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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)

Overview

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 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).

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 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.

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

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 International Association for Impact Assessment has an active health section.

A HIA People Directory can be found on the HIA GATEWAY.

HIA worldwide

HIA used around the world, most notably in Europe, North America, Australia, New Zealand, Africa and Thailand (Winkler et al. 2020).

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).

References

Acheson, D (1998), Independent Inquiry into Inequalities in Health, London: Stationery Office.
ADB (2018), Health Impact Assessment: A Good Practice Sourcebook, Manila, Asian Development Bank. https://www.adb.org/documents/health-impact-assessment-sourcebook
ECHP (1999), Health Impact Assessment: Main concepts and suggested approach (Gothenburg Consensus Paper) (PDF), Brussels: European Centre for Health Policy, archived from the original (PDF) on 2006-10-07, retrieved 2006-06-23.
IMPACT (2004), European Policy Health Impact Assessment: A guide (PDF), Liverpool, archived from the original (PDF) on 2006-09-03, retrieved 2006-07-02{{citation}}: CS1 maint: location missing publisher (link).
Kemm, J (2003), "Perspectives on Health Impact Assessment" (PDF), Bulletin of the World Health Organization, 81 (2): 387, PMC 2572477, PMID 12894317.
Taylor, L; Gorman, N; Quigley, R (2003), Evaluating Health Impact Assessment: Learning from practice bulletin (PDF), London: Health Development Agency, archived from the original (PDF) on 2007-07-30, retrieved 2006-07-02.
Taylor, L; Quigley, R (2002), Health Impact Assessment: A review of reviews, London: Health Development Agency, archived from the original on 2007-05-02, retrieved 2006-06-30.
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, PMC 7246701, PMID 32344882.

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, ISBN 978-0-19-965601-1.
Kemm, J; Parry, J; Palmer, S (2004), Health Impact Assessment: Concepts, theory, techniques and applications, Oxford: Oxford University Press, ISBN 978-0-19-852629-2.
Peralta, G.M., and Hunt, J.M. (2003). A Primer of Health Impacts of Development Programs. Manila, Asian Development Bank.
Ross, C; Orenstein, M; Botchwey, N (2014), "Health Impact Assessment in the United States", Impact Assessment and Project Appraisal, 33 (3), New York: Springer: 233, Bibcode:2015IAPA...33..233V, doi:10.1080/14615517.2015.1020101, S2CID 130501272.
Ståhl, T; Wismar, M; Ollila, E; Lahtinen, E; Leppo, K (2006), Health in All Policies: Prospects and potentials (PDF), Helsinki: Finnish Ministry of Social Affairs and Health, ISBN 978-952-00-1964-8, archived from the original (PDF) on 2006-10-04, retrieved 2006-09-20. Includes several chapters on HIA.

Journal articles

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, PMC 2516559, PMID 18709140.
Birley, Martin (2003), "Health Impact Assessment, integration and critical appraisal", Impact Assessment and Project Appraisal, 21 (4): 313–321, Bibcode:2003IAPA...21..313B, doi:10.3152/147154603781766158, S2CID 140546560
Dannenberg, AL; Bhatia, R; Cole, BL; Heaton, SK; Feldman, JD; Rutt, CD (2008), "Use of Health Impact Assessment in the US: 27 Case Studies, 1999-2007" (PDF), American Journal of Preventive Medicine, 34 (3): 241–256, doi:10.1016/j.amepre.2007.11.015, PMID 18312813.
Douglas, MJ; Conway, L; Gorman, D; Gavin, S; Hanlon, P (2001), "Achieving Better Health Through Health Impact Assessment", Health Bulletin, 59 (5): 300–305, PMID 12664743.
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, PMC 4592749, PMID 26433492.
Harris-Roxas, BF; Harris, PJ (2007), "Learning by Doing: The value of case studies of health impact assessment", NSW Public Health Bulletin, 18 (9–10): 161–163, doi:10.1071/NB07110, PMID 17949583
Krieger, N; Northridge, M; Gruskin, S; Quinn, M; Kriebel, D; Davey Smith, G; Bassett, M; Rehkopf, DH; et al. (2003), "Assessing Health Impact Assessment: Multidisciplinary and international perspectives", Journal of Epidemiology and Community Health, 57 (9): 659–662, doi:10.1136/jech.57.9.659, PMC 1732566, PMID 12933768.
Scott-Samuel, A (1996), "Health Impact Assessment: An idea whose time has come (editorial)", British Medical Journal, 313 (7051): 183–184, doi:10.1136/bmj.313.7051.183, PMC 2351622, PMID 8696181.

Journal special issues

IJERPH (2020), "Special Issue - Health Impact Assessment", International Journal of Environmental Research and Public Health.
IUHPE (2017), "Special Issue on Health Impact Assessment", Global Health Promotion, 17 (2).
New South Wales Department of Health (2007), "HIA in Urban Settings Special Issue", NSW Public Health Bulletin, 18 (9–10).
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.

Manuals and guidelines

ICCM (2010), Good Practice Guidance on Health Impact Assessment, London: International Council on Mining and Metals.
Harris, P; Harris-Roxas, B; Harris, E; Kemp, L (2007), Health Impact Assessment: A practical guide (PDF), Sydney: UNSW and NSW Health, archived from the original (PDF) on 2009-10-30.
IHPI (2006), Health Impact Assessment Guidance, Dublin: Institute of Public Health in Ireland, archived from the original on 2007-06-17, retrieved 2006-06-23.
PHAC (2005), A Guide to Health Impact Assessment: A policy tool for New Zealand (PDF) (2nd ed.), Wellington: Public Health Advisory Committee, archived from the original (PDF) on 2006-07-22, retrieved 2006-06-23.
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.
Mahoney, M; Simpson, S; Harris, E; Aldrich, R; Stewart Williams, J (2004), Equity Focused Health Impact Assessment Framework (PDF), Newcastle, Australia: Australasian Collaboration for Health Equity Impact Assessment, archived from the original (PDF) on 2007-09-28, retrieved 2006-11-19.
enHealth Council (2001), Health Impact Assessment Guidelines (PDF), Canberra: enHealth Council, National Public Health Partnership, archived from the original (PDF) on 2009-10-13.
Scott-Samuel, A; Birley, M; Ardern, K (2001), The Merseyside Guidelines for Health Impact Assessment (PDF) (2nd ed.), 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.