ABSTRACT
La salud no depende sólo de factores biológicos o hábitos de vida. Numerosos factores económicos, sociales, políticos y ambientales configuran la forma de vivir y enfermar de las personas. Así, la salud no es únicamente el resultado de las políticas sanitarias, y por ello las administraciones públicas se interesan cada vez más en conocer el efecto de sus políticas sectoriales en la salud. La evaluación del impacto en la salud es una metodología prospectiva que trata de predecir los impactos en la salud de las políticas para maximizar sus impactos positivos y evitar sus efectos negativos inesperados en la salud. El cribado es la primera fase y tiene especial importancia, porque permite seleccionar las intervenciones que pueden beneficiarse de una evaluación del impacto en la salud completa. Teniendo en cuenta la limitación de los recursos, y que no es posible valorar todas las intervenciones gubernamentales, son esenciales herramientas de priorización. Como primer paso del proceso de validación de una herramienta de cribado sistemático en el contexto español, se presenta el procedimiento de recopilación y tipificación de las políticas públicas no sanitarias planificadas en la octava legislatura del Gobierno Vasco. De las 97 políticas analizadas, el 76% se relacionaba con determinantes estructurales de las desigualdades sociales en salud, el 79% era de naturaleza táctica/operacional, el 67% se dirigía a grupos específicos de población y el 66% estaban ya iniciadas. En relación con el trabajo intersectorial, las percepciones del personal técnico de los departamentos participantes acerca de la iniciativa, de su justificación y del proceso, fueron positivas. Esta primera experiencia ha permitido conocer con mayor detalle la naturaleza de la planificación política no sanitaria en Euskadi como medio para avanzar en la incorporación de la perspectiva de la salud en todas las políticas(AU)
Health not only depends on biologic or lifestyle factors but also on other economic, social, political, and environmental factors that shape the way people live and become ill. Thus, health policies are not the only policies affecting health, and consequently governments are increasingly interested in identifying the effect of other non-health policies on health. Health impact assessment is a prospective methodology that aims to predict the health impacts of policies before their implementation so that modifications can be suggested to maximize positive effects and avoid unexpected negative repercussions on health. The first stage in this process is screening, which can be used to select the interventions that could benefit from complete health impact assessment. Since resources are limited and not all government interventions can be assessed, tools that allow prioritization are essential. As a first stage in the validation of a systematic screening tool for health impact assessment in Spain, this article presents the process of compiling and classifying the non-health public policies of the eighth term of office of the Basque Government. Of the 97 policies analyzed, 76% were related to structural determinants of health inequalities, 79% were tactical or operational, 67% were aimed at specific population groups, and 66% were already implemented. The technical staff of other participating departments perceived the entire process of this initiative and its rationale positively. This initial experience allowed the planning of non-health policies in the Basque Country to be determined in detail as a means to move forward in incorporating impact on health in all policies (AU)
Subject(s)
Humans , Impacts of Polution on Health/policies , /methods , 50207 , Mass Screening/organization & administration , Health Status Disparities , Social Impact Indicators , 24436ABSTRACT
Health not only depends on biologic or lifestyle factors but also on other economic, social, political, and environmental factors that shape the way people live and become ill. Thus, health policies are not the only policies affecting health, and consequently governments are increasingly interested in identifying the effect of other non-health policies on health. Health impact assessment is a prospective methodology that aims to predict the health impacts of policies before their implementation so that modifications can be suggested to maximize positive effects and avoid unexpected negative repercussions on health. The first stage in this process is screening, which can be used to select the interventions that could benefit from complete health impact assessment. Since resources are limited and not all government interventions can be assessed, tools that allow prioritization are essential. As a first stage in the validation of a systematic screening tool for health impact assessment in Spain, this article presents the process of compiling and classifying the non-health public policies of the eighth term of office of the Basque Government. Of the 97 policies analyzed, 76% were related to structural determinants of health inequalities, 79% were tactical or operational, 67% were aimed at specific population groups, and 66% were already implemented. The technical staff of other participating departments perceived the entire process of this initiative and its rationale positively. This initial experience allowed the planning of non-health policies in the Basque Country to be determined in detail as a means to move forward in incorporating impact on health in all policies.
