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."
HIA is intended to produce a set of evidence
-based recommendations to inform decision-making
. 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, 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
. 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
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 .
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 determinants then leads to changes in health outcomes or the health status of individuals and communities. The determinants of health are largely environmental
, 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.
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) . 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 . 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.
ThInternational Association for Impact Assessment
has an activhealth section
HIA People Directory
can be found on thHIA GATEWAY
HIA used around the world, most notably in Europe
, North America
, New Zealand
The 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.
**Environmental impact assessment
**Equality Impact Assessment
**Four-Step Impact Assessment
**Healthy development measurement tool
**Social impact assessment
**Ottawa Charter for Health Promotion
**List of environmental health hazards
**Social determinants of health
''This page uses Harvard referencing
. References are sorted alphabetically by author surname.''
Books and edited book chapters
* . Includes several chapters on HIA.
Journal special issues
Manuals and guidelines
''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.''
HIA resource websites
Health Impact Project
- Funding for HIA and resources
HIA ConnectHIA Gateway''IMPACT'' - International Health Impact Assessment ConsortiumRIVM HIA DatabaseWorld Health Organization HIA Site
Government HIA websites
* ttps://web.archive.org/web/20061007033621/http://www.who.dk/echp European Centre for Health Policy (Belgium)HPP-HIA Program (Thailand)Institute for Public Health in Ireland (Ireland)Planning for Healthy Places with Health Impact Assessments (United States)US Environmental Protection Agency (United States)
University HIA websites
University of Birmingham, ''HIA Research Unit'' (Birmingham, UK)University of California, Berkeley, ''Health Impact Group'', School of Public Health (Berkeley, USA)University of California, Los Angeles, ''HIA Project'' (Los Angeles, USA)
* ttp://www.ihia.org.uk University of Liverpool, ''IMPACT - International Health Impact Assessment Consortium'' Department of Public Health and Policy.(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)
* ttp://www.iaia.org IAIASociety for Practitioners of Health Impact Assessment (SOPHIA)
Other HIA websites
Health Impact Assessment - International (Email Discussion Group)HIA BlogHIA Blog on Twitter
''This page uses Harvard referencing
. External links are sorted alphabetically.''
Category:Health care quality