FAQ


 

 

What is Health Impact Assessment?

Health impact assessment (HIA) is most often 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” (World Health Organization, 1999). This broad definition from the World Health Organization European Center for Health Policy (ECHP) and presented in the Gothenburg Consensus paper on HIA reflects the many variants of HIA.


A somewhat more precise definition is that HIA is “a multidisciplinary process within which a range of evidence about the health effects of a proposal is considered in a structured framework, …based on a broad model of health which proposes that economic, political, social, psychological, and environmental factors determine population health” (Northern and York Public Health Observatory, 2004).

 

What is the purpose of HIA?

The fundamental goals of HIA are to ensure that public decisions account for their consequences to human health and to help shape those decisions to promote and improve population health.  To that end, HIA aims to:

  • Evaluate health effects of programs, projects, plans or policies, particularly on disadvantaged populations vulnerable to or suffering from health disparities, based on diverse sources of knowledge
  • Provide evidence-based recommendations for decision-makers that would enhance the positive health impacts and eliminate, reduce or mitigate negative impacts of proposed projects, programs and policies

 

What is the value of HIA in decision-making processes?

HIA has a number of benefits for the decision-making process and its outcomes.  Some of the key potential benefits are:

  • Providing a comprehensive lens on issues and trade-offs in public decision-making
  • Identifying and estimating positive and negative health effects of a project or policy
  • Identifying long-term health effects and effects on socially excluded populations
  • Supporting community engagement in decision-making processes
  • Motivating health-promoting changes in the design of a project or policy
  • Increasing transparency in the policy-making process
  • Increasing policy-maker and public understanding of health and policy relationships
  • Mobilizing political support for social change
  • Securing funding for project mitigations
  • Building consensus and buy-in for policy decisions and their implementation
  • Facilitating disparate organizations and agencies to work in a interdisciplinary way

 

What are the steps conducted in an HIA?

HIA describes diverse methods used to inform policy-makers about how policies, plans, programs, or projects can affect health, health behaviors, and social resources necessary for health.  A typical HIA include five steps:

  1. Screening - Determine the need and value of an HIA;
  2. Scoping - Determine which health impacts to evaluate, the methods for analysis, and the workplan for completing the assessment;
  3. Assessment/Analysis/Appraisal - Use qualitative and quantitative data, expertise and experience to judge the magnitude and direction of potential health impacts;
  4. Reporting - Communicate the results of the HIA to stakeholders and decision-makers.  This can take many forms including written reports, comment letters, and public testimony; and
  5. Monitoring - Track the effects of the HIA on the decision, and on health determinants and health outcomes.


Within this general framework, approaches to HIA vary greatly with regards to the breadth of issues analyzed, the research methods employed, their relationship to regulatory impact assessment requirements, the role of policy-makers, stakeholders and the public in the analysis, and the ways the assessment is used to influence policy.

 

Is HIA one standard tool?

No, HIA is not one single tool, but generally refers to a systematic process that may use diverse tools and methods.  For example, HIA can focus on a single health determinant or health outcome, or it can more comprehensively consider all potential adverse and beneficial effects on health.  HIA may be conducted by a single expert or public institution, or by a community organization.  HIA may be conducted independently or integrated within existing regulatory and non-regulatory assessment processes.  Finally, HIA can use existing data and published research, or it can include the collection and analysis of new data using multiple quantitative and qualitative methods.


Overall, the practice of HIA in the United States and internationally is varied. Practice does not appear to conform to any existing or established norms or standards, and shares boundaries with other forms of decision analysis processes, such as Environmental Impact Assessment.

 

When is an HIA carried out?

Given that the purpose of HIA is to help decision-makers make informed decisions, an HIA is most often carried out before the decision is made or the policy is implemented.  HIA may be conducted on any decision regarding a project, policy or plan, on a local, regional, state, or national scale.

 

What are the typical triggers for an HIA?

HIAs can be initiated by public health practitioners, policy advocates, affected stakeholders, responsible public agencies, or policy-makers who are concerned with the consideration of health in a decision-making process.  HIA can also be required by project-specific legislation or to comply with EIA regulations.

 

How much does conducting an HIA cost?

Because HIA can be described as a spectrum of practice, there is no standard cost for conducting one.  Its scale and approaches vary widely based on:

  • The depth and breadth of issues analyzed
  • The types of research methods employed
  • The extent to which stakeholders are involved in developing the HIA
  • The way that HIA findings are used
  • The relationship to regulatory requirements

 

What are the roles for stakeholders in HIA?

Opportunities and needs for stakeholder participation exist at each stage in the HIA process. Stakeholders include any individuals or groups with a known interest or perceived interest in the outcomes of a decision potentially subject to a HIA. Stakeholders may include sponsors of development projects, public health officials, government agencies responsible for policy implementation or enforcement, as well as residents, employees, or employers.  Inclusive and meaningful participation of stakeholders helps the HIA process to identify relevant research questions, sources of data and information, and proposals for alternatives and mitigations.


