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HIA Part 3: What's in a name?

This is the third and final in a series of blog posts recapping the 12th International Health Impact Assessment Conference, which I attended in Quebec City in August. Part 1 was an introduction to Health Impact Assessment (HIA), Part 2 discussed the benefits to conducting HIA, and in Part 3 I'll talk about the myriad of different types of assessment - and what is (and isn't) in a name.

EIS2There are many, many types of impact assessments. A 2004 literature review identified 142 different types: environmental, health, health equity, collective... and the list goes on (and on). As I talked about in Part 2, one reason to conduct an HIA is that it provides a framework to access the impacts on non-health policies or programs on health - which means that you can 'sneak' health onto the agenda even if there is little political will around health issues.

But is HIA the only – or best- way to go? In some cases, the decision about which types of assessment to conduct may come down to expertise or personal preference. The decision could also be determined by legislation or policy, or a level of government could make a conscious decision about which type of assessment to promote. For example, in Ontario, the Ministry of Health and Long Term Care (MOHLTC) has developed a Health Equity Impact Assessment (HEIA) tool. HEIA is a way to identify unintended impacts, support equity-based improvements, embed equity and raise awareness of the importance of health equity. As April McInness from the MOHLTC said in her presentation, health equity matters because poor living is a result of poor environments which are a result of poor policies. For example, in the City of Hamilton, Ontario, there is a 20 year variation in life expectancy between neighbourhoods. HEIA provides a way to identify potential harms and ensure that the proposed program or policy will be effective.

It is a confusing world of impact assessment out there - but as Isabelle Goupil-Sermany said in her presentation, "If you hear of any (type of) assessment happening, this is your opportunity to get health in. (These assessments) are the same language with different words".

In desperately trying to sum up HIA in general, and the incredible conference in particular, I find I'm still struggling, nearly two weeks later, to process everything. A few things are clear to me and so here are my final (for now?) thoughts on HIA:


  • HIA has the potential to bring collaborators together, to engage the community, and get health on the agenda of non-health folks. In this way, HIA may be a different "basket" or package of skills and techniques many of us in health promotion/public health already use: the aforementioned collaboration and community engagement, also research, analysis, contingency planning and advocacy.
  • There are a myriad of types of impact assessments out there. Be clear about why you want to conduct an impact assessment: that may help you to choose which type and framework to use.
  • If you're thinking about conducting an HIA or HEIA (or any other type of assessment) – stop thinking and get out there and do it! Look for others to experiment with you, track everything that you do, and learn as you go. There are lots of fantastic resources and experts out there (I have found a LinkedIn group for HIA) that you can tap in to.

Thanks for going on this 3 part HIA journey with me. I'd love to hear your comments, thoughts, experiences and ideas on HIA or other types of impact assessments. Let's learn together!

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HIA Part 2: Why should I do HIA? What’s in it for health?

This blog post is part of a series on the 12th International Health Impact Assessment conference which I attended in August in Quebec City. In Part 1 I gave an overview on HIA in case you – like me - are new to HIA (Health Impact Assessment). In this post, I'll try to answer the question "What's in it for me?" (with the 'it' being conducting an HIA) by exploring the themes that emerged over the course of the 7 plenary sessions/ keynote presentations and 6 concurrent sessions that I attended. These three themes, which really speak to the outcomes and benefits of conducting an HIA, are:
• Collaboration and expanded social networks
• Community engagement/participation
• Address health through non-health policies/programs

HIA provides opportunities for collaboration with sectors/organizations/people that may not have worked together previously. The process of conducting an HIA can build mutually respectful relationship and establish common language. While many of us work with partners in various sectors, HIA can take intersectoral collaboration to concrete action. HIA can be a way to build social networks by establishing new relationship and collaborations amongst people whose work addresses similar issues, but have not worked together (or even spoken to each before). For example, Rajiv Bhatia from the San Francisco Department of Public Health shared that in his city, the planning and education sectors did not have a working relationship until an HIA was conducted. The HIA brought the two sectors together and through the project, they established a relationship that carried on after the HIA was completed into future projects and planning.

HIA provides opportunities for community engagement and participation and gives communities a voice in matters that deeply affect them. In Thailand, conducting an HIA on "potentially harmful projects" is required by the Constitution and the National Health Act guarantees the right of citizens to participate in the process. In this way, HIA is a tool that gives people power- and a voice- in policy making. In Oakland California, the Change Lab conducted an HIA received a community participation grant to conduct an HIA regarding the placement of a transit.

