Implementation Of Health Impact Assessment Research Articles

Health Impact Assessment (HIA): a tool to drive health in all policies?

Abstract Health Impact Assessment (HIA) is often promoted as a tool to implement ‘health in all policies’ and sustainable development approaches to improve health and equity outcomes. However, is this truly the case? Currently global HIA practice is variable. This paper shares learning from the development and implementation of HIA in Wales to date to understand how HIA has been, and can be, used to inform policies and decisions and reduce health inequalities. The research investigated if, and how, HIA can be used as a tool to mobilise HiAP in reality. It followed a mixed methodological approach and investigated the contribution of HIA to practically advancing HiAP viewed through the lens of Wales and internationally. Primary and secondary evidence and statistics were collected and analysed. A literature review, stakeholder interviews, online statistical questionnaires and case studies were conducted. Thematic and content analysis techniques used. Findings include the importance of conceptual considerations i.e. the perspective on health - social determinant an equity or environmental determinant driven - taken by those carrying out or commissioning a HIA; the importance of centres of expertise to learn from; and practical considerations such as the political and regulatory environment, workforce and organisational knowledge and capacity. Wales has a dedicated expert HIA Unit, an enabling political environment and has led to HIA influencing policies and plans over 20 years. It has transferrable learning for other nations and the research including the online survey has been replicated by others, led to collaborations with nations such as Portugal and contributed to the reviewed literature by providing case studies on a topics like climate change which have influenced decision makers. Tangible ways forward for policy makers, researchers and academics include the need to develop more cross collaboration and fill gaps in the evidence i.e. on institutionalisation of HIA. Key messages • HIA is a excellent process to drive Health in all policies approaches. • HIA needs an enabling environment and workforce support such as that in Wales to thrive.

A New Framework for Monitoring and Evaluating Health Impact Assessment: Capitalising on a French Case Study with the Literature in Evaluation.

Health impact assessment (HIA) is a prospective approach that aims to identify the potential consequences of policies or projects on health in order to propose measures to make them healthier. Initiated in the late nineties, the approach emerged over ten years ago in France. However, the evaluation of HIA effectiveness remains seldomly practised and its theoretical background should be deepened. The aim of this article is to generate a discussion on how to evaluate HIA effectiveness and contribute to its methodological tooling, drawing on an evaluative experience of multiple French HIAs. Our work is based on an iterative approach between an analysis of the evaluation literature and a critical look at an HIA evaluation. We first carried out the evaluation of three HIAs in 2017-2018, combining a normative approach and qualitative research in order to explore each HIA as a phenomenon in its own context. Two years later, we conducted a self-assessing expertise on this evaluation, supported by an analysis of the literature in the field of public policy evaluation, in order to refine the theoretical framework for evaluating HIA effectiveness and ultimately to enhance professional practice by evaluators. This work led to the production of a logic model that identifies, through three dimensions (context, implementation and governance), the multiple pathways that HIA may take to bring about change. It also seeks to show the interdependence of these pathways towards change and helps identify the key drivers and mechanisms of HIA success. In this respect, it complements existing HIA evaluation models as it can serve both as a generic framework for evaluating HIA effectiveness and as an instrument for monitoring HIA implementation.

The Performance of Environmental and Health Impact Assessment Implementation: A Case Study in Eastern Thailand.

Environmental impact assessment (EIA) performance has remained of interest, and over the past ten years, the evaluation technique has evolved. Thailand implemented an EIA with a health impact assessment (HIA) as an environmental health impact assessment (EHIA), which necessitated investigating and developing these instruments; however, its implementation performance has been questioned. The main goal of this study is to comparatively assess how well EIAs and EHIAs are performed in projects in an area in Thailand. Six projects in various sectors that were implemented in Eastern Thailand were studied. The 162 residents (nine local authorities and 153 villagers) closest to the project completed a survey and evaluated the performance according to three aspects (i.e., substantive, procedural, and transactive), using a rating scale and evaluation checklists. The results were presented as a percentage of the total scores and interpreted according to the five scales. The overall performance reached a satisfactory level, albeit not significantly different between cases; however, it was pointed out that the shortcomings of EHIAs and EIAs, particularly their dependability, lack of public involvement, and the need for more transparency, could be addressed through the establishment of an open access database, which would help to simplify the assessment of all stages of EIAs and EHIAs.

