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.     

Rethinking human health impact assessment

Most EIA programs around the world require the consideration of human health impacts. Yet relatively few EIA documents adequately address those impacts. This article examines how, why, and to what extent health impacts are analyzed in environmental impact assessments in the U.S. An empirical study of 42 environmental impact statements found that more than half contained no mention of health impacts. In the others, health impacts were analyzed narrowly, if at all, using risk assessment to quantify the carcinogenic potential of a single substance over a single generation. This analytic focus overlooks other significant morbidity and mortality risks, cumulative and intergenerational effects, and broader determinants of health. This article investigates these problems and provides recommendations to improve human health impact assessment, using strategic environmental assessment, qualitative health data, health outcomes in addition to cancer, and a precautionary approach to risk.     

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.     

Advancing strategic environmental assessment in the offshore oil and gas sector: Lessons from Norway,Canada, and the United Kingdom

Abstract: Strategic environmental assessment (SEA) for offshore oil and gas planning and development is utilized in select international jurisdictions, but the sector has received limited attention in the SEA literature. While the potential benefits of and rationale for SEA are well argued, there have been few empirical studies of SEA processes for the offshore sector. Hence, little is known about the efficacy of SEA offshore, in particular its influence on planning and development decisions. This paper examines SEA practice and influence in three international offshore systems: Norway, Atlantic Canada and the United Kingdom, with the intent to identify the challenges, lessons and opportunities for advancing SEA in offshore planning and impact assessment. Results demonstrate that SEA can help inform and improve the efficacy and efficiency of project-based assessment in the offshore sector, however weak coordination between higher and lower tiers limit SEA's ability to influence planning and development decisions in a broad regional environmental and socioeconomic context.     

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.     

Testing an ex-ante framework for the evaluation of impact assessment laws: Lessons from Canada and Brazil

Scholars have been increasingly investigating legislative changes in Environmental Impact Assessment (EIA). However, most of the existing evaluation frameworks have been applied to ex-post scenarios, after EIA laws and respective policies and regulations had been implemented for some time. This article has a twofold objective: first, to propose an ex-ante framework for the evaluation of proposed EIA laws and, second, to test the application of the framework to bills C-69 and PL-3729, which target federal-level EIA reform in Canada and Brazil, respectively. The proposed framework is meant to indicate the extent to which proposed legislative changes meet 50 good practice criteria, thus providing a more balanced and transparent account of the issues that should be addressed effectively in the legislative process and in future regulations and guidelines. Results indicate very contrasting scope and potential effects of proposed legislative changes in the two countries. Brazil's bill is essentially intended to integrate existing regulations into a law that would make EIA faster, simpler and less frequent. Canada's bill, recently approved by Parliament, includes a new Impact Assessment Act that is expected to deliver more comprehensive and credible assessments. The ex-ante framework, by exposing how close or distant proposed EIA regimes are from good practices, can be particularly helpful in lawmaking and regulatory design. The article finally discusses limitations and highlights future avenues of research.     

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.     

Equity-focused health impact assessment: A tool to assist policy makers in addressing health inequalities

In Australasia (Australia and New Zealand) the use of health impact assessment (HIA) as a tool for improved policy development is comparatively new. The public health workforce do not routinely assess the potential health and equity impacts of proposed policies or programs. The Australasian Collaboration for Health Equity Impact Assessment was funded to develop a strategic framework for equity-focused HIA (EFHIA) with the intent of strengthening the ways in which equity is addressed in each step of HIA. The collaboration developed a draft framework for EFHIA that mirrored, but modified the commonly accepted steps of HIA; tested the draft framework in six different health service delivery settings; analysed the feedback about application of the draft EFHIA framework and modified it accordingly. The strategic framework shows promise in providing a systematic process for identifying potential differential health impacts and assessing the extent to which these are avoidable and unfair. This paper presents the EFHIA framework and discusses some of the issues that arose in the case study sites undertaking equity-focused HIA.     

