Health impact assessment: the wider context.

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At the World Summit on Sustainable Development, the International Association for Impact Assessment (IAIA) submitted a briefing paper on the important contribution impact assessment (IA) can make to carrying out the agenda for sustainable development (1). The paper emphasizes the need to make human health and safety an integral part of the impact assessment of policies, plans, and, of course, development projects. Such an integrated perspective was adopted by WHO in its support of Health Impact Assessment (HIA) in the 1980s, and has been reinforced by the Memorandum of Understanding signed with LAIA in 2001. It can also be seen, for example, in the Gothenburg consensus paper which briefly considers HIA in relation to other forms of impact assessment (2). Publications in a number of countries have adopted a similarly wide, impact-assessment context for HIA (for example, 3). However, for many new practitioners of this discipline, particularly in the public health area, HIA is a recent innovation, designed specifically to serve their needs as health professionals. The wider context of impact assessment is often unrecognized. It is very encouraging to see HIA more widely adopted to improve health outcomes in both industrialized and developing countries, but there is a real concern that too much effort is being spent on reinventing impact assessment itself, rather than building on what already exists. Moreover, there has been a large amount of information sharing between individuals and groups in the public health community in various countries, especially in Asia, Australasia, and Europe, as they develop guidelines, models or case studies for HIA. This has resulted in a high degree of recycling of information within these networks, often with little reference to wider impact-assessment literature. The danger of evolving in isolation is obvious. One consequence of this process, I would argue, has been the proliferation of suggested approaches to HIA (e.g. Europe has seen the development of perhaps a dozen HIA "models" such as the Liverpool model and the Swedish County Councils model). These do not, as yet, appear to have been the subject of searching critical review, and seem to be used by practitioners almost as a menu of options from which to choose a model for a given HIA exercise. Without critical review and evaluation, there can be little real sense of direction in the future development of the practice of HIA. Also, we have seen the introduction and rapid uptake of new terminology, such as "prospective", "concurrent", and "retrospective" HIA (for example, 4). Not only are these terms largely redundant, but they may also be dangerous, as they suggest that there are distinct forms of HIA in relation to purpose and timing. IA encompasses not only the prediction or forecasting of particular, significant impacts but also their subsequent management, and may continue until the planned activity has ceased and, if necessary, the local area has been rehabilitated (5). Hence, all impact assessment is "prospective" in nature. "Concurrent" HIA is, in IA circles, a form of monitoring carried out within the overall IA process to assist impact management. "Retrospective" HIA would refer in IA circles to health impact auditing, and is part of evaluating the IA process and learning about actual impacts for future assessments. …