HIA as a standard tool for effective decision-making on NCD policies

Abstract Background Increasing rates of NCD are observed within EU countries. This paper aims to highlight the potential of Health Impact Assessment (HIA) in informing projects, plans, and programs related to health improvement, thus enhancing its role in the decision-making process. Methods The preliminary analysis focuses on HIA's involvement in the decision-making process regarding NCD in the EU, particularly in CEE countries over the past decade. The study examines various aspects of the identified HIAs, including their general information, the time frame of the HIA, proposed preventive measures, methods used, the description of the determinants of health affected by the decision, the type of document assessed, the affected population, the impact of the HIA on subsequent decisions, the source and cost of funding, the limitations of the study, HIA as a part of EIA or not, the use of artificial intelligence algorithms in the possibility of HIA implementation, etc. The impact of each HIA on subsequent decisions was categorized using an adaptation of a classification system developed by Wismar et al. for use in evaluating European HIAs (Wismar et al. 2007). Results The findings suggest that HIA is crucial in addressing the public and providing transparent information to entities with decision-making authority. It is recommended that the HIA process be a standard tool used to clarify information on health risk factors, implement new health policies, and monitor their effectiveness. The study also indicates that a completely digital approach to HIA is an open question that requires further research. AI algorithms can potentially aid in improving HIA's efficiency and processing complex information and data. Conclusions HIA has excellent potential to improve the decision-making process related to non-communicable diseases, and its incorporation as a standard tool is essential. The use of AI algorithms in HIA implementation is a promising area for future research. Key messages • HIA is a crucial tool in addressing the public and providing transparent information to entities with decision-making authority. • The use of AI algorithms in HIA implementation is a promising area for future research.

Implementing Health Impact Assessment policy on infrastructure development in the London Borough of Tower Hamlets

ABSTRACT This case study articulates findings from a policy analysis that explored key challenges to the development and adoption of a Health Impact Assessment (HIA) Policy within the infrastructure development setting in the London Borough of Tower Hamlets. Tower Hamlets sought to test whether the mechanisms provided by the planning system were achievable and measurable or whether policy changes were needed to make the implementation of HIA Policy more effective. In 2020, the HIA Policy was adopted in the Tower Hamlets Local Plan to systematically assess the health impact of new infrastructure development. This case study details how in 2018, a policy analysis was undertaken, building on an international literature review, considering evidence from health and development databases and relevant academic texts. Primary research was undertaken, incorporating a knowledge attitude and practice survey underpinned by grounded theory. Despite HIAs being widely encouraged within infrastructure development, there was limited published peer-reviewed literature demonstrating their effectiveness in this setting; however, insights emerged around capacity building, the development process, and community participation. The findings of the analysis initiated a capacity building programme, known as the ‘HIA Implementation Programme’, with recommendations proposed and subsequently accepted by decision makers across Public Health and Planning teams.

Driving HIA implementation in Ireland: The role of academia and public health institutions

Abstract Over the past decades public health research has presented compelling evidence that health is socially determined. To address structural inequalities and inequities in health, public policies require intersectoral development and implementation. Health Impact Assessment (HIA) is an established tool for analysing potentially detrimental health outcomes of policies, programmes and projects. In Ireland, we are presented with a unique opportunity to examine HIA implementation by capitalising on the synergy of recent policy commitments driving HIA implementation. Specifically, the national public health framework Healthy Ireland 2013-2025, and the newly developed all-island Institute of Public Health HIA guidance (2021), have coalesced in steering the strategic direction of HIA. This presentation outlines the current synergistic policy context on the island of Ireland, including the publication of new HIA guidance, which opens opportunities and new possibilities for implementing HIA. Reflections will be made on the potential and reality of current HIA training programmes in Ireland. Learning from the lessons of a dearth of HIA implementation at varying time periods since 2000, this presentation discusses the mechanisms in place, such as the successful World Health organization-led healthy cities projects in Ireland, such as Cork Healthy Cities, and those key drivers that are required to capture policy synergy for meaningful HIA implementation.

