Case study A - A Rapid Health Impact Assessment (HIA) for the Sexual Health Prevention Service

The rapid HIA was carried out to inform a decision regarding the future financial envelope for the sexual health prevention service. It was used to understand and anticipate the effects of a change to the budget on the health of Gloucestershire residents, the influence on health inequalities, and the impact on other health and social care services; ensuring that decision makers were informed on any potential risks and opportunities that could arise.

It was decided that a rapid HIA was the most appropriate form of HIA to be used in this scenario due to the timeframe the HIA was required within to ensure it could influence decision making, and also the resource available within the team to undertake the HIA.

The rapid HIA was carried out to inform a decision regarding the future financial envelope for the sexual health prevention service. It was used to understand and anticipate the effects of a change to the budget on the health of Gloucestershire residents, the influence on health inequalities, and the impact on other health and social care services; ensuring that decision makers were informed on any potential risks and opportunities that could arise.

It was decided that a rapid HIA was the most appropriate form of HIA to be used in this scenario due to the timeframe the HIA was required within to ensure it could influence decision making, and also the resource available within the team to undertake the HIA.

The rapid HIA was led by a Public Health Consultant, with input from all members of the public health team who supported the sexual health portfolio area. This included a Public Health Manager, a Public Health Officer, and a Public Health Support Officer.

Initially a literature review was undertaken to understand the effectiveness of the individual components of the current sexual health prevention service model. A summary of the evidence was produced and shared with the group undertaking the HIA.

Following this, the group met face to face to undertake a casual mapping exercise. This was a creative process, where large pieces of paper, coloured markers, flip charts, post-its etc were used to record the groups discussion. A casual mapping process takes an intervention and maps the immediate factors which could follow, and then what the possible health impacts could be. For our scenario, we took each of the components of the current service model and mapped the potential impacts on health should these components be removed. As well as the impact on health, we also considered the impact on other health and social case services, and the social, political, and reputational impact. It is important as part of the assessment to consider the impact of the interventions, both positive and negative, on any protected characteristic group.

The casual mapping was then reproduced digitally to provide a visual representation of the HIA and enable communication of the potential consequences to decision makers.

The findings from the evidence review and casual mapping were then written up into a report aimed at decision makers. The report included recommendations on how to reduce the negative impacts and maximise the positive impacts of the interventions.

Initially a literature review was undertaken to understand the effectiveness of the individual components of the current sexual health prevention service model. A summary of the evidence was produced and shared with the group undertaking the HIA.

Following this, the group met face to face to undertake a casual mapping exercise. This was a creative process, where large pieces of paper, coloured markers, flip charts, post-its etc were used to record the groups discussion. A casual mapping process takes an intervention and maps the immediate factors which could follow, and then what the possible health impacts could be. For our scenario, we took each of the components of the current service model and mapped the potential impacts on health should these components be removed. As well as the impact on health, we also considered the impact on other health and social case services, and the social, political, and reputational impact. It is important as part of the assessment to consider the impact of the interventions, both positive and negative, on any protected characteristic group.

The casual mapping was then reproduced digitally to provide a visual representation of the HIA and enable communication of the potential consequences to decision makers.

The findings from the evidence review and casual mapping were then written up into a report aimed at decision makers. The report included recommendations on how to reduce the negative impacts and maximise the positive impacts of the interventions.

The rapid HIA report was used to support the case for continued investment in the sexual health prevention service.

The rapid HIA process challenged the group to explore in more depth the impacts the service has and really follow the impact at an individual and population level.

It provided a process and framework which enabled us to articulate some of the complex and interwoven factors.

The rapid HIA process challenged the group to explore in more depth the impacts the service has and really follow the impact at an individual and population level.

It provided a process and framework which enabled us to articulate some of the complex and interwoven factors.

Approximately 2 days in total.

Advantages:

A useful tool when trying to understand the health impacts of complex interventions or proposals.
Ensures that the consequences of interventions on population health is captured and considered.
The findings of the HIA would support the writing of any Equality Impact Assessments (EIAs) which are required.

Disadvantages:

Time and resource. Even a rapid HIA took the group approximately 2 days

Advantages:

A useful tool when trying to understand the health impacts of complex interventions or proposals.
Ensures that the consequences of interventions on population health is captured and considered.
The findings of the HIA would support the writing of any Equality Impact Assessments (EIAs) which are required.

Disadvantages:

Time and resource. Even a rapid HIA took the group approximately 2 days

The initial literature review was a useful step to ensure the impacts identified at the causal mapping stage were evidence-based. It is also important to gather together all your sources of intelligence to help you have a picture of local need.

Producing a simplified digital version of the causal mapping is a visual way to convey your HIA on a page.

When we undertook the rapid HIA all the group members worked in public health on the sexual health portfolio area. It might have been helpful to have some external stakeholders as group members to provide alternate perspectives and challenge.

A HIA should be seen as a dynamic process and something you should keep under review and ensure is updated.