12.4 Health Impact Assessment

Health Impact Assessment (HIA) is a powerful tool for evaluating how policies and projects affect public health. It considers social, economic, and environmental factors to maximize positive outcomes and minimize negative impacts, especially for vulnerable groups.

HIAs follow a structured process of screening, scoping, assessment, and recommendations. They involve diverse stakeholders, use various data collection methods, and aim to influence decision-making to promote health equity across different sectors and communities.

HIA Process

Overview of Health Impact Assessment (HIA)

• Systematic process evaluates potential health effects of a proposed policy, plan, program, or project before implementation
• Considers social, economic, and environmental determinants of health
• Aims to maximize positive health outcomes and minimize negative impacts, particularly for vulnerable populations
• Conducted by a multidisciplinary team of experts (public health professionals, urban planners, transportation specialists, environmental scientists)
• Follows a structured framework consisting of screening, scoping, assessment, and recommendations

Screening and Scoping Stages

• Screening determines whether an HIA is needed and feasible based on potential health impacts, available resources, and stakeholder interest
• Involves reviewing existing data, consulting with stakeholders, and assessing the project's timeline and decision-making process
• Scoping establishes the HIA's objectives, study area, affected populations, health determinants, and methods
• Identifies key health issues, research questions, data sources, and stakeholders to engage (community members, policymakers, industry representatives)
• Develops a work plan outlining the HIA's timeline, budget, and responsibilities

Assessment and Recommendations Phases

• Assessment phase collects and analyzes data to characterize the baseline health status of the affected population and predict potential health impacts
• Uses quantitative methods (risk assessment, epidemiological studies, health impact modeling) and qualitative approaches (community surveys, focus groups, expert interviews)
• Considers positive and negative health effects, their magnitude, likelihood, and distribution across different population subgroups
• Recommendations suggest actions to enhance positive health outcomes and mitigate negative impacts based on the assessment findings
• Prioritizes recommendations based on their feasibility, effectiveness, and alignment with stakeholder priorities
• Examples include modifying project design (adding green spaces to promote physical activity), implementing mitigation measures (installing air filters to reduce pollution exposure), or supporting health-promoting policies (investing in affordable housing)

HIA Outcomes and Follow-up

Reporting and Dissemination

• Reporting communicates the HIA's findings, recommendations, and decision-making process to stakeholders and the public
• Includes a written report, executive summary, and presentations tailored to different audiences (community members, policymakers, media)
• Emphasizes key messages, actionable recommendations, and transparent documentation of methods and limitations
• Dissemination strategies aim to raise awareness, build support, and facilitate the uptake of HIA recommendations (public meetings, media outreach, online platforms)

Monitoring and Evaluation

• Monitoring tracks the implementation of HIA recommendations and assesses their impact on health determinants and outcomes over time
• Uses indicators and data sources identified during the scoping and assessment phases (health surveys, environmental monitoring, community feedback)
• Evaluation assesses the HIA's process, impact, and effectiveness in influencing decision-making and promoting health equity
• Involves collecting data from stakeholders, reviewing documents, and conducting interviews or surveys
• Identifies strengths, weaknesses, and lessons learned to improve future HIA practice and inform ongoing decision-making processes

Evidence-Based Decision Making

• HIAs provide decision-makers with evidence-based recommendations to promote health and equity in policies, plans, and projects
• Supports the integration of health considerations into non-health sectors (transportation, housing, education) and promotes cross-sectoral collaboration
• Enhances transparency and accountability in decision-making by documenting the potential health impacts and trade-offs of different options
• Strengthens the capacity of communities and stakeholders to participate in decision-making processes and advocate for their health needs
• Contributes to the growing body of evidence on the effectiveness of HIAs in promoting health and equity in diverse contexts (urban planning, natural resource extraction, climate change adaptation)

HIA Principles

Addressing Determinants of Health

• HIAs recognize that health is influenced by a wide range of social, economic, and environmental factors beyond individual behaviors and healthcare access
• Considers the distribution of health determinants across different population subgroups and their cumulative impacts over time
• Examples of health determinants include income, education, housing, transportation, social support, environmental quality, and access to health services
• HIAs assess how proposed policies or projects may influence these determinants and their associated health outcomes (cardiovascular disease, respiratory illness, mental health)
• Aims to promote health equity by identifying and addressing the root causes of health disparities and ensuring that all population groups have the opportunity to attain their full health potential

Stakeholder Engagement and Participation

• HIAs emphasize the importance of engaging diverse stakeholders throughout the assessment process to ensure that their perspectives, knowledge, and values are considered
• Stakeholders may include community members, policymakers, public health professionals, industry representatives, and academic experts
• Engagement strategies aim to build trust, facilitate dialogue, and promote shared decision-making (community forums, advisory committees, participatory mapping)
• Seeks to empower communities, particularly those most affected by the proposed policy or project, to participate in the HIA process and advocate for their health needs
• Recognizes that stakeholders may have different interests, power dynamics, and capacities to participate, and aims to create an inclusive and equitable engagement process
• Examples of stakeholder engagement in HIAs include involving community members in data collection and analysis, seeking input on draft recommendations, and disseminating findings through community-based organizations and networks