Health Impact Assessment
See also Health Risk Assessment and Centre for HIA
Purpose of HIA
The way we perceive and interact with the physical environment – built and natural – has a significant impact on individual and community wellbeing.
It does so by providing a systematic analysis of the potential community health impacts as well as developing options for maximising the positive health impacts, minimising the negative impacts and enhancing health equity/reducing health inequalities.1
HIA is about both protecting health, by reducing exposures to harmful agents, as well as improving health by capitalising on opportunities to promote and enhance health and wellbeing.
HIAs are generally done when a policy, plan, programme or project is in development and before they are implemented as this is the best time to easily, quickly and cost-effectively modify them.
Nationally and internationally assessing the health impacts of new plans and projects is seen as good practice.
Key benefits of HIA include:
- It supports the plan and decision-making process by providing timely, relevant and credible public health information and analysis.
- It improves plan and project design, development, delivery and implementation.
- It increases community support and reducing community concerns.
- It reduces costs and liabilities further down the plan and project cycle.
- It enhances reputation and supports corporate responsibility.
- It provides cost-effective and value added analysis that improves the success of a plan or project.
- IOM CHIA has extensive experience and expertise in HIA research, consulting, teaching, method development and application.
Definition of HIA
The Gothenburg Consensus definition of HIA is
A combination of procedures, methods and tools by which a policy, programme or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population. 2
The International Association for Impact Assessment has recently updated this definition and states that HIA is:
A combination of procedures, methods and tools that systematically judges the potential, sometimes unintended, effects of a policy, plan, programme or project on the health of a population, including the distribution of those effects within the population, and identifies appropriate actions to manage those effects. 3
Historical roots of HIA
HIA has its roots in firstly, the Healthy Public Policy movement of the 1970’s and 1980’s which recognised that non-health policies, e.g. housing, transport, welfare, are as important, if not more important, than health care policy as determinants of public health; secondly, the Environmental Impact Assessment movement from the 1950s onwards and its perceived deficiencies in assessing the wider public health impacts of new projects particularly infrastructure projects in the developing world; thirdly, the sociology of health; and fourthly, epidemiology and quantitative health risk assessment.
HIA is currently an important strand in the Health in All Policies and Healthy Urban Planning movements.
Principles that underpin HIA
HIA draws on an explicit value framework that promotes:
- A transparent HIA and decision-making process that involves and informs affected communities (Democratic/Participatory).
- A focus on unequal impacts especially on those individual and groups who are already vulnerable because of their personal, social, economic and environmental circumstances (Health Equity/Inequalities).
- The equal consideration of the health needs of future generations, and the long term costs, alongside the needs of current generations and short term benefits (Sustainable Development).
- The transparent use of qualitative and quantitative evidence that is credible, robust, balanced and based on a range of disciplines (Ethical Use of Evidence).
Types of HIA
HIA is a flexible approach that can be adapted to a wide variety of project types, budgets and timeframes. The types of HIA described below differ primarily in scale and level of detail though the principles and process remain similar.
Rapid HIAs are desk-based analyses that take hours, days or weeks to carry out.
In-depth Intermediate HIAs are more detailed analyses that involve some on-the-ground fieldwork to assess the baseline conditions of local communities; some focused stakeholder involvement, e.g. stakeholder focus group workshops and interviews; and generally conduct a relatively systematic rapid literature review. They generally take weeks or months to carry out.
In-depth Comprehensive HIAs are very detailed analyses involving detailed and comprehensive on-the-ground fieldwork; wide-ranging, and often representative, consultation of stakeholders through surveys, workshops and interviews; and a detailed systematic literature review. They generally take months or up to a year to carry out.
Integrating HIA with other Impact Assessments
Increasingly HIA is either done in conjunction with or being integrated into other forms of impact assessment at both policy/plan and project/programme levels including Environmental Impact Assessment, Social Impact Assessment (SIA), Strategic Environmental Assessment (SEA), Sustainability Appraisal (SA), Equalities Impact Assessment, Regulatory Impact Assessment and other policy appraisals. This is increasingly being badged as Integrated Impact Assessment or Integrated Policy Appraisal.
HIAs integrated with EIA and SIA are termed Environmental, Social and Health Impact Assessment.
HIA and Healthy Urban Planning
Healthy urban planning and design is an approach to planning that puts people - individuals, families and communities – and their health and wellbeing at the heart of the planning and regeneration process. The physical environment, which is shaped by planning decisions, affects health and wellbeing through enabling people’s ability to walk, cycle and enjoy the outdoors; by encouraging social interactions between neighbours and other local people; by providing good quality housing; and access to jobs, shops, services and public transport.
Health Impact Assessment (HIA) is a useful approach to analysing the potential impacts of masterplan designs. Masterplans are the set of documents, particularly design drawings, that are developed to show how the physical environment of an area is going to be transformed from one set of existing buildings and land uses to another similar, or different, set of buildings and land uses.