Top-Down Policy Risk Assessment

The primary aim of the Risk Assessment from Policy to Impact Dimension (RAPID) 2009–2012 EU project was to develop a methodological guidance for policy risk assessment. The main idea was that the systematic analysis of complex impact schemes requires the description of the “full chain” of causal pathways considering all levels of causality in an integrated manner. The analysis should proceed from the top to the bottom of the causal chain, i.e. from the cause, that is the policy, through health determinants and risk factors to the effect that are health outcomes. The top-down risk assessment approach follows a logical structure that can be readily applied in the risk appraisal phase of policy health impact assessments. Lessons learned from case studies were used in the RAPID project to achieve the goal of developing a methodological model, formulate recommendations, and finally to prepare a unified guidance on top-down full chain assessment of health risks of policies, that can be then pilot tested as applied for the assessment of an international policy. Project partners worked on separate case studies representing diverse topics. The work started with the selection and detailed description of a specific policy. Following this step, each partner identified and characterized the wider determinants of health influenced by the policy and risk factors linked to these determinants. As the final step, health outcomes related to the selected risk factors were assessed. The experiences of case studies allowed for making recommendations on various practical aspects, such as information need and feasibility, integration of quantitative and qualitative assessment elements in specified pathways, and characterization of uncertainty. This chapter presents short summaries of the case studies. They discuss different topics except the two studies on road safety. However, the policy context is essentially different even for them, as one assesses a new legislation but the other a completed program. The elaboration of the assessment, the understanding of the elements of the causal chain, as well as the use of quantitative methods shows high diversity among the studies. Nevertheless, all case studies provided opportunities to draw valuable conclusions that could be applied in the formulation of a unified guidance.