NewPublicHealth Q&A: Alain Poirier, MD
Quebec will be the host city of the 12th HIA International Conference this week, the first time the meeting will be held in North America.
Quebec is a strong choice as host city. In 2001, the province of Quebec institutionalized health impact assessments (HIAs) by requiring that all laws and by-laws that could have an effect on health be evaluated for their impact. To help develop effective strategy, internal procedures were created at the Ministry of Health and Social Services to respond to requests, as well as HIA guidelines, a research program, and communication tools to help disseminate the HIA outcomes. Over 500 requests for advice have been generated since the requirement was put in place.
NewPublicHealth recently spoke with Alain Poirier, MD, chairman of the HIA meeting’s local organizing committee and the former National Public Health Director and Assistant Deputy Minister in Quebec’s Ministry of Health and Social Services.
NewPublicHealth: How did the 2001 law come about?
Dr. Poirier: The Health Minister at the time had been an official with the World Health Organization and so was well acquainted with the work being done in some European countries on evaluation the impact of laws on health. Our Public Health Act said the health minister “shall” be consulted, not “should” be consulted on any measures resulting from a new law or by-law that could have an impact on health.
And just saying that is not enough. I was made the person in charge in the Ministry of Health and Social Services of taking responsibility for the evaluations with the help of different groups, including academia. We also have a public health institute, the Institute National de Santé Publique du Quebec, which also has a mandate to help evaluate public policies and counsel the health minister about the impact of public policy.
We’ve had a lot of demand to evaluate new proposals, in part because every five years all the ministers in Quebec are required to issue a report on strategic planning. So when we screen the strategic planning we could foresee in advance what is going to be worked on in other ministries.
NPH: What is an example in Quebec of an HIA that was done that has resulted in a change in policy?
Dr. Poirier: The government considered ending the lottery and switching to online poker instead. While the Ministry of Health and Social Affairs issued a recommendation against that, out of concern that it would increase gambling addiction. The online poker was allowed, though because of our concern there is an expert group that will be looking at the online poker games and if, depending on their evaluation, there is a recognition of dependency or addictiveness to the game, it may be modified or even eliminated. An analysis of some of the projects submitted to the Ministry for consultation shows that the advice and recommendations of the Ministry seem to be taken into account in 80 percent of the projects adopted between 2002 and 2007.
NPH: How has your influence changed policies when it comes to health matters?
Dr. Poirier: I think we’ve had the opportunity for a real “health in all policies approach.” More and more we work on strategy, on plans on different projects, so it’s not restricted to laws and by-laws. And it builds on the fact that prior to the Act we had a lot of strategies well known to emphasize health promotion and prevention rather than just treatment services. It’s part of a bigger process. We’ll be releasing research at the conference to show how well it has worked, which will include recommendations for improving health impact assessments. My experience is that in the last few years, gradually, we’ve been involved more often during the preparation of policies.
NPH: What do you think will be different about the conference this year?
Dr. Poirier: One thing for sure is that the level of interest from Canadians and Americans will be greater. There have also been two other important meetings on health impact assessments this year that we have attended because we wanted to be complementary at our meeting, including the inaugural National Health Impact Assessment meeting in Washington, D.C. We wanted to be sure our meeting was, in some ways, a follow-up to these meetings.
A critical goal we want to share is that we want to be health promoters at the beginning, rather than health protectors at the end of the process. Health in all policies is more about being involved in advance. We have to have a long-term vision. Instead of reacting, we want to be acting in advance to influence the policies in the right direction.