Scientific Papers

A realist impact evaluation of a tool to strengthen equity in local government policy-making | International Journal for Equity in Health


Sample characteristics

We analysed 33 documents related to 18 EIAs. The majority (78%) of EIAs related to new policies, with the remaining focused on policies that were under review. EIAs included in the analysis related to policies from across the City, with the majority (55%) from the Healthy Communities and Environments directorate.

Forty employees participated in the survey (response rate of 68%). Participants held various roles in the EIA process, including workshop participant (44%), EIA Lead (27%), EIA Champion (15%) and ‘other’ roles including authorising manager and observer (14%). The majority had been involved in up to three EIAs (84%).

Seventeen staff members participated in one-on-one, semi-structured interviews (average duration 55 min). Participants held various positions within the City, including director/manager/co-ordinator (n = 5) and officer (n = 12) roles, representing all directorates, with the largest participation from the community health and wellbeing directorate (65%). All roles involved in the EIA process were represented in the sample (i.e., EIA Lead, EIA Champion, EIA workshop participant and authorising managers).

Impact of EIA tool and process on policies

Document analysis of completed EIAs indicated that 17 of the 18 EIAs recommended that action be taken to make the policy, program or service more equitable. All were approved by the authorising manager, nine had been fully implemented, one partially implemented and seven were in planning. The EIA that recommended ‘no changes’ be made related to an internal operational policy, which would not typically require an EIA (as it did not meet the criteria of ‘direct and significant public impact’). The decision to conduct the EIA was made by a senior manager who wanted the EIA to explore potential gender impacts of the current policy. Table 1 provides a summary of EIAs reviewed as part of the document analysis.

Table 1 Appraisal of equity impact assessment recommendations against the un women’s intersectionality framework for action

The EIA tool and process commonly produced recommendations that acted on individual-level factors (Table 1). In particular, recommendations that aimed at improving an individual’s ‘agency, commitment, knowledge and skills’ were most frequently observed. These included making information and consultations more accessible by catering to different levels of English language literacy, digital literacy, cultural background, geographic location and internet access, as well as developing resources, training and other support for marginalised or under-represented groups. Recommendations that aimed to improve ‘access and control of resources and opportunities’ included updating the community grant application form and process to identify who was applying and who was benefiting from the grant, in order to prioritise grants from and for under-represented or marginalised groups. Several survey and interview participants also observed that often EIA recommendations targeted individual-level factors, despite a range of structural barriers to equity being identified in EIA Workshops. Some interviewees described this as “picking the low-hanging fruit”, where recommendations are chosen because they are easier to implement, despite their potentially lower impact on inequities. This may relate to survey results that found only half of participants indicated that EIAs produced more equitable policies, despite the majority of participants (77%) indicating EIAs added value to policy development and review processes. (Fig. 1).

Fig. 1
figure 1

Impact of EIAs on policies, programs and services as perceived by local government stakeholders (n = 40)

Where recommendations acted at the organisation/society/systems levels, some were aimed at addressing ‘social norms and exclusionary practices’. These included updating terms of reference for panels or committees to promote diversity in representation, and developing processes to better engage under-represented groups in community consultations. Recommendations related to ‘policies, laws, resource allocations and accountability mechanisms’ included the development and incorporation of equity criteria into the overall criteria for an infrastructure plan that helped prioritise resource allocation to lower-socioeconomic, remote areas. We found that both individual and structural-level recommendations had potential for broader impacts across other policies. For example, several participants described how an EIA that recommended gender neutral, culturally-appropriate, dementia-friendly toilets on a discrete building project led to discussion to develop a broader equity-centric toilet strategy that could be used to inform all future building projects. Likewise, policy changes to prioritise under-represented groups flowed down to decision-making in related programs and services.

I can say hand on heart, it (the EIA on a building refurbishment plan) has changed outcomes at a programmatic level, at a project level and at a service delivery level

– Interview participant

Several interview participants expressed frustration that while the EIA process identified a range of opportunities to address inequities, the final recommendations only included one or two actions. Given EIAs are only conducted when policies are developed or reviewed (often every 3–4 years), it was suggested that EIAs should endeavour to recommend multiple actions, which could be implemented over time if necessary.

Whilst the tool was underpinned by an intersectionality lens, participants discussed how EIAs were more likely to examine gender and other forms of discrimination in silos, rather than taking an intersectional approach. Participants suggested this siloed approach was partly due to lack of current equity-competency across the organisation, with many staff hearing about intersectionality for the first time in their first EIA workshop.

“…it is tricky to keep all the different lenses front of mind during the workshop. It’s a lot to cover and so we start to talk about experiences/needs/issues in a siloed way because there’s so much to unpack in a short session”

– Survey participant

Two notable exceptions related to public space infrastructure plans where projects initially looked at the needs of women and/or gender diverse people, then explicitly considered those who were also from low socioeconomic areas, culturally diverse and/or living with a disability.

