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 International Association for Impact Assessment has an active health section.
A HIA People Directory can be found on the HIA GATEWAY.
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.
Acheson, D (1998), Independent Inquiry into Inequalities in Health, London: Stationery Office.
ECHP (1999), Health Impact Assessment: Main concepts and suggested approach (Gothenburg Consensus Paper)(PDF), Brussels: European Centre for Health Policy, archived from the original (PDF) on 2006-10-07, retrieved 2006-06-23.
IMPACT (2004), European Policy Health Impact Assessment: A guide(PDF), Liverpool, archived from the original (PDF) on 2006-09-03, retrieved 2006-07-02.
Kemm, J (2003), "Perspectives on Health Impact Assessment" (PDF), Bulletin of the World Health Organization, 81 (2): 387, PMC2572477, PMID12894317.
Taylor, L; Gorman, N; Quigley, R (2003), Evaluating Health Impact Assessment: Learning from practice bulletin(PDF), London: Health Development Agency, archived from the original (PDF) on 2007-07-30, retrieved 2006-07-02.
Taylor, L; Quigley, R (2002), Health Impact Assessment: A review of reviews, London: Health Development Agency, archived from the original on 2007-05-02, retrieved 2006-06-30.
Winkler, M; Furu, P; Viliani, F; Cave, B (2020), "Current Global Health Impact Assessment Practice", International Journal of Environmental Research and Public Health, 17 (9): 2988, doi:10.3390/ijerph17092988, PMC7246701, PMID32344882.
This page uses Harvard referencing. References are sorted alphabetically by author surname.
Books and edited book chaptersEdit
Birley, M (1995), The Health Impact Assessment of Development Projects, London: Her Majesty's Stationery Office.
Birley, M (2011), Health Impact Assessment: principles and practice, London: Earthscan.
Kemm, J (2013), Health Impact Assessment: Past Achievement, Current Understanding, and Future Progress, Oxford: Oxford University Press, ISBN 978-0-19-965601-1.
Kemm, J; Parry, J; Palmer, S (2004), Health Impact Assessment: Concepts, theory, techniques and applications, Oxford: Oxford University Press, ISBN 978-0-19-852629-2.
Ross, C; Orenstein, M; Botchwey, N (2014), Health Impact Assessment in the United States, New York: Springer.
Ståhl, T; Wismar, M; Ollila, E; Lahtinen, E; Leppo, K (2006), Health in All Policies: Prospects and potentials(PDF), Helsinki: Finnish Ministry of Social Affairs and Health, ISBN 978-952-00-1964-8, archived from the original (PDF) on 2006-10-04, retrieved 2006-09-20. Includes several chapters on HIA.
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.
Birley, Martin (2003), "Health Impact Assessment, integration and critical appraisal", Impact Assessment and Project Appraisal, 21 (4): 313–321, doi:10.3152/147154603781766158, S2CID 140546560
Dannenberg, AL; Bhatia, R; Cole, BL; Heaton, SK; Feldman, JD; Rutt, CD (2008), "Use of Health Impact Assessment in the US: 27 Case Studies, 1999-2007" (PDF), American Journal of Preventive Medicine, 34 (3): 241–256, doi:10.1016/j.amepre.2007.11.015, PMID18312813.
Douglas, MJ; Conway, L; Gorman, D; Gavin, S; Hanlon, P (2001), "Achieving Better Health Through Health Impact Assessment", Health Bulletin, 59 (5): 300–305, PMID12664743.
Harris-Roxas, Ben; Harris, Elizabeth (2010), "Differing Forms, Differing Purposes: A Typology of Health Impact Assessment", Environmental Impact Assessment Review, 31 (4): 396–403, doi:10.1016/j.eiar.2010.03.003.
Haigh, F; Harris, E; Harris-Roxas, B; Baum, F (2015), "What makes health impact assessments successful? Factors contributing to effectiveness in Australia and New Zealand Health policies, systems and management in high-income countries", BMC Public Health, 15: 1009, doi:10.1186/s12889-015-2319-8, PMC4592749, PMID26433492.
Harris-Roxas, BF; Harris, PJ (2007), "Learning by Doing: The value of case studies of health impact assessment", NSW Public Health Bulletin, 18 (9–10): 161–163, doi:10.1071/NB07110, PMID17949583
Krieger, N; Northridge, M; Gruskin, S; Quinn, M; Kriebel, D; Davey Smith, G; Bassett, M; Rehkopf, DH; et al. (2003), "Assessing Health Impact Assessment: Multidisciplinary and international perspectives", Journal of Epidemiology and Community Health, 57 (9): 659–662, doi:10.1136/jech.57.9.659, PMC1732566, PMID12933768.
