Elsevier

Public Health

Volume 122, Issue 11, November 2008, Pages 1177-1187
Public Health

Review paper
A review of health impact assessment frameworks

https://doi.org/10.1016/j.puhe.2008.03.014Get rights and content

Summary

Background

Consideration of health impacts of non-health sector policies has been encouraged in many countries, with health impact assessment (HIA) increasingly used worldwide for this purpose. HIA aims to assess the potential impacts of a proposal and make recommendations to improve the potential health outcomes and minimize inequalities. Although many of the same techniques can be used, such as community consultation, engagement or profiling, HIA differs from other community health approaches in its starting point, purpose and relationship to interventions. Many frameworks have been produced to aid practitioners in conducting HIA.

Objective

To review the many HIA frameworks in a systematic and comparative way.

Study design

Systematic review.

Method

The literature was searched to identify published frameworks giving sufficient guidance for those with the necessary skills to be able to undertake an HIA.

Results

Approaches to HIA reflect their origins, particularly those derived from Environmental Impact Assessment (EIA). Early HIA resources tended to use a biomedical model of health and examine projects. Later developments were designed for use with policy proposals, and tended to use a socio-economic or environmental model of health. There are more similarities than differences in approaches to HIA, with convergence over time, such as the distinction between ‘narrow’ and ‘broad’ focus HIA disappearing. Consideration of health disparities is integral to most HIA frameworks but not universal. A few resources focus solely on inequalities. The extent of community participation advocated varies considerably.

Conclusion

It is important to select an HIA framework designed for a comparable context, level of proposal and available resources.

Introduction

The 1997 Jakarta Declaration recommended that public and private sector policy development should incorporate equity-focused health impact assessment (HIA).1 Almost a decade later, the 2006 Bangkok Charter on Health Promotion in a Globalized World highlighted the role of HIA as a key tool to aid decision-making.2

This paper reviews the published frameworks available for HIA. It is intended neither as an introduction to HIA nor as a detailed guide, as these exist elsewhere.3, 4, 5, 6 This review aims to compare the different HIA frameworks and how they have evolved with use by the public health community. In this review, ‘framework’ is defined as a ‘how—to’ guide to conducting an HIA.

HIA, which has been encouraged in most areas of the world,1, 3, 7 is a process which primarily aims to predict positive and negative effects of a proposal, including otherwise unanticipated effects. Its primary outcome is a set of evidence-based recommendations to modify a project or policy to minimize potential negative outcomes, maximize positive effects, and reduce any impacts on health inequalities. Such proposals may have health as their driver (e.g. air quality management) or it may be incidental or not considered (e.g. town or transport planning) because of different understanding of roles and responsibilities. Secondary aims of HIA include raising awareness among decision-makers of their influence on their citizens' health through actions on determinants, the importance of the environment (physical, social and economic) in which individuals make decisions that affect their risk of disease (e.g. smoking), and involving the local community.8 HIA has been found to be cost-effective.9 Potential benefits of HIA include extending the protection of human health, reducing ill health, enhancing cross-sectoral coordination, promoting greater equity in health, eliminating health sector costs of treating health consequences of non-health policies overlooked during planning, and potential for re-allocation of saved resources.10, 11 A number of well-accepted definitions are provided in a web appendix (Box w1).11, 12, 13, 14, 15

Despite these, the term ‘HIA’ is used to describe a range of activities; some would not be termed ‘HIA’ by HIA practitioners, while the term ‘HIA’ is not used by other professionals despite conducting similar appraisals.16 While acknowledging the potential benefits of HIA, the need for credibility of the process and suggestions for improvements have been reported.3, 17 Concern has been expressed about the availability and/or quality of evidence used in HIA.3, 18, 19 There has also been confusion about what HIA entails, and the similarities and differences between the various approaches that have been employed. Therefore, the authors reviewed the available frameworks.

Section snippets

Method

A systematic literature search was conducted using both PubMed and Google to identify HIA frameworks published in peer-reviewed or grey literature, respectively, that gave sufficiently detailed advice for someone with (access to) the necessary skills to conduct (or organize) an HIA on a proposal in any field. Details of the search strategy and inclusion and exclusion criteria are provided in a web appendix (Box w2).16, 20, 21, 22, 23, 24, 25, 26 Topic-specific resources and those aimed at

Results

When reviewing the many frameworks found, most fell easily into one of a small number of models of HIA (Table 1). More detailed analysis of the different frameworks is provided in a web appendix (Excel file).

Table w1 summarizes the main features of:

  • many earlier approaches to HIA that envisaged it as a component of environmental impact assessment (EIA), often associated with a ‘chemical hazard or risk assessment’ approach and a medical model of health;

  • other earlier approaches to HIA; and

  • more

Discussion

For historical and developmental reasons, information about HIA, both theory and practical examples, has tended to be published as grey literature. Older resources have been included in this review, not only to investigate changes over time but also because some people are likely to continue to use instruments with which they are familiar.

This paper comments on resources that enable a reader to conduct an entire HIA, given suitable skills. In addition, useful toolkits exist to aid particular

Conclusion

A plethora of resources now exist to provide guidance on conducting HIA. Morgan commented in 2003:

‘The proliferation of suggested approaches to HIA…. seem to be used by practitioners almost as a menu of options from which to choose a model’68

According to the World Health Organization, these different approaches to conducting HIA are part of its strength, demonstrating a pragmatic ability to engage with other sectors to influence decision-making.11 This review has shown that the many HIA

Acknowledgements

The authors wish to thank Mike Joffe, Erica Ison, Harry Rutter, and Andy Dannenberg for helpful comments on an earlier version of this review.

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