targeted by the project) can be monitored and evalua

Process evaluation is particularly important for understanding why a project programme or policy failed or succeeded an

seeing how it can be improved in future. In the past an evaluation was sometimes called a retrospective HIA.

Evidence base

The evidence base refers to the body of information, drawn from routine statistical analyses, published studies, “grey” literature, views of key informants and experts and views of residents and stakeholders. Evidence from the literature an

other sources tells us something about what is already known about how different factors affect health. For example, in

field of housing and health there are a number of studies which demonstrate the links between damp and cold housing

respiratory disease and, increasingly, the links between high quality housing and quality of life).

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Health gain

Improvement in health status.

Health impact

A health impact can be positive or negative.

A positive health impact occurs when good health is promoted or health is improved or harm to health is prevented. For

example, having a sense of control over one’s life and having choices is known to have a beneficial effect on mental hea

and well being, making people feel “healthier”.

A negative health impact is the opposite and occurs when health is harmed. For example, working in unhygienic or unsa

conditions or spending a lot of time in an area with poor air quality is likely to have an adverse effect on physical health

status.

Health improvement and modernisation plans (HIMP)

All health authorities in England have, in recent years, produced a health improvement programme (HIMP) which sets o

their strategic framework for improving health, reducing health inequalities and delivering high quality services. Most Hwere developed in partnership with local authorities and other local agencies and, as required by the government, inclu

three year human resources and organisational development action plan.




Health Inequalities Impact Assessment (HIIA)

The term Health Inequalities Impact Assessment is sometimes used for an assessment which places particular emphas

reducing health inequalites. One could argue that every HIA should have an emphasis on reducing health inequalities in

case the term HIIA is redundant.

Health inequality and inequity

Health inequalities can be defined as differences in health status or in the distribution of health determinants between

different population groups. Inequity exists where the differences are unfair and avoidable. It is important to distinguisbetween inequality and inequity in health.

Some health inequalities are attributable to biological variations or free choice. For example the longer life expectancy oyoung person compared to an older person or the greaer risk of injury in someone who choses hang gliding as a hobby

compared to someone who does not. In these examples of inequality it is not possible or unacceptable to change the he

determinants and so there is no inequity.

On the other hand some inequalities are attributable to the external environment and conditions mainly outside the con

the individuals concerned. For example the shorter life expectancy in people from manual social classes as opposed to t

from non manual a social classes or the higher infant mortaliy in residents of some areas compared to residents in othe

areas. In these examples the uneven distribution of health may be unnecessary and avoidable and therefore unjust and

unfair. They are therefore examples of inequity.

Healthy Living Centres

The Healthy Living Centre (HLC) initiative was set up in January 1999 by the New Opportunities Fund which draws on f

raised through the national lottery. The programme aims to promote health in its broadest sense and to target the mosdisadvantaged areas and groups of the population, although it is envisaged that Healthy Living Centres will be accessib

20% of the population over the lifetime of the initiative. The Centres are intended to complement existing provision bysupporting national and local health strategies and contributing to tackling health inequalities. In order to encourage

innovation in developing new and imaginative ways of responding to local needs there is no one model for a HLC projec

may not necessarily be based in a building or be attached to an existing health service. All, however, must aim to foster

partnerships between a range of organisations and local interest groups.

Healthy public policy

Healthy public policy is a key component of the Ottawa Charter for Health Promotion (1986). The concept includes polic

designed specifically to promote health (for example banning cigarette advertising) and policies not dealing directly with

health but acknowledged to have a health impact (for example transport, education, economics).

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Impact assessment

Impact assessment is about judging the effect that a policy or activity will have on people or places. It has been define

the “prediction or estimation of the consequences of a current or proposed action”.

Inequalities audit

See Equity Audit.

Index of Multiple Deprivation 2007 (IMD 2007)

The index of multiple deprivation 2007 combines a number of indicators chosen to cover a range of economic, social an

housing issues into a single score for each small area in England. This allows each area to be ranked relative to one ano

according to their level of deprivation. Further information will be found at the Communities and Local Government web

IMD 2007 replaces an indicator based on earlier data IMD 2004.

