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Health impact assessment
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)
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).
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 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 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 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.
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, PMC2516559, PMID18709140.
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.
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.