Stakeholder participation in health impact assessment: A multicultural approach

The literature on impact assessment (HIA) registers the importance of stakeholder participation in the assessment process, but still lacks a model for engaging stakeholders of diverse ethnic, professional and sectorial backgrounds. This paper suggests that the multicultural approach can contribute to HIA through a revision of the generic 5-step HIA model, and its implementation in a metropolitan plan in Southern Israel. The health issue scoped by the stakeholders in the HIA is related to land uses in the vicinity of the national hazardous industry and hazardous waste site. The stakeholders were representatives of the diverse populations at stake, including rural Bedouins and Jewish city dwellers, as well as representatives from the public sector, private sector, non-governmental organizations and academia. The case study revealed that a multicultural stakeholder participation process helps to uncover health issues known to the community which were not addressed in the original plan, and provides local knowledge regarding health conditions that is especially valuable when scientific data is uncertain or absent. It enables diverse stakeholders to prioritize the health issues that will be assessed. The case study also reveals ways in which the model needs revisions and improvements such as in recruitment of diverse participants. This paper presents a multicultural model of HIA and discusses some of the challenges that are faced when HIA is implemented in the context of current decision-making culture.     

Health impact assessment and health equity in sub-Saharan Africa: A scoping review

BackgroundNatural resource extraction projects can have positive but also negative effects on the health of affected communities, governed by demographic, economic, environmental, physical and social changes. Negative effects often prevail and these might widen existing health inequities. Health impact assessment (HIA) is a decision-support tool that aims at maximizing benefits and minimizing negative impacts on people's health. A core value of HIA is equity; yet, little is known about health equity in the frame of HIA, particularly in sub-Saharan Africa.MethodologyWe conducted a scoping review to determine whether and to what extent HIA in sub-Saharan Africa addresses health equity. We included peer-reviewed publications and guidelines pertaining to HIA, environmental impact assessment (EIA) and social impact assessment (SIA). Health equity was investigated by identifying (i) how health considerations were addressed and (ii) whether health was stratified by subgroups of the community.ResultsOut of 1′640 raw hits, we identified 62 articles (16 HIA, 36 EIA, one SIA and nine integrated assessments), 32 of which specifically addressed health. While 20 articles focused on a specific health topic, 12 articles used a more comprehensive approach to address health. In 15 articles there were specific subgroup analyses (e.g. mothers, children or marginalized groups) as a measure of health equity. Another 12 papers referred to the community in a more general way (e.g. affected). Without exception, health was an integral part of the nine included guidelines. HIA guidelines addressed health systematically through environmental health areas, risk assessment matrix or key performance indicators.ConclusionsWe found evidence that previously conducted HIA in sub-Saharan Africa and current guidelines address health equity. However, there is a need to stratify community subgroups more systematically in order to determine health differentials better. Future HIA should consider community heterogeneity in an effort to reduce health inequities by “leaving no one behind”, as suggested by the Sustainable Development Goals.     

Knowledge, data and interests: Challenges in participation of diverse stakeholders in HIA

Stakeholder participation is considered an integral part of HIA. However, the challenges that participation implies in a multi-disciplinary and multi-ethnic society are less studied. This paper presents the manifestations of the multiplicity of sectors and population groups in HIA and discusses the challenges that such diversity imposes. Specifically, there is no common ground between participants, as their positions entail contradictory knowledge regarding the current situation, reliance on distinct data and conflicting interests. This entails usage of multiple professional and ethnic languages, disagreements regarding the definition of health and prioritizing health issues in HIA, and divergent perceptions of risk. These differences between participants are embedded culturally, socially, individually and, maybe most importantly, professionally. This complex picture of diverse stakeholder attributes is grounded in a case study of stakeholder participation in HIA, regarding zoning of a hazardous industry site in Israel. The implication is that participatory HIAs should address the multiplicity of stakeholders and types of knowledge, data and interests in a more comprehensive way.     