Integrated impact assessment

Integrated impact assessment brings together components of environmental, health, social and other forms of impact

assessment in an attempt to incorporate an exploration of all the different ways in which policies, programmes or proje

may affect the physical, social and economic environment.

Integrated Pollution Prevention Control regulations

In October 1996 the European Commission published a Directive on Integrated Pollution Prevention and Control (IPPC)

came into effect on 30 October 1999. As a result, European Union Member States were required to introduce a regulato

system to ensure that particular industries take action to ensure “an integrated approach to pollution control” in order t

achieve “a high level of protection for the environment as a whole” when considering both routine and accidental releas

The definition of pollution in the Directive includes releases to air, land or water “which may be harmful to human healt

the UK, Pollution Prevention and Control regulations were introduced in 2000 and they require that health authorities ar




consulted on IPPC. There are around 7,000 sites affected across the country and the types of activity which are covered

the regulations include the energy, metals, oil, chemical and waste management industries, paper production, food pro

and some intensive livestock rearing.

Intermediate HIA

An intermediate HIA is less intensive than a comprehensive HIA and more intensive than a Rapid HIA. It may combine

workshop with key stakeholders followed by desk based work to build up a more detailed picture of the potential health

impacts than those which would be identified during a rapid or “mini” HIA. It may involve a limited literature search, us

non-systematic, and is mostly reliant on routine, readily available data.

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Local Area AgreementLocal Area Agreements are part of the process by which government encourages and incentivises local government to

improve. Local Strategic Partnerships led by the local authority agree with the Department of Communities and LocalGoveernment to achieve certain measured outcomes.

Local strategic partnership

Local strategic partnerships (LSPs) were launched in March 2001 by the former Department for the Environment, Transand the Regions. The idea is that every local authority area should be covered by a partnership made up of (unelected)

representatives of the public, private, voluntary and community sectors locally. Their aim is to identify the priorities of t

communities they serve and to work with local people to address them, using mainstream funding and existing structur

carry out their core tasks:

to prepare and implement a community strategy for the area

to bring together local plans, partnerships and initiatives to work with local authorities in developing local public service agreements (PSAs)

to develop and deliver a local neighbourhood renewal strategy.

Local transport plan

Local transport plans are developed by partnerships of local authorities, businesses, transport operators and service use

part of the New Deal for Transport initiative and aim to promote integrated local transport systems and to tackle proble

congestion and pollution. Further information will be found at Department of Transport website.

Logic Diagram / Causal Pathway

A logic diagram sets out the postulated causal links between a proposal and the possible ultimate health impacts. It is a

important part of the scoping stage of an HIA. It makes clear the possible causal steps which may need further investig

in the HIA.

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Monitoring

Monitoring is the process of keeping track of events. For example, the monitoring of a project may involve counting the

number of people coming into contact with it over a period of time or recording the way in which the project is administ

and developed. Monitoring is often an important part of evaluation.

Multidisciplinary

HIA is not the preserve of any one disciplinary group. Instead, it draws on the experience and expertise of a wide range

“stakeholders”, who are involved throughout the process. These may include professionals with knowledge relevant to

issues being addressed, key decision makers, relevant voluntary organisations and – perhaps most importantly –representatives of the communities whose lives will be affected by the policy.

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National Service Framework

National Service Frameworks (NSFs) were introduced by the Department of Health in April 1998 as part of a range of

measures intended to improve quality and decrease variations in the health service. They set national standards and de

service models for a defined service or care group; · put in place strategies to support implementation; and · establish

performance milestones against which progress within an agreed time-scale will be measured. The rolling programme o

began with the already established frameworks for cancer and paediatric intensive care and now frameworks cover the

following conditions

mental health

coronary heart disease

older people




diabetes

renal services children’s services

neurological conditions

Usually one new framework is published each year. Each NSF is developed with the assistance of an external reference

which brings together health professionals, service users and carers, health service managers, partner agencies, and o

advocates.

Neighbourhood

The term neighbourhood usually refers to a local area which is defined in some way physically (for example, an estate o

area bounded by major roads) or by people’s perceptions of what constitutes their local area. Neighbourhoods are usua

fairly small. For example, neighbourhoods designated for New Deal for Communities funding were usually made up of a

4,000 households or around 10,000 people.

