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What is a Health Impact Assessment?

___A Health Impact Assessment is a combination of procedures, methods, and tools by which a policy, program [a series of projects over time], or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within that population.

___An HIA is intended not to determine, but to support decision-making.

___An HIA may be conducted as a desktop, rapid, or comprehensive process.

___An HIA may be prospective, concurrent, or retrospective.

___HIA’s guiding values are democracy, equity, sustainability, and the ethical use of evidence.

___HIA takes a community or broader perspective on health, and considers the social, psychological, economic, environmental, and political determinants of health as important as specific health issues in assessing health impacts.

Why conduct a Health Impact Assessment?

___HIAs make for better decisions.

___HIAs promote cross-sectoral cooperation.

___HIAs raise the profile of health and health issues, and make it more likely that they’ll be considered in all circumstances.

___HIA champions a participatory approach that values, includes, and empowers the community.

___HIAs bring the community together.

___HIAs promote equity.

___HIAs promote healthy behaviors and practices.

___HIAs can be used in numerous and varied situations.

___Prospective HIAs provide information before the fact, leaving time to make adjustments in plans.

___HIAs can promote sustainable development and environmental responsibility.

___HIA is adaptable to the needs of many different groups.

___HIA policy makers address policy making requirements.

___HIA recognizes that other factors besides health guide decisions.

___HIA is a proactive process that improves positive outcomes and decreases negative outcomes.

When should you conduct a Health Impact Assessment?

___If possible, HIAs should be conducted before the proposed project or policy is fully planned or implemented, so that it can take advantage of the information the HIA provides.

Who should be involved in conducting a Health Impact Assessment?

___HIAs should involve representatives of all stakeholders.

These include:

___Those who are directly affected by the proposed actions or policies.

___Those who are involved in carrying out the proposed actions or policies.

___Nonprofit and non-governmental organizations (NGOs) concerned with the issues and/or the populations affected.

___Advocacy groups.

___The decision-makers themselves.

___Government agencies that have responsibility for the issues and/or populations in question.

___Representatives of other sectors that are affected by the proposal.

___Health workers at local, national or international levels.

___Employers and unions.

___The commissioner(s) of the HIA – those who set it in motion (and pay for it, in many cases.)

___Those who actually conduct the HIA.

How do you conduct a Health Impact Assessment?

Political aspects of conducting an HIA

___In order for HIA to become common, and particularly for it to be institutionalized, politicians and government agencies have to understand:

  • That health is important enough to be integral to any project or policy that can have an impact on it.
  • That health is not simply an individual issue, but has to be viewed in a larger – community, regional, national, or international – context, depending on the scope of the project or policy proposed.
  • That health is more than the alleviation, elimination, or prevention of disease, injury, or medical conditions, but also includes the promotion, psychological implications, and other aspects of health.
  • That the social and other determinants of health are both real and crucially important to creating a healthy community and society.
  • That health transcends any one department or ministry – i.e., that more than public health agencies need to be involved in examining the health impacts of a project or policy, and that interdepartmental and inter-sectoral collaboration is necessary in order to fully understand the health impacts of projects or policies.
  • That they need the best, most accurate, most nearly complete information possible in order to make good decisions that take health impacts into account.                          

___HIAs won’t happen with any regularity or quality control unless they’re institutionalized by a legal basis of some sort – a law, an agency regulation, a clear policy, permit requirements, etc..

___HIAs have to be paid for.

___Government agencies have to collaborate for an HIA to be of high quality.

___Government has to be willing to involve, and listen to (and heed) the concerns and advice of those who will be affected.

Practical aspects of conducting an HIA

___Choose people to conduct the HIA.

___HIA practitioners ideally are trained and experienced, or, at the very least, have the professional, interpersonal, and organizational skills needed to conduct an HIA successfully.

___HIA consists of five stages:

  • Screening
  • Scoping
  • Assessment
  • Reporting
  • Evaluation.

___Screening is the examination of the project or policy to see if an HIA is needed.

___Scoping is the actual planning of the HIA – identifying ways in which the decision in question could potentially affect health (positively or negatively) – the people who might be affected, how impacts should be assessed, whose expert opinion you need to get the full picture, what resources are needed to conduct the HIA, what kinds of evidence should be gathered, etc..

___A general guideline for developing a plan might take these steps:

  • Using logic, prior knowledge, and the concerns of the community, make an educated guess about the possible health impacts of the proposed project or policy.
  • Determine the sectors, populations, groups, and individuals that need to be consulted and/or drawn into the process.
  • Assemble a team from among them, representing all stakeholders, to plan and do the groundwork for the HIA.
  • Become familiar with the current state of the project or policy, possible alternatives to current options, and the decisions that can and/or must be made.
  • Assign responsibilities for all parts of the HIA.

___Perform the actual assessment.

  • Review existing evidence.
  • Familiarize yourself with the proposed project or policy.
  • Learn what the range of options is.                                   
  • Conduct individual and group interviews, hold meetings, administer surveys, etc., to gather other evidence and obtain community input.
  • Gather or compile statistics and other evidence currently unavailable which is necessary for a full picture of the situation.
  • Gather information available from the various agencies, NGOs, think tanks, businesses, institutions, and other groups whose responsibilities or concerns are directly or indirectly relevant to the HIA or the issue, sector, geographic area, or population potentially affected.
  • Assess the impacts of the proposed project or policy on the health of populations affected.
  • Determine the impacts that come with different options.

___Compose and deliver an understandable two-part report to all stakeholders and the public, describing the HIA process and conclusions, and making recommendations for maximizing the positive health impacts and minimizing the negative health impacts of the project or policy.

___Evaluate the HIA’s effectiveness.

___Continue to use the HIA conclusions and recommendations to guide the implementation of the project or policy, making adjustments and revisions as necessary to reflect changing conditions or new information.