Health impact assessment (HIA) is "a combination of procedures, methods and tools by which a policy, programme 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". (1) The main purpose of undertaking HIA is to move towards healthier societies through the development of "healthy public policy"--in other words, the development of policies, programmes and projects that take account of their likely or actual impacts on health. If the use of HIA is to achieve its potential, assessments need to be undertaken at regional and global levels as well as at local and national levels.
Although several alternative models exist, the HIA process includes:
* the obtainment of an agreement on the scope of the HIA in terms of depth, duration, spatial and temporal boundaries, methods and outputs;
* an analysis of policy context and content;
* a profile of areas and communities likely to be affected by the policy;
* the collection of qualitative and quantitative data on potential impacts and their distribution from stakeholders, key informants and existing evidence;
* an evaluation of the importance, scale and likelihood (and, if possible, costs) of potential impacts;
* the development of options and recommendations for action; and
* a framework for monitoring and evaluation following implementation of recommendations.
HIA is an important public policy tool because it can: (2)
* promote equity, sustainability and healthy public policy in an unequal and frequently unhealthy world;
* improve the quality of decision-making in health and partner organizations by incorporating the need to address health issues into planning and policy-making;
* emphasize social and environmental justice (it is usually those who are already disadvantaged who suffer most from negative health impacts);
* encourage public participation in debates about public policy issues;
* give equal status to both qualitative and quantitative assessment methods;
* make values and politics explicit, and open issues to public scrutiny;
* demonstrate that health-relevant policy is far broader than health-care issues.
HIA is used in public policy decision-making in a wide and rapidly increasing range of developed and less developed countries throughout the world. HIA has had a high profile in "developing" countries since the 1980s, where it was used mainly as part of development projects. In "developed" countries, HIA became popular during the past 15 years in Australia, Canada, New Zealand and several European countries, such as the Netherlands, Sweden and the United Kingdom. Since 2000, HIA has been used in the United States. In all of these countries the chief focus of HIA has been on the impacts affecting the physical environment, such as transport and urban development. Using HIA in this way helps spread understanding of the determinants of health among policy-makers working outside the health ministries and encourages them to take account of health impacts on residents. However, HIA remains relatively inward-looking; for example, it does not engage with the health impacts of foreign policy. This applies "in the UK, Europe and worldwide". (3)
The European Commission has implemented proposals to undertake integrated impact assessments of all European policies. (4) Integrated impact assessments involve relatively superficial evaluations of the impact of policies along several different dimensions. The European Commission's initiative was partly in response to the range of assessments--for example, environmental, health, gender and economic--being carried out on new European policies. However, major policies require more in-depth assessments, and the European Commission has also funded the development of a European policy HIA methodology. …