Evaluating the impact of HIA on urban reconstruction decision-making. Who manages whose risks?

Practitioners and academic researchers increasingly look to evaluation of health impact assessment (HIA) to improve its practice, its efficiency and its legitimacy. Evaluation is also used to account to policy-makers, who express doubts that the benefits of HIA justify its costs. Until recently evaluation of HIA focused on instrument design and procedures but now the focus needs to shift to analysis of the interaction of HIA and decision-making. Multiple case studies have been applied to identify the conditions in which HIA produces the desired benefits. These studies used analytical concepts derived from the literature on evaluation, knowledge utilization, science of sociology and knowledge management.This paper describes a case study in which the strategic motives of the decision-makers affected the impact of an HIA. This HIA comprised of a quantitative environmental model ‘City & Environment’ that was used to assess environmental health impacts of an urban reconstruction plan in a Dutch city. The evaluation of the HIA shows that the decision to follow the recommendations of the HIA was part of a damage control strategy. The more HIA goals deviate from the policy problem and the less HIA is embedded in institutional procedures, then the more HIA impact will be subject to strategic decision-making behaviour. Appropriate cognitive and social strategies are needed to avoid ‘negative learning’ in those the HIA seeks to influence.     

Meaningful and efficient? Enduring challenges to Aboriginal participation in environmental assessment

This paper explores the underlying practice-based challenges to meaningful and efficient Aboriginal participation in environmental assessment (EA) - participation that provides meaningful opportunities for Aboriginal communities to shape EA, yet assures a degree of efficiency for project proponents who need to obtain EA approvals in a timely and financially viable manner. We do so based on an analysis of the EA policy community's experience with uranium exploration and mining in Saskatchewan, Canada. Many of the challenges to meaningful and efficient Aboriginal participation that emerged are multi-dimensional, often concerning participation processes, decision-making, and relationships. Although scholars have explored many of these issues and have proposed numerous solutions, challenges persist in practice. Several other issues also emerged from our study that have received limited attention, including the non-commitment to early and ongoing participation by smaller project proponents, and the EA exemption of exploration projects; the limited availability of information to project developers on local right holders and Aboriginal interests; expectations about the integration of traditional knowledge and land use in EA not aligning with the information that is available to proponents; confusion about who is responsible for initiating early participation and consultation processes; the lack of early relationship building with potentially affected communities, particularly by governments; and the lack of other viable avenues, outside EA, for Aboriginal communities to raise more strategic issues of concern that affect traditional lands and treaty rights.     

Building capacity for Health Impact Assessment: Training outcomes from the United States

BackgroundDespite the continued growth of Health Impact Assessment (HIA) in the US, there is little research on HIA capacity-building. A comprehensive study of longer-term training outcomes may reveal opportunities for improving capacity building activities and HIA practice.MethodsWe conducted in-depth interviews with HIA trainees in the United States to assess their outcomes and needs. Using a training evaluation framework, we measured outcomes across a spectrum of reaction, learning, behavior and results.ResultsFrom 2006 to 2012, four organizations trained over 2200 people in at least 75 in-person HIA trainings in 29 states. We interviewed 48 trainees, selected both randomly and purposefully. The mean duration between training and interview was 3.4 years. Trainees reported that their training objectives were met, especially when relevant case-studies were used. They established new collaborations at the trainings and maintained them. Training appeared to catalyze more holistic thinking and practice, including a range of HIA-related activities. Many trainees disseminated what they learned and engaged in components of HIA, even without dedicated funding. Going forward, trainees need assistance with quantitative methods, project management, community engagement, framing recommendations, and evaluation.ConclusionsThe research revealed opportunities for a range of HIA stakeholders to refine and coordinate training resources, apply a competency framework and leverage complimentary workforce development efforts, and sensitize and build the capacity of communities.     

