Health Impact Assessment (HIA) 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 the population WHO, European Centre for Health Policy. Gothenburg Consensus Paper, Health Impact Assessment- main concepts and suggested approach. Brussels, 1999.
Why use HIA? We have to think about the effects policies have on health, and in particular, how they can alter the health of all people in the population. Non-health sector proposals, where health is not the main objective, may have major effects on the health and well-being of people, particularly vulnerable groups.
HIA explained • HIA is an approach that gets people to think about what they are doing, and how it may alter people’s health. It promotes health – and in the long term contributes to the health of local people • Imagine someone was planning to build a new motorway. An HIA would answer ‘How would this new development affect people’s health?’
An HIA would ask…. • Would the motorway increase or decrease noise, air or light pollution? • How would the motorway affect local businesses and jobs? • Would the new motorway reduce or increase the stress for local people? • How would a new motorway change the local infrastructure needs - and would this be good or bad for local people?
The purpose/function of HIA is to: • Inform and influence the decision maker • Help address inequalities in health. • Promote joined-up working. • Place public health on the agenda • Reduce conflict between stakeholders • Encourage sustainable development
HIA does this by: • Using a broad understanding of health. • Using a participatory approach that considers which stakeholders need to be involved • Helping involve local people in decisions and responding to their concerns about health. • Considering different types of evidence - from local views to scientific information. • Assessing how the proposal will affect all members of the community – particularly the most vulnerable. • Assisting with sustainable development by considering short and long term impacts.
Many factors impact on your health • the social and economic environment • the physical environment • and the person’s individual characteristics and behaviours. For example, income and social status - higher income and social status are linked to better health. The greater the gap between the richest and poorest people, the greater the differences in health. For example, education – low education levels are linked with poor health, more stress and lower self-confidence.
What international policies support HIA? • Article 152 of the Amsterdam Treaty - the European Union (EU) should examine the possible impact of major policies on health. • The new Strategic Environmental Assessment protocol - places a special emphasis on the consideration of human health for Europe • 1997 Organisation of African Unity Harare Declaration on Malaria Prevention and Control in the Context of African Economic Recovery and Development - included calls for EIA and HIA of all new developments in Africa. • Health21 – The health for all policy framework - outlines strategies to ensure the use of health impact assessment in Europe.
What international policies support HIA? • The Strategic Environmental Directive -adopted by the European Commission to ensure that environmental consequences of certain plans and programmes are identified and assessed during their preparation and before their adoption. • Environmental impact assessment - a statutory requirement in many countries. Similar to HIA, EIA explores the effect of policies, programmes and projects on the environment.
When is an HIA undertaken? • Before implementation (prospective) - to allow steps to be taken to change a proposal at the planning stage.
Steps in HIA • Identifying if an HIA should occur (screening) -systematically deciding if an HIA necessary. • Identifying what to do and how to do it (scoping) -reviewing the issue in more detail, setting the boundaries for the HIA, and considering how the HIA appraisal stage should be undertaken • Identifying health hazards and considering evidence of impact - considering a range of evidence between the determinants of health and key elements of the proposal.
Steps in HIA • Developing recommendations to reduce hazards and/or improve of health - set of recommended changes to the proposal to the decision makers. • 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.
HIA tools and guidance Many different toolkits are available, as are basic guides to carrying out HIA. Find all these at: www.who.int/hia
Some examples of where HIA has been used. • Building a new road near residential areas. • The local village school policy to implement safer routes to school. • Building an out-of-town shopping centre. • Increasing runway & passenger capacity at an airport. • Changing the fuel used in a cement kiln. • Assessing the common agricultural policy.
Where to from here? Many examples of HIA are available on www.who.int/hia website. The site also provides information: • About HIA • Tools and methods to do HIA • How HIA contributes to policy making • The evidence used in HIA • HIA related links and networks.