20: Health Impact Assessment (HIA)

Dr Adrian Davis

Top line: HIA can be a useful tool whereby health impacts of policies, programmes and interventions and their distribution across the population can be assessed in order to enhance positive and reduce negative health impacts identified.

HIA is the term given to the process by which the health impacts of certain plans, policies or actions are judged. In HIA a social model of health is applied which acknowledges the influence of economic, political, social and environmental factors on population health. HIA considers the health impacts of a specific proposal on a defined population usually over a specified time interval. There are now a considerable number of HIAs of road transport policies and interventions.1

While there is no statutory requirement for HIA in England, the Government committed itself to the routine consideration of the impact of ‘non-health’ interventions on population health through the application of methods of appraisal such as HIA.2 At a European level Article 129 of the Treaty of Maastricht includes the subparagraph:

“Health protection requirements shall form a constituent part of the communities other policies”

and Article 152 of the Amsterdam Treaty includes the subparagraph:

“A high level of human health protection shall be ensured in the definition and implementation of all Community policies and activities”.

HIA methodologies vary with some utilising similar approaches to that of Environmental Impact Assessment and Strategic Environmental Assessment.3 4 Integrating HIA with such assessments can lead to more informed and rounded assessments.

The HIA process involves collecting a wide range of evidence in order to interpret health risks and potential health gains. There is an explicit focus on health inequalities by giving specific consideration to whether impacts of a proposal fall disproportionately on vulnerable groups. It presents this information, along with recommendations to decision makers. It has been noted that HIA is a process that:

  • Considers the scientific evidence about the relationships between a proposed policy, programme or project and the health of a population
  • Takes account of the opinions, experience and expectations of those who may be affected by a proposed decision
  • Highlights and analyses the potential health impacts of proposals
  • Enables decision makers to make more informed decisions and to maximise positive and minimise negative health impacts
  • Enables consideration of effects on health inequalities.

1 See http://www.apho.org.uk/default.aspx?QN=P_HIA accessed 8 May 2009.
2 Department of Health, 2004 Choosing Health: Making healthier choices easier, London: TSO
3 Mindell, J., Joffe, M. 2003 Health impact assessment in relation to other forms of impact assessment, Journal of Public Health Medicine, 25(2): 107-113.
4 Mindell, J., Ison, E., Joffe, M. 2003 A glossary for health impact assessment, Journal of Epidemiology and Community Health, 57: 647-651.

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