Exploring experts' views and perspectives on the enhancement of Strategic Environmental Assessment in European small islands

Small islands have the attention of the international community because they are territories with unique features, and a pressing need for the enhancement of sustainability. Strategic Environmental Assessment (SEA) has characteristics that may promote the development and improvement of sustainability in these territories: (i) changing the mind-set, and the decision-making and institutional paradigm, (ii) facilitating cooperation and coordination between different stakeholders, and (iii) providing a framework for good governance and community empowerment. The scientific literature suggests that there may be a need for context-specific SEA in these territories. However, SEA studies often do not incorporate local contextual information, including intuitive knowledge and sense of place. Therefore, there is a possible gap between what is found in the literature and what local communities think, including different stakeholders and experts. Hence, the main goal of this research was to gain an insight into the views and perspectives of small islands SEA experts about issues related to SEA in European small islands, including context-specific approaches, as well as the contribution of SEA for sustainability in these territories. To achieve the research aim, exploratory research using a questionnaire-based survey was designed, aimed at experts on SEA in European small islands. Findings showed regional cooperation networks may have a fundamental role when developing SEA-specific approaches in these territories. This is because SEA-specific approaches encourage a joint effort among islands within one region to improve SEA capacity-building, develop and share a baseline information system, and to share and exchange resources, overall. Also, guidelines are preferred among experts over more legal frameworks and regulations. Finally, the research showed that experts view SEA as a way to enhance sustainability in small islands. This study highlights the importance of integrating stakeholders, such as territorial experts, to learn and promote the use and improvement of environmental and sustainability tools such as SEA.     

Advancing the practice of health impact assessment in Canada: Obstacles and opportunities

Health Impact Assessment (HIA) is recognized as a useful tool that can identify potential health impacts resulting from projects or policy initiatives. Although HIA has become an established practice in some countries, it is not yet an established practice in Canada. In order to enable broader support for HIA, this study provides a comprehensive review and analysis of the peer-reviewed and gray literature on the state of HIA practice. The results of this review revealed that, although there is an abundance of publications relating to HIA, there remains a lack of transparent, consistent and reproducible approaches and methods throughout the process. Findings indicate a need for further research and development on a number of fronts, including: 1) the nature of HIA triggers; 2) consistent scoping and stakeholder engagement approaches; 3) use of evidence and transparency of decision-making; 4) reproducibility of assessment methods; 5) monitoring and evaluation protocols; and, 6) integration within existing regulatory frameworks. Addressing these issues will aid in advancing the more widespread use of HIA in Canada.     

Health impact assessment in Latin American countries: Current practice and prospects

BackgroundWith the objective to avoid and mitigate potential adverse health impacts of projects, programmes and policies, health impact assessment (HIA) offers an opportunity for disease prevention and health promotion. Although HIA has gained importance over the past two decades, it is unclear whether and to what extent HIA practice has been established and institutionalised in Latin America. To address this issue, the current practice and prospects of HIA in Latin America was assessed in the peer-reviewed literature and existing guidelines.MethodologyThe peer-reviewed literature was systematically searched using five electronic databases until February 2016. Studies were included on a set of pre-defined criteria. The search was carried out in English, French, Portuguese and Spanish. Additionally, a search for HIA guidelines used in Latin American countries and territories was performed by means of a Google search and on websites of government departments and institutions that may promote HIA.ResultsThe search yielded 167 hits in the peer-reviewed literature of which 17 articles met inclusion criteria. Only four peer-reviewed articles described prospective HIAs and four featured a discussion of the HIA approach. The remaining nine articles presented health impact evaluations. Most studies were published only recently, after 2012 (88%). Seven HIA guideline documents were identified, two of which were country-specific (i.e. Brazil and Mexico) and the remaining five addressed HIA at the regional level.ConclusionsThis study confirmed the paucity of literature pertaining to HIA implementation, as well as HIA guidelines in Latin America. Mexico, Brazil and Cuba have the longest track record in scientific literature and guidelines on HIA. In order to better understand current barriers and limitations to practice and institutionalisation of HIA in Latin American countries, a broad discussion among policy makers, academic institutions and HIA practitioners is warranted nationally and regionally.     

