Introduction

Health impact assessment (HIA) has really come of age and gone global. There are exciting developments occurring, at policy and project levels, in Africa, Asia, Australasia, Europe, Middles East, North America and South America. HIA has been undertaken in, at least, the following countries:

Africa
Egypt, Ghana, Kenya, South Africa

Asia
Bhutan, China, India, Japan, Nepal, Phillipines, South Korea, Taiwan, Thailand

Australasia
Australia, New Zealand

Europe
Belgium, Denmark, England, Finland, France, Germany, Ireland, the Netherlands, Norway, Portugal, Russia, Scotland, Spain, Sweden, Ukraine

Middle East
Israel, Lebanon, Saudi Arabia, United Arab Emirates

North America
Canada, United States of America

South America
Brazil, Chile, Columbia, Costa Rica, Ecuador, Mexico, Panama

So what is HIA?

HIA is the key systematic approach to identifying the differential health and wellbeing impacts of proposed plans and projects - within a democratic, equitable, sustainable and ethical use of evidence framework - so that positive health impacts are maximised and negative health impacts minimised (within a given population). It uses a range of structured and evaluated sources of qualitative and quantitative evidence that includes public and other stakeholders' perceptions and experiences as well as public health, epidemiological, toxicological and medical knowledge. It aims to influence policy and decision-making by providing a rigorous analysis of the potential impacts and options for enhancing positive impacts, mitigating negative ones and reducing any health inequalities that might arise from a proposed plan or project.

HIA in North America

HIA has really picked up momentum as the leading public health institution in the USA, the Center for Disease Control and Prevention (CDC) in Atlanta have taken HIA on board and begun to carry out pilot HIAs across the States. The Director of Public Health of Public Health in San Francisco is undertaking a major longitudinal, in HIA jargon comprehensive and prospective, HIA of the Eastern Neighborhoods Community. The Eastern Neighborhoods Community planning process will decide the mix of residential and commercial developments, the location of parks and other public amenities, and routes and means for travel in several San Francisco neighbourhoods. As the Mayor of San Francisco, Gavin Newson, put it: “The most livable cities are those guided by a planning process that integrates planning across city departments and throughout the city". And past experience tells us that where San Francisco leads, California tends to follows, and where California goes the rest of the US tends to go a few years down the line.

Canada has been in the vanguard of health impact assessment theory and practice with the Health Canada, the Canadian Ministry of Health, producing the four volume manual the Canadian Handbook of Health Impact Assessment in 1999. Of the Canadian Provinces, Quebec, British Columbia and Nova Scotia have been pioneers in the use and development of health impact assessment with two widely recognised models for carrying out HIA having been developed; British Columbia model of policy HIA and the PATH (People Assessing Their Health) Community HIA Tool. Canada’s HIA policy framework has focussed on environmental health assessment; the integration of health into environmental impact assessment.

HIA in Europe

There is an amazing diversity and richness in the development of theory and practice across Europe. Sweden alongside he UK have been the pioneers of HIA theory and practice closely followed by Germany, Finland and the Netherlands.

In the UK, the NHS Executive commissioned the three volume Resources for Health Impact Assessment and the then Health Development Agency, now merged into the National Institute of Clinical Excellence, was a pioneer in developing the first internationally authoritative website on HIA, the HIA Gateway. The UK has also developed a number of models of HIA practice. England has developed the globally recognised Merseyside Guidelines on HIA, the East London Health Action Zone Model of HIAand the now less used Kirklees Metropolitan Council HIA Model. In Wales, the Bro Taf health Authority developed the Bro Taf Health Inequalities Impact Assessment Screening and Appraisal Tool which has been incorporated into the new National Public Health Service for Wales. The Wales Centre for Health is the leading policy and practice institution in Wales and is promoting HIA in Wales through the work of WHIASU (the Wales HIA Support Unit). In Scotland the Public Health Institute of Scotland has carried a number of pilot HIAs and NHS Lothian, has been spearheading the use of HIA as a mainstream activity in its public health in the Lothian region. Scotland is also working on embedding a strong health element within Scottish guidance on strategic environmental assessment (SEA).

Sweden has developed the Swedish County Council’s Model of policy HIA and the Swedish Institute of Public Health has carried out a number of HIAs and recently produced HIA guidance with a focus on social and environmental sustainability and brings together the HIA work to date in Sweden. In Finland, through a governmental research institute STAKES has developed human impact assessment which aims to incorporate public perceptions of health risks into the health impact assessment process.

Germany has developed the Bielefeld Model of HIA and has developed a model for environmental health impact assessment. The Netherlands carried out the first prospective study on the health impacts of airport developments on Schipol Airport and their national Institute of Public Health has set up a HIA database for reports, evidence and research reports on HIA.

The New Member States, such as the Czech Republic, Slovak Republic and Poland are also embedding HIA both as part of EIA and SEA and as a separate process in its own right. There is also growing awareness of HIA in Switzerland and a number of HIAs are currently being undertaken there.

The European Commission is also investigating how EIA and SEA can be further enhanced to better incorporate human health issues at both policy and project levels across the European Union (EU). They have commissioned research investigating practice across the EU as well as on developing integrated methodologies for assessing health impacts of environmental factors.

