Health Impact Assessment

Principles and Practice

Martin Birley

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781136764516
• Edition: 1
• Topic: Biological Sciences
• Subtopic: Environmental Science
• Index: Biological Sciences

Health Impact Assessment (HIA) is primarily concerned with the future consequences of plans, proposals and policies on the health of communities. It is a rapidly growing complement to Environmental Impact Assessment, increasingly mandated by national and international requirements. Guidelines have been produced by many national and international organizations and it is being introduced in a number of undergraduate or postgraduate university curricula. However, there has been until now no broad-based, introductory text of international scope to the subject, suitable for both these courses and for professional training.

The purpose of this book is to fill this gap and to introduce the subject of Health Impact Assessment using plain language, in both general and specific contexts and with reference to both market and less developed economies. As a result, the reader should be able to describe what HIA can and cannot achieve, identify the components of a successful HIA and participate in an assessment as a member of a team. Examples are provided from a number of planning and development sectors, including extractive industry, water resource management, and housing. The reader, whether student or professional, need not be a health specialist, although prior knowledge of some public or environmental health would be an advantage.

CHAPTER 1

Introduction

This introductory chapter will inform you:

• What health impact assessment (HIA) is about and why it is needed.

• Who this book is for.

• What the drivers are for HIA nationally and internationally, publicly and privately.

• The different contexts in which HIA takes place.

• Some other forms of assessment and how they overlap with HIA.

• Some of the challenges.

1.1 WHAT IS HEALTH IMPACT ASSESSMENT?

In this introductory text, health impact assessment (HIA) is an instrument for preparing justified recommendations for the management of the future health impacts of proposals. The proposals may be policies, plans, programmes or projects. HIA is primarily used before the proposal is activated and examines both positive and negative consequences. The intention of HIA is to make recommendations supported by evidence that modify the proposal in order to safeguard and enhance population health. The sentences in this opening paragraph are necessarily dense and incomplete and the remainder of the book is required in order to explain them.

Example of health impacts

A government may decide to build a road from the periphery to the centre of a city. The aim is to enable goods and people to be transported rapidly. The unintended impacts could include: obesity, social severance, road traffic accidents, respiratory disease, loss of well-being and psychosocial disorder.

Well-planned transport could improve fitness and well-being while reducing accident rates.

Figure 1.1 An overview of HIA

HIA itself is guided by policies, regulations, procedure, methods and tools: see Figure 1.1. The policies provide the enabling environment for HIA. When effective, this often leads to regulations to ensure that an organization implements the agreed policies. The procedure consists of deciding when an HIA is required, what it should include, who should draft it and who should be consulted, and how to manage reports, evaluation, acceptance and implementation. The methods of HIA include literature review, health profiling, systematic classification, analysis, community consultation, prioritization and development of recommendations. Tools refer to the various ways in which the methods are applied. When I first started to think about HIA, as a practising scientist, I naturally assumed that the method was the most important component. In practice this is not the case and this book will explain why.

There are a number of definitions of impact assessment, such as the following (IAIA, undated):

Impact assessment, simply defined, is the process of identifying the future consequences of a current or proposed action.

There have also been a number of definitions of HIA. A popular one was the product of a meeting in 1999 that is known as the Gothenburg consensus (WHO European Centre for Health Policy, 1999). This was modified in 2006 by the International Association for Impact Assessment (IAIA) to include a final sentence that explains why the assessment is being conducted (Quigley et al, 2006):

A combination of procedures, methods, and tools by which a policy, program 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 identifies appropriate actions to manage those effects.

The distribution of effects acknowledges that different communities will be affected in different ways, and this is also referred to as health inequalities. There is much additional detail that cannot be captured in a definition, for example the role of public participation and transparency.

1.1.1 Policies, plans, programmes and projects

This book is about the health impact of policies, plans, programmes and projects. The generic term that will be used for these is ‘proposal’. A proposal is defined as a plan or suggestion, especially a formal or written one, put forward for consideration by others (OUP, 2010).

One characteristic of proposals is that they have aims and objectives that are stated in advance. For example, the aims might be to move people from A to B as quickly as possible, to extract minerals from a deposit, to improve educational status, or to provide a better medical service. All proposals have both intended and unintended consequences. The intended consequences are stated in the aims. The unintended consequences may include positive and negative impacts on human health.

Projects are tangible and specific. They often consist of specific infrastructure to be built in specific locations. Programmes are arrays of projects that may proceed sequentially or concurrently. Plans have a multitude of meanings. Policies are sets of decisions that are oriented towards a long-term purpose. When policies are made by governments they are often embodied in legislation and apply to a country as a whole. Much of the discussion in this book is focused on project-level HIA, but applies to a greater or lesser extent to all proposals. In some contexts, programmes and plans have a legal meaning. For example, the UNECE Protocol on Strategic Environmental Assessment applies to programmes and plans that are defined in a specific way (UNECE, 2010).

1.1.2 Timing of impact assessment

The IAIA definition above refers to proposed or current impact assessments. Sometimes people distinguish the following kinds of impact assessment:

• Prospective – undertaken before the proposal is implemented or construction has commenced; undertaken to safeguard the health of the affected communities in the future.

• Concurrent – undertaken during proposal implementation, construction or early operation. This is often a last-minute attempt to assess impacts, even though there is little room to change the design or operation.