As I talked about in my first blog post, HIA provides a framework to address health though non-health policies/programs. This gives the health sector an opportunity to influence strategies, policies and programs that affect health but are directed by other sectors. A note of caution here: that there is often seen to be a push-pull relationship between health and other sectors whereby health "pulls" other sectors into "our" territory and "pushes" those sectors to do work which they may see as the work of the health sectors. This can often evolve into a tug-of-war between health and other sectors. Danny Broderick, from South Australia, advised us to "drop the rope" and instead of attempting to pull sectors into our territory, move into the territory of the other sectors. This theme was echoed and referred to throughout the conference.

A final reason to conduct an HIA is this: it works. In New Zealand, nearly 50 HIAs have been conducted on a variety of strategies and policies. 17 were evaluated and 24 were included in a meta-analysis which showed that HIA does work. The majority of the recommendations made in the HIAs were accepted by the local council/government: this is the dream of those of us who work in policy development! When asked "What does HIA achieve?" Robert Quigley, who has worked in HIA in New Zealand, the UK and Australia, answered that HIA:
• informs and changes the proposal
• alters the proposal development process
• informs and changes the work of other sectors
• develops knowledge and skills of HIA and the social determinants of health
• develops technical, methodological, consultative, partnership development and community engagement skills of those conducting and involved in the HIA

As Francois Benoit, from the National Collaborating Centre for Healthy Public Policy noted, HIA is a WIN WIN WIN: a win for public health, for policy makers and for the community.

I'll wrap up this blog post by quote Robert Quigley again: you don't have to be an expert at HIA at the start. You'll build capacity along the way. Just get out and do one!

Stay tuned for the last blog post in this series: HIA Part 3: What's in a name?

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HIA Part 1: What is Health Impact Assessment?


Last week, I attended the 12th International Conference on Health Impact Assessment in Quebec City. The conference's theme was "How Health Impact Assessment matters in Health in all Policies" and it attracted 365 participants from 42 countries!

It's impossible to condense learning from a two and a half day conference into one blog post - so I'll be writing a three part series for the HC Link Blog. In this first post, I'll talk a little bit about what Health Impact Assessment (HIA) is. The second post will attempt to summarize some of the conference themes, how HIA can be applied in health promotion and what the benefits to conducting an HIA are. In the third and final blog post, I'll talk about Ontario's approach to HIA.



I am quite new to HIA. In fact, my pre-conference reading and then the conference itself were my first exposure to it. I think a good way to explain what HIA and what it's used for is to compare it to a more well-known type of assessment- environmental impact assessment. These are conducted for proposed projects – such as the Northern Gateway Pipeline project in Alberta, to determine what the effects of the project on the environment would be. In a similar fashion, Health Impact Assessments aim to predict the potential positive and negative effects of policies and programs on health, wellbeing and health inequalities.

HIA recognizes that the health of individuals and communities is largely determined by decisions made in other sectors; for example an oil/gas pipeline project may – or may not- have effects on health, but the health sector may not be involved in the decision-making process. HIA provides a framework to assess non-health policies or programs on health and helps decision-makers make choices about alternatives and improvements to prevent disease/injury and to actively promote health.

The World Health Organization's HIA is a four step framework. The screening phase determines whether or not the HIA should be conducted. In order to determine this, question if the policy will affect/address any of the 12 social determinants of health as well as any particular priority groups (such as Aboriginals, new Canadians, the homeless etc). In the scoping phase, decisions are made about how to conduct the HIA and who will do it. It's very important here to define the parameters for the HIA, as generally speaking, resources and time are limited! In the appraisal phase, health hazards are identified and impact evidence is considered. HIAs can incorporate a wide variety of data sources, from statistics and health data to findings from the literature to focus groups, community meetings and individual interviews with groups who will be impacted by the policy or program. In the final reporting phase, recommendations to reduce hazards and/or improve health are made. The Centers for Diseases Control and Prevention add two additional steps for reporting to decision-makers, and monitoring and evaluating the effect of HIA on the decision.

HIA, whether for a policy (such as land-use planning in a municipality) or a program (such as a Good Food Box program), is best done early in the development stages. In the policy development process, HIA can be a part of steps 1 to 3 in the Roadmap for Policy Development. In program planning, conducting as HIA can be done as part of step 2 (situational assessment). HIA can also be a powerful tool for community participation and engagement (more on this in part 2).

Please stay tuned for HIA Part 2: Why should I do HIA? What's in it for health?


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