Subject(s)
Government , Health Policy , Outcome Assessment, Health Care , Public Policy , Humans , SpainABSTRACT
La evaluación del impacto en la salud es una herramienta de carácter predictivo, de ayuda a la toma de decisiones. La experiencia acumulada muestra que podría desempeñar un papel primordial en el desarrollo de la estrategia de salud en todas las políticas. La evaluación del impacto en la salud ha sido ampliamente utilizada en otros países europeos, en diversos ámbitos sectoriales y administrativos. En la mayoría de los casos se ha introducido de forma no obligatoria e independiente de otros tipos de evaluación del impacto de las políticas sectoriales. Su uso en España es relativamente reciente, escaso, y principalmente limitado a experiencias en el ámbito local y al cribado de actuaciones de una comunidad autónoma. La reforma normativa y organizativa de la salud pública actualmente en curso en España es una gran oportunidad para impulsar el desarrollo de la evaluación del impacto en la salud. Entre las barreras para su desarrollo destacan el predominio de la visión biomédica de la salud entre los profesionales, los responsables políticos y la población general; la desafección política, la escasa cultura de participación ciudadana y de tradición evaluadora en la elaboración de políticas públicas; y el insuficiente desarrollo del trabajo intersectorial. Dado el potencial de la evaluación del impacto en la salud para avanzar en el logro de una mejor salud poblacional y en la reducción de las desigualdades sociales en salud, deberían dedicarse esfuerzos políticos, formativos y de investigación para que esta evaluación se introduzca y desarrolle en los distintos ámbitos administrativos y sectoriales (AU)
Health impact assessment is a predictive tool to support decisions in policy-making. Current experience shows that health impact assessment could play an important role in the development of the Health in All Policies strategy. This strategy has been extensively used in other European countries and in a wide range of policy and administrative sectors. Health impact assessment is hardly ever mandatory and is frequently carried out separately from other impact assessments. The use of this process in Spain is relatively new, limited and fundamentally based on local level experiences and the screening of regional interventions. The current normative and organizational reform of public health in Spain provides an excellent opportunity to promote the development of health impact assessment. Some of the barriers to the development of this process are related to the biomedical model of health prevailing among health professionals, politicians, and the general population, political disaffection, lack of assessment culture, underdevelopment of community participation processes, and insufficient intersectoral work. Health impact assessment provides an opportunity to move toward improving the populations health and reducing inequalities in health. Consequently, political commitment, as well as investment in education and research, is needed to introduce and develop health impact assessment in all administrative settings and policy sectors (AU)
Subject(s)
Humans , Health Status , Health Policy , Spain , Europe , Evaluation Studies as TopicABSTRACT
Health impact assessment is a predictive tool to support decisions in policy-making. Current experience shows that health impact assessment could play an important role in the development of the Health in All Policies strategy. This strategy has been extensively used in other European countries and in a wide range of policy and administrative sectors. Health impact assessment is hardly ever mandatory and is frequently carried out separately from other impact assessments. The use of this process in Spain is relatively new, limited and fundamentally based on local level experiences and the screening of regional interventions. The current normative and organizational reform of public health in Spain provides an excellent opportunity to promote the development of health impact assessment. Some of the barriers to the development of this process are related to the biomedical model of health prevailing among health professionals, politicians, and the general population, political disaffection, lack of assessment culture, underdevelopment of community participation processes, and insufficient intersectoral work. Health impact assessment provides an opportunity to move toward improving the population's health and reducing inequalities in health. Consequently, political commitment, as well as investment in education and research, is needed to introduce and develop health impact assessment in all administrative settings and policy sectors.
Subject(s)
Health Policy , Health Status , Europe , Evaluation Studies as Topic , Humans , SpainABSTRACT
Interventions implemented by governments are very frequently related to the determinants of health. Health impact assessment (HIA) is used as a predictive tool to include health in nonhealth policymaking. This paper defines HIA, describes its methods, procedures and applications, and discusses opportunities and challenges associated with HIA. Doing a HIA implies studying the intervention, profiling the target population, and estimating its impacts on health by means of combining quantitative and qualitative evidence. HIA has been used in different kinds of policies (transports, urban regeneration, culture, energy development etc.), at different levels (local, national, European) and in many countries. Despite its scarce use in Spain, HIA allows to consider health in sectorial policymaking, taking into account social inequalities in health, so that healthier public policies can be designed. On the other hand, HIA is a tool under methodological development which use is hindered due to the existing narrow biomedical perspective on the determinants of health, and to the difficulties in working in public policy-making with multisectorial and participative perspectives.
Subject(s)
Health Policy , Health , Public Health , Humans , SpainABSTRACT
Las intervenciones que se realizan desde las administraciones públicas, muy a menudo tienen que ver con los determinantes de la salud. La evaluación del impacto en la salud (EIS) se utiliza como una herramienta predictiva para incorporar la salud en las políticas públicas no sanitarias. En este trabajo se definen la EIS y sus métodos, procedimientos y aplicaciones, y se discuten las oportunidades y los retos que plantea. La realización de una EIS implica estudiar la intervención, caracterizar la población objeto de la intervención y, mediante la combinación de evidencias cuantitativas y cualitativas, estimar sus impactos potenciales sobre la salud. La EIS se ha ido extendiendo a múltiples sectores (transportes, regeneración urbana, cultura, desarrollo energético, etc.), en ámbitos diversos (local, nacional, europeo) y en numerosos países. A pesar de su escaso uso en España, la EIS permite incorporar la salud en la toma de decisiones de las políticas sectoriales, teniendo en cuenta las desigualdades sociales en salud, y desarrollar así políticas públicas más saludables y equitativas. Por otra parte, se trata de una herramienta en pleno desarrollo metodológico, cuya aplicación se ve dificultada por el predominio de la visión biomédica reduccionista de los determinantes de la salud, y por la dificultad de trabajar con enfoques multisectoriales y participativos en las actuaciones del ámbito público(AU)
Interventions implemented by governments are very frequently related to the determinants of health. Health impact assessment (HIA) is used as a predictive tool to include health in nonhealth policymaking. This paper defines HIA, describes its methods, procedures and applications, and discusses opportunities and challenges associated with HIA. Doing a HIA implies studying the intervention, profiling the target population, and estimating its impacts on health by means of combining quantitative and qualitative evidence. HIA has been used in different kinds of policies (transports, urban regeneration, culture, energy development etc.), at different levels (local, national, European) and in many countries. Despite its scarce use in Spain, HIA allows to consider health in sectorial policymaking, taking into account social inequalities in health, so that healthier public policies can be designed. On the other hand, HIA is a tool under methodological development which use is hindered due to the existing narrow biomedical perspective on the determinants of health, and to the difficulties in working in public policy-making with multisectorial and participative perspectives(AU)