Old and new challenges of HIA Capacity building in Portugal

Abstract Within the European framework on health, adopted in 2012 by the Member States in the World Health Organization European Region, Health Impact Assessment (HIA) plays a crucial role in achieving the Sustainable Development Goals by supporting decision-makers to address health impacts and inequalities and ensure health gains. In Portugal, the integration of HIA in the Public Health Services (PHS) is still lacking despite of several attempts to implement HIA. In the pandemic and post-pandemic context, Public Health Authorities are busy with a lot of mandatory tasks, and the absence of a national policy framework for HIA that puts into practice the legal obligations arising from the Environment Impact Assessment Directive 2014/52/EU inhibits its sustainable implementation. The National Institute of Health Doutor Ricardo Jorge (INSA) has been involved in capacity building initiatives designed to further support the institutionalization of HIA in Portugal. This presentation outlines the lessons learned from this experience and will identify key facilitators and barriers elements for HIA implementation in specific contexts. The role of PHS in HIA development and execution will be discussed taking into consideration policy dialogue conclusions, and data collected from a survey aim to address the use and perception of this methodology in Public Health Units at the local level. The more recent Portuguese Fundamental Law on Health (Law nº95/2019) provides an important policy support ensuring Health in All Policies (HiAP) and it also opens a new pathway to enable HIA implementation at the national, regional, and local levels. In this respect, the PHS could play a crucial role taking leadership for HIA in Portugal. Novel and old approaches are still withstanding challenges.

Networking experiences for promoting HIA implementation in Andalusia

Abstract The Health Impact Assessment (HIA) is a useful tool that allows policymakers and project developers to predict and control the consequences of their proposals on the health and equity of the affected population. The existence of a legislative framework for the institutionalization of HIA has been proposed as a critical factor in providing permanent rules and in legitimizing HIA within the decision-making process. In Andalusia (Southern Spain), the HIA is legally binding after the approval of the Public Health Act 16/2011 and Decree 169/2014, which establishes the HIA procedure in the Andalusian context. This new legal framework made necessary to promote capacity-building programs in HIA, but also to develop an online platform that would allow sharing experiences and knowledge among all those public health professionals involved in the review and approval of HIA reports submitted by the developers of proposals. These tasks were addressed by a leading group of the HIA network made up of officials from the Regional Ministry of Health and experts from the Andalusian School of Public Health (EASP). The platform, set up in 2018, integrates around 90 professionals from different administrative bodies according to the proposal's scope (local, regional), covering the great geographical dispersion of Andalusia, and allowing to evaluate more than 2400 proposals in 4 years. The platform also facilitates the traceability of files (both for improving internal management and in responding to external queries), and acts as a source of relevant evidence, supporting the work of professionals involved in HIA. The platform allows extracting data and generating figures, showing information on the number of files created and resolved by different periods, provinces, type of proposals, etc. This tool has been very useful for the continuous training of professionals involved in HIA in Andalusia, following a coaching approach. Speakers/Panellists Robert Otok ASPHER, Brussels, Belgium

9.G. Workshop: Health in all Policies: key driver for better health still awaiting of greater governing stewardship

