Health Impact Assessment
A Health Impact Assessment is 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. In other words it is a process that considers the wider effects of local and national policies or initiatives and how they, in turn, may effect people's health. The environment, income, employment, transport, the design and condition of houses, crime and the social and physical condition of local neighbourhoods all contribute to good and poor health. HIA identifies how a particular decision will alter these determinants and assesses the likely impact on the health of different groups in a population.
There is no standard way of doing a Health Impact Assessment. The combination of procedures, methods and tools will depend entirely on the type of proposal that is being assessed and the decision making structures of the organisation undertaking the assessment. The proposal concerned may range from projects (such as a housing development), to programmes (such as urban regeneration) to policies (such as a transport strategy).
Wherever possible assessments should be done in partnership with stakeholders (ie those affected by, and/or have an interest in, the proposal in question). HIAs make use of any relevant evidence or expertise that would help them to make judgements about the potential impacts and is therefore a mechanisms to support evidence and knowledge based decision making.
Why do it?
- To promote greater equity in health
- To promote evidence and knowledge based planning and decision making
- To maximise health gain and minimise health loss by informing and influencing decision-making in favour of health
- To reduce inequalities by addressing health impacts on vulnerable populations
- To encourage better co-oirdination of action between sectors to improve and protect health
- To identify the connections between health and developments in other policy areas
- To increase awareness of health in the wider policy arena
How do we do it?
There are five stages to carrying out a Health Impact Assessment.
Screening – the process of deciding whether it is appropriate or necessary to carry out an HIA?
Scoping – How should we do the HIA? Determining the focus, methods and work plan.
Appraisal/Assessment – Identifying the health impacts
Reporting and Decision Making – Influencing the process
Monitoring and Evaluation – of the process, impact and outcomes
There are also different levels of HIA; rapid, intermediate and comprehensive. The level of HIA depends on a number of factors:
- what is being assessed
- the complexity of what is being assessed
HIAs can also be conducted retrospectively, prospectively or concurrently. Obviously, the ideal would be for the HIA to take place prospectively in order for the process to have maximum impact and influence on the proposal. However, the assessment should not be carried out so early that the objectives of the proposal are not clear. Sometimes it can be useful to carry out retrospective HIAs on unexpected events from which lessons can be learnt.
A good HIA:
- takes a broad view of health and inequalities
- involves a range of disciplines
- involves a range of stakeholders
- engages public health in planning process
- provides information to aid decision making
- adds value
HIA does not:
- provide ‘the' answer
- provide exact quantitative results
- duplicate other impact assessments
- exist in a social, cultural or political vacuum
- avoid the need for difficult decisions
Important issues to consider:
- Steering Group and accountability
- Who are the stakeholders?
- Who are the decision makers?
- What resources are available?
- Other impact assessments
EMPHO is keen to build capacity and provide support in HIA across the East Midlands. These pages will be developed to be a comprehensive resource for anyone thinking about conducting a HIA, including providing a medium for examples of HIAs to be shared and best practice ‘showcased'. If you have any questions about the information on these pages, would like to make a comment or suggestion about how they can be improved, or have examples of good practice relating to HIAs or examples of current and completed HIAs that you would like to share on these pages, please contact:
In addition, if you have a particular interest in Health Impact Assessment and would like to be part of an East Midlands HIA network please email
with your contact details.
Links to more detailed, existing guidance about how to carry out a health Impact Assessment are below.
The Institute of Public Health in Ireland have produced the following ‘tool' to give practitioners step by step guidance.
The Welsh Health Impact Assessment Support Unit have also produced a practical guide to health impact assessment which includes a very useful basic screening record sheet and assessment summary sheet.
Guidance and information about how to carry out an HIA can be found on the HIA Gateway website.
The Merseyside Health Impact Assessment Steering Group have produced this guidance.
The Care Services Improvement Partnership - North West Development Centre have produced a Mental Health Webb-being Impact Assessment Toolkit which is designed to help to identify how a proposed policy, programme or project will impact on mental well-being and what can be done to ensure it has the most it has the most positive impact.