Health Impact Assessment

Health Impact Assessment

Health Impact Assessment (HIA) is defined as "a combination of procedures, methods and tools bywhich a policy, program or project may be judged as to its potential effects on thehealth of a population, and the distribution of those effects within the population." Harv|ECHP|1999|p=4


HIA is intended to produce a set of evidence-based recommendations to inform decision-making Harv|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 and 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. Therefore, usually because of financial and time constraints, HIA does 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 to those of the original HIA. A 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 Harv|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 determinanats 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. Harv|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) Harv|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 Harv|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 degree should not be regarded as an indication of competency.

HIA worldwide

HIA is currently being used or developed around the world, most notably in Europe, North America, Canada, Australia, New Zealand and Thailand.The new 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, under the Equator Principles. Health impact assessments are becoming routine in many large development projects in both public and private sectors of developing countries. For example, guidelines are available in the Oil and Gas sector. There is also a long history of health impact assessment in the water resource development sector -- large dams and irrigation systems.

HIA conferences

The International Association for Impact Assessment conference [] was held in Seoul in 2007 and in Perth in 2008. The 9th International HIA Conference [] (previously known as the United Kingdom and Ireland HIA Conference) will be held in Liverpool in October 2008.

The 2nd South East Asian and Oceania Regional HIA Conference [] is being held in Chiang Mai, Thailand in December 2008.



"This page uses . References are sorted alphabetically by author surname."

Further reading

Books and Edited Book Chapters

*. Includes several chapters on HIA.

Journal Articles



Journal Special Issues


Manuals and Guidelines


Online Guides


Other Publications




"This page uses . 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."

External links

HIA Resource Websites

* [ HIA Community Wiki]
* [ HIA Connect, includes HIA Blog]
* [ HIA Gateway]
* [ "IMPACT" - International Health Impact Assessment Consortium]
* [ RIVM HIA Database]
* [ World Health Organization HIA Site]

Government HIA Websites

* [ Environmental Health Branch, New South Wales Health (Australia)]
* [ European Centre for Health Policy (Belgium)]
* [ HPP-HIA Program (Thailand)]
* [ Institute for Public Health in Ireland (Ireland)]
* [ San Francisco Department of Public Health (United States)]

HIA Practitioner Websites

* [ Ben Cave Associates]
* [ Birley HIA]
* [ Centre for Health Impact Assessment, Institute of Occupational Medicine]
* [ Habitat Health Impact Consulting]
* [ Human Impact Partners]
* [ "IMPACT" - International Health Impact Assessment Consortium]
* [ Peter Brett Associates]

University HIA Websites

* [ Deakin University, "HIA Unit" (Melbourne, Australia)]
* [ Monash University, "SHIA@Monash" (Melbourne, Australia)]
* [ University of Birmingham, "HIA Research Unit" (Birmingham, UK)]
* [ University of California at Berkeley, "Health Impact Group", School of Public Health (Berkeley, USA)]
* [ University of California Los Angeles, "HIA Project" (Los Angeles, USA)]
* [ University of Liverpool, "IMPACT - International Health Impact Assessment Consortium" (World Health Organization Collaborating Centre for Health Impact Assessment), Division of Public Health (Liverpool, UK)]
* [ University of New South Wales, "HIA Connect", Health Inequalities, Health Impact Assessment and Healthy Public Policy Program (CHETRE), Research Centre for Primary Health Care and Equity, Faculty of Medicine (Sydney, Australia)]
* [ University of Otago, "Health, Wellbeing and Equity Impact Assessment Unit", Wellington School of Medicine and Health Sciences (Wellington, New Zealand)]

Professional Associations

* [ IAIA]

Other HIA Websites

* [ HIA Blog]
* EU funded research project to develop a quantitative software tool for HIA [http:///]

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ee also

**Environmental impact assessment
**Four-Step Impact Assessment
**Healthy development measurement tool
**Risk assessment
**Social impact assessment
*Health promotion
**Jakarta Declaration
**Ottawa Charter for Health Promotion
*Health protection
**List of environmental health hazards
**Precautionary principle
**Risk assessment
*Population health
**Public health
**Social determinants of health

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