Abstract Healthy public policies are those that take accountability of all possible health impacts, acknowledging the causal pathways resulting from the modification of upstream health determinants (e.g. transport strategies, etc.), and related risk factors downstream (e.g. air pollutants). The strategy of Health in All Policies (HiAP), promoted by the World Health Organization (WHO) and adopted by the European Union (EU) in 2006, reinforced the need to reduce inequalities and improve health and wellbeing as essential pillars for a sustainable economic development. Central to HiAP is the notion that health is not only the responsibility of the health sector, but also a shared responsibility with many other sectors. In this context, Health impact Assessment (HIA) was proposed as the combination of methods to support HiAP implementation by providing scientific evidence on the positive and negative effects that any new proposal may have on health and health equity. The COVID-19 pandemic, and the climate change threat, are two of the main challenges that emphasise the need of integrated responses across many sectors to mitigate not only effects on health and inequalities, but also in the economy. However, HiAP and HIA implementation remains almost at a conceptual level, with a few remarkable exceptions in Europe. One of the most relevant reported barriers contributing to this uneven HiAP implementation is the lack of political stewardship and commitment. The difficulties in applying the guiding principles of HiAP (and consequently of HIA) at local, regional, or national governance level are in many cases linked to a conflict between the right to work and mobilization of the economy, with the right to health and reduction of inequities. This is where the role and drive of public health actors comes across, as HiAP requires public health professionals to build partnerships and engage meaningfully with the sectors affecting the social determinants of health and health equity, external to the health sector. A good proxy example to HiAP implementation, facilitating local and regional initiatives with communities, is the WHO initiative of Healthy Cities. The present panel discussion intends to analyse, from different perspectives, why HiAP has not gained a meaningful place within governing contexts, the current and future status of the intersectoral approach, and the advocacy role of public health in this context. The session is scheduled with a first overview presentation followed by a debate framed around the following aspects: – Different perceptions regarding the concrete implementation of HiAP at all political levels. – Perceived barriers or trade-offs for a broader implementation of HiAP. – Role of public health actors in the implementation of HiAP at a strategic, policy level, and how it could gain a more prominent role. – Level of understanding and awareness of the utility of HIA for HiAP implementation by public health actors. Key messages • HiAP, a recognised approach requiring all sectors to address decisions’ health and equity implications for reaching better global health, has not yet been implemented with an overarching vision. • Public Health actors can disentangle political and technical aspects, seeking for synergisms, and clarifying to non-health sectors the complexity and interrelatedness of social health determinants.

Common Agricultural Policy (CAP) from a Public Health Perspective

Abstract European Common agricultural policy (CAP) can impact several health outcomes like increased antibiotic resistant infections, poor health of farm workers and unhealthy diets which lead to several non-communicable diseases. Rapid literature review of public health recommendations for a new CAP covers several topics from environment, pesticides, livestock and antimicrobial resistance (AMR) to diet, food systems and others. Recommendations on pesticides are to periodically upgrade minimum standards of pesticides, reduce or abandon the use of pesticides and sustainable management of water quality in agriculture. In relation to livestock and antimicrobial resistance, EU should dedicate financial resources for programmes aimed at decreasing animal numbers, stop support for industrial livestock production through CAP subsidies and adopt low-antibiotics farming methods. To ensure better diet and food systems we need sustainable dietary guidelines, food labelling schemes, public procurement of healthy, local and seasonal foodstuffs, food education and campaigns, promoting food systems thinking at all levels, increase productivity of fruit and vegetable cultivation and social innovation in food supply chains. Other recommendations state that CAP should end support for wine sector and that CAP should include training, payment of adequate wages and health and safety standards, and lastly implementation of Health impact assessment of CAP. Agricultural policy is a very complex field with many stakeholders and consequently also implications on many levels. To make health a more visible and important objective, we need more public health experts to take part in advocacy for healthier CAP.

2.H. Workshop: Role of Health impact assessment in the policy-making process for the control of COVID-19 pandemic

Abstract The COVID-19 pandemic represents one of the most challenging health emergencies faced by humanity in modern history, with global effects on the economy and social well-being of people. This outbreak has abruptly brought public health back to the top of the policy agenda, making even more evident the need for adopting the comprehensive social determinants of health (SDOH) framework in designing effective mitigation and prevention measures. The novelty of the COVID-19 virus and the associated uncertainties about its health consequences and spread led to a massive generation of information from different sources, in some cases conflicting and contradictory. Conducting a systematic analysis and synthesis of existence scientific-evidence, considering all SDOH potentially affected, is crucial for supporting proportionated policy-decisions that reverse the spread of the virus and support health systems across Europe and worldwide. Health Impact Assessment (HIA) aims precisely at supporting the decision-making process by providing information and scientific evidence on the positive and negative effects that any new proposal may have on health and health equity. Its prospective nature also allows the introduction of corrective measures as an ongoing learning process, managing the estimated impacts and optimizing the health results of each proposal. HIA was launched as a methodology/tool by the World Health Organization (WHO) in 1999 and adopted by the EU in 2006 for supporting the development of healthier policies, projects and programs, related to both health and non-health sectors. However, its implementation in Europe is uneven across countries. The COVID-19 outbreak provides a good scenario for analysing the extent to which decision-makers are basing their decisions on the best available scientific evidence, and on the benefits of using the HIA approach. The present workshop will analyse and debate several experiences of using HIA as a supporting tool in the formulation of some of the most conflictive measures adopted by European governments related to the COVID-19 pandemic, such as ‘Lockdowns', ‘Staying at Home' and social distancing policies and requirements to work from home. Some of the questions that we intend to address in this workshop are: To which extent have decisions for managing the COVID-19 pandemic been based on the best scientific evidence available? What are the advantages of adopting an HIA approach in public health policy decisions? Are science and public health experts providing quick, synthetic and useful information for decision-making in the special circumstances of the current pandemic? Key messages COVID-19 pandemic reinforce the need for policy-makers based their decisions on best available scientific evidence through systematic processes such as HIA. Mitigation measures for the control of COVID-19 should go beyond healthcare assistance, making a more extensive implementation of HIA and a comprehensive approach to health.

