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Health Impact Assessment (HIA) is defined as "a combination of procedures, methods and tools by which a policy, program 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." (ECHP 1999, p. 4)


HIA is intended to produce a set of evidence-based recommendations to inform decision-making (Taylor & Quigley 2002, p. 2). HIA seeks to maximise the positive health impacts and minimise the negative health impacts of proposed policies, programs or projects.

The procedures of HIA are similar to those used in other forms of impact assessment, such as environmental impact assessment or social impact assessment. HIA is usually described as following the steps listed, though many practitioners break these into sub-steps or label them differently:

  1. Screening - determining if a HIA is warranted/required
  2. Scoping - determining which impacts will be considered and the plan for the HIA
  3. Identification and assessment of impacts - determining the magnitude, nature, extent and likelihood of potential health impacts, using a variety of different methods and types of information
  4. Decision-making and recommendations - making explicit the trade-offs to be made in decision-making and formulating evidence-informed recommendations
  5. Evaluation and monitoring (and follow-up) - process and impact evaluation of the HIA and the monitoring and management of health impacts

The main objective of HIA is to apply existing knowledge and evidence about health impacts, to specific social and community contexts, to develop evidence-based recommendations that inform decision-making in order to protect and improve community health and wellbeing. Therefore, usually because of financial and time constraints, HIA does not generally involve new research or the generation of original scientific knowledge. However, the findings of HIAs, especially where these have been monitored and evaluated over time, can be used to inform other HIAs in contexts that are similar to those of the original HIA. A HIA's recommendations may focus on both design and operational aspects of a proposal.

HIA has also been identified as a mechanism by which potential health inequalities can be identified and redressed prior to the implementation of proposed policy, program or project (Acheson 1998).

A number of manuals and guidelines for HIA's use have been developed (see Further Reading).

Determinants of health

The proposition that policies, programs and projects have the potential to change the determinants of health underpins HIA's use. Changes to health determinanats then leads to changes in health outcomes or the health status of individuals and communities. The determinants of health are largely environmental and social, so that there are many overlaps with environmental impact assessment and social impact assessment.

Levels of HIA

Three forms of HIA exist:

  • Desk-based HIA, which takes 2-6 weeks for one assessor to complete and provides a broad overview of potential health impacts;
  • Rapid HIA, which takes approximately 12 weeks for one assessor to complete and provides more detailed information on potential health impacts; and
  • Comprehensive HIA, which takes approximately 6 months for one assessor and provides a in-depth assessment of potential health impacts. (IMPACT 2004, p. 7)

It has been suggested that HIAs can be prospective (done before a proposal is implemented), concurrent (done while the proposal is being implemented) or retrospective (done after a proposal has been implemented) (Taylor, Gorman & Quigley 2003, p. 1). This remains controversial, however, with a number of HIA practitioners suggesting that concurrent HIA is better regarded as a monitoring activity and that retrospective HIA is more akin to evaluation with a health focus, rather than being assessment per se (Kemm 2003, p. 387). Prospective HIA is preferred as it allows the maximum practical opportunity to influence decision-making and subsequent health impacts.

HIA practitioners

HIA practitioners can be found in the private and public sectors, but are relatively few in number. There are no universally accepted competency frameworks or certification processes. It is suggested that a lead practitioner should have extensive education and training in a health related field, experience of participating in HIAs, and have attended an HIA training course. It has been suggested and widely accepted that merely having a medical degree should not be regarded as an indication of competency.

HIA worldwide

HIA is currently being used or developed around the world, most notably in Europe, North America, Canada, Australia, New Zealand and Thailand. The new safeguard policies and standards of the International Finance Corporation (IFC), part of the World Bank, were established in 2006. These contain a requirement for health impact assessment in large projects. The standards have been accepted by most of the leading lending banks, under the Equator Principles. Health impact assessments are becoming routine in many large development projects in both public and private sectors of developing countries. For example, guidelines are available in the Oil and Gas sector. There is also a long history of health impact assessment in the water resource development sector -- large dams and irrigation systems.

HIA conferences

There are two annual international conferences that focus on HIA-related issues. The first of these is the International Association for Impact Assessment conference [1], which was held in Stavanger in 2006 and will be held in Seoul in 2007. The second conference is the International HIA Conference [2] (previously known as the United Kingdom and Ireland HIA Conference), which was held in Cardiff, Wales in 2006 and will be held in Ireland in 2007.

A South East Asian and Oceania Regional HIA Conference [3] is being held in Sydney, Australia in November 2007.


This page uses Harvard referencing. References are sorted alphabetically by author surname.

Further reading

Books and Edited Book Chapters

  • Ståhl, T, Wismar, M & Ollila, E, et al. (2006), Health in All Policies: Prospects and potentials, Helsinki: Finnish Ministry of Social Affairs and Health, ISBN 9520019642. Includes several chapters on HIA.
  • Kemm, J, Parry, J & Palmer, S (2004), Health Impact Assessment: Concepts, theory, techniques and applications, Oxford: Oxford University Press, ISBN 0198526296.
  • Birley, M (1995), The Health Impact Assessment of Development Projects, London: Her Majesty's Stationery Office.

Journal Articles

Journal Special Issues

  • New South Wales Department of Health (2005), "HIA Special Issue", NSW Public Health Bulletin, vol. 16, no. 7-8.
  • World Health Organization (2003), "HIA Special Issue", Bulletin of the World Health Organization, vol. 81, no. 6.

Manuals and Guidelines

Online Guides

Other Publications


This page uses Harvard referencing. Further reading categories are sorted alphabetically; citations are sorted by year (newest to oldest), then alphabetically by author surname within years. If citations are included in the references section they are not listed in the further reading section.

External links

HIA Resource Websites

Government HIA Websites

Private HIA Practitioner Websites

University HIA Websites

Professional Associations

Other HIA Websites

This page uses Harvard referencing. External links are sorted alphabetically.

See also


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