What is HIA?
Health Impact Assessment, or HIA, has been 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” (Gothenburg Consensus Statement, 1999). The key element that makes HIA different from traditional public health assessment is that its approach is prospective. Ideally, the health impacts of a proposal are assessed before a final decision is made, allowing the results of the HIA to be considered in the decision making process. The ultimate goal of HIA is utilize objective information to minimize the negative health impact and maximize the positive health impacts of a project or policy.
What are the benefits of conducting HIA?
In addition to ensuring that health considerations are incorporated into projects and policies, HIA has several other benefits including:
- Conducting HIA raises awareness about health in other sectors, such as land use and transportation. While projects in these sectors can have a profound impact on the health of populations, consideration of health has not been a routine part of decision making. HIA is one way that public health professionals can work with other sectors to integrate health into these processes.
- HIA uses a broad definition of health that ensures that social and environmental determinants of health are included in the assessment. This may include factors such as education, housing, transportation, or access to goods and services.
- HIA has a focus on equity and social justice. These values are central to HIA due to the emphasis of the distribution of health effects in the population.
- HIA is multidisciplinary in nature, and requires collaboration with partners in other fields.
- HIA invites communities to participate in the process. Community members are the experts on local issues, and so involvement is crucial in selecting topics for assessment, prioritizing issues to study, collecting local information, and disseminating results to stakeholders
What are the steps of HIA?
There are five recognized steps of HIA:
- Screening. In the first step of any HIA, a project or policy on which to conduct and assessment is selected. Screening involves the consideration of several factors including whether a) the proposal affects health, b) a report can be completed and recommendations made in time to inform a decision, and c) resources exist to complete the assessment. Screening is ideally conducted by a group of stakeholders.
- Scoping. After a policy or project is selected on which to conduct an HIA, the scope of the project must be determined. Which health impacts will be considered? Which project components have the greatest impact on health? Which populations will be affected by this proposal? These are some of the questions to be answered through scoping. Scoping also helps determine how in-depth the analysis will be based on the time and resources available.
- Assessment. Assessment comprises the bulk of the work in HIA. This process provides data and information on the health impacts that were identified in the scoping phase, and the people who will be affected by the project or policy. This information can be both quantitative and qualitative, and can be drawn from many sources. These sources include published peer reviewed literature, data from local or regional assessments, modeled data, focus groups or prior HIAs. The process is similar to traditional public health assessment, but with a focus on a specific proposal.
- Reporting and Recommendations. Your assessment will result in a set of conclusions about the health impacts of the project or policy you have studied. From these conclusions, project or policy recommendations can be proposed that would minimize the negative and maximize the positive health impacts. The final HIA report can be presented in several formats, including a full report, a letter to decision makers or a contribution to and Environmental Impact Statement. An important part of reporting is disseminating your final product to decision makers and other stakeholders through various avenues.
- Monitoring and Evaluation. After an HIA is completed, the project or policy should be monitored so that you can judge whether your HIA was successful. Did the decision makers utilize your recommendations about health in their final decision? Were the recommendations followed when the project was implemented? Did your HIA have other impacts, either anticipated or unanticipated? Continued monitoring of your HIA and the project or policy can help answer some of these questions. Collecting information from monitoring can help you evaluate whether your HIA achieved its goals.
Where can I get more information about HIA in the United States?
The CDC Healthy Places initiative is part of the National Center for Environmental Health. They focus on building capacity for HIA nationwide through mentoring partners, providing resources and technical assistance, raising awareness about HIA with multiple stakeholders.
The Health Impact Project, a collaboration of the Pew Charitable Trusts and the Robert Wood Johnson Foundation, has funded multiple HIA projects acrooss the country in the past few years. Their webiste has the most complete library of completed HIAs in the United States, in an online data base that is searchable by sector and geography.
Human Impact Partners is a nonprofit based in Oakland, California that focuses on getting health considered in decision making through conducting HIA with community partners, providing training and mentorship (including the Oregon Public Health Division), and advocating for healthy projects and policies.
The Society of Practioners of Health Impact Assessment (SOPHIA) is an association of individuals and organizations providing leadership and promoting excellence in the practice of health impact assessment. The SOPHIA website contains multiple tools and resources for HIA practitioners.
Where can I get more information about HIA around the world?
World Health Organization Health Impact Assessment
International Health Impact Assessment Consortium
Health Impact Assessment Gateway (England)
HIA Connect (Australia)