Developing health impact assessment in the European Union.

Abstract

It is not surprising that the use of impact assessments has been pioneered at local and regional levels, where the potential impacts of a proposal cover a limited geographical area and the projects tend to be specific and tangible, such as infrastructure plans for roads and airports. Evaluating the potential impact of a piece of legislation, or even a whole policy area, is much more complex; to do so at the European Union (EU) level adds further layers of complexity. As EU interest in health matters and powers regarding them has increased, so has its interest in intersectoral approaches to health. This is attributable to several factors. First, the European Community's involvement in health is largely through work outside its narrow public health competence. Secondly, there is already a strong tradition of impact assessments within the Community, in particular environmental impact assessment (EIA). Thirdly, the Community institutions are insisting on coherent approaches to health across policies. An initial starting point to understanding the rationale behind applying health impact assessment (HIA) within the EU is to examine the legal base of its activities. The Treaty of Rome stipulates, in Article 152, "A high level of human health protection shall be ensured in the definition and implementation of all Community policies and activities". This obligation is unique compared with most Member States in introducing a basic requirement to give consideration to possible health implications of measures and actions. The European Commission has put into place procedures to implement the Treaty objective. These include a mandatory consultation of the Commission's Directorate General in charge of health on proposals for policy or legislation with a potential health dimension. Moreover, the Interservice Group on Health was established to coordinate health-related initiatives across different areas of Community policy. Strengthening health-related work is a central priority of the current Commission; the Community's health strategy, published in May 2000 (Communication from the Commission to the Council, the European Parliament, the Economic and Social Committee and the Committee of the Regions, COM (2000) 285 final of 16.5.2000), ensures coherence and coordination between health-related policy areas. In order to improve understanding of how different policy areas link to health, the Commission has taken an interest in the assessment of health impacts of policies, legislation and proposals, the scientific background and methodology of the impact assessment, and its application to decision-making processes. As far as the application of HIA is concerned, the Commission has drawn on national experiences across Europe--set out elsewhere--and on experiences with related impact assessments at Community level. The Community's EIA legislation foresees compulsory impact assessments to be undertaken for projects of a certain size and cost. Effects on human beings, which must include health effects, are an integral part of the EIA regulatory framework. It is not surprising that in some countries HIA has developed as a sub-speciality of EIA. However, health issues tend not to be in the forefront of regular EIAs. Experience in the Community has therefore been to develop independent work on HIA, while at the same time exploring synergies with and connections to other impact assessments. Especially at Community level, a number of key questions arise concerning the application of HIA (summarized in Box 1). These questions need to be answered convincingly before large investments in health impact assessments would be feasible. For example, the amount of research and analysis necessary to assess a particular policy or proposal will differ considerably from case to case. Decisions have to be taken on whether--because of time pressures--a superficial analysis is sufficient or whether in-depth analysis is required. …