Health Impact Assessment Practitioners Research Articles

Walking the talk: a mixed-methods study investigating current opportunities for promoting health impact assessment practice

ABSTRACT Although Health Impact Assessment (HIA) has been gaining momentum over the past decade, it is still a relatively small field of practice. Here we explore whether possible opportunities to promote the field of HIA can be translated into concrete actions. We pursued an exploratory sequential mixed-methods approach. In a first step, HIA practitioners’ ideas were collected across 18 semi-structured interviews. Building on these insights, a survey questionnaire was developed in a second step, and answers from 25 HIA practitioners were collected in a last step. We found that delivering awareness on HIA creates the most important opportunities. To exploit these opportunities, high potential was recognized in the strengths of HIA practice, namely in broader stakeholder engagement and showcasing HIA’s evidence-based approach. HIA practitioners are best positioned to initiate actions that promote their practice, but they also depend on various influential actors such as governments and the World Health Organization (WHO). Developing an open exchange platform allowing all HIA stakeholders to connect seems an urgent strategy to pursue for strengthening HIA’s popularity, appeal, and reach.

Evaluating Racial/Ethnic Equity in Planning-Related U.S. Health Impact Assessments Involving Parks and Greenspaces

Problem, research strategy, and findings Health impact assessment (HIA) reports are used by government agencies, other organizations, and stakeholders to evaluate potential health effects of plans/policies/projects. HIAs have the potential to promote anti-racist practices. We developed and used the Tool for the Racial/Ethnic Equity Evaluation of Health Impact Assessments (TREE-HIA) to score 50 U.S. HIA reports on planning-related projects/plans involving parks and greenspaces (2005–2020). More recent and more comprehensive HIA reports addressed racial/ethnic equity to a greater degree (e.g., median TREE-HIA scores: −1.3 in 2009–2012, 4.0 in 2017–2020, where higher scores indicate greater racial/equity considerations). Overall, HIA reports addressed racial/ethnic equity to a lesser degree than expected given the principal tenet of equity guiding HIAs and urban planning alike (42% had negative TREE-HIA scores indicating inadequate racial/ethnic equity consideration). However, the limited number and types of HIAs included in this study may affect generalization to all HIAs. Takeaway for practice HIAs incorporating racial/ethnic equity comprehensively throughout the HIA process will better enable urban planners, HIA practitioners, decision makers, and communities of color to work together to combat racist planning practices through the shared goals of addressing health disparities and equity. TREE-HIA provides professionals and researchers with a brief tool that can be used/adapted to guide and evaluate future HIAs for racial/ethnic equity considerations.

Updating the Minimum Elements and Practice Standards for HIA to Reflect Evolution in the Field of Practice

The Minimum Elements and Practice Standards for Health Impact Assessment (MEPS) outline the minimum elements that need to be addressed for a study to be considered a health impact assessment (HIA), as well as best practices for how an HIA should be conducted. The document was originally created by a group of leading HIA practitioners in 2009. Since then, it has been updated twice to reflect the evolution of HIA as a practice and the expanded use of HIA as a tool to implement health in all policies. This commentary describes current efforts to revise the MEPS—the first update in six years.

The use of health impact assessments performed in Quebec City (Canada) – 2013–2019: Stakeholders and participants' appreciation

Health impact assessment (HIA) is an approach that aims to prospectively assess the potential effects of a policy, program or project on the health of the population and to formulate recommendations to minimize the negative effects, and to maximize the positive effects. In Quebec City, a particular process has been put in place to perform HIA. This paper presents the impacts and outcomes of the performed health impact assessments, based on the HIA participants (stakeholders)’ perceptions. More specifically the aims were to 1) analyze the implementation of the HIA procedure in the urban planning process and to identify levers, constraints and potential for improvement; 2) analyze the deployment of the HIA approach, including the stakeholders' involvement, the ability of HIA to support decision making and to make changes in the stakeholders' practice; and 3) identify success factors and challenges for the integration of HIA into the urban planning process. A survey was developed to question the HIA participants (stakeholders) (response rate 62.5%, n = 25/40). Themes were created according to the provided answers. This study provided a positive feedback on the implemented HIA process. It allowed the identification of issues regarding its use in the urban planning process and a better understanding of the stakeholders' evaluation of HIA. The results indicate the potential HIA has at enhancing the interdisciplinary decision-making process in urban planning. Improvements in the practices used were also identified and many were similar to those presented in other contexts. The obtained results can be useful to HIA practitioners and municipalities wishing to implement HIA.

