Policy decisions on everything from childhood education to housing can have unintended consequences on the public’s health. A Healthy Equity Impact Assessment (HEIA) is a decision support tool designed to identify these unintended consequences. It walks users through the steps of identifying how a program, policy or similar initiative will impact population groups in different ways. It is a valuable opportunity to consider broader impacts of a policy change before it is implemented and to make any necessary adjustments. It can also be a useful asset in the development of a Health in All Policies strategy for all government sectors.
The Ontario Ministry of Health and Long Term Care has already adopted the use of an HEIA tool. However, the tool is not only intended for use by organizations within the health care system, but also by organizations outside the health care system whose work can have a major impact on health outcomes.
One example of its use outside of the traditional health care sector is a health equity impact assessment recently developed by the Wellesley Institute in response to Ontario government’s elimination of the Community Start Up and Maintenance Benefit (CSUMB). This benefit was in place to help people receiving social assistance pay for large or unexpected housing-related costs, supporting them to become and remain housed. Housing is an important social determinant of health, it is an absolute necessity for living a healthy life. Living in unsafe, unaffordable or insecure housing increases the risk of many health problems. The loss of this targeted homelessness prevention support benefit and its subsequent download to municipalities (along with a 50% reduction in funding) will have significant health impacts amongst social assistance recipients and low income Ontarians, such as women and children fleeing domestic abuse situations.
Policy decisions about issues as wide ranging as childcare to the environment all affect the health of a population. Applying a health equity impact assessment lens provides a high level view of the potential impacts of a complex policy change and should be used by policy makers to make more informed decisions to reduce adverse unintended consequences for vulnerable populations.
HEIA tools have been adopted in a number of international jurisdictions including Australia, New Zealand, the United Kingdom and Wales. HEIA is also used and advocated by the World Health Organization (WHO). Unfortunately, HEIA is still in its infancy in Ontario and most of Canada. I hope that soon we’ll see it adopted across all government sectors. If we do not, we will continue to see the negative consequences of public policy disproportionately hurt our most vulnerable.
Lori Kleinsmith is a health promoter at Bridges Community Health Centre (CHC). Follow Lori on Twitter @LoriKleinsmith.