The Built Environment and Health in Low- and Middle-Income Countries: a Review on Quantitative Health Impact Assessments.

Features and attributes of the built environment (BE) impact positively and negatively on health, especially in cities facing unprecedented urban population growth and mass motorization. A common approach to assess the health impacts of built environment is health impact assessment (HIA), but it is rarely used in low- and middle-income countries (LMICs) where urbanization rates are fastest. This article reviews selected HIA case studies from LMICs and reports the methods and tools used to support further implementation of quantitative HIAs in cities of LMICs. In total, 24 studies were reviewed across Algeria, Brazil, China, India, Iran, Kenya, Thailand, Turkey, and Mauritius. HIAs examine specific pathways through which the built environment acts: air pollution, noise, physical activity, and traffic injury. Few HIAs of BE addressed more than one exposure pathway at a time, and most studies focused on air pollution across the sectors of transport and energy. A wide number of tools were used to conduct exposure assessment, and different models were applied to assess health impacts of different exposures. Those HIAs rely on availability of local concentration data and often use models that have set exposure-response functions (ERFs). ERFs were not adapted to local populations except for HIAs conducted in China. HIAs of BE are being successfully conducted in LMICs with a variety of tools and datasets. Scaling and expanding quantitative health impact modeling in LMICs will require further study on data availability, adapted models/tools, low technical capacity, and low policy demand for evidence from modeling studies. As case studies with successful use of evidence from modeling emerge, the uptake of health impact modeling of BE is likely to increase in favor of people and planet.

Enjeux de la pratique en évaluation d’impact sur la santé : observations sur l’expérimentation de cette démarche au Québec

The Quebec Government Policy of Prevention in Health incited several regional Public health departments (PHD) to initiate health impact assessment (HIA) as a way to strengthen collaboration with municipal decision makers and improve their projects of urban planning projects. This article presents the main HIA implementation issues encountered in the last two years and the solutions applied or envisaged. The documentation of the issues is based on the observations of HIA experts drawn from working sessions with practitioners from different regional PHDs and from the activities of a community of practice. Five issues have been identified : appropriation of the HIA process and new skills, support and collaboration of municipal partners, intersectoral work, access to expertise and evidence as well as HIA funding. A common implementation framework offering different tools, a scientific support and a vibrant community of practice will help to develop skills of practitioners and capacities of their respective organizations. These solid foundations will increase the credibility and relevance of HIA for municipal partners. An in-depth evaluation will be carried out at the end of the experiment to examine the relevance, feasibility and acceptability of HIA and to better understand the conditions necessary for a successful integration of this practice in various contexts. It will make it possible to assess whether the services and instrumentation made available to practitioners are useful or how they can be improved.

Internationally validating a conceptual framework for health impact assessment

Aims: This study has internationally tested and refined a framework for institutionalizing and practicing health impact assessment (HIA). HIA is conducted differently in different contexts and recently HIA experts suggest that broader context, in which HIAs are carried out is linked to technical aspects of the HIA. Materials and Methods: A survey internationally attained viewpoints of academics and practitioners (n = 38) on the identified parameters of the framework including factors influencing HIA. Structural equation modeling (SEM) through SmartPLS was used to test for relations between the factors. Finally, the model was modified to reach an appropriate fit. Results: The framework emphasizes HIA Context, HIA Capacities including Institutional, Technical and Participation capacities, HIA Content, and HIA Outcomes as key factors in implementation and practice of HIA. This framework reflects the broad range of factors that influence HIA. All broad factors were perceived as significant influences on the practice of HIAs. Some fit measures, i.e., the standardized root mean square residual appear to be in the acceptable range. Conclusion: We have demonstrated the utility of SEM for developing and testing a framework to do HIA in different country contexts.