Impact of EIAs on organisational capacity

At an organisation-level, the majority of survey participants agreed that EIAs helped build an equity-focused culture (85%) and increased knowledge and skills about equity across the City (88%). Approximately three-quarters of participants reported that being involved in the EIA process improved their awareness, knowledge and confidence in addressing inequities in policies (Fig. 2). In contrast to training-only approaches to building equity capacity, interview participants described how EIAs provided the opportunity to ‘learn by doing’, noting that EIAs provided a unique opportunity for staff to learn about equity and intersectionality and challenge their own unconscious biases, in the context of their policy area.

“I love seeing the ‘a-ha’ moments for participants who engage in an EIA. I think the most powerful learning for many people is through their involvement in the EIA process. I realise the perception that these are ‘additional work’ is present – but the benefits over time, outweigh this resistance exponentially!”

– Survey participant

Fig. 2
figure 2

Impact of equity impact assessments on employee awareness, knowledge and confidence, as perceived by local government stakeholders (n = 40)

Notwithstanding, some staff (18–27% of survey participants) reported that the EIA process had no impact on their awareness, knowledge and confidence in addressing inequities. Interviews revealed potential reasons for this including some staff may have been resistant to the EIA process as they did not agree that an EIA was required, while others may have perceived that barriers and recommendations were “already on the radar”. Other staff believed that, even in the latter circumstance, EIAs still provided a benefit.

I was already aware (of the barriers) and was already planning to do it (the recommendation), but it is now better informed. We’re better informed to be able to do that well… when we are implementing that action, I feel more confident we’ll do a better job than we would have before the EIA.”

– Interview participant.

Survey data revealed that, on average, participants rated the extent to which the EIA process added too much to their existing workloads as 3.21 (SD = 1.07, min = 1 (strongly disagree), max = 5 (strongly agree)). During interviews, participants indicated that leading an EIA was a lot of work, although subsequent EIAs required less time. Participants highlighted the value of the EIA process in fostering cross-departmental collaboration and engagement with those that represent equity groups, such as the multicultural officer, disability and inclusion committee and relevant external stakeholders.

Factors that influenced the impact EIAs had on policies and organisational capacity

Four main themes described the key factors perceived to influence the impact of EIAs: (i) organisational commitment to conduct well-considered EIAs and implement meaningful equity-driven recommendations; (ii) organisational capacity for equity-driven policies; (iii) process-level factors related to the type and timing of EIAs and iv) implementation support, perceived to strengthen the first three themes (Fig. 3).

Fig. 3
figure 3

Factors perceived to influence the impact of Equity Impact Assessments (EIAs) on policies and organisational capacity

Organisational commitment to conduct well-considered EIAs and implement meaningful equity-driven recommendations

The first theme centred around the organisational commitment to conduct well-considered EIAs across the whole organisation and an explicit intent to identify and implement recommendations that will have a meaningful equity impact.

Mandated criteria and process

Both external and internal mandates were perceived to enable the uptake of the City’s EIA tool and process. As the City’s EIA tool is an adaptation of state-legislated Gender Impact Assessments (GIAs), there is clear criteria for determining when EIAs need to be conducted (i.e. on all policies, programs and services that have a significant and direct public impact). This external legislation was perceived as crucial for addressing the political vulnerabilities inherent in the organisation’s uptake of EIAs, particularly in policy areas not directly related to health. Participants also discussed the importance of two internal governance mechanisms. Firstly, an “Is an EIA required?” survey is completed and submitted to a centralised officer to ensure EIAs are conducted as required by legislation and the City’s internal policy. Additionally, the EIA process is integrated into approval systems for policies that require executive management endorsement, which meant that the City’s executive request evidence of an EIA (or justification for why it was not required) prior to approval.

Leadership support and involvement

Councillors and senior leaders at the City were perceived to possess strong, authentic equity values, and explicitly support EIAs and equity-driven policy-action. This was exemplified by actions such as the executive management team setting Key Performance Indicators (KPIs) for themselves to participate in EIAs, managers incorporating EIA updates in team meetings, and team leaders supporting EIA Leads with adequate time and resources to conduct well-considered EIAs. To further reinforce this leadership support for EIAs, some participants suggested introducing EIA participation KPIs for all levels of management. Furthermore, more explicit executive-level support and resources to implement recommendations that address both structural and individual-level barriers was considered important to generate EIAs that produce more equitable policy impacts.

“What we do and don’t fund represents what we do and don’t value, that’s just the reality.”

– Interview participant

Equity-passionate people

Participants highlighted the important role passionate staff, who embody strong equity and community values, played in supporting and advocating for EIAs to be done and done well. When these equity-passionate people were in an EIA Lead role, they were perceived to commit more time and effort to the process, especially in research and stakeholder engagement activities. They often volunteered to be EIA Champions or EIA Workshop participants, and if they were in a manager role, they were perceived to be more likely to support well-considered EIAs. Interview participants residing in the directorate responsible for community health and wellbeing reported that they generally felt well supported within their team, while some participants from other directorates discussed feeling isolated due to a lack of knowledge or support for equity and EIAs within their team.

