A review of health impact assessment frameworks

Abstract

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 in a systematic and comparative way the many HIA frameworks. Study design: Systematic reviewMethod: 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. 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.

Time for a paradigm change? Tracing the institutionalisation of health impact assessment in the Republic of Ireland across health and environmental sectors

“…In order to progress HIA in the absence of a lead agency, these divisions require greater inter-governmental, inter-agency and cross-departmental working. Collaboration could be facilitated by partnership working [5] and communication amongst health professionals, decision makers and other relevant stakeholders in the design and conduct of HIA [37,51]. Such change could contribute not only to the institutionalisation of HIA but broader intersectoral actions for health, thereby promoting the ethos of healthy public policy more generally [2].…”

“…The determinants of health conceptual framework has been influenced by the fields of public health, health promotion, health needs assessment, and evidencebased medicine [5,[8][9][10][11]. All policy development could potentially be subjected to some method of HIA, with consideration of categories of potential impacts on health including, socio-economic, cultural, environmental, and economic factors, as well as living and working conditions, lifestyle, biological factors and health services [5].…”

“…All policy development could potentially be subjected to some method of HIA, with consideration of categories of potential impacts on health including, socio-economic, cultural, environmental, and economic factors, as well as living and working conditions, lifestyle, biological factors and health services [5].…”

“…The reason for this is that many of the questions explored in HIA are common to other assessments [33]. Mindell et al [5] has pointed out that a number of organisations are working to develop guidance on integrated impact assessment [34,35]. In this vein, major efforts have been made to include HIA as an integral part of Strategic Environmental Assessment (SEA) across Europe [36].…”

“…The overarching objective of HIA is to provide a set of evidence-based recommendations to influence or modify a policy or project in order to maximise health gain and minimise negative outcomes and health inequalities [5,6]. It can therefore aid the development of healthier public policy [7].…”