The basics of health impact
assessment (HIA): Part 1
Erica Ison
Specialist Practitioner in HIA and HiAP
Expert Adviser in HIA,
WHO Network of European Healthy Cities,
Phase IV
What is the overall purpose of HIA?
To improve the health of the population by:
• Encouraging an awareness and understanding
of health at every level of policy- and
decision-making
• Establishing a desire to improve health as
routine during policy- and decision-making
• Making policy- and decision-making
“healthy”
What is the intention behind HIA?
• The main intention when undertaking HIA is to
provide information to support decisionmaking about a particular proposal:
– Potential impacts of a proposal – beneficial and harmful;
differential
– Suggestions about ways to maximise the benefits and
minimise the harms, and ways to reduce inequalities
and/or inequities
• HIA offers decision-makers the possibility of
changing a proposal to protect and improve
health, and to reduce inequalities/inequities,
thereby achieving health gain
Definition of HIA
“a combination of procedures, methods and
tools by which a policy, a program or project
may be judged as to its potential effects on
the health of a population and the
distribution of effects within the population”
WHO Gothenburg Consensus Paper, 1999
HIA: How is the term used?
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Concept
Process
Models
Methods
Tools
Approach
Models of HIA
Biomedical model of health Social or socio-economic
focusing on illness and
model of health focussing
disease
on prevention and health
promotion
Biophysical or
Social or socio-economic
environmental model of
model of HIA
HIA
Environmental
determinants of health
Socio-economic
determinants of health
Quantitative evidence
Qualitative evidence
Measurement of variables;
modelling
Descriptive
What are the determinants of health?
Determinants of health could be referred to as
the conditions of living that have an influence
on health:
• Social conditions
• Economic conditions
• Environmental conditions
• Cultural conditions
• Political context
Dahlgren & Whitehead: determinants of health
Barton
and Grant
HIA: judging potential effects
on health
Any proposal has two main types of effect
on health:
1. Direct
2. Indirect, through the determinants of
health
Investigating the potential impacts on health
and well-being
Proposal
Indirect Effects
Direct Effects
HEALTH
DETERMINANTS OF
HEALTH
Characteristics of HIA
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Multidisciplinary
Intersectoral
Range of different methods
Use of quantitative and qualitative evidence
Focus on health inequalities
Participatory
Values for HIA
• Sustainability – work
towards sustainable
development or
sustainable
communities
• Equity
• Democracy – people’s
democratic right to
participate in open and
transparent decisionmaking processes
• Ethical use of evidence
Classic process of HIA
5 stages
6 stages
Screening
Screening
Scoping
Scoping
Appraisal, including reporting
Appraisal
Reporting
Supporting decision-makers
Supporting decision-makers
Monitoring & evaluation
Monitoring & evaluation
Classic process of HIA
Stage of HIA
Key questions to answer
Screening
Do we undertake an HIA on this proposal or not?
Scoping
What are the boundaries for the HIA study? What are the
management arrangements? What are the overall governance
and accountability arrangements?
Appraisal
What are the proposal’s effects on health, for the whole
population and for vulnerable groups? How can we achieve
health gain through health protection, health improvement and
reducing health inequalities?
Reporting
How do we present the information about health impacts, and
suggestions to address those impacts, in an ethically responsible
way that is useful to and usable by decision-makers?
Supporting
decision-makers
How do we support decision-makers to understand the HIA
results in relation to other information about the proposal?
Monitoring and
evaluation
Process evaluation: Did the HIA process go well? Could it be
improved? Effectiveness evaluation: What effect did the HIA
have on the proposal? Outcome evaluation: What effect did the
amended proposal have on health?