Health impact assessment

Health impact assessment (HIA) is a combination of methods whose aim is to assess the health consequences to a population of a policy, project, or programme that does not necessarily have health as its primary objective. It has emerged to identify those activities and policies likely to have major impacts on the health of a population. Health impact assessment is a means of evidence based policy making for improvement in health.

What is HIA?
Health Impact Assessment:
Assesses plans, project, program or policies before they are implemented. Predicts the health impacts of these proposals, including: > assessing the severity and likelihood of the identified
positive and negative impacts; > determining whether these are direct or indirect impacts, and > assessing the distribution of impacts.

Recommends mitigation measures:

> to maximise positive health impacts and minimise negative health impacts; and > engage decision makers so that they consider health impacts and the determinants of health in their deliberations

 HIA is both a health protection and health promotion tool. In HIA, health should be broadly defined to include assessments of both health hazards and health benefits of a proposal and the potential ways in which health and wellbeing can be both protected and promoted

 Potential determinants of health considered in an HIA process

Biological factorsfor example, age, sex, genetics Pre conceptual and in-utero exposurefor example, maternal nutrition and health during pregnancy Personal behaviour and lifestylefor example, diet, smoking, alcohol, exercise, risk taking Psychosocial environmentfor example, family structure, community networks, culture, social exclusion Physical environmentfor example, air, water, housing, transport, noise, waste disposal Socioeconomicsfor example, employment, education Public servicesfor example, quality of, and access to, childcare, transport, shops, education, leisure, health, and social services Public policyfor example, economic, welfare, crime, transport, and health policies

HIA functions
Predicting the consequences of different project- related options Providing information required to help prioritize prevention and control strategies throughout the project cycle Serving as a vehicle to engage companies and key stakeholders in a collaborative decision-making process Identifying the most critical environmental and social determinants of health that may be affected by the project Addressing health issues that may influence overall sustainability objectives

What are Health Impacts?

Health impacts are the overall effects, direct or indirect, of a policy, plan, program or project on the health of a population. These may include both: direct effects on the health of the population, for example
exposure to pollutants (including noise) that a proposal may release in the air, water and soil; indirect effects through a proposals influence on the determinants of the health, for example the affects a proposal might have on the local job market, access to local shops and amenities and the availability of public spaces.

Why undertake HIA?

HIA is a structured, solution-focused and actionoriented approach to maximising the positive and minimising the negative health impacts of new initiatives .There are five reasons that are generally given for why HIA helps to improve planning and policy development: 1. To identify hazards to health from the proposal being developed. 2. To reduce or eliminate the potential risks to health arising from these hazards and to undertake risk communication on the remaining risks as part of this process

 3. To identify, and where feasible strengthen, the ways in which the proposed development can promote and enhance health. 4. To identify and address underlying social, environmental and economic impacts of the development that will have both direct and indirect impacts on health. 5. To reduce or eliminate health inequities occurring as a result of the proposal

When should you conduct a Health Impact Assessment?

If possible, HIAs should be conducted before the proposed project or policy is fully planned or implemented, so that it can take advantage of the information the HIA provides.

Who should be involved in conducting a Health Impact Assessment?

HIAs should involve representatives of all stakeholders. These include: Those who are directly affected by the proposed actions or policies. Those who are involved in carrying out the proposed actions or policies. Nonprofit and non-governmental organizations (NGOs) concerned with the issues and/or the populations affected. Advocacy groups.

 The decision-makers themselves.

Government agencies that have responsibility for the issues and/or populations in question. Representatives of other sectors that are affected by the proposal.

Health workers at local, national or international levels.

Employers and unions.

The commissioner(s) of the HIA those who set it in motion (and pay for it, in many cases.)
Those who actually conduct the HIA.

Conducting an HIA
HIA consists of five stages:

1. Screening
2. Scoping 3. Assessment 4. Reporting and recommendations 5. Evaluation & monitoring

Steps in HIA
1. Screening is the examination of the project or policy to see if an HIA is needed.
2. Scoping is actually the planning of the HIA identifying ways in which the decision could affect health, the people who might be affected, how impacts should be assessed, whose expert opinion you need to get the full picture, what resources are needed to conduct the HIA, what kinds of evidence should be gathered, etc.. A general guideline for developing a plan might take these steps:
Using logic, prior knowledge, and the concerns of the community, make an educated guess about the possible health impacts of the proposed project or policy. Determine the sectors, populations, groups, and individuals that need to be consulted and/or drawn into the process. Assemble a team from among them, representing all stakeholders, to plan and do the groundwork for the HIA. Become familiar with the current state of the project or policy, possible alternatives to current options, and the decisions that can and/or must be made. Assign responsibilities for all parts of the HIA.

Steps in HIA
3. Perform the actual assessment.
a. Review existing evidence. b. Familiarize yourself with the proposed project or policy. c. Learn what the range of options is. d. Conduct individual and group interviews, hold meetings, administer surveys, etc., to gather other evidence and obtain community input. e. Gather or compile statistics and other evidence currently unavailable which is necessary for a full picture of the situation. f. Gather information available from the various agencies, NGOs, think tanks, businesses, institutions, and other groups whose responsibilities or concerns are directly or indirectly relevant to the HIA or the issue, sector, geographic area, or population potentially affected. g. Assess the impacts of the proposed project or policy on the health of populations affected. h. Determine the impacts that come with different options.

Steps in HIA
Compose and deliver an understandable two-part report to all stakeholders and the public, describing the HIA process and conclusions, and making recommendations for maximizing the positive health impacts and minimizing the negative health impacts of the project or policy.

5. Evaluate the HIAs effectiveness. Evaluation and monitoring:

whether the HIA has influenced the decision making process (and the subsequent proposal);

monitoring the implementation of the proposal to ensure that any recommendations that decision-makers agreed to, actually occur;
longer term monitoring of the health of populations is sometimes a component of larger proposals

Continue to use the HIA conclusions and recommendations to guide the implementation of the project or policy, making adjustments and revisions as necessary to reflect changing conditions or new information.