Knowledge transfer and translation

Often interview participants (unless they were EIA Leads or Champions) reported being unaware of the final recommendations or potential outcomes of EIAs. It was suggested that centralised collation, reporting and celebration of learnings, outcomes and impacts produced by EIAs would mean those that had been involved in an EIA would be more likely to see value in the process, interest and commitment from those that had not yet been involved in an EIA may increase, and efficiencies could be gained by translating learnings between EIAs.

“I think we should have a register that talks about all the epiphanies that we’ve had as a result of these conversations …I would love to see that being captured so we can look at getting buy-in from those late adopters, but also celebrate.”

-Interview participant

Organisational capacity for equity-driven policies

The second theme centred around staff’s ability to identify relevant equity considerations and develop recommendations that are likely to strengthen equity in policies.

Equity knowledge

Participants discussed the benefit of staff possessing a foundational understanding of equity and intersectionality before engaging in their first EIA. Those with backgrounds in health, social work, or community development, those with a lived experience of inequities and those with prior EIA experience were perceived to add significant value to the EIA process. Conversely, for many participants, their initial exposure to equity-related concepts occurred during a brief introduction in the EIA workshops. Consequently, separate foundational equity training prior to an employee’s first EIA was commonly recommended.

“In some ways I think we’ve run before we could walk… the process is more sophisticated than most people’s knowledge and skill levels. We need to keep building people’s understanding of key concepts, why this process is important and the benefits it can bring.”

-Interview participant

Knowledge of policy levers

While participants generally agreed that addressing structural barriers was key for EIAs to have a meaningful impact, diverse perspectives on the extent of local government power to act on such barriers was observed. Some participants perceived that structural-level actions, such as social housing initiatives, were largely beyond the scope of local government. Others, however, perceived numerous avenues available to local governments, including advocating to higher government levels and non-government organizations, redistributing local government resources and opportunities, demonstrating leadership in inclusivity and equity-driven policies and practices. While a few participants perceived that existing regulations and codes (such as ‘universal design principles’, access and inclusion principles and building codes), already provided an equity lens for some local government policies, the majority discussed how EIAs complemented and advanced these regulatory and voluntary tools by providing an important person-centered, intersectional lens.

Fit of EIA with policy and process characteristics

The extent to which EIAs fit with the type of policies and timing of EIAs within the policy development or review process was perceived to have considerable influence on the impact of EIAs.

Type of policy

EIAs were sometimes perceived to be more effective for identifying barriers to health equity related to a specific program or projects, such as community programs and infrastructure projects, and less so for high-level strategies, such as a 30-year housing and infrastructure growth strategy. While acknowledging the advantages of a mandated equity tool, some participants advocated for greater autonomy and flexibility in how, and when, the EIA tool and process is applied and suggested that a different type of equity tool or approach may be more suitable for some policy types.

“I really think it works really well when you’ve got like a master plan for a park or like a discrete project, you can really tease it out. But for such a high level document, it was really quite a struggle to come up with something that we might focus on… so I suppose in a way, because it was so high level, I’m not sure how much value it added.”

– Interview participant

Timing of EIAs

Participants generally advocated for conducting EIAs as early as possible in the policy process, recognizing that some policies were too advanced for structural recommendations to be made, potentially resulting in individual-focused recommendations. Conversely, when policies and projects were not yet scoped, the absence of context and parameters were perceived to make it challenging to select a focus area or develop recommendations, potentially resulting in suboptimal outcomes. In these instances, flexibility in the timing of EIAs to optimize outcomes was suggested.

Implementation support

This cross-cutting theme relates to the critical role implementation support played in optimising the impact that the EIA process had on policy-action and on organisational capacity. Firstly, the EIA guide and toolkit that was developed specifically for the City was highly valued, and was perceived to provide clear steps and guiding questions to help staff through the process. Some participants recommended that the language could be further simplified to ensure it is accessible to everyone regardless of previous equity knowledge.

EIA Workshops were also valued for their ability to facilitate diverse input into the EIA process, especially when they could tap into the expertise of internal or external specialists (e.g. cultural diversity officer, disability and inclusion committee). Participants acknowledged the tension between EIA Workshops serving as a platform to gain valuable input from diverse, equity “specialists” and as a platform for building equity-related competency in staff. This was perceived to have important implications for who was invited to workshops, with participants generally indicating a balance between equity “specialists” and those with less knowledge and experience would be beneficial.

EIA Champions were perceived to be integral to supporting staff, especially early in their EIA journey. Some staff acknowledged further benefit when EIA Champions were from the same directorate or a similar team as EIA Lead and Workshop participants.

“I think having those EIA Champions across the org from different directorates is really positive because it is that trickle thing. And people are always going to respond to people in their own particular area… If someone in finance can see that someone else in finance is asking equity type questions then I just think it just makes it more relevant.”

-Interview participant

Participants suggested that for EIAs to have greater impact, EIA Leads could benefit from more assistance in accessing and utilising equity-centric data and information. Furthermore, ensuring a strong intersectional equity lens is applied to standard community engagement practices so under-represented voices are already present in community consultation data prior to the commencement of an EIA was suggested as one way to avoid EIAs producing lower-impact recommendations, such as a recommendation to conduct more equitable community consultation.



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