Process, Practice and Progress: A Case Study of the Health Impact Assessment (HIA) of Brexit in Wales.

Health impact assessment (HIA) is a systematic and flexible tool, which is advocated by the World Health Organisation as a method through which to consider the impact of policies on the health and well-being of a population, and the inequalities that may arise because of it. In 2018, the HIA support unit in Wales carried out a comprehensive and unique HIA on the impact of Brexit in Wales. The aims were to understand the differential impacts that Brexit would have on the health and well-being of the population and to provide evidence to inform decision makers across a range of public bodies. It followed a five-step process for HIA and utilised a wide range of evidence sources and health intelligence including both quantitative and qualitative evidence. This paper reflects on the process of carrying out the HIA and the methods used. It discusses the stages of the HIA, and shares the findings and reflections of implementation which will be beneficial to other HIA practitioners and policy makers. It does not concentrate on the findings of the HIA in detail, but focusses on what worked and any challenges encountered. It has been used to progress the practice of HIA in Wales and demonstrates the value of HIA as a method to inform and influence complex decisions.

Current Global Health Impact Assessment Practice.

Health impact assessment (HIA) practice has expanded across the world, since it was established more than two decades ago. This paper presents a snapshot of current global HIA practice based on the findings of an online questionnaire survey. HIA practitioners from all world regions were invited to participate. A total of 122 HIA practitioners from 29 countries completed the survey, following a broad international outreach effort. The large variety in the types of HIAs conducted, and the application of HIA in various fields reported by respondents, demonstrates that HIA practice has evolved over the past two decades. Although differences in the use of HIA were reported across world regions, an overall increasing trend in global HIA practice can be observed. In order to sustain this upward trend, efforts are needed to address the main barriers in the utilisation of HIA. The establishment of new national and international HIA teaching and training offerings seems to be an obvious strategy to pursue along with the strengthening of policies and legal frameworks that specify the circumstances, under which HIA is required, and to what extent.

Health Impact Assessment of Transportation Projects and Policies: Living Up to Aims of Advancing Population Health and Health Equity?

Health impact assessment (HIA) is a forward-looking, evidence-based tool used to inform stakeholders and policy makers about the potential health effects of proposed projects and policies and to identify options for maximizing potential health benefits and minimizing potential harm. This review examines how health equity, a core principle of health impact assessment (HIA), has been operationalized in HIAs conducted in the United States in one sector, transportation. Two perspectives on promoting health equity appear in the broader public health research literature; one aims at reducing disparities in health determinants and outcomes in affected populations, whereas the other focuses on facilitating community participation and self-determination. Variations in how these perspectives are applied in HIA informed our typology of five ways of addressing health equity in HIA. Transportation HIAs commonly included two of these-selecting vulnerable populations for the focus of the HIA and stakeholder engagement, seen in more than 70% of the 96 HIAs reviewed. Fewer than half of the HIAs assessed current health disparities or changes in their distribution. Only 15% of HIAs addressed equity by focusing on capabilities development or empowerment. Routinely assessing and reporting how an HIA aims to address health equity might better manage expectations and could make HIA practitioners and users more conscious of how an HIA can realistically be used to advance health equity.

Advocacy in HIA: Increasing Our Effectiveness and Relevance as Practitioners to Address Health, Equity, and Democracy

The role of advocacy in Health Impact Assessment (HIA) is debated among practitioners. Concerns revolve around whether engaging in advocacy undermines objectivity and credibility. While there is agreement that dissemination of findings and recommendations is necessary, there is a spectrum of activities that can be undertaken in an HIA, one end of which might be considered advocacy.In this Perspective from the Field, We posit that in conducting an HIA, practitioners are choosing to advocate for a set of causes that may include improved health, decreased inequity, and increased democracy. We come to the table with these values and the intent to advocate for them. For any HIA to be relevant and effective at advancing these causes in decision-making contexts, practitioners must use the best available evidence and a range of strategies to communicate evidence to policy audiences, including deliberate tactics with community organizations, decision makers, and others that can aid in addressing power imbalances. Though we believe that HIA practice cannot reach its full potential without embracing advocacy, practitioners must make decisions given their context, including local power dynamics as to how far into the advocacy spectrum they venture in any given HIA.This paper is geared towards HIA practitioners and others who want to understand the opportunity advocacy provides. We begin by describing the underlying values of HIA that inspire this perspective, including those in the 1999 Gothenburg Consensus Paper on HIA (Quigley et al., 2006). After briefly describing concerns HIA practitioners may have with advocacy, particularly that it undermines the objectivity and credibility of the HIA process, we then discuss common advocacy activities practitioners might undertake, and ways to address risks these activities may pose. These opportunities to undertake advocacy include partnering with diverse stakeholders, developing advisory committees, gauging the power and policy context, and thinking broadly about the best tactics to effectively communicate findings. We conclude with a case study describing how advocacy was used in the Treatment Instead of Prison HIA in Wisconsin to advance health, equity, and democracy.