Knowledge brokerage - potential for increased capacities and shared power in impact assessment

Constructive and collaborative planning theory has exposed the perceived limitations of public participation in impact assessment. At strategic levels of assessment the established norm can be misleading and practice is illusive. For example, debates on SEA effectiveness recognize insufficiencies, but are often based on questionable premises. The authors of this paper argue that public participation in strategic assessment requires new forms of information and engagement, consistent with the complexity of the issues at these levels and that strategic assessments can act as knowledge brokerage instruments with the potential to generate more participative environments and attitudes. The paper explores barriers and limitations, as well as the role of knowledge brokerage in stimulating the engagement of the public, through learning-oriented processes and responsibility sharing in more participative models of governance. The paper concludes with a discussion on building and inter-change of knowledge, towards creative solutions to identified problems, stimulating learning processes, largely beyond simple information transfer mechanisms through consultative processes. The paper argues fundamentally for the need to conceive strategic assessments as learning platforms and design knowledge brokerage opportunities explicitly as a means to enhance learning processes and power sharing in IA.     

Evaluating impacts of marine governance on human communities: Testing aspects of a human impact assessment model

A human impact assessment (HIA) model was developed to guide research to understand how changes in a fishery can impact fishermen and fishing communities. Path analysis demonstrates that job satisfaction is an important variable intervening between marine governance and well-being. Individual-level variables in the demographic latent variable influence aspects of job satisfaction as well as well-being. It is variance in management that influences satisfaction with fishing which has a direct effect on well-being. In the HIA model, the three components of job satisfaction (self-actualization, income, and psycho-social) have the greatest total impact on well-being. The model also indicates complex relationships between management, fishing activity attributes, job satisfaction, and individual and social attributes. Relationships between community context and differences in job satisfaction in the Northeast and Alaska regions confirmed that these factors, also included in the HIA model, are important aspects of impact assessment. Results help to show that changes in ocean governance have impacts on the human communities who use these important resources. To anticipate and ameliorate potential impacts on human well-being as indicated by tools such as the HIA model, research needs to be accomplished to appropriately design and account for these impacts.     

The community cost of consultation: Characterising the qualitative social impacts of a wind energy development that failed to proceed in Tasmania,Australia

Energy developments affect communities in a range of ways. Impacts on communities can be caused by changes to landscape amenity and access, disruptions to community cohesion, increased or decreased income streams, effects on property values, and population changes. These changes are ideally captured in the social impact assessment (SIA) process, where proponents outline in a formal statement the balance of benefits and burdens on local communities, and measures that will be taken to minimise negative outcomes for the community. In SIA practice there is a tendency toward quantitative socio-economic impacts, such as changes to demographics, income, and land values, with some qualitative assessment of amenity impacts. While the academic literature promotes inclusion of changes to the community itself, such as impacts on community cohesion and social capital, these qualitative changes are not consistently evident in SIA practice. Additionally, SIA practice assesses the impacts of the project, i.e. how the development of wind turbines or other energy infrastructure will affect the community. Because the consultation process around a proposed project typically commences prior to the characterisation and assessment of any associated social impacts and the finalisation of the SIA process, the potential impacts of this consultation are rarely, if ever, evaluated. Here, we examine a case study of an Australian wind energy project that did not proceed to implementation. Through this case study we are able to analyse the anticipatory impacts of the proposal; those stemming from the consultative process rather than the development of the project itself. We present these qualitative social changes, and outline the pathways through which the social changes manifest in two overarching social impacts: a divided community and future development capacity. We discuss the implications of this analysis in the context of good engagement practice and energy governance.     

