Integrating health into impact assessment: challenges and opportunities

Abstract

O OTHER FIELD OF IMPACT assessment has been so popular in recent years as health impact assessment (HIA). The last five years, in particular, have seen a surge in published papers, reviews, guidelines and websites related to HIA. Such increasing popularity makes one ask: Has HIA in its development come closer to environmental impact assessment (EIA)? What challenges face the integration of EIA and HIA? What are the opportunities for such integration and what lessons, if any, can HIA and EIA learn from each other’s research and practice? In the development of HIA, two main trends may be distinguished. The first, called environmental health impact assessment (EHIA), was initially promoted by the World Health Organisation (WHO) in the 1980s to address neglected health considerations in conventional EIA. EHIA is based on the biomedical model of health, illustrated in changes of mortality, morbidity and injuries. Here, similar to EIA, the prospective nature has been emphasised. First applied to large infrastructure projects, such as dams or large irrigation schemes, in developing countries, EHIA is now practised in developed countries such as Australia, New Zealand and Canada. Additionally, the African and Eastern Mediterranean Regional Offices of the WHO funded a number of projects involving workshops and guidelines on EHIA during the 1990s in some of the countries of the regions concerned. The second trend of HIA evolved from the concept of ‘healthy public’ policy. Influenced by a number of fields allied to public health such as health promotion, health needs assessment and evidence-based medicine, this trend emphasises the participatory nature of HIA and its role in reducing health inequalities and forming partnerships. It is based on a ‘socio-environmental’ model of health, where population health is determined by a wide range of factors (that is, the determinants of health): individual (for instance, age); social (for instance, crime); economic (for instance, unemployment rate) and institutional (for instance, public policy and capacity, and capability of a wide range of services). This trend has been hugely popular in developed countries such as Canada, the UK, Sweden and the Netherlands, although some developing countries such as Thailand have also found it very relevant to their needs (Phoolcharoen et al, 2003). It is this trend of HIA that has captured the imagination of public health professionals and spurred publications and wider debate in public health literature and circles in the last few years.