1	Health Impact Assessment for Healthy Places: A Guide for Planning and Public Health
2	What is a HIA? An HIA is a combination of procedures, methods and tools by which a policy 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. WHO Gothenberg consensus paper 1999
3	How Can You Use an HIA? You can use an HIA to focus the attention of decision-makers on the health consequences of the projects and policies they are considering. An HIA should lead to a better informed decision with respect to health.
4	What Values Underpin an HIA? Democracy Equity Sustainable development Scientific and robust practice Holistic approach to health Source: National Institutes for Health and Clinical Excellence
5	What are the Benefits of Including the Community in an HIA? Increases buy-in Helps identify social issues as well as health issues Addresses community concerns Builds community capacity
6	What are the Challenges of Including the Community in an HIA? May substantially add to time and resources needed to conduct an HIA At times, lay and expert knowledge may come into conflict It may be difficult to identify and engage all stakeholders in a timely manner
7	Environmental Impact Assessments 1969 National Environmental Policy Act (NEPA) Requires Environmental Impact Assessments The purpose of NEPA is to protect the “human environment” and “stimulate the health and welfare of man” (NEPA, 1979, sec. 2)
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10	Steps in Completing an HIA Include: Screening Scoping Assessment Reporting Evaluation
11	SCREENING
12	Steps in the Screening Process Define the policy, program or project Determine whether you should conduct an HIA Determine what type of assessment to complete Make a preliminary assessment of whether to proceed Briefly assess the potential health impacts Review decision with stakeholders Start to identify modifications to the policy/projects which may increase positive health outcomes and minimize negative health outcomes
13	Define the Project or Policy An HIA is most useful when: Health issues are brought to the planning table The policy or project decisions do not traditionally consider health There are likely to be significant health impacts that are not already being considered The HIA can be completed before key decisions are made and stakeholders are likely to use information Sufficient data and resources are available
14	When is an HIA Not Appropriate? Instances where information is vague, unreliable or not available Situations when there is little or no local support for an HIA Decisions where the stakeholders will not take health into consideration Situations when decisions have already been made and there is no turning around
15	Types of HIAs Rapid Intermediate Comprehensive
16	A Rapid HIA… Provides a broad overview of possible health impacts Can be used at an early policy development stage or where limited time/resources are available Involves collecting and analyzing existing data and researching previous HIAs Is usually carried out in days to weeks with minimal resources
17	An Intermediate HIA… Provides more detailed information of possible health impacts Most frequent HIA approach Allows more thorough investigation of health impacts Involves reviewing available evidence, any similar HIAs and collecting and analyzing new data Can take weeks to months to complete May involve community input
18	A Comprehensive HIA Provides a thorough assessment of potential health impacts Contains most robust definitions of impacts, but least frequently used Involves a review of available evidence and any similar HIAs Involves collecting and assessing new data using multiple methods and sources (quantitative and qualitative data including stakeholders’ opinions) Takes a long time to complete Involves community input
19	Scoping
20	The Purpose of Scoping Establishes the foundation for conducting the health impact assessment Designs and plans the HIA Highlights key issues that will be considered Determines what impacts to assess
21	Steps in the Scoping Process Establish ground rules Define the policy or project Gather preliminary information Specify what impacts to assess Create a logic framework summarizing the relevant causal linkages or Complete a scoping checklist Consider assessment approach
22	1. Establish Ground Rules Clarify roles of stakeholders and partners involved in scoping the HIA Determine who has final authority to decide the scope of the HIA Set timelines Establish responsibility for convening meetings and other administrative tasks Determine who will pay for the HIA
23	2. Define the Policy or Project Describe the policy or project and its likely impacts Establish boundaries for the HIA Identify needed resources Identify partners Describe the intended impacts Determine geographical, temporal, and population based parameters
24	3. Gather Preliminary Information Describe the characteristics of the population Identify at-risk groups Describe the health status of the population Define environmental conditions of the target population
25	Finding the Information Gray literature Peer reviewed literature Key informants or stakeholders who provide local information that may not be available in the public domain Experts in relevant fields who can identify the health related outcomes
26	4. Specify What Impacts to Assess Identify how the policy or project will affect health Identify the health outcomes of interest
27	Tools to Help Specify Impacts to Assess A logic framework summarizing the relevant causal linkages or A scoping checklist
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29	A Scoping Checklist… Is another way to identify what health impacts to assess Is a systematic method for quickly identifying and assessing health impacts Have previously been developed by: UCLA Greater London Authority
30	5. Consider Assessment Approach Most HIAs will use a combination of quantitative and qualitative data Quantitative HIAs should not be seen as superior to qualitative HIAs The most important point is that the HIA has an impact on the decision
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32	Types of Assessment Qualitative and Quantitative Qualitative – describes the direction and certainty but not magnitude of predicted results. Quantitative – describes the direction and magnitude of predicted results.
33	5. Consider Assessment Approach Qualitative Takes less time Is less complicated Quantitative Is more complicated May require modeling skills Needs high quality baseline and impact data Results are often “viewed” as more credible
34	What Impacts to Assess Most HIAs will use a combination of quantitative and qualitative data Quantitative HIAs should not be seen as superior to qualitative HIAs The most important point is that the HIA has an impact on the decision
35	"“not everything that can..." “not everything that can be quantified is important…and not everything that is important can be quantified” -Mindell, et al. 2001 (page 173)
36	Steps in the Assessment Process Determine what data are needed and what are available. Gather information using a variety of sources. Previous HIAs on similar topics Census data, BRFSS, NHANES Grey literature and published literature Assess qualitative and quantitative evidence If possible, construct quantitative models and estimate potential health effects
37	Information Gathering Characterize the population in terms of size, density, distribution, age, sex, employment rates, SES and other demographic information Determine the health status of the population in terms of mortality, disability and morbidity data Identify health risk behaviors and locations where at-risk groups may be concentrated Determine the environmental conditions of the population
38	Qualitative Methods to Determine Health Impacts Assess evidence pertaining to each of the links in the causal chains leading the policy to the health outcomes If possible, use evidence from the literature to determine direction (positive, negative, neutral, or can’t estimate effect) and certainty (speculative, probable, definite)
39	Quantitative Methods to Determine Health Impacts Construct quantitative models and estimate potential health effects Perform sensitivity analysis (a.k.a. confidence intervals) List the assumptions and limitations Quantitative assessment may not be feasible due to data, time, or resource constraints
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41	Components of Good Reports Deliver clear recommendations Address the needs of the audience Include only what is necessary Provide findings that will support decision making Use a format that addresses the audience Involve the community
42	How to Formulate Recommendations Explore what has been done elsewhere Use common sense Determine what is feasible but also consider what is possible Provide several options reflecting different cost and impact levels Look to the community and stakeholders for creative solutions Provide incentives such as tax breaks or a quick approval process
43	Reports for Different Audiences A technical manual for other HIA specialists A manuscript for academics (sometimes) A brief summary for the public, stakeholders and the media
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45	Benefits of HIA Evaluation Improve the HIA process Modify future procedures or models Assess the accuracy of predictions made during appraisal
46	Three Types of HIA Evaluation Process evaluation Evaluates the process of completing the HIA Impact evaluation Evaluates the effect the HIA had on the decision making process Outcome evaluation Evaluates whether the predicted health outcomes were correct or not
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