Please note that Dawn Morgan has now left the PHO. If you have any queries regarding Health Impact Assessment please contact Lorraine Oldridge on 01904 328221, email lo5@york.ac.uk.

HIA Health Impact Assessment

Frequently asked questions about Health Impact Assessment

What is it?
Why do it?
Who does it and when?
How are health impacts assessed?
Where can I find examples of good practice in the Yorkshire and Humber Region?
What support is currently available in the region?
Tell us about your HIA activity

HIA: What is it?

HIA definition: 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 a population” (WHO 1999, Gothenburg Consensus Paper).

HIA has a number of essential characteristics:

A focus on specific policy or project proposals
Comprehensive consideration of potential health impacts
A broad, population-based perspective focussing on multiple determinants and dimensions of health
A multidisciplinary systems-based analytical approach
A highly structured but flexible process (Cole and Fielding 2007).

HIA aims to maximize the positive health benefits and minimize potential adverse effects of a proposal identifying health gains and losses posed by the different options.

HIA: Why do it?

A set of key principles inform HIA practice:

Holistic approach to health - recognises that health is determined by a broad range of factors from all sectors of society - the wider determinants of health
Democracy – the HIA process emphasises the right of people to participate in the formulation of policies that affect their life, both directly and through elected decision makers.
Equity - emphasises the reduction of inequity that results from avoidable and unjust differences in health status between different peoples
Sustainable development – aiming to meet today's needs without compromising those of future generations
Scientific and robust practice – transparent, systematic and impartial processes are used, utilising the best available evidence from different scientific disciplines and methodologies (WHO 1999).

HIA: Who does it and when?

HIA is undertaken by a range of different practitioners in different sectors at different levels. It can be a lengthy process undertaken over a period of months - comprehensive HIA - or it can be a ‘desk top’ exercise carried out in as little as a day. Whilst best undertaken prospectively, on proposals that have not yet been implemented, HIA can be applied in the development stage (concurrent) and on those completed (retrospective) (Quigley et al 2005).

HIA: How are health impacts assessed?

HIA: A framework for determining health impacts

HIA is a broad concept with common elements providing a framework for common action (IHIA).

Steps in HIA

Screening:

Deciding whether an HIA is necessary/ health relevance of proposal. The use of screening tools or checklists is common Scoping: Clarifying questions to ask, deciding how to undertake the HIA/sets the boundaries of the HIA Appraisal: Identifying, collecting and considering the evidence (community profiling, stakeholder and key informant and research), of health impact for different options – can be rapid or in-depth Recommendations and reporting: For each option make recommendations which enhance positive impacts and minimise negative impacts. Report findings to decision makers

Evaluation:

Evaluate the quality of the HIA, highlighting learning. Attempts to assess extent to which the recommendations were adopted and actual impacts on health The HIA Framework takes account of the best available evidence from a variety of sources – community profile and research, incorporating the views and opinions of key stakeholders (those who are involved or affected by the proposal). HIA then, typically involves a high level of engagement seeking to balance these views and experience with quantitative and qualitative research information.

Guidance and tools:

A large number of guides providing information on how to undertake a HIA (or consider health in other forms of impact assessment) have been developed. These can be accessed via the HIA Gateway – Guides page (link here). Screening and other tools can also be accessed via the Gateway – Tools page (link here).

Other forms of impact assessment

Economic Impact Assessment: Explores the ways in which the economy will be affected by a policy, programme or project (WHO accessed Feb 08).

Environmental Impact Assessment:

An assessment of the impact of planned activity on the environment. In many countries there is a statutory requirement to undertake EIA under certain circumstances, prior to application for development consent (DH 2007).

Strategic Environmental Assessment:

Integrates environmental considerations into the preparation of plans and programmes and is a means of promoting sustainable development whilst ensuring high levels of protection for the environment (DH 2007).

Race Equality Impact Assessment:

The assessment by public bodies of the impact their policies or functions will have on different groups within the population to ensure they don’t discriminate, promoting equality of opportunity wherever possible (DH 2007, Quigley et al 2005).

Mental Well-being Impact Assessment:

The structured analysis of policy, programmes and projects might influence mental health and well-being (Coggins et al 2007)

Integrated Impact Assessment:

Assesses potential impacts of proposals previously assessed separately. It brings together components of environmental, health, social and other forms of impact assessment in an attempt to explore ways in which policy, programmes or projects may affect the physical, social and economic environment (WHO accessed Feb 08, Quigley et al 2005).

Where can examples of good practice in Yorkshire and Humber be found?

In 2003 the Centre for Regional Economic and Social Research (CRESR) at Sheffield Hallam University conducted a survey of HIA activity in the Yorkshire and Humber Region. Ninety six Local Authorities and health organisations were included and an effective response rate of over 60% was achieved. An initial questionnaire was followed up with semi-structured telephone interviews to obtain more detailed information.

The survey highlighted a number of examples of good practice as well as local initiatives to support HIA projects. The range of activity identified is detailed in the full report, ‘Health Impact Assessment in the Yorkshire and Humber Region’ The survey showed that: "HIA is do-able".

The body of knowledge and information available continues to grow providing examples of good practice and key learning points from HIA activity. The recently reviewed and updated HIA Gateway website has further examples of completed HIA projects in the Yorkshire and Humber Region and beyond.

What support is currently available in the Region?

YHPHO has been given the task of further supporting the development of HIA in the region. The Health Impact Assessment Development Manager, Dawn Morgan, working alongside regional partners will continue to progress this work. A 2008/09 work programme is proposed focusing on three key areas - supporting HIA (and other forms of impact assessment), capacity building and embedding HIA, providing:

Support and advise to practitioners
Working to Influence policy development and
Promoting best practice

Yorkshire and Humber Impact Assessment scoping exercise and network

A Yorkshire and Humber Impact Assessment scoping exercise aiming to identify ongoing/planned impact assessment activity, to develop a Directory of Practitioners/those with an interest in Impact Assessment in the Region and to build a repository of HIA Leaning by doing projects, will take place throughout 2008. This exercise will inform and be part of a Regional Impact Assessment Training Needs Analysis.

Tell us about your HIA project

If you have a completed project or are currently undertaking HIA and would like to inform us about it or if you require information or support with you impact assessment activity, please Click Here and send a brief email. We will get back to you very soon.

Email: dem501@york.ac.uk

Address: Yorkshire and Humber Public Health Observatory ARRC The University of York Heslington YORK YO10 5DD

Tel: 01904 724592

References: Cogins et al (2007). Mental Well-being Impact Assessment: A Toolkit “A Living and Working Document”. Cheshire, CSIP North West Development Centre

Cole, B. L. & Fielding, J. E. (2007). Health Impact Assessment: A Tool to Help Policy Makers Understand Health Beyond Health Care. Annu. Rev. Public Health 2007. 28:393-412

Department of Health (2007). Draft Guidance on Health in Strategic Environmental Assessment Consultation Document. London, DH Publications

Quigley et al (2005). Clarifying approaches to: Health Needs Assessment, Health Impact Assessment, Integrated Impact Assessment, Health Equity Audit and Race Equality Impact Assessment. London, Health Development Agency World Health Organisation, European Centre for Health Policy (1999). Gothenburg consensus paper. Health Impact Assessment Main concepts and suggested approach. Brussels, ECHP

World Health Organisation. http://www.who.int/hia/en/ accessed February 2008

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Updated 01/06/2008