Reconceptualizing public participation in environmental assessment as EA civics

Notwithstanding the considerable attention placed on creating meaningful opportunities for public participation in environmental assessment (EA), many participants and those who have reviewed participation processes often find practice sorely wanting. This reality stands in stark juxtaposition to future environmental governance needs, which will require increased openness, deliberation and transdisciplinary knowledge in order to deal with environmental change that is ever more uncertain, complex and conflictual. In this paper, our purpose was to consider how to meet those needs through reconceptualizing public participation as EA civics, founded on an active citizen base, deliberative in nature and orientated toward learning. We do this through developing a new conceptual model of next generation participation processes that is relevant at multiple spatial scales and institutional levels, is applicable to the entire assessment cycle and spans temporal scales through feedback loops. Our EA civics model builds on the “civics approach” to environmental governance and “action civics” by extending their core ideas to participation in EA. We did this by conducting an integrative literature review (including numerous papers we have contributed over the years) and reflecting on our own experiences as EA participants. We apply current thinking on public participation design to our EA civics conceptualization and highlight important design features that have received scant attention. We conclude that EA civics holds promise for fairer and more robust participation processes if all aspects of the model are considered and the actions related to each are implemented.     

Perception survey on the relevance of main categories of health determinants for conducting health impact assessment

Addressing the characterization of social and economic determinants of health (SDH) properly is a key aspect in conducting a Health Impact Assessment (HIA). This article explores the level of knowledge on HIA environmental and public health professionals have as well as their perception regarding key concepts such as the definition of ‘health’ and the relevance of SDH. With this purpose in mind, a survey was conducted among experts (n = 41) who attended a technical session on HIA within the framework of the most important conference on the Environment on a national level in Spain. A hierarchical cluster analysis was conducted to categorize groups of respondents depending on their working profile and professional expertise and a Friedman test was used to compare mean ranks so as to assess the importance given to SDH according to the target respondents' perception. Strong differences were found in the relevance given to diverse SDH according to their contribution to a good state of health, the block referring to ‘Habits and lifestyle’ being the one perceived as more significant. SDH were ranked in a diverging order from that reported in the scientific evidence regarding the association between SDH and a wide range of health outcomes. Also, some diverging trends were illustrated between groups of respondents according to the relevance given to each block of SDH. However, differences in responses between groups of respondents were not statistically significant. A self-appraisal by respondents also revealed that the practitioner's level of knowledge on HIA ranged between low to medium. Therefore, it is recommended to improve their capacity.     

The role of Health Impact Assessment in the setting of air quality standards: An Australian perspective

The approaches used for setting or reviewing air quality standards vary from country to country. The purpose of this research was to consider the potential to improve decision-making through integration of HIA into the processes to review and set air quality standards used in Australia.To assess the value of HIA in this policy process, its strengths and weaknesses were evaluated aligned with review of international processes for setting air quality standards.Air quality standard setting programmes elsewhere have either used HIA or have amalgamated and incorporated factors normally found within HIA frameworks. They clearly demonstrate the value of a formalised HIA process for setting air quality standards in Australia.The following elements should be taken into consideration when using HIA in standard setting. (a) The adequacy of a mainly technical approach in current standard setting procedures to consider social determinants of health. (b) The importance of risk assessment criteria and information within the HIA process. The assessment of risk should consider equity, the distribution of variations in air quality in different locations and the potential impacts on health. (c) The uncertainties in extrapolating evidence from one population to another or to subpopulations, especially the more vulnerable, due to differing environmental factors and population variables. (d) The significance of communication with all potential stakeholders on issues associated with the management of air quality.In Australia there is also an opportunity for HIA to be used in conjunction with the NEPM to develop local air quality standard measures. The outcomes of this research indicated that the use of HIA for air quality standard setting at the national and local levels would prove advantageous.     

Health impact assessment research and practice: A place for paradigm positioning?