HIA in Asia-Pacific

Australia and New Zealand have led the way in the Asia-Pacific Region with Thailand following closely behind.

In Australia almost every state is institutionalising HIA into its governmental structures, with a strong emphasis on integrating it into EIA. Tasmania has led the way being the first region in the world to have HIA made mandatory through legislation for certain developments. The Deakin University in Victoria and CHETRE (Centre for Health Equity Training, Research and Evaluation, University of South Wales) in New South Wales both have active programmes developing the theory and practice of HIA in Australia at policy and project levels. At national level Australia has developed an Equity-focused approach to HIA.

In New Zealand, project level HIA have been undertaken on project level HIAs since 1991but recent legislative and policy guidance, A Guide to HIA: a policy tool for New Zealand, through their Public Health Advisory Committee has accelerated the HIAs on policies as well as projects.

In Thailand, despite the tensions between economic growth and community welfare, as the country moves from a largely agrarian to an industrial nation, there has been strong national government momentum on ensuring the health and wellbeing of local communities and HIA was been embedded in their National Health Act 2002. There is continuing research on HIA theory and practice relevant to emerging economies and country in transition like Thailand.

More recently the Asian Development Bank undertook a large project to build capacity in the Mekong Region and further institutionalise HIA within the Bank.

HIA in the rest of the world

Health impact assessment, usually as environmental health impact assessment, has been championed for the last ten-twenty years, by both the World Bank and the World Health Organisation in recognition of the tremendous environmental and human suffering that has been generated by large scale capital projects funded by international donors in developing countries. There have been integrate environmental and health impact assessment on a range of projects from the Sarawak Dam in Malaysia, the use of cotton pesticides in Egypt, the treatment of waste water in Syria and the building of the Sakhalin oil refinery in Russia.

The future of HIA

Is HIA here to stay? Yes, absolutely! There is a discernable global movement to incorporate health into the sustainability agenda and into national and regional policies. There is also a push to integrate HIA into EIA, SEA and other forms of impact assessment as well as carry out separate HIAs. The 21st century will see the blossoming of public health, in a similar way to sustainability, to become an integrated part of policy and practice. At policy level, policies as diverse as land use, transport and defence to education, crime and social welfare will integrate the assessment of potential health impacts within their drafting processes and through SEA. Similarly, at project level, whether nuclear power stations and energy-from-waste facilities or housing and transport infrastructure projects all major projects will undergo some from of assessment of their potential health impacts whether as a separate HIA or as an integrated component within an EIA.

Will there be a convergence of theory and practice across the world? Probably, but the where that convergence lies is still not discernable. The big challenge for HIA is to develop a robust and broad theoretical foundation that takes on board theoretical developments and understandings from fields as diverse as risk perception, communication and management, sociology, environmental psychology, economics as well as epidemiology, toxicology and public health.

What’s so special about HIA compared to other forms of impact assessment?

Health impact assessment brings together the impact science, community engagement and an understanding of the factors that drive public perceptions of environmental health risks into a single coherent package thereby dealing with community concerns in a more open, credible and effective way. HIA brings a technical and a transformational element to policy and decision-making processes that have a significant impact on neighbourhoods and communities. The technical element provides the rigorous and science-based analysis and development of options. While the transformational element creates a process and arena where trust, communication and consensus-building are enhanced at the same time that concerns and conflicts are reduced.

Key steps in a HIA

Scoping

This stage sets the ‘terms of reference’ for the HIA i.e. what aspects will be considered, what areas and groups might need particular focus, what will be excluded from the HIA, how the HIA process will be managed and so on.

Baseline Assessment

This stage uses routine national and local datasets e.g. national census, local surveys, area profiles, and other demographic, social, economic, environmental and health information to develop a local community profile with a strong focus on health and wellbeing issues and vulnerable groups as a baseline from which to assess the potential positive and negative impacts.

Evidence Base

This stage involves the focused collation of relevant evidence on the potential positive and negative health impacts. This includes policy and lay knowledge as well as more formal research evidence.

Consultation and involvement

This stage uses workshops, questionnaires, interviews, surveys and other methods of consultation and involvement to engage key stakeholders, particularly local people, in the identification and appraisal of the potential or actual health and wellbeing impacts, the development of mitigation and enhancement measures; and options for monitoring and evaluating these identified impacts.

Analysis

This stage involves a systematic analysis of the potential impacts, their size; their significance, the groups likely to be most affected and the strength of the evidence for these impacts.

Mitigation and Enhancement Measures

This stage involves the identification of a range of measures to minimise the potential negative health effects and maximise the positive health benefits identified in the consultation and analysis.

Monitoring and Evaluation

This stage involves identifying monitoring and evaluation indicators and processes to ensure that health gains are maintained and any health inequalities reduced over the short and long terms.

Conclusions and Recommendations

This stage summarises the key conclusions, options and recommendations emerging from the assessment.

Useful links for further information

World Health Organisation – Health Impact Assessment
Very useful website bringing an international perspective to HIA policy and practice with some very useful resources on HIA.
http://www.who.int/hia/en 

Citation

Vohra, S. (2020) HIA: a global perspective. Available at: https://publichealthbydesign.squarespace.com/hia-a-global-perspective .