Scott-Samuel, A (1996), "Health Impact Assessment: An idea whose time has come (editorial)", British Medical Journal, 313 (7051): 183–184, doi:10.1136/bmj.313.7051.183, PMC2351622, PMID8696181.
Journal special issuesEdit
IJERPH (2020), "Special Issue - Health Impact Assessment", International Journal of Environmental Research and Public Health.
IUHPE (2017), "Special Issue on Health Impact Assessment", Global Health Promotion, 17 (2).
New South Wales Department of Health (2007), "HIA in Urban Settings Special Issue", NSW Public Health Bulletin, 18 (9–10).
New Zealand Ministry of Social Development (2006), "HIA in New Zealand Special Issue", Social Policy Journal of New Zealand (29), archived from the original on 2007-10-24, retrieved 2007-09-26.
New South Wales Department of Health (2005), "HIA Special Issue", NSW Public Health Bulletin, 16 (7–8).
World Health Organization (2003), "HIA Special Issue", Bulletin of the World Health Organization, 81 (6), archived from the original on June 27, 2003.
Manuals and guidelinesEdit
ICCM (2010), Good Practice Guidance on Health Impact Assessment, London: International Council on Mining and Metals.
Harris, P; Harris-Roxas, B; Harris, E; Kemp, L (2007), Health Impact Assessment: A practical guide(PDF), Sydney: UNSW and NSW Health, archived from the original (PDF) on 2009-10-30.
IHPI (2006), Health Impact Assessment Guidance, Dublin: Institute of Public Health in Ireland, archived from the original on 2007-06-17, retrieved 2006-06-23.
PHAC (2005), A Guide to Health Impact Assessment: A policy tool for New Zealand(PDF) (2nd ed.), Wellington: Public Health Advisory Committee, archived from the original (PDF) on 2006-07-22, retrieved 2006-06-23.
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, archived from the original (PDF) on 2009-12-11, retrieved 2010-09-30.
Mahoney, M; Simpson, S; Harris, E; Aldrich, R; Stewart Williams, J (2004), Equity Focused Health Impact Assessment Framework(PDF), Newcastle, Australia: Australasian Collaboration for Health Equity Impact Assessment, archived from the original (PDF) on 2007-09-28, retrieved 2006-11-19.
enHealth Council (2001), Health Impact Assessment Guidelines(PDF), Canberra: enHealth Council, National Public Health Partnership, archived from the original (PDF) on 2009-10-13.
Scott-Samuel, A; Birley, M; Ardern, K (2001), The Merseyside Guidelines for Health Impact Assessment(PDF) (2nd ed.), Liverpool: International Health Impact Assessment Consortium (IMPACT) University of Liverpool, archived from the original (PDF) on 2009-12-11, retrieved 2010-09-30.
Birley, M; Gomes, M; Davy, A (1997), Health aspects of environmental assessment, Washington: Environmental Division, The World Bank
Birley, M; Peralta, G (1992), Guidelines for the Health Impact Assessment of Development Projects, Manila: Asian Development Bank Environment Paper.
Birley, M (1991), Guidelines for Forecasting the Vector-Borne Disease Implications of Water Resources Development, Geneva: World Health Organization, WHO/CWS/91.1. PEEM Guidelines Series 2..
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 websitesEdit
Health Impact Project - Funding for HIA and resources
IMPACT - International Health Impact Assessment Consortium
RIVM HIA Database
World Health Organization HIA Site
Government HIA websitesEdit
Environmental Health Branch, New South Wales Health (Australia)
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)
San Francisco Department of Public Health (United States)
Centers for Disease Control and Prevention (United States)
US Environmental Protection Agency (United States)
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)
University of California, Los Angeles, Health Impact Assessment Clearinghouse Learning and Information Center (Los Angeles, USA)
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)
University of Otago, Health, Wellbeing and Equity Impact Assessment Unit, Wellington School of Medicine and Health Sciences (Wellington, New Zealand)
Society for Practitioners of Health Impact Assessment (SOPHIA)
Other HIA websitesEdit
Health Impact Assessment - International (Email Discussion Group)
HIA Blog on Twitter
This page uses Harvard referencing. External links are sorted alphabetically.