A Comparative Analysis of Health Impact Assessment Implementation Models in the Regions of Montérégie (Québec, Canada) and Nouvelle-Aquitaine (France).

Many countries have introduced health impact assessment (HIA) at the national, regional, or local levels. In France and in Québec, there is increasing interest in using HIA to inform decision-makers and influence policies, programs, and projects. This paper aims to compare HIA implementation models in two regions: Nouvelle-Aquitaine (France) and Montérégie (Québec, Canada) using a case study methodology. The objective is to gain a better understanding of the similarities and differences in the approaches used to achieve the operationalization of HIA. The methodological approach involves four steps: (1) design of an analytical framework based on the literature; (2) exchanges within the research team and review of documents concerning the two implementation strategies under study; (3) development of the case studies based on the proposed framework; and (4) cross-comparison analysis of the case studies. The findings show that the two regions share certain similarities, including the strong commitment and political will of the public health organizations involved and a well-established culture of engaging in intersectoral action with municipal partners. Differences mainly concern their different approaches to implementing HIAs in accordance with the regional policies and the organizational and administrative contexts in place. This study identifies potential avenues for supporting the practice of HIA at the municipal level.

Health Impact Assessment (HIA): A Comparative Case Study of Sri Lanka and Wales: What Can a Developing Country Learn From the Welsh HIA System?

The health impact assessment (HIA) is increasingly recognized around the world as an effective governance tool to incorporate Health in All Policies to address the wider determinants of health. However, it is still poorly recognized and practiced in many developing countries, including Sri Lanka, where its applicability is most appropriate considering the complexity of social determinants of health and inequalities. This comparative case study aimed to explore the barriers for implementation of HIA in Sri Lanka in the areas of supportive policy framework, institutional infrastructure, capacity-building, and multi-sectoral collaboration and to compare them with a successful HIA system in a developed country (Wales) with a view toward identifying the "best practices" applicable in a developing country context. The case study revealed that there is an emerging government commitment in Sri Lanka to embrace the Health in All Policies approach and much potential in the health system to develop a centrally dedicated expert team with peripheral counterparts and multi-sectoral collaboration, which were the primary pillars of success in the Welsh system. However, there is a great need for capacity-building and for development of country-specific tools, which would facilitate the establishment and sustainability of HIA processes in Sri Lanka.

Experiences and needs of licensed health risk assessors conducting health impact assessment in the Czech Republic.

The main aim of this study is to discover and analyse the utilization of health impact assessment (HIA) among HIA certificate holders, and to ascertain their opinions on the current situation in the Czech Republic and on the possible future nationwide implementation of health impact assessment. The target group of the research was identified as holders of professional competence certificates in the field of public health impact assessment. A structured questionnaire was developed. The first part mapped the recent use of HIA in the Czech Republic, the second addressed the issue of linking HIA to regional policies and to the national strategy, the third aimed to gain information about the preparedness of the Czech Republic for the full implementation of HIA, and the last part focused on quality assessment and capacity building for HIA. The results of the survey point to the inconsistencies in the perception of the whole concept of HIA in the Czech Republic by the professional public, and also to a shortage of experts in this area. There is only a narrow circle of experts, especially in the field of health care. It also lacks an informational base, which assist in the unification of processes in this area. As the results of the questionnaire showed, the problems are the lack of interest in the application of the HIA method and, subsequently, the lack of demand. The collected data showed obstacles and gaps in the implementation of the HIA methodology in the Czech Republic. At the same time it has revealed possible ways to change the current situation, based on the opinions of those who practice this methodology in the Czech Republic.

Health Impact Assessment (HIA) of a fluvial environment recovery project in a medium-sized Spanish town.

