New innovation: Rapid Health Impact Assessments
Imagine a local authority where housing, planning, engineering and regeneration staff routinely assess the health impacts of the policies and projects they are working on, and then do something to address them.
Luton Borough Council is trying to do just that by training officers to do rapid health impact assessments (HIA). A rapid HIA (or ‘rapid assessment') is, as the name suggests, a relatively speedy slimmed down version of a HIA. It usually includes participatory workshops and desktop research.
Luton has a history of using HIA to assess the health impacts of development projects, including large scale facilities (Luton Airport) and regeneration projects
(the redevelopment of a local estate called Marsh Farm).
While this work has been valuable, it has tended to focus on big projects and not on the cumulative impact of lots of smaller development. To counter this Gerry Taylor, Joint Director of Public Health at Luton Council and NHS Luton, says that
‘we felt it would be helpful to give more local authority and PCT staff some of the skills to carry out rapid HIA so we could use it more widely because… the built environment and transport can have big implications for health.'
On the buses
The training kicked off with a master class for senior managers on rapid assessment. Officers from across the council - including the Department for Environment and Regeneration - and the PCT were assigned to one of three groups, and then embarked on a three-day training course. Crucially, each group focused on a real local project as the focus for learning: the proposed Luton-Dunstable guided busway, a primary care building and a potential housing development site.
Participants are currently finalising their rapid assessments. For example, the Luton-Dunstable guided busway rapid assessment confirms that the busway would improve access to health services such as Luton and Dunstable Hospital, and potentially help to reduce health inequalities. And it has also identified some health issues for future busway operators to take into account. For example, lower emission buses - critical for improving air quality - are also much quieter than those with diesel engines, which creates a potential danger if you rely on hearing them coming (as a blind bus user pointed out to the rapid HIA team). It also revealed that the tendering process for the bus operator should specify that drivers receive training on the experiences of disabled passengers so they can be more alert to these passengers' requirements, and that buses should be suitably designed for the requirements of families with children and people in wheelchairs.
Driving health forward
Chimeme Egbutah is Luton's Health and Wellbeing Coordinator. She believes that HIA actually has the most impact
‘away from health services… It [HIA] is really good at picking up unintended consequences and helping to get things in at the start that can improve health.'
Armed with this belief she has been a driving force behind Luton's commitment to spreading HIA across the council, building on her experiences of coordinating and undertaking large-scale HIAs, first as an employee of the council and now as someone who is jointly appointed by the local authority and NHS Luton.
From her base in the council's Department of Environment and Regeneration, Chimeme has used her departmental links to help nurture a health perspective among built environment professionals at Luton. She enthuses that this would not have been possible ‘without leadership support… I felt like I was pushing at an open door.'
The open door she found belonged to the Director of Environment and Regeneration, Colin Chick. He believes that HIA is an ideal tool for reconciling his twin responsibilities of promoting economic growth in a local economy hit hard by the collapse of the manufacturing sector in the 1980s, while at the same time improving the environment. He says that
‘HIA is ultimately a way of thinking which is more in-the-round than professional silos such as the economy and the environment - so it adds that extra value.'
He believes that putting his staff through the rapid HIA training will help them to ‘think about the impact of what they are doing in a much broader sense'.
Getting the wheels in motion
This level of corporate support is obviously welcome - but if it isn't there already, how can you convince managers that utilising HIA is an important extra skill for built environment professionals?
Gerry Taylor believes that linking the rapid HIA training to actual projects in the borough was very persuasive:
‘Because staff used a real piece of work they saw how it could actually benefit them rather than simply being another task that they were supposed to do, and that generated lots of enthusiasm.'
This focus was also a good way of linking PCT and council staff who didn't normally work together.
She maintains that this kind of training ‘doesn't need a lot of extra money', although Luton already had in-house expertise of undertaking HIAs.
Finally, this programme of training sits within a broader framework of explicitly linking the built environment and health. Luton has recently set up a health and built environment group which sits under the local strategic partnership (LSP) and feeds into two LSP theme groups: health and wellbeing, and environment. The group is led jointly by the Director of Public Health and the Director of Environment and Regeneration - its work programme includes supporting Luton's Play Strategy and pathfinder projects, influencing planning decisions that may inadvertently help to create obesogenic environments, exploring how derelict land can be used to improve health (growing food, more play space) and reviewing transport policies to see how they could be amended to improve health.
It's a long list - but with officers in the relevant departments now being trained to focus on the health impacts of what they do, there should potentially be many more opportunities to plan health into, rather than out of, the local environment. Gerry cautions that it is early days, and that Luton will need to evaluate the influence of the rapid HIA training. A ride on the busway in a few year's time should be a good pointer to what difference this training has made.
Health and Wellbeing Coordinator
Luton Borough Council and NHS LutoN
Tel: 01582 546114.
10 January 2012