In this article, we provide a critical review of the place of paradigm in health impact assessment (HIA) research and practice. We contend that most HIA practitioners have given insufficient attention to paradigm positioning when developing and applying HIA methodologies and that some concerns about current HIA practice can be attributed to this. We review HIA literature to assess the extent and nature of attention given to paradigm positioning and these related concerns. We then respond to our critique by exploring the implications, opportunities and challenges of adopting a critical realist paradigm, which we believe has the potential to help HIA practitioners to develop HIA methodology in a way that addresses these issues.     

A prospective health impact review of the redevelopment of Central Manchester Hospitals

Health Impact Assessment (HIA) is increasingly being acknowledged as an important tool for considering the health implications of projects and programmes of activity at local, national and international levels. However, standard HIA tools can be difficult to apply when the policy of programme under consideration is particularly complex and intertwined or where significant time, resource and skill constraints are involved. This paper describes a Health Impact Review (HIR) of the plans for a major redevelopment of Central Manchester Hospitals (England). This approach to HIA drew not only from HIR but also from Integrated Impact Assessment (IIA) in order to produce a summary of the most significant health impacts of a policy, programme or project in a more timely and cost-effective way. This example highlights the potential for involving Local Authority Overview and Scrutiny Committees in the HIA process as a way of ensuring that the recommendations of HIA are mainstreamed as part of the ongoing development of projects.     

Community Participation in Natural Resources Management: Reality or Rhetoric?

In the developing world, the term ‘participation’ has in recent years become a household word in the same way that ‘democracy’ or ‘gender’ have. Development agencies are demanding increased participation in their programmes. The use of the word or its application has become a centre of debate. Due to the difficulties involved in measuring ‘participation’ or indeed determining levels at which participation should take place, who participates and when, many ‘doubting Thomases’ have questioned its effectiveness. It has, however been acknowledged in many areas that popular participation changes policies and enhances management and governance. In complex issues of natural resources management, participatory techniques have helped communities develop collective responsibilities towards management of their resources and projects. This paper discusses the complexities of community participation in natural resources management, ranging from interrelations among stakeholders to resource ownership based on the experiences in the Kasanka Game Management Area (KGMA). Lessons learnt from the Kasanka Game Management Area (GMA) communities, Serenje district, Zambia     

Understanding why impact assessment fails; a case study of theory and practice from Wafi-Golpu,Papua New Guinea

From an instrumental or management perspective, impact assessment (IA) is a process of identifying impacts, finding solutions and achieving project approval. A recipient community, however, has a completely different perspective. For them the IA is about living with impacts, individually and collectively, perhaps over generations, and contested processes of self-determination, consultation and exclusion. IA practitioners live in a third space, usually bound to the proponent but also aware of responsibilities to communities and eco-systems. Seeking to better understand how IA is practiced and experienced, we explore the proposed Wafi-Golpu mine, located in the Morobe Province of Papua New Guinea. Determinably focused on local effects we situate the proposed mine within the context of the national mining experience and discuss how IA practices see local and/or Indigenous communities. We find that the Wafi-Golpu IA is blind to local ways of being and seeing the world, with an opaque and arbitrary assessment that reflects its technical and Western basis and bias. We finish with observations about the proposed Wafi-Golpu mine and IA that is relevant to the approval process, as well as making a decolonial, Southern contribution to IA theory and practice, extractive industry regulation and mining-affected communities elsewhere.     

The impact and effectiveness of health impact assessment: A conceptual framework

The use of health impact assessment (HIA) has expanded rapidly and there are increasing demands for it to demonstrate its effectiveness. This paper presents a conceptual framework for evaluating HIA and describes its development through (i) a review of the literature, (ii) a review of work undertaken as part of a major HIA capacity building project and (iii) an in-depth study of seven completed HIAs. The framework emphasises context, process and impacts as key domains in understanding and evaluating the effectiveness of an HIA. This new framework builds upon the existing approaches to evaluating HIA and extends them to reflect the broad range of factors that comprise and influence the effectiveness of HIAs. It may be of use in evaluating completed HIAs and in planning HIAs that are yet to be undertaken.