Drawing from the well of community participation: an evaluation of the utility of local knowledge in the health impact assessment process

Engagement with local residents is increasingly being used as a source of evidence for making health impact assessment (HIA) predictions. However, there have been criticisms about the community engagement process and the value of evidence derived from it. This study aims to investigate the constraints of engagement and to gage the usefulness of local knowledge to the HIA evidence base. Questionnaire responses were collected from 52 HIA practitioners in the United Kingdom, and interviews were conducted with 11 practitioners (8 of whom also completed the survey). Forty-two of the 52 respondents (81%) had undertaken engagement with local residents, and the techniques used for community engagement were focus groups (76%), workshops (52%), questionnaire surveys (43%), interviews (41%), and other less common approaches (14%). Interestingly, while more than one-third of the practitioners found engagement difficult, nearly all of them rated local knowledge to be a useful or very useful source of evidence. It is vital, therefore, to understand ways of minimizing the constraints encountered in the community engagement process in order to fully tap into local knowledge and strengthen the evidence base of the HIA process.

Strategies and incentives for enhancing the application of health impact assessment (HIA) in Nigeria: a view from those who should know

In consonance with the paradigm shift from curative to more preventive healthcare, there has been an increasing application of health impact assessment (HIA) in many developed countries. However, progress towards the integration of HIA into public policy in many developing countries has been comparatively very slow. This article is a primary research to evaluate the barriers and motivational factors; and to proffer effective strategies and incentives for enhancing the application of HIA in health and development policies in Nigeria. Semi-structured questionnaires were designed and primarily disseminated online to a random sample of health and non-health professionals, public service workers, policy-makers and business entrepreneurs in Nigeria. Additional questionnaires were also hand-delivered. Inferential statistics was used in the analysis of the 510 responses that were received. The findings show that 71% of the respondents had never heard about HIA, and 80.7% of those who were aware of HIA had not received any form of HIA training. However, 86.6% of the informed group strongly agreed that HIA is a necessary tool for effective public health delivery, indicating a high level of motivation and expectations about the contributions that HIA can make towards improving public health in Nigeria. It is therefore important to raise the level of awareness and training of HIA practitioners, and also political commitment for HIA. Similarly, the HIA process should be people-centred, emphasise on corporate social responsibilities and also focus on the determinants of communicable diseases in order to be relevant and sustainable in Nigeria.

Advancing Efforts to Achieve Health Equity: Equity Metrics for Health Impact Assessment Practice

Equity is a core value of Health Impact Assessment (HIA). Many compelling moral, economic, and health arguments exist for prioritizing and incorporating equity considerations in HIA practice. Decision-makers, stakeholders, and HIA practitioners see the value of HIAs in uncovering the impacts of policy and planning decisions on various population subgroups, developing and prioritizing specific actions that promote or protect health equity, and using the process to empower marginalized communities. There have been several HIA frameworks developed to guide the inclusion of equity considerations. However, the field lacks clear indicators for measuring whether an HIA advanced equity. This article describes the development of a set of equity metrics that aim to guide and evaluate progress toward equity in HIA practice. These metrics also intend to further push the field to deepen its practice and commitment to equity in each phase of an HIA. Over the course of a year, the Society of Practitioners of Health Impact Assessment (SOPHIA) Equity Working Group took part in a consensus process to develop these process and outcome metrics. The metrics were piloted, reviewed, and refined based on feedback from reviewers. The Equity Metrics are comprised of 23 measures of equity organized into four outcomes: (1) the HIA process and products focused on equity; (2) the HIA process built the capacity and ability of communities facing health inequities to engage in future HIAs and in decision-making more generally; (3) the HIA resulted in a shift in power benefiting communities facing inequities; and (4) the HIA contributed to changes that reduced health inequities and inequities in the social and environmental determinants of health. The metrics are comprised of a measurement scale, examples of high scoring activities, potential data sources, and example interview questions to gather data and guide evaluators on scoring each metric.

