A guide to Quantitative Methods in Health Impact Assessment

Håkan Brodin, Stephen Hodge
Swedish National Institute of Public Health, (SNIPH) 2008

Available online at: http://www.fhi.se/PageFiles/4375/R200841_Health_Impact_200812.pdf?epslanguage=en

This report is a guidance for quantitative (or numerical) analysis of health impact assessments (HIAs), when such analysis is needed. It is intended to be a complement to other guidance, published by the Swedish National Institute of Public Health (SNIPH), and is based on accepted methods from health technology assessment (HTA).

This report reviews and defines a number of important concepts. It connects HIAs in their context to highlight not only health aspects but also related indicators and determinants.

The report reviews a number of problem areas that may lead to discussions.
Firstly, the discussion about ends and means is important to facilitate comparability between different parts of a HIA or between different HIAs in a wider context.
Also, discounting is the usual way of comparing costs and health consequences over time. In relation to the concept of discounting it is often necessary also to discuss the magnitude of the social discount rate.

One important aspect of HIAs is if the programme leads to gained or lost lives, for instance in road projects. This report reviews the technique usually applied when such effects need to be compared to other effects, for instance the gained or lost lives as a consequence of changes in the programme level of safety ambition. Another point of discussion related to gained or lost lives is health related quality of life and how this may be quantified in relation to other health effects.

Cost aspects are probably the most common factor in comparing alternative programmes from a quantitative perspective. This report points at important techniques to measure costs based on general economic principles, nationally as well as internationally. Examples of such principles are the concept of marginal cost and conventions to measure lost production.

Content:
Foreword
How to use this guide
Summary
Important terms used in this guide
Background
When are quantitative health impact assessments needed?
Who is this guide written for?
Determinants of Health
Problem areas
. Differentiating aims, objectives and means
. Comparing costs and effects over time
. Assigning a price on the loss of, or the saving of, a human life
. Assigning a price on ill-health
. What is the real HIA cost or HIA benefit of a programme?
. Managing many different benefits/effects in HIA.
. How should productivity losses be priced?
. How can an HIA be carried out if necessary data is not available?