Introduction: The Interdepartamental Public Health Plan of Catalonia (2014) seeks to enforce Health in All Policies (HiAP) at the regional and local levels. Within this context, the City Council of Sant Andreu de la Barca (SAB), the Metropolitan Area of Barcelona (MAB), and the Public Health Agency of Catalonia started a Health Impact Assessment (HIA) of an urbanistic redesign of the Llobregat fluvial area in SAB, the results of which are presented in this paper. Methodology: In 2018, after a HIA screening, a prospective nonquantitative HIA was conducted. Politicians, professionals, and citizens participated in identifying potential impacts. Impacts were prioritized and linked to health determinants, scientific evidence, and potentially affected social groups. Afterwards, recommendations were formulated in order to improve the health impacts of the project. Finally, indicators were selected to evaluate HIA implementation. Results: The HIA was successfully implemented with the participation of technicians and citizens of SAB. The health impacts identified were mainly related to environmental, public safety, lifestyle, socioeconomic, and political contexts. Ten recommendations were defined to minimize the potential negative health impacts of the project, with six of them directly included and only one dismissed due to incompatibility. Conclusion: A HIA was successfully carried out in the medium-sized town of Catalonia, promoting Health in all Policies at a local level and improving health impacts of an urbanistic project.

Combining Public Health Issues and EIA – a Case Study of an Austrian Rural Road Traffic Project

Background Since 1994 it has been mandatory in Austria to conduct environmental impact assessment (EIA) for certain infrastructure projects according to its EIA Act. The health issue is not explicitly addressed in this federal law, only “human beings” are considered as one of the factors to be protected. In 2010, the Austrian Health Impact Assessment (HIA) Action plan and in 2011, a national HIA Support Unit (2011) were established in order to foster the implementation of HIA in Austria on a voluntary basis. The development of tools and methods in order to perform HIAs and to test them in certain areas are of strategic importance for human health and necessary. Aim: Since there are few experiences in the conduction of HIA projects available in Austria, a comprehensive pilot HIA of a road traffic project has been carried out showing how HIA can be applied into transport planning. The objectives of the pilot project were (i) to examine the potential health and well-being impacts of the road traffic project at local level as its starting point to undertake further HIAs in the transport sector, and (ii) to cooperate with the regional transport department on how HIA can be implemented and used within EIA. Methods A steering group comprising representatives from central agencies, municipalities, research organizations, HIA experts and affected people has submitted valuable comments during the course of the project. A participation concept has been developed to promote involvement of affected inhabitants and relevant companies within the project. In order to achieve the objectives, a mix of methods has been applied: (a) a literature survey; (b) a survey, which was sent to all households in the affected area; (c) two focus groups with affected individuals and representatives of local SME's; (d) qualitative interviews; and (e) workshops on scoping, appraisal recommendations involving national and regional opinion leaders and stakeholders. Results A number of potential health impacts were considered using a range of sources of information. As a main result, ten recommendations have been drafted, discussed and derived for the proponent and local politicians. Through the development of a participation concept the needs of particular groups of the population were systematically addressed. Conclusion This case study, concerning a road traffic project, represents the first (voluntary) HIA in transport sector in Austria and shows how a HIA can supplement an EIA process in order to give priority to both environmental and social sustainability. This case study is in particular interesting for practitioners, but there are scientific lessons learnt too.

Exploration of the functions of health impact assessment in real-world policymaking in the field of social health inequality: towards a conception of conceptual learning.

With the implementation of health impact assessment (HIA)'s conceptual model into real-world policymaking, a number of fundamental issues arise concerning its decision-support function. Rooted in a rational vision of the decision-making process, focus regarding both conceptualisation and evaluation has been mainly on the function of instrumental policy-learning. However, in the field of social health inequalities, this function is strongly limited by the intrinsic 'wickedness' of the policy issue. Focusing almost exclusively on this instrumental function, the real influence HIA can have on policymaking in the longer term is underestimated and remains largely unexploited. Drawing insights from theoretical models developed in the field of political science and sociology, we explore the different decision-support functions HIA can fulfill and identify conceptual learning as potentially the most important. Accordingly, dominant focus on the technical engineering function, where knowledge is provided in order to 'rationalise' the policy process and to tackle 'tame' problems, should be complemented with an analysis of the conditions for conceptual learning, where knowledge introduces new information and perspectives and, as such, contributes in the longer term to a paradigm change.