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)
Screening - determining if an 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, 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. Because of financial and time constraints, HIAs do 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. An 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).
The proposition that policies, programs and projects have the potential to change the determinants of health underpins HIA's use. Changes to health determinants 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.
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 or health degree should not be regarded as an indication of competency.
The 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 who are parties to the Equator Principles. Health impact assessments are becoming routine in many large development projects in both public and private sectors of developing countries. There is also a long history of health impact assessment in the water resource development sector - large dams and irrigation systems.
Of the regional development banks, the Asian Development Bank has the longest and most consistent history of engaging with HIA. This engagement dates back to 1992, when it produced its first HIA Guidelines (ADB, 1992); this focused on the state of the art of methods and procedures at this early stage in the development of HIA. A second guidance document, a primer on health impacts of Development Project was published ten years later (Peralta and Hunt, 2003), with a focus on health risks and opportunities in development from sector-specific perspectives.
Between 2015 and 2018, the Governments of Australia and the UK funded the Regional Malaria and Other Communicable Disease Threats Trust Fund (RMTF) which supported multi-country, cross-border and multisector responses to urgent malaria and other communicable disease issues, focused on the countries of the Greater Mekong Subregion (GMS). Under the domain of promotion and prevention mainly HIA capacity development was addressed. This resulted in a new publication: Health Impact Assessment: A Good Practice Source Book (2018).
Winkler, M; Furu, P; Viliani, F; Cave, B (2020), "Current Global Health Impact Assessment Practice", International Journal of Environmental Research and Public Health, 17 (9): 2988, doi:10.3390/ijerph17092988, PMC7246701, PMID32344882.
This page uses Harvard referencing. References are sorted alphabetically by author surname.
ADB (1992). Guidelines for the Health Impact Assessment of Development Projects. ADB Environment Paper no. 11. Manila, Asian Development Bank.
Birley, M (1995), The Health Impact Assessment of Development Projects, London: Her Majesty's Stationery Office.
Birley, M (2011), Health Impact Assessment: principles and practice, London: Earthscan.
Kemm, J (2013), Health Impact Assessment: Past Achievement, Current Understanding, and Future Progress, Oxford: Oxford University Press, ISBN978-0-19-965601-1.
Kemm, J; Parry, J; Palmer, S (2004), Health Impact Assessment: Concepts, theory, techniques and applications, Oxford: Oxford University Press, ISBN978-0-19-852629-2.
Peralta, G.M., and Hunt, J.M. (2003). A Primer of Health Impacts of Development Programs. Manila, Asian Development Bank.
Bhatia, Rajiv; Wernham, Aaron (2008), "Integrating human health into environmental impact assessment: An unrealized opportunity for environmental health and justice", Environmental Health Perspectives, 116 (8): 991–1000, doi:10.1289/ehp.11132, PMC2516559, PMID18709140.
Harris-Roxas, Ben; Harris, Elizabeth (2010), "Differing Forms, Differing Purposes: A Typology of Health Impact Assessment", Environmental Impact Assessment Review, 31 (4): 396–403, doi:10.1016/j.eiar.2010.03.003.
Haigh, F; Harris, E; Harris-Roxas, B; Baum, F (2015), "What makes health impact assessments successful? Factors contributing to effectiveness in Australia and New Zealand Health policies, systems and management in high-income countries", BMC Public Health, 15: 1009, doi:10.1186/s12889-015-2319-8, PMC4592749, PMID26433492.
New Zealand Ministry of Social Development (2006), "HIA in New Zealand Special Issue", Social Policy Journal of New Zealand (29), archived from the original on 2007-10-24, retrieved 2007-09-26.
New South Wales Department of Health (2005), "HIA Special Issue", NSW Public Health Bulletin, 16 (7–8).
World Health Organization (2003), "HIA Special Issue", Bulletin of the World Health Organization, 81 (6), archived from the original on June 27, 2003.
Abrahams, D; Pennington, A; Scott-Samuel, A; Doyle, C; Metcalfe, O; den Broeder, Lea; Haigh, F; Mekel, O; Fehr, R (2004), European Policy HIA A Guide(PDF), Liverpool: International Health Impact Assessment Consortium (IMPACT) University of Liverpool, archived from the original(PDF) on 2009-12-11, retrieved 2010-09-30.
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 Organization, WHO/CWS/91.1. PEEM Guidelines Series 2..
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.