Click here for a table of potential roles for stakeholders in the HIA process.

 

What are the underlying values of HIA?

In 2006, the International Association of Impact Assessment outlined a set of values and principles for the practice of HIA: democracy; equity; sustainable development; ethical use of evidence; and comprehensive approach to health (Quigley 2006).

 

What does a completed HIA produce?

Generally, a completed HIA results in a report that documents the HIA process as well as findings.  However, the decision-making process will likely inform the communication of HIA findings, and the need for more publicly-accessible materials.  For example, the identification of key messages (e.g., positive and negative impacts on health), audiences (e.g., stakeholders, decision-makers) and use of media (e.g., letters, reports, press releases) will likely follow the release of the HIA report, and form the basis of communication strategies.

 

What is the relationship of HIA to Environmental Impact Assessment?

HIA is procedurally similar and complementary to Environmental Impact Assessment (EIA) conducted under the National Environmental Policy Act (NEPA) and equivalent State statutes, such as the California Environmental Quality Act (CEQA).  NEPA requires Environmental Impact Statements (EIS) to include consideration and analysis of health effects of specified federal agency actions. NEPA does not refer by name to "HIA" as a separate requirement per se, and the current practice of health analysis in the EIS has been limited.  Given the legal mandate to consider health in EIA, though, when conducted within the context of an inter-disciplinary EIA, HIA is an appropriate way to meet statutory requirements for health effects analysis.

 

What is the difference between HIA, community health assessment, and health risk assessment?

HIA should be distinguished from other forms of stand-alone assessment or forecasting methodologies, even though these other forms may be used within an HIA.  For example, community health assessment is the ongoing process of regular and systematic collection, assembly, analysis, and distribution of information on the health needs of the community.  Generally, community health assessments gather statistics on health status as well as data on community health needs/gaps/problems and assets.  Within HIA, community health assessments both support policy analysis and development and existing conditions analysis. Health risk assessment is a quantitative analytic method used for characterizing the nature and magnitude of health risks associated with exposures to chemical contaminants and other environmental substances and processes. HRA is not comprehensive, but HRA conclusions can be used within HIA to forecast effects of specific exposures.

 

Do legal requirements exist for HIA in California?

No specific legal or regulatory requirements for HIA exist in California.  Some environmental laws applicable to planning and development require analysis of some health impacts.  For example, the California Environmental Quality Act requires that all potential environmental changes that can result in significant adverse impact on humans or public health must be addressed in an environmental impact report.  (Section 15126.2 (a); Section 15065)


HIA may also help fulfill the implementation of rules for social or community health impact assessment.  For example, where project areas contain low- or moderate-income housing, California Redevelopment Law requires a neighborhood impact report which describes in detail the impact of the redevelopment plan “…upon the residents of the project area and the surrounding areas, in terms of relocation, traffic circulation, environmental quality, availability of community facilities and services, effect on school population and quality of education, property assessments and taxes, and other matters affecting the physical and social quality of the neighborhood.”

 

What types of issues does HIA consider?

The definition of health within the context of HIA is holistic, and so HIA considers a broad set of social and environmental determinants of health status. An ecological framework for health is necessary because most public decisions affect health indirectly through their effects on social, economic, or environmental conditions.  Thus, the impacts analyzed within HIA can include physical and mental health outcomes like mortality and disability, but also may include behavioral, family, neighborhood, public, environmental, economic and political factors. While HIA may include analysis of a broad array of issues, ultimately it must contribute to understanding explicit causal pathways linking the decision at hand and health outcomes.

 

Why have most HIAs focused on the built environment?

HIA is an emerging practice in the United States. Only a handful of HIAs have been conducted, and they address only a small fraction of the public policy decisions that are likely to have public health impacts.  Thus far, HIAs have mostly been applied to the built environment, as there is abundant evidence that land use, transportation and community design have significant and wide-ranging impacts on the environment and health.  Despite similar and complementary objectives, land use planning, environmental protection, and public health agencies typically have little communication on many existing and emerging public and environmental health issues.  While it seems commonsense that major decisions regarding the built environment should be judged against their potential health benefits and burdens, mechanisms and mandates for such consideration do not exist, and city and regional planning agencies do not have the resources or expertise to assess the health impacts of planning.  As such, public health practitioners have begun using HIA as a tool to fill this gap.


However, another role for HIA is to provide a health perspective to policy decisions, and the San Francisco Bay Area HIA Collaborative members have engaged in policy HIAs as well.  Public policies by definition have broad impacts, and while some policies target health directly, many of them affect public health indirectly through their effects on social, economic, and environmental conditions. By defining and quantifying a policy’s expected impacts to public health, an HIA can have healthy and far-reaching influences on society.