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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:
- Screening - determining if a HIA is warranted/required
- Scoping - determining which impacts will be considered and the plan for the HIA
- 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
- Decision-making and recommendations - making explicit the trade-offs to be made in decision-making and formulating evidence-informed recommendations
- 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 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 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.
There are two annual international conferences that focus on HIA-related issues. The first of these is the International Association for Impact Assessment conference , which was held in Stavanger in 2006 and will be held in Seoul in 2007. The second conference is the International HIA Conference  (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.
- Acheson, D (1998), Independent Inquiry into Inequalities in Health, London: Stationery Office.
- ECHP (1999), Health Impact Assessment: Main concepts and suggested approach (Gothenburg Consensus Paper), Brussels: European Centre for Health Policy.
- IMPACT (2004), European Policy Health Impact Assessment: A guide, Liverpool.
- Kemm, J (2003), "Perspectives on Health Impact Assessment", Bulletin of the World Health Organization, vol. 81, no. 2, p. 387.
- Taylor, L, Gorman, N & Quigley, R (2003), Evaluating Health Impact Assessment: Learning from practice bulletin, London: Health Development Agency.
- Taylor, L & Quigley, R (2002), Health Impact Assessment: A review of reviews, London: Health Development Agency.
This page uses Harvard referencing. References are sorted alphabetically by author surname.
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.
- Birley, M (2005), "Health Impact Assessment in Multinational Corporations: A case study of Shell", Environmental Impact Assessment Review, vol. 25, p. 702-713.
- Krieger, N, Northridge, M & Gruskin, S, et al. (2003), "Assessing Health Impact Assessment: Multidisciplinary and international perspectives", Journal of Epidemiology and Community Health, vol. 57, p. 659-662.
- Birley, M (2003), "Health Impact Assessment, integration and critical appraisal", Impact Assessment and Project Appraisal, vol. 21, p. 313-321
- Douglas, M, Conway, L & Gorman, D, et al. (2001), "Achieving Better Health Through Health Impact Assessment", Health Bulletin, vol. 59, no. 5, p. 300-305.
- Mittelmark, M (2001), "Promoting Social Responsibility for Health: Health impact assessment and healthy public policy at the community level", Health Promotion International, vol. 16, no. 3, p. 269-274.
- Scott-Samuel, A (1996), "Health Impact Assessment: An idea whose time has come (editorial)", British Medical Journal, vol. 313, p. 183-184.
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
- IHPI (2006), Health Impact Assessment Guidance, Dublin: Institute of Public Health in Ireland.
- PHAC (2005), A Guide to Health Impact Assessment: A policy tool for New Zeland (2nd ed.), Wellington: Public Health Advisory Committee.
- Mahoney, M, Simpson, S & Harris, E, et al. (2004), Equity Focused Health Impact Assessment Framework, Newcastle, Australia: Australasian Collaboration for Health Equity Impact Assessment.
- enHealth Council (2001), Health Impact Assessment Guidelines, Canberra: enHealth Council, National Public Health Partnership.
- Scott-Samuel, A, Birley, M & Ardern, K (2001), The Merseyside Guidelines for Health Impact Assessment (2nd ed.), Liverpool: International Health Impact Assessment Consortium (IMPACT).
- Birley, M, Gomes, M & Davy, A (1997), Health aspects of environmental assessment, Washington: Environmental Division, The World Bank
- Birley, M & Peralta, G (1992), Guidelines for the Health Impact Assessment of Development Projects, Manila: Asian Development Bank Environment Paper.
- Birley, M (1991), Guidelines for Forecasting the Vector-Borne Disease Implications of Water Resources Development, Geneva: World Health Organisation,WHO/CWS/91.1. PEEM Guidelines Series 2..
- IMPACT (2006), European Policy Health Impact Assessment (Web Edition), Liverpool.
- CHETRE (2003-2006), New South Wales Health Impact Assessment Project eNews, Sydney: Health Inequalities Program (CHETRE), Research Centre for Primary Health Care and Equity, University of New South Wales.
- Banken, R (2001), Strategies for Institutionalising HIA, Brussels: European Centre for Health Policy, WHO Europe.
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.
HIA Resource Websites
- HIA Community Wiki
- HIA Connect, includes HIA Blog
- HIA Gateway
- IMPACT - International Health Impact Assessment Consortium
- RIVM HIA Database
- World Health Organization HIA Site
Government HIA Websites
- Environmental Health Branch, New South Wales Health (Australia)
- European Centre for Health Policy (Belgium)
- HPP-HIA Program (Thailand)
- Institute for Public Health in Ireland (Ireland)
- San Francisco Department of Public Health (United States)
Private HIA Practitioner Websites
- Ben Cave Associates
- Birley HIA
- IMPACT - International Health Impact Assessment Consortium
- Peter Brett Associates
University HIA Websites
- Deakin University, HIA Unit (Melbourne, Australia)
- University of Birmingham, HIA Research Unit (Birmingham, UK)
- University of California at Berkeley, Health Impact Group, School of Public Health (Berkeley, USA)
- University of California Los Angeles, HIA Project (Los Angeles, USA)
- University of Liverpool, IMPACT - International Health Impact Assessment Consortium (World Health Organization Collaborating Centre for Health Impact Assessment), Division of Public Health (Liverpool, UK)
- University of New South Wales, HIA Connect, Health Inequalities, Health Impact Assessment and Healthy Public Policy Program (CHETRE), Research Centre for Primary Health Care and Equity, Faculty of Medicine (Sydney, Australia)
Other HIA Websites
This page uses Harvard referencing. External links are sorted alphabetically.
- Health promotion
- Jakarta Declaration
- Ottawa Charter for Health Promotion
- Health protection
- Population health
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