Neighbourhood renewal

Neighbourhood renewal is the term commonly used when referring to the regeneration of local areas. At national

governmental level in England there is a Neighbourhood Renewal Unit charged with coordinating and promoting

neighbourhood renewal in the most disadvantaged areas of the country. The Neighbourhood Renewal Fund from 2001

provided funds to support local renewal and regeneration porjects in 88 of the most deprived local authorities. The

programme has now been replaced by the Local Area Agreement programme.

New Deal for Communities (NDC)

New Deal for Communities was a key programme in the English government's strategy to tackle multiple deprivation in

most deprived neighbourhoods in England, giving some of the poorest communities the resources to tackle their proble

an intensive and coordinated way. All NDC partnerships tackled 5 key themes.

poor job prospects

high levels of crime

educational under-achievement

poor health problems with housing and physical environment

There were 39 New deal for Communities Partnerships but the programme has now been subsumed into the Local Area

Agreement programme.

New Deal for Transport

The New Deal for Transport initiative was launched in a government White Paper in July 1998. Its stated aim is to crea

more integrated transport system and to tackle problems of congestion and pollution through national policy and the

development of local initiatives. Key to this are local transport plans which are to be developed by partnerships of local

authorities, businesses, transport operators and service users.

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Outcomes

The effect the process has had on the people targeted by it. These might include, for example, changes in disease freq

self-perceived health status or changes in the distribution of health determinants, or factors which are known to affect

health, well-being and quality of life.

Outputs

The products of the process. These might include, for example, how many people a project has affected, their ages and

groups or the number of meetings held and the ways in which the findings of the project are disseminated.

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Partnership

A group of people or organisations brought together with a common purpose such as developing a regeneration program

undertaking .

Policy

There are various definitions of policy:-

deliberate plan of action to guide decisions and achieve rational outcomes

a definite course or method of action selected from among alternatives in light of given conditions to guide and




determine present and future decisions

the process by which governments (or organisations or individuals) translate their political vision into programm

actions to deliver outcome - desired changes in the real world

Policies can result in acting or not acting and may be explicitly stated or merely implicit. Where a policy is to be the sub

an HIA it needs to be fairly well defined and explicit. National governments create policies to influence (produce change

prevent change) conditions affecting their countries. Local government similar have policies intended to influence condi

for their own populations. other organisations and individuals can similarly have policies to guide actions and activities.

For example, “Saving Lives: Our Healthier Nation” can be seen as a national health policy aimed at improving the health

the population of England, reducing health inequalities and setting objectives and targets which can be used to monitor

progress towards the policy’s overall goal or aims.

Primary Care Trusts

Primary Care Trusts (PCTs) were established in England in April 2002. They are health authorities which have responsib

assessing health needs in their areas (typically 250,000 population), planning and commissioning primary care, second

care and specialist health services, usually from local NHS trusts.

Process

A course of action or series of activities.

Programme

The term programme usually refers to a group of activities which are designed to be implemented in order to reach poli

objectives. For example, Choosing Health lists various bundles of activities or programmes each of which is concerned w

particular health problem such as health inequalities, smoking, obesity, sexual health, mental health and alcohol.

Project

A project is a discrete piece of work addressing a single issue with a pre-set time limit. Examples of a project might be

building a new road, building a bridge, regenerating an area of a town, building a new health centre, a scheme to provi

money to private landlords in order to bring their rented properties up to housing fitness standards and so on.

Prospective HIA

All HIA is prospective since it involves predicting how a project programme or policy will effect health. The term prospec

HIA is therefore unhelpful.

Public Service Agreement (PSA)

Public Service Agreements are a series of objectives and performance targets that government departments undertake

achieve. For example the first objective of the PSA for the Department of Health commits it to "substantially reduce mo

rates by 2010. Reduce mortality rates from heart disease, stroke and related disease by at least 40% in people under 7

at least a 40% reduction in the inequalities gap between the fifth of areas with the worst health and deprivation indicato

the population as a whole. Further information will be found on the Treasury website.