The fit between health impact assessment and public policy: Practice meets theory

Purpose and settingThe last decade has seen increased use of health impact assessment (HIA) to influence public policies developed outside the Health sector. HIA has developed as a structured, linear and technical process to incorporate health, broadly defined, into policy. This is potentially incongruent with complex, non-linear and tactical policy making which does not necessarily consider health. HIA research has however not incorporated existing public policy theory to explain practitioners' experiences with HIA and policy. This research, therefore, used public policy theory to explain HIA practitioners' experiences and investigate ‘What is the fit between HIA and public policy?’ MethodsEmpirical findings from nine in-depth interviews with international HIA practitioners were re-analysed against public policy theory. We reviewed the HIA literature for inclusion of public policy theories then compared these for compatibility with our critical realist methodology and the empirical data. The theory ‘Policy Cycles and Subsystems’ (Howlett et al., 2009) was used to re-analyse the empirical data. FindingsHIAs for policy are necessarily both tactical and technical. Within policy subsystems using HIA to influence public policy requires tactically positioning health as a relevant public policy issue and, to facilitate this, institutional support for collaboration between Public Health and other sectors. HIA fits best within the often non-linear public policy cycle as a policy formulation instrument. HIA provides, tactically and technically, a space for practical reasoning to navigate facts, values and processes underlying the substantive and procedural dimensions of policy. ConclusionsRe-analysing empirical experiential data using existing public policy theory provided valuable explanations for future research, policy and practice concerning why and how HIA fits tactically and technically with the world of public policy development. The use of theory and empiricism opens up important possibilities for future research in the search for better explanations of complex practical problems.

Health impact assessment: A comparison of 45 local, national, and international guidelines

This article provides a comparison of health impact assessment (HIA) guidelines from around the world and for multiple geographic scales. We identify commonalities and differences within HIA guides to discuss the plausibility of consensus guidelines and to inform guideline development. The practice of HIA has grown over the last two decades with a concurrent growth of HIA guides. This study expands on earlier review work and includes guides published since 2007 (Mindell, Boltong and Forde, 2008). From April 2010 to October 2011, 45 HIA guides were identified through an internet search and review of previous research. Common characteristics, key features, and the HIA process were analyzed. The 45 documents recommended similar but not identical processes for conducting HIAs. These analyses suggest that guidelines for HIAs are similar in many areas of the world and that new HIA practitioners can use these findings to inform their approach. Further discussion is needed to determine if the approaches established in these guidelines are followed and if one set of common guidelines could be written for use in numerous countries and regions.

The essential elements of health impact assessment and healthy public policy: a qualitative study of practitioner perspectives

ObjectivesThis study uses critical realist methodology to identify the essential and contingent elements of Health Impact Assessment (HIA) and Healthy Public Policy (HPP) as operationalised by practitioners.DesignData collection—qualitative interviews and...

Health impact assessment research and practice: A place for paradigm positioning?

In this article, we provide a critical review of the place of paradigm in health impact assessment (HIA) research and practice. We contend that most HIA practitioners have given insufficient attention to paradigm positioning when developing and applying HIA methodologies and that some concerns about current HIA practice can be attributed to this. We review HIA literature to assess the extent and nature of attention given to paradigm positioning and these related concerns. We then respond to our critique by exploring the implications, opportunities and challenges of adopting a critical realist paradigm, which we believe has the potential to help HIA practitioners to develop HIA methodology in a way that addresses these issues.

