The impact and effectiveness of equity focused health impact assessment in health service planning

Abstract

This thesis by publication examines the use of equity focused health impact assessment (EFHIA) on health service plans. The research questions addressed are:

• What are the direct and indirect impacts of EFHIAs conducted on health sector plans? • Does EFHIA improve the consideration of equity in the development and implementation of health sector plans? • How does EFHIA improve the consideration of equity in health planning?

The thesis is made up of seven peer-reviewed publications - five journal articles and two book chapters. It describes the use and evolution of health impact assessment (HIA) and EFHIA internationally and in Australia, how it has been used in relation to health service plans, examines its effectiveness and impacts on decision-making and implementation and examines several EFHIAs using case study and interpretive description methodologies.

The thesis makes two substantial theoretical contributions in the form of (i) a typology for HIAs and (ii) a conceptual framework for evaluating the impact and effectiveness of HIAs. This conceptual framework is tested for its applicability to EFHIA in health service planning contexts and refined in this thesis based on three case studies of EFHIAs conducted on health service plans in the state of New South Wales, Australia.

This research shows that EFHIA has the potential to have both direct and indirect impacts on health service planning. These impacts are influenced by a broad range of factors however, which are linked to the context in which the EFHIA is undertaken and the inputs into the EFHIA process and the procedures followed. The EFHIAs included in this thesis show that engagement with the EFHIA process and the extent to which EFHIA is regarded as a broader learning process are important factors that mediating the extent to which EFHIAs influence subsequent activities. This research also suggests that it is not possible to adequately describe the full range of impacts of EFHIA on decision-making and implementation without looking at individual perceptions of effectiveness. These perceptions change over time, suggesting that future research on the effectiveness of HIA should look at the mechanisms by which this change occurs.