Introduction
Health impact assessment (HIA) is a tool for facilitating the intersectoral action that has been advocated by policies such as health for all and Agenda 21 for years. HIA is defined as “a combination of procedures, methods and tools by which a policy, programme 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.”1 HIA goes beyond providing information – it aims to influence decisions and the people who make them. HIA’s participatory approach brings together people from a range of sectors, and from the community to consider how a proposed policy, programme or project may positively or negatively impact on health. As such, it is an important tool for raising awareness of the wide range of economic, social and environmental influences that determines health.
Some milestones in HIA
1981 Establishment of PEEM (Panel of Experts in Environmental Management for vector control) by WHO, FAO and UNEP.1
1984 Start of the HIA component as part of annual EIA training at the Centre for Environmental Impact Assessment and Management in Aberdeen (partly sponsored by WHO Europe). Annual sessions continued up to the beginning of the 1990s.2
1986 WHO meeting on the Health and Safety component of environmental impact assessment (22).
1988 Analysis of the methodological and substantive issues affecting human health considerations by the Monitoring and Assessment Research Centre, London (23).
1989 First edition of the Guidelines for forecasting the vector-borne disease implications of water resources development by PEEM (24).
1991 Survey on HIA/EIA practice in Canada (25).
1992 Handbook for practitioners on environmental and health impact assessment of development projects (26).
1992 Asian Development Bank guidelines for the health impact assessment of development projects (27).
1993 Quebec Framework for HIA/EIA, including a section on social impact assessment (28).
1994 Australian national framework for environment and health impact assessment (29).
1994 Publication of the German Framework on HIA/EIA (30).
1997 Update on HIA in the Environmental Assessment Sourcebook of the World Bank (12).
1998 Publication on health and environmental impact assessment by the British Medical Association (31).
1998 HIA Section at the International Association for Impact Assessment.
1999 Gothenburg Consensus Paper on HIA (32).
2000 The Canadian handbook on health impact assessment – a work in progress (33).
2000 Memorandum of Understanding between the International Association for Impact Assessment and the World Health Organization.
The HIA process has the potential to:
• Increase awareness about the health effects of plans for transport, the built environment housing, social services, education, etc.
• Establish a shared understanding of health (in the context of sustainable development) among a wide range of stakeholders.
• Create a sense of responsibility for health among sector representatives, while providing a clear process for taking action to improve health.
• Identify interventions to minimize negative and maximize positive health outcomes, based on intersectoral action.
• Place health at the heart of policy-making.
• Provide a systematic approach for integrating the principle of equity into decision making.
• Provide a better understanding of local needs for public services and the way they are used, enabling sectors to better target resources.
• Highlight opportunities to coordinate actions across sectors.
Guiding Principles for HIA
Adapted from: Quigley R, den Broeder L, Furu P, Bond A, Cave B, Bos R. Health Impact Assessment International Best Practice Principles. Fargo, USA: International Association of Impact Assessment, 2006.
Democracy – emphasizing the right of people to participate in the formulation and decisions of proposals that affect their life, both directly and through elected decision makers. In adhering to this value, the HIA method should involve and engage the public, and inform and influence decision makers. A distinction should be made between those who take risks voluntarily and those who are exposed to risks involuntarily (World Health Organization, 2001).
Equity – emphasizing the desire to reduce inequity that results from avoidable differences in the health determinants and/or health status within and between different population groups. In adhering to this value, HIA should consider the distribution of health impacts across populations, paying specific attention to vulnerable groups and recommend ways to improve the proposed development for affected groups.
Sustainable development – emphasizing that development meets the needs of the present generation without compromising the ability of future generations to meet their own needs. In adhering to this value, the HIA method should judge short- and long-term impacts of a proposal and provide those judgments within a time frame to inform decision makers. Good health is the basis of resilience in the human communities that support development.
Ethical use of evidence – emphasizing that transparent and rigorous processes are used to synthesize and interpret the evidence, that the best available evidence from different disciplines and methodologies is utilized, that all evidence is valued, and that recommendations are developed impartially. In adhering to this value, the HIA method should use evidence to judge impacts and inform recommendations; it should not set out to support or refute any proposal, and it should be rigorous and transparent.
Comprehensive approach to health – emphasizing that physical, mental and social well-being is determined by a broad range of factors from all sectors of society (known as the wider determinants of health). In adhering to this value, the HIA method should be guided by the wider determinants of health.
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