Evidence‐based health impact assessment (EBHIA): a situation report

This research was carried out to ascertain the different types and sources of evidence commonly applied to the Health Impact Assessment (HIA) process in the United Kingdom; and to also examine the factors that influence the derivation and usage of the different types of evidence. A questionnaire survey of 52 HIA practitioners who had conducted a total of 103 HIAs over a 3-year period was carried out, followed by semi-structured interviews of 11 practitioners to gain deeper insights into the questionnaire findings. Ten different sources of evidence were seen to have been applied to the HIA process. Literature review was discovered to be the most commonly utilized source of evidence, having been used by 37 out of 52 practitioners (71.2%) and in 83.5% of the 103 HIAs. Engagement with local residents was second in terms of usage by practitioners (69.2%) and expert opinion was third, having been used by 67.3% of respondents. Other sources of evidence included completed HIA reports, survey, modelling and Delphi exercises. The findings point to efforts to ensure that predictions are grounded on robust sources of evidence, although several issues need to be addressed in the pursuit of evidence-based HIA (EBHIA).

Vital statistics relating to the practice of Health Impact Assessment (HIA) in the United Kingdom

Purpose of research To examine the practice of Health Impact Assessment (HIA) in the UK and provide information which can serve as baseline data for monitoring changes and future developments in HIA. A survey of HIA practitioners was conducted using semi-structured questionnaires. Results • 42% of the 103 HIAs were rapid assessments, 33% were intermediate, and 25% were comprehensive appraisals. • While 70% of the HIAs were conducted prospectively, 23% were concurrent, and 7% were retrospective assessments. • 64% of the 52 practitioners were employed in the public sector, 13% in the academia and research sector, 10% were employed in the private sector, 6% were self employed and the remaining 7% were working in other sectors of the British economy. Conclusions The majority of the HIAs investigated in this study were rapid and prospective assessments, which were mostly commissioned by government agencies. Additionally, the majority of the HIA practitioners were employed in the public sector of the UK economy.

Assessing the unintended health impacts of road transport policies and interventions: translating research evidence for use in policy and practice

BackgroundTransport and its links to health and health inequalities suggest that it is important to assess both the direct and unintended indirect health and related impacts of transport initiatives and policies. Health Impact Assessment (HIA) provides a framework to assess the possible health impacts of interventions such as transport. Policymakers and practitioners need access to well conducted research syntheses if research evidence is to be used to inform these assessments. The predictive validity of HIA depends heavily on the use and careful interpretation of supporting empirical evidence. Reviewing and digesting the vast volume and diversity of evidence in a field such as transport is likely to be beyond the scope of most HIAs. Collaborations between HIA practitioners and specialist reviewers to develop syntheses of best available evidence applied specifically to HIA could promote the use of evidence in practice.MethodsBest available research evidence was synthesised using the principles of systematic review. The synthesis was developed to reflect the needs of HIA practitioners and policymakers.ResultsAside from injury reduction measures, there is very little empirical data on the impact of road transport interventions. The possibility of impacts on a diverse range of outcomes and differential impacts across groups, make it difficult to assess overall benefit and harm. In addition, multiple mediating factors in the pathways between transport and hypothesised health impacts further complicate prospective assessment of impacts. Informed by the synthesis, a framework of questions was developed to help HIA practitioners identify the key questions which need to be considered in transport HIA.ConclusionPrinciples of systematic review are valuable in producing syntheses of best available evidence for use in HIA practice. Assessment of the health impacts of transport interventions is characterised by much uncertainty, competing values, and differential or conflicting impacts for different population groups at a local or wider level. These are issues pertinent to the value of HIA generally. While uncertainty needs explicit acknowledgement in HIA, there is still scope for best available evidence to inform the development of healthy public policy.

Learning by doing: the value of case studies of health impact assessment

The nine health impact assessment (HIA) case studies in this issue represent a considerable contribution to the HIA literature and provide a number of lessons. These lessons include the value of using evidence in HIA to aid decision-making; the various forms that stakeholder and community involvement in HIA can take; and the fact that HIA can act as a catalyst for intersectoral engagement. They also highlight challenges faced by HIA practitioners, including time, methods of assessment, developing evidence summaries and considering equity.

Can health feasibly be considered as part of the planning process in Scotland?

The planning system is significant because of its capacity to determine the quality of the built environment as well as the health, well-being and quality of life of the individuals and communities therein. Development planning is especially important because of the long-term impact of the decisions. This paper was developed in response to increasing recognition amongst HIA practitioners in Scotland of the importance of planning for health. It focuses on the relationship between the planning system in Scotland, specifically the Development Planning element of it, and population health and considers how the health impact assessment (HIA) approach can facilitate and support joint working with planners. In particular, consideration is given to the potential impact of the introduction of Strategic Environmental Assessment (SEA) on the linkages between health, HIA and planning.