Health Impact Assessment (HIA)

Question 1

What is a HIA?

Answer 1

• Combination of procdures, methods and tools
• Used to judge a policy, programme or project on its potential effects on the health of a population and the distribution of those effects within the population

WHO 1999

Question 2

What does a HIA aim to achieve?

Answer 2

• Aims to produce a set of evidence-based recommendations to inform decision making
• Seeks to enhance the +ve health impacts and reduce (or eliminate) any -ve impact of a proposed policy, programme or project
• Gives opportunity for community engagement, partnership building
• Can address health inequities (incl. among difference socio-economic groups)

Question 3

Why type of tool is a HIA?

Answer 3

A decisional tool

NOT an evaluation

Question 4

What are the core values of HIA?

Answer 4

Democracy

Equity

Addressing health inequalities

Sustainable development

Openness and transparency

Ethical use of evidence

Question 5

How is health status determined? (give %s)

Answer 5

30% by genetics
10% by healthcare
60% by social & environmental conditions and behaviour

Question 6

What does HIA address?

Answer 6

The determinants of health

e.g. how does the proposed policy, plan or project affect:
democratic process, noise, housing, air quality, nutrition, parks and natural space, livelihood, social equity, water quality, education, social networks, private goods and services, public services
and lead to health outcomes

Question 7

Give some examples of where HIA has been used

Answer 7

Building a large dam & irrigation system

Building a new road near residential areas

Building an out-of-town shopping centre

Increasing runway & passenger capacity at an airport

Question 8

In which continents are countries actively promoting HIA and produced guidelines on it?

Answer 8

N & S America
Europe
Australasia
Russia and C Asia

Question 9

What are the different levels of HIA?

Answer 9

National or subnational

International

Question 10

Describe the two approaches of national/subnational HIA

Answer 10

Voluntary - countries have policies that support HIA but do not require it (e.g. many European countries, an increasing number of Asian countries like China)

Regulatory - different types of legislation and requirements at national/subnational level (e.g. certain states of Australia, Thailand)

Question 11

Describe the two approaches of international HIA

Answer 11

Voluntary - international organisations recommending HIA as an important approach for health promotion (e.g. WHO, the EU)

Regulatory - requirement that human health be considered according to the IFC performance standard 4: -loan agreement with IFC

Question 12

What are the different types of HIA?

Answer 12

Prospective : done before a proposal is implemented

Concurrent : done while a proposal is being implemented

Retrospective : done after a proposal has been implemented

Question 13

There are different durations for a HIA? Name and describe them.

Answer 13

DESKTOP HIA

• 2-6 weeks for 1 assessor
• broad overview of possible health impacts
• analysis of existing & accessible data - no new data collection

RAPID HIA

• 12 weeks for 1 assessor
• provides more detailed information of possible health impacts
• analysis of existing data - no new data collection
• stakeholder & key informant analysis

COMPREHENSIVE HIA
-6 months or more for 1 assessor
robust definitions of impacts
-provides a comprehensive assessment of potential health impacts
-substantial searching of evidence - new data collection
-participatory approaches involving stakeholders and key informants

Question 14

What are steps 1-3 in a HIA?

Answer 14

1. Screening - determining if an HIA is warranted/required for a specific policy, programme or project.
2. Scoping- identifying which health impacts will be considered and the plan for the HIA
3. Assessment - quantifying/describing health impacts of the decision

Question 15

What are steps 4-6 in a HIA?

Answer 15

4. Reporting - presenting results to decision makers, affected communities and other stakeholders
5. Recommendations - suggesting changes to the proposal (evidence based recommendations to inform decision making) to promote +ve or mitigate -ve health effects
6. Monitoring and evaluation - determining the HIA’s impact on the decision making process; monitoring the implementation to ensure that any recommendation the the decision makers agreed to, actually occur; monitoring the health of populations

Question 16

How does an assessment differ from a recommendation?

Answer 16

Assessment - tells you the impact of implemeting a proposal

Recommendation - tells you the gains from making changes

Question 17

What are the concerns for an HIA and the responses to them?

Answer 17

HIA IS COSTLY
Not as costly as treatment of the health impacts in the long-run

HIA IS TIME CONSUMING AND WILL SLOW DECISION MAKING PROCESS DOWN
Conduction a HIA early will bring issues to the front of the decision making process, potentially speeding approval processes & preventing costly litigations that delay projects

HIA WILL STOP ECONOMIC DEVELOPMENT
Role of HIA is to identify mitigations and recommendation, not to say “don’t do that”

HIA IS NOT SCIENTIFIC
Role of HIA is to pull disparate pieces of the best available evidence to make a broad statement about impacts

Question 18

What is the challenge when doing a HIA?

Answer 18

When working within a narrow regulatory framework that offers limited remedies for problem identified outside your regulatory authority what can you do?

What is the value of disclosing impacts if you can’t address them?