Environmental impact assessment in urban transport planning: Exploring process-related barriers in Spanish practice

The effectiveness of EIA for evaluating transport planning projects is increasingly being questioned by practitioners, institutions and scholars. The academic literature has traditionally focused more on solving content-related problems with EIA (i.e. the measurement of environmental effects) than on process-related issues (i.e. the role of EIA in the planning process and the interaction between key actors). Focusing only on technical improvements is not sufficient for rectifying the effectiveness problems of EIA. In order to address this knowledge gap, the paper explores how EIA is experienced in the Spanish planning context and offers in-depth insight into EIA process-related issues in the field of urban transport planning. From the multitude of involved actors, the research focuses on exploring the perceptions of the two main professional groups: EIA developers and transport planners. Through a web-based survey we assess the importance of process-related barriers to the effective use of EIA in urban transport planning. The analyses revealed process issues based fundamentally on unstructured stakeholders involvement and an inefficient public participation     

Integrated assessment of potential health impact of global environmental change: Prospects and limitations

Estimating the future health impact of global environmental change requires scientific methods that extend beyond conventional health risk assessment in relation to existing exposures. The dynamic and non‐linear nature of these changes in large complex biophysical systems, the interactions between them, and the reference to future scenarios all contribute uncertainty. Potential health impacts can be estimated from historical analogues, by mathematical modelling, or by reasonable foresight (especially in relation to social and economic disruptions). Integrated assessment methods draw upon all these techniques. In particular, integrated mathematical modelling techniques are evolving, as scientists (and policy‐makers) come to terms with this complex scenario‐based impact assessment task.     

Validating health impact assessment: Prediction is difficult (especially about the future)

Health impact assessment (HIA) has been recommended as a means of estimating how policies, programmes and projects may impact on public health and on health inequalities. This paper considers the difference between predicting health impacts and measuring those impacts. It draws upon a case study of the building of a new hypermarket in a deprived area of Glasgow, which offered an opportunity to reflect on the issue of the predictive validity of HIA, and to consider the difference between potential and actual impacts. We found that the actual impacts of the new hypermarket on diet differed from that which would have been predicted based on previous studies. Furthermore, they challenge current received wisdom about the impact of food retail outlets in poorer areas. These results are relevant to the validity of HIA as a process and emphasise the importance of further research on the predictive validity of HIA, which should help improve its value to decision-makers.     

Quantitative health impact assessment methodology for societal initiatives: A scoping review

Health initiatives are increasingly situated outside the institutionalised public health sector. The intersectoral character of societal initiatives, along with indirect relationships between initiatives and health, makes making projections of reach, impact and goal achievement complex. This scoping review of the peer-reviewed literature searches for appropriate methods to conduct quantitative health impact assessment for such initiatives. Database searches were done in PubMed and Web of Science, as well as a reference list search. Studies were then selected in a systematic manner. The review includes 64 studies. Most studies made estimates using simulation methods, notably with Monte Carlo, Markov and system dynamics modelling. Inputs for the models such as transition probabilities and price elasticities were taken from census, register and survey data, evidence from previous (scientific) studies and sometimes outcomes from stakeholder participation. Of different health outcome measures, the number of deaths was most frequently used, followed by QALYs and DALYs and life years. Health effect distribution is frequently mentioned, but not often estimated. Scientific methodological publications on HIAs focusing on civil society initiatives are relatively sparse, indicating possibilities for further methodological advancement. Estimating health effect distributions and incorporating stakeholder participation could make meaningful additions to standard practice.     

Air quality monitoring in NIS (SERBIA) and health impact assessment

The aim of this study is to indicate the significance of air quality monitoring and to determine the air quality fields for the assessment of air pollution health effects, with special attention to risk population. Radial basis function network was used for air quality index mapping. Between 1991 and 2005, on the territory of Nis, several epidemiological studies were performed on risk groups (pre-school children, school children, pregnant women and persons older than 65). The total number of subjects was 5837. The exposed group comprised individuals living in the areas with unhealthy AQI, while the control group comprised individuals living in city areas with good or moderate AQI. It was determined that even relatively low levels of air pollution had impact on respiratory system and the occurrence of anaemia, allergy and skin symptoms.