Qualitative and quantitative

Generally speaking, quantitative evidence is based on what can be counted or measured objectively with numbers. Qua

evidence refers to matters which cannot be measured in the usual ways and may be more subjective, encompassing peperceptions, opinions, worries, hopes and views.

HIA takes account of the quantitative, “scientific” evidence where it can be found but also recognises the importance of

qualitative information, which will include the opinions, experience and expectations of those people most directly affec

the proposed project, programme or policy. HIA tries to balance the various types of evidence.

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Rapid (mini) HIA

A rapid or “mini” HIA, as the name suggests, is done quickly. It may be a “desk top” exercise, reliant on information wh

already available already available “off the shelf”, or through a half day or one day workshop with key stakeholders. In

case, there is usually a minimum quantification of the potential health impacts which are identified.

Regeneration

Regeneration is a broad concept used to describe a wide variety of measures that are designed to revive disadvantaged

(mainly urban) areas. This might include




development requires that a strategic approach to the environment be adopted. SEA is by European legislation for cert

projects and the European legislation has been incorporated into UK and other national legisaltion.

Strategic Health Authorities (SHA)

Strategic Health Authorities are the upper tier health authorities for England. After April 2007 there has been one SHA f

each region (except for South East region which has two SHAs) looking after a population of about 5 million. They are

responsible for planning and developing health services strategically in their regions and for performance management

PCTs and NHS trusts.

Currently there are 10 SHAs which replaced the 30 smaller SHA created in the NHS reorganisation of April 2002 by mer

the 95 previous health authorities.

StrategyThe term strategy usually refers to a series of broad lines of action intended to achieve a set of goals and targets set ou

within a policy or programme. For example, Choosing Health laid out broad priorities for improving health and broadapproaches to be taken in order to achieve them.

Sure Start

Sure Start is a government funded programme in England designed to improve services for young children and their famIt encourages statutory services, voluntary organisations and community groups to work together to provide services, a

ask local people what services they want. Its overall aim is to improve the health and well being of children so that they

ready to flourish when they start school and to identify children who need help at an earlier stage so that professional h

can be given as soon as possible. Part of this process involves helping children’s social and emotional development by

supporting the early bonding of children and their parents as well as improving children’s ability to learn by encouraging

and improving language skills.

Sustainability and sustainable development

The plethora of regeneration and neighbourhood renewal initiatives under way are all intended to provide sustainable ch– that is to say, benefits for the future as well as the present. A commonly used definition of sustainable development is

“development which meets the needs of present generation without compromising the ability of future generations to m

their own needs”.

Sytematic Literature Review

A Systematic Literature Review involves trying to find all the published material on a particular topic as oppose to just t

articles that one happens to know about or the articles that support yout point of view. A search strategy is designed to

all relevant articles using appropriate key words. Electronic databases have made the task of searching the literature in

way much easier. Then all articles identified are retrieved and selected or rejected using clearly defined criteria. While m

published journals are fully indexed on electronic databases articles in books and in the "grey" literature (literature whic

not been formally published) may be much more difficult to find. A systematic search is likely to need the help of a train

librarian and may take several months to perform.

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Toolkit

The term toolkit is generally held to mean an information resource including, for example, routinely available data whic

be required for quantifying potential health impacts, a compilation of literature on health determinants or a template fo

organising a HIA or parts of the HIA process such as a workshop for key stakeholders.

Well-being impact assessment

Well-being impact assessment is difficult to distinguish from HIA although it could be argued that, instead of looking at

aspects of health, including medical factors, it concentrates primarily on aspects of quality of life and physical and mentbeing.

Working group

In contrast to a steering group, a working group convened for the purpose of carrying out usually consists of those charwith carrying out the work on a day to day basis. Typically it might include people with a range of complementary public

health skills such as project management, epidemiology, statistical analysis and presentation, questionnaire design and

community development.

Workshops

Workshops involve bringing together a group of people for a specific purpose. In HIA this might include, for example,

identifying key stakeholders’ health concerns in relation to the policy, programme or project being addressed, identifyin

sources of current knowledge in relation to the evidence base or training staff in HIA techniques. Workshops are usually
