What is health impact assessment (HIA)?
A definition that is widely accepted across Europe is:
'Health impact assessment (HIA) is 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'. (Gothenburg Consesn
In other words it is a process that considers the wider effects of local and national policies or initiatives and how they, in turn, may affect people’s health.
This definition is also useful in that it suggests that there is no standard way of conducting an assessment. The combination of procedures, methods and tools used will depend on both the decision making structures of the organisation undertaking the assessment and on the nature of the proposal in question.
It also highlights the health inequalities dimension as policies, programmes or other developments can affect groups within a given population in different ways. HIA can help to ensure that the people who are most vulnerable to the causes of ill-health stand to gain as much as possible.
However, alternative definitions have recently been proposed (Elliott et al, 2010) as the practice of HIA has evolved:
‘...a process through which evidence (of different kinds), interests, values and meanings are brought into dialogue between relevant stakeholders (politicians, professionals and citizens) in order imaginatively to understand and anticipate the effects of change on health and health inequalities in a given population’.
The second definition recognises that the direction and nature of health impacts are not obvious or universally accepted, are subject to debate and involve different ideas about what health is and what the conditions for health should be. HIA nonetheless provides a framework through which different views of evidence and health can both be made explicit and scrutinized.
Wherever possible assessments should be conducted in partnership with representatives of stakeholder groups (those affected by, and/or have an interest in, the proposal in question). HIAs make use of any relevant evidence and expertise that would help them to make judgements about the potential impacts and is therefore a mechanism to support evidence and knowledge based decision making.
Integrated decision making and the determinants of health
The environment, income, employment, the organisation of transport, the design and condition of houses, crime and the social and physical condition of local neighbourhoods all contribute to good and poor health. HIA identifies how a particular decision will alter these determinants and assesses the likely impact on the health of different groups in a population.
The NHS cannot be the sole agency responsible for our health and well being. Integrated decision making is needed to address the complex and multiple effects of policies, programmes and projects, and should be central to any national and local strategy to improve health and tackle inequalities. In Wales the consequences of industrial decline have left an unwelcome legacy in terms of long term physical and mental ill-health, and early death. HIA can ensure that concerns about health and well being cut across strategies for regenerating the most deprived areas in the country.
The benefits of HIA
The benefits of HIA can include:
It is not controversial to claim that a range of factors, unrelated to the health services themselves, shape the health and well being of people and the communities in which they live. The environment, income, employment, the organisational of transport, the design and condition of houses, crime, and the social and physical condition of local neighbourhoods all contribute to good and ill health. In addition, the more deprived a community is the more likely it is to have higher rates of mental and physical illness and for its people to live shorter lives. It is therefore more surprising that health policy has focused almost entirely on health services for people who are ill rather than the conditions that could help them to stay well.
HIA is the technical name for a common sense idea. It is a process that considers the wider effects of local and national policies and initiatives and how they, in turn, may affect people’s health. Some of these may be positive, and others could be more harmful. The idea is to ensure that any proposed initiative can be adjusted to ensure maximum benefits in terms of its effects on local health. In addition it is a way of ensuring that those people who are most vulnerable to the causes of ill health stand to gain as much as possible.
The Wales Health Impact Assessment Support Unit (WHIASU) aims to develop this process with organisations, particularly local government, that make important decisions about people living in Wales.
Last updated: 31/10/2012