Health Impact Assessment (HIA)

* The next Lothian HIA Group meeting is scheduled for 07 August 2006 at 1pm, Meeting Room 2 at Deaconess House, Edinburgh.*

Health and wellbeing are determined by many things. Although NHS services are vitally important in treating people's illnesses and aiding recovery, many of the factors that determine our health status are actually not related to the NHS. Transport, housing, employment, education and leisure are just a few of the things that have a massive influence on people's wellbeing. In recent years, particularly since the 1998 Acheson Report into health inequalities, there has been much focus on how to engage with non-health sector policies and programmes as a way to tackle health inequalities. Health impact assessment has been identified as one approach to addressing health inequalities both inside and outside the NHS.

The most commonly used definition of health impact assessment (HIA) is taken from the World Health Organisation Gothenburg consensus paper on HIAⁱ:

'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'.

HIA has a clear purpose: to minimise the likelihood of negative health outcomes, maximise positive health impacts and therefore produce better policy and decision-making.

HIA includes consideration of qualitative and quantitative evidence about the relationships between a proposal and the health of a population, including the views of communities who may be affected by it. It tries to identify all potential health impacts: intended and unintended, positive and negative. This should provide both decision makers and the public with a more complete picture of the health consequences, and lead to recommendations for change, to enhance the positive and mitigate the negative health impacts of a proposal.

HIAs should be completed on policies, projects or proposals prior to their implementation. There are three types of HIA carried out in Lothian: health impact screening, rapid health impact assessment and detailed health impact assessment.

• Health impact screenings usually involve a screening exercise and a written report about the screening and the conclusions reached.
• Rapid HIAs take into account more than one screening and may supplement the written report of the screenings with further research about the topic under discussion. They tend not to involve public consultation.
• A detailed HIA is done for major projects where a screening suggests that there may be significant health impacts or considerable uncertainty about the impacts of a policies etc. Detailed HIAs are usually undertaken on major policies etc. e.g. housing developments, regeneration proposals and so on - and necessitate substantial research and consultation.