• Retrospective – undertaken after the proposal has become operational; used to gather evidence about how proposals have affected health and to modify an existing operation. Arguably, this is actually evaluation, not impact assessment.

In this text, HIA refers primarily to prospective impact assessment, which is the most effective stage for safeguarding health.

1.2 WHO IS THIS BOOK FOR?

Despite nearly three decades of global capacity building, HIA remains a relatively unknown subject that does not form a large part of university curricula and is not invoked systematically in proposal design. It is often introduced at postgraduate degree level in fields such as public health, environmental epidemiology and environmental science. Professionals may first encounter it when they are managing a new proposal, as part of their duties as a health, safety, security and environment (HSSE) officer or sustainability officer, or when including health in an environmental impact assessment (EIA), social impact assessment (SIA) or strategic environmental assessment (SEA). Demand for HIA is increasing and a number of short training courses are available worldwide.

The audience for this introductory book is therefore very diverse and includes:

• university undergraduates and postgraduates;

• professionals seeking an introduction to the subject;

• participants in short courses;

• project stakeholders;

• informed or concerned members of the public, such as communities who wish to undertake an HIA themselves;

• HSSE managers in private corporations;

• occupational health and safety specialists;

• public health practitioners;

• policy-makers;

• environmental health practitioners;

• town, land-use and spatial planners;

• geographers;

• social scientists;

• development bank advisers;

• international development practitioners;

• national and international non-governmental organizations;

• water and sanitation engineers;

• agricultural development officers;

• miners and oilmen;

• road builders;

• landlords;

• EIA, SIA or SEA practitioners.

The audience may be located in any country in the world, because proposals are made everywhere. In many countries, professionals will be encountering HIA for the first time. So the needs of the audience will vary. Some will need a brief overview of what they must manage. Others will need to participate in an HIA as a member of a new team. Some will need in-depth knowledge and skills and will be seeking pointers to the wider literature. Many, but not all, of the skills required are generic. Some of the generic skills will be familiar to those trained in public health, EIA or SEA.

This book is intended as a personal account in which general principles are illustrated by practical experience for the benefit of newcomers to the subject. The orientation is project rather than policy, and includes low-income as well as high-income economies. It is not intended as an exhaustive review of the literature as there are already a number of excellent reviews and guides. See, for example, the HIA Gateway (APHO, undated).

One of the challenges in writing for a diverse audience is that the material will be too simple for some and too advanced for others. Whenever possible, I hope to err on the side of being clear and simple.

1.3 WHY IS HIA NEEDED?

As stated above, all proposals can have unintended positive and negative impacts. The impacts affect the environment, society and human health. Environmental impact assessment (EIA) was formulated in the 1970s in order to manage environmental impacts by encouraging transparency and the supply of information to the public. This included some, but by no means all, health impacts. For example, EIA can be a good tool for managing the health impacts of pollution, providing that an acceptable threshold has been agreed elsewhere for the concentration of a pollutant at the point of contact with a susceptible human. But there are many more health impacts that EIA cannot identify or resolve (Harris et al, 2009).

It is the duty of the health sector within national and local government to safeguard and improve community health. However, many major health improvements are made through other sectors and health is sometimes one of the least resourced of the government sectors. In a low-income economy, it may receive less than 2–5 per cent of the annual government budget (UNDP, 2008). In some of the more developed economies it may receive 8–15 per cent. Whatever the actual percentage, it is clear that far more money is spent by government in all the other sectors combined, than in the health sector itself. This is illustrated in Figure 1.2. The question then arises, which expenditure is likely to have the most influence on health: the small amount spent in the health sector, or the very much larger amount spent in all the other sectors? On the basis of expenditure alone, it can be argued that non-health sectors have far more influence on health than the health sector does. Some of these other expenditures are focused directly on human health: these include the supply of clean drinking water, sanitation, food safety and security. There are many more expenditures which do not include human health as a direct objective, but which affect it nevertheless. Transport, energy and education are examples.

Newcomers to health issues may believe that the major improvements that have occurred in public health status over time are the result of activities by the health sector. However, this is not generally the case. For example, infant mortality rates from communicable diseases in Europe fell rapidly before the introduction of effective medical care. What caused that? Apparently it was general improvements in the standard of living, the environment and the wealth of the community (McKeown, 1979). With the introduction of modern vaccination, childhood mortality rates from communicable diseases fell further. While important, the health sector contribution added to a general trend that was already established.

Figure 1.2...

Table of contents

• Cover
• Halftitle
• Title
• Copyright
• Dedication
• Contents
• List of figures, tables and boxes
• Foreword by Sir Michael Marmot
• Foreword by Robert Goodland
• Preface
• About the author
• Acknowledgements
• Chapter 1 Introduction
• Chapter 2 Health and its determinants
• Chapter 3 History of HIA
• Chapter 4 HIA management
• Chapter 5 Methods and tools
• Chapter 6 Baseline report
• Chapter 7 Prioritization
• Chapter 8 Recommendations and management plan
• Chapter 9 Water resource development
• Chapter 10 Extractive industries
• Chapter 11 Housing and spatial planning
• Chapter 12 Current and future challenges
• Sources of further information
• Glossary and acronyms
• Index