Presentation from RTPI CPD June 2013

1. Health Impact Assessment (HIA)
&
Planning
18th June 2013
RTPI (West Midlands)
Sue Wright
Knowledge and Evidence Manager (Higher Level) HIA
Knowledge and Intelligence Team (West Midlands)
Sue.wright@phe.gov.uk

2. What is HIA?
• Combination of procedures, methods & tools
• That systematically judges the potential, & sometimes unintended,
effects of a policy, programme or project
• On both the health of a population, & the distribution of those effects
within the population
• HIA identifies appropriate actions to manage those effects
Quigley, R., L. den Broeder, P. Furu, A. Bond, B. Cave and R. Bos 2006 Health Impact Assessment International Best
Practice Principles. Special Publication Series No. 5. Fargo, USA: International Association for Impact Assessment.

3. What is HIA?
Screening
Consider whether
to perform an HIA
Scoping
Plan how the
HIA is to be done
Appraisal
Assessment of
Health impacts
Recommendations
Formulates
recommendations
for decision makers
Monitoring and
Evaluation
Actions to monitor
impacts and
evaluate HIA
Present health profile
Factors influencing health
How will plan change these
Is everyone equally
affected?
Enhance positive health
impacts
Reduce negative health
impacts/Mitigation
Reduce health inequalities

4. Purpose of HIA
The purpose of a HIA is to develop evidence based recommendations which
influence the decision making process. The recommendations inform decision
makers of the ways in which their proposal needs to be amended to enhance the
positive impacts and reduce or eliminate the negative impacts.
• Informs a decision and is a decision support tool
• Predicts the health consequences of implementing different options
But also
•
Increases awareness of health and health inequalities (better
informed)
•
Participation and engagement of stakeholders (decisions more open)
•
Fosters interagency working

5. HIA and Planning
• Planning has the potential to support,
sustain and improve health
• HIA is a tool to assess the health
consequences of decisions e.g. plans,
projects and programmes
• If HIA is considered at the planning and
design stage then HIA can contribute to
better decision making for health

6. Key features of HIA
• Broad definition of health
– More than just absence of disease
– More than access to healthcare/services
• Wider determinants of health
– Understanding of the many factors influence health
– E.g.: transport, education, income, social networks,
housing, income (see Dahlgren & Whitehead 1991 model)
• Addresses health inequalities
– Assesses differential impact on population groups

7. Food Safety
What doesSmoking
Health mean?
Older people
Drugs
Meningitis
Blood
Pressure
Accidents
Family
Bad Housing
Street
Suicide
Waiting
Lists
Diabetes
Lighting
Parenting
Water
Fluoridation
Feeling good
HIV/AIDS
Are you healthy?
Positive health
Exercise
What makes you healthy?
Health is “… a resource for everyday life, not the objective of living. Health is a
Heart Disease
Teenage
positive concept emphasizing social and personal resources, as well as physical
Pregnancy
capacities."[
World Health Organization. The Ottawa Charter for Health Promotion. Adopted at the First International Conference on Health
Promotion, Ottawa, 21 November 1986 - WHO/HPR/HEP/95.1.

8. 8
Haglund, Svanström, KI, revision, Beth Hammarström
HEALTH & HEALTH
INEQUALITIES

9. Prediction of health impacts
HIA makes assumptions explicit.
Show how a project may potentially affect the health of people
through intermediate variables
Proposal/
Project
Intermediate
Variables
Expected
Outcomes
Assumption that changes in one factor lead to other changes
which in turn lead to changes in health.
Build new
road
Increased
road speed &
traffic
Increased
road
accidents
Critical Guide to Health Impact Assessment (West Midlands Public Health Observatory)

10. Appraisal Stage of HIA
The appraisal stage of a HIA involves collecting the evidence and assessing the
health impacts. This is done by:
Policy Context
Community Profile
Literature & reports
Evidence
Analyse &
prioritise
Stakeholder views
Local Data
Expert knowledge
Modelling
Describe impacts
Which groups?

11. Unintended Health Impacts of
Health related Policies
Increase employment
opportunities/reduce
emissions
Improve
accessibility to
city centre
Cars
Emissions
“Park & Ride”
scheme in
outer city
Winter and Farthing (1997); Barker (1995)
Local bus
services not
viable in outer
city
Local
Business
Social
networks

12. Concerns about HIA
Criticism
Response
Costly
Estimated to be 0.01% of master plan development and
implementation1; not as costly as treatment of health impacts in
the long run
Time-consuming Conducting the HIA early will bring issues to the front of the
& slows
decision-making process, potentially speeding approval
decision making processes, and preventing costly litigation that delays projects
Stops economic
development
HIA identifies mitigations and recommendations to enhance
health and reduce risks but not to say “don’t do that”
HIA not
scientific
HIA pulls together disparate pieces of the best available
evidence to make a broad statement about impacts
Health impacts
already covered
e.g. open space,
cycling/walking
Unintended impacts and health inequalities not always
addressed; additional health enhancing actions could be
recommended (see HIA of Herne Bay)
1Cost
Benefit Analysis of Health Impact Assessment. University of York Health Economics Consortium (2006).

13. Does HIA work?
Studies
Impacts
Impacts
16 HIAs in England
2006
Positive influence on
decision making
Benefits outweighed
costs
HIA in 19 European
countries 2004-07
Increased awareness
of potential health
impacts across
sectors
Contributed to
specific policy
changes
76 HIAs in US 2010
Health successfully
incorporated into
planning processes

14. Gateshead 2008-present
Stoke –on-Trent 2009-present
Wanted to integrate health into Council
decision making
Integrate health into policies and decision
making
Established HIA steering group and HIA
champions in council departments
Research project on how the council
makes decisions and where health is
taken into account (SoT is a Healthy City)
HIA Steering Group
4 Pilot HIAs
4 Pilot HIAs supported by 2year
mentoring project
HIA events/awareness raising/training.
Guide to HIA published
HIA events/HIA training, also
development of high level IIA tool
Partnership with HIA expert
Partnership with HIA expert and
academic institution
Identified health impacts of council
decisions
Assessed council reports for HIA
Introduced “Place making for Health”
Supplementary Planning Document
Healthy Urban Planning-all development
plans (specific size) have to have HIA
Integrated HIA into Health and Wellbeing
Boards
Guide to health proofing master plans
published

15. What does HIA add?
Herne Bay Regeneration
Sustainability
Appraisal (SA) themes
SA Focus
HIA themes
HIA Focus
Historic
Environment
Historic character of
buildings
and identity
Neighbourhood image
Reputation and pride of place – impacts on
health-related behaviour e.g. relatively high
rates of binge drinking and teenage
pregnancy.
Need for community involvement in
shaping the character of the town
Employment and the
Economy
Out-commuting, need for
local employment, and
diversification of the
economy
Employment,
education and the
local economy
Out-commuting, need for local employment,
and diversification of the economy, protection
of those displaced in the regeneration.
Promote healthy workplaces in new
employment areas
Transport
Need to reduce
congestion and address
parking pressures
Traffic flow, car
parking and travel
Congestion and car parking management.
Safety of all road users; shared space;
active
travel
Quality of Life
Need for investment in
business and leisure
sectors
Participation; healthy
lifestyles
Integrate healthy lifestyle interventions
with community involvement in the
regeneration.
Focus on healthy settings approach

16. www.hiagateway.org.uk

17. What HIA is
about and other
health related
IAs
HIA reports from
1996 to present
Resources to
help do HIA
People to
contact; training;
events; and
other websites
http://www.apho.org.uk/default.aspx?RID=44538; www.hiagateway.org.uk