Liveability as determinant of health: Testing a new approach for health impact assessment of major infrastructure

Abstract

Major urban infrastructure projects are intended to alter the built, human ecology for the better. Even when they are not labelled as health projects, arguably they should produce public health benefits that are commensurate with their scale, particularly when they are publicly funded. Health impact assessment (HIA) is an established method of evaluating major infrastructure projects using a determinants of health equity lens. HIA explicitly puts health front and centre to ask, ‘How should the proposed infrastructure project be altered to improve the determinants of health equity?’ There are well-established HIA protocols, but few provide a framework for scoping possible impacts. Given interest in the concept of liveability we introduce an exhaustive, evidence-based framework of 11 liveability domains for HIA. We then test the framework by scoping the impacts of the Upfield Level Crossing Removal (LXR) project in Melbourne, Australia to hypothesise its impacts on health. Scoping this case study suggests that many domains will be affected in complex ways, some positively and some negatively, exemplifying the potential for the framework to detect major infrastructures' pervasive impacts on determinants of health. The paper includes a plan to validate the liveability framework with empirical research in the HIA assessment stage. The paper concludes with a discussion of the contribution and usefulness of the liveability domains as a framework for structuring HIA and for building its profile, thus advancing the discipline, and helping to ensure that all major infrastructures constitute a prudent investment in public health.