Advancing Efforts to Achieve Health Equity: Equity Metrics for Health Impact Assessment Practice

Jonathan Heller,Tim Choi,Maria Jandu,Marjory Givens,Solange Gould,Tina Yuen,Emily Bourcier

doi:10.3390/ijerph111111054

Abstract

Equity is a core value of Health Impact Assessment (HIA). Many compelling moral, economic, and health arguments exist for prioritizing and incorporating equity considerations in HIA practice. Decision-makers, stakeholders, and HIA practitioners see the value of HIAs in uncovering the impacts of policy and planning decisions on various population subgroups, developing and prioritizing specific actions that promote or protect health equity, and using the process to empower marginalized communities. There have been several HIA frameworks developed to guide the inclusion of equity considerations. However, the field lacks clear indicators for measuring whether an HIA advanced equity. This article describes the development of a set of equity metrics that aim to guide and evaluate progress toward equity in HIA practice. These metrics also intend to further push the field to deepen its practice and commitment to equity in each phase of an HIA. Over the course of a year, the Society of Practitioners of Health Impact Assessment (SOPHIA) Equity Working Group took part in a consensus process to develop these process and outcome metrics. The metrics were piloted, reviewed, and refined based on feedback from reviewers. The Equity Metrics are comprised of 23 measures of equity organized into four outcomes: (1) the HIA process and products focused on equity; (2) the HIA process built the capacity and ability of communities facing health inequities to engage in future HIAs and in decision-making more generally; (3) the HIA resulted in a shift in power benefiting communities facing inequities; and (4) the HIA contributed to changes that reduced health inequities and inequities in the social and environmental determinants of health. The metrics are comprised of a measurement scale, examples of high scoring activities, potential data sources, and example interview questions to gather data and guide evaluators on scoring each metric.

Highlights

Over the last several decades, public health evidence has led to an increased focus on the role of social and environmental determinants of health—that is the context in which we live, work, and play—in shaping health and health equity
(2) Four respondents either “strongly agree” or “agree” with the statement that the metrics were useful for evaluating equity in Health Impact Assessment (HIA) and/or proactively thinking about how to include equity considerations in HIA
(3) Another reviewer shared that the metrics were very specific to a comprehensive HIA, rather than other forms of HIA or Health in All Policies (HiAP) approaches

Summary

Introduction

Over the last several decades, public health evidence has led to an increased focus on the role of social and environmental determinants of health—that is the context in which we live, work, and play—in shaping health and health equity. Adding to the practical application of these resources, a set of clear metrics for evaluating the degree to which an HIA successfully incorporated equity could encourage HIA practitioners to take a more intentional and thorough approach to addressing equity Developing such metrics could serve as a resource for evaluators, equity advocates, and others interested in assessing the progress toward equity within and across HIAs conducted. Assessment” [11] regarding the incorporation of equity into HIA practice, and provide a practical resource to guide assessments grounded in the underlying values of HIA The use of these metrics may promote a greater systematic and explicit inclusion of equity considerations within HIA and within the broader field of public health. The first two outcomes, when achieved, can contribute to the final two outcomes, which can take place over a longer time period after the HIA has been completed or the decision has been finalized

Experimental Section

Results and Discussion

Conclusions