Topic: Equity focused health impact assessment: social determinants of health

Order Description Equity focused health impact assessment: social determinants of health Journal paper article Please view the uploaded book chapter and try to do a paper very similar to the sample but please do not re write it Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=tiap20 Download by: [115.64.3.252] Date: 19 November 2015, At: 03:28 Impact Assessment and Project Appraisal ISSN: 1461-5517 (Print) 1471-5465 (Online) Journal homepage: http://www.tandfonline.com/loi/tiap20 Health impact assessment: the state of the art Ben Harris-Roxas , Francesca Viliani , Alan Bond , Ben Cave , Mark Divall , Peter Furu , Patrick Harris , Matthew Soeberg , Aaron Wernham & Mirko Winkler To cite this article: Ben Harris-Roxas , Francesca Viliani , Alan Bond , Ben Cave , Mark Divall , Peter Furu , Patrick Harris , Matthew Soeberg , Aaron Wernham & Mirko Winkler (2012) Health impact assessment: the state of the art, Impact Assessment and Project Appraisal, 30:1, 43-52, DOI: 10.1080/14615517.2012.666035 To link to this article: http://dx.doi.org/10.1080/14615517.2012.666035 Published online: 24 Feb 2012. Submit your article to this journal Article views: 3379 View related articles Citing articles: 7 View citing articles Health impact assessment: the state of the art Ben Harris-Roxasa,b*, Francesca Viliania,c, Alan Bondd, Ben Cavee, Mark Divallf, Peter Furug, Patrick Harrisb, Matthew Soebergh, Aaron Wernhami and Mirko Winklerj,k aHealth Section Co-Chair, International Association for Impact Assessment; bCentre for Primary Health Care and Equity, University of New South Wales, Australia; cInternational SOS, Denmark; dSchool of Environmental Sciences, University of East Anglia, UK; eBen Cave Associates, UK; fShape Consulting, Channel Islands/South Africa; gDBL Centre for Health Research and Development, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; hHealth Inequalities Research Programme, Department of Public Health, University of Otago, New Zealand; iHealth Impact Project, Pew Charitable Trusts, USA; jDepartment of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Switzerland; kUniversity of Basel, Switzerland (Received 4 January 2012; final version received 9 February 2012) Health impact assessment (HIA) has matured as a form of impact assessment over the past two decades. The use of HIA methods and approaches has expanded rapidly, and it now has applications in both the public and private sectors and in an increasing number of countries around the world. This paper presents an overview of the historical and recent international developments in HIA, before detailing the existing strengths, weaknesses, opportunities and threats to practice. It draws upon the HIA literature, five workshops on ‘Current issues in HIA practice’ held at International Association for Impact Assessment (IAIA) conferences between 2006 and 2011, and the experience of the authors. Keywords: health impact assessment; public health; international; history Background Health is not a new concern within impact assessment. Many of the events that created the impetus for regulatory environmental assessment first came to public attention because of their human health impacts (WHO 1979, Kasperson 1983). Since then the consideration of health within impact assessment has expanded and in the past two decades the use of health impact assessment (HIA) as a discrete form of impact assessment has become relatively widespread (Vohra 2007). This paper presents an overview of HIA activity internationally and suggests future directions for the field. It addresses the history of HIA; examples from various countries of the legal and policy frameworks to support HIA’s use; a consideration of strengths, weaknesses, opportunities and threats to current practice; and the potential future directions for HIA. This paper is part of a collection of articles on the state of the art in impact assessment and like the others in this collection it updates the last International Association for Impact Assessment (IAIA) overview of the field that was published in 1995 (Vanclay and Bronstein 1995) and its chapter on HIA (Birley and Peralta 1995). To provide this overview it draws on published HIA literature; five workshops on ‘Current issues in HIA practice’ that were held at IAIA conferences between 2006 and 2011; and the experience of the authors, who are all IAIA Health Section members and have collectively practised across six continents and been involved in more than 200 HIAs. All too often, health professionals consider the health infrastructure implications of proposed developments, rather than the broader health implications of the design (e.g. whether a housing development encourages walking or driving), and non-health professionals have insufficient understanding of health to understand the consequences of their actions. Greater dialogue would go a long way towards improving the consideration of health in decisionmaking (Bond et al. 2011), and one of the roles of HIA is to provide the forum for that dialogue, to ensure that health professionals are engaged in decisions that affect health outcomes rather than treating the problems at a later date. History of health impact assessment The evolution of HIA differs from that of environmental impact assessment (EIA) and many other forms of impact assessment. Historically, EIA had been closely linked to assessment of major projects as part of environmental protection legislation (Caldwell 1988) dating back to the US National Environmental Policy Act (1969). Impact assessment practice has since expanded to encompass strategic environmental assessment (SEA) and other forms of impact assessment (Wright et al. 2007, Joffe 2008), but often without detailed consideration of human health impacts (Bhatia and Wernham 2008, Harris et al. 2009). HIA’s history and development is distinct, however, because its origins do not lie solely in EIA and environmental health concerns but also in public health professional movements that have emphasized its potential role in promoting action for health at a policy level and as a measure for redressing and promoting more equitable health impacts (Scott-Samuel et al. 2001, Mahoney et al. 2007, Nilunger Mannheimer et al. 2007, Kang et al. 2011). Given this different history, it has been recognized that HIA can learn a lot from the experience and development of other forms of impact assessment (Bond 2004, Bond ISSN 1461-5517 print/ISSN 1471-5465 online q 2012 IAIA http://dx.doi.org/10.1080/14615517.2012.666035 http://www.tandfonline.com *Corresponding author. Email: [email protected] Impact Assessment and Project Appraisal Vol. 30, No. 1, March 2012, 43–52 Downloaded by [115.64.3.252] at 03:28 19 November 2015 et al. 2005). At the same time, some forms of HIA practice have emerged that are aligned with emerging practice in other forms of impact assessment, such as a focus on enhancing potentially positive impacts of a proposal as well as assessing negative impacts, which has been referred to as ‘health opportunities’ (Quigley et al. 2006) (cf. the growing interest in seeking enhancement in sustainability assessment, Bond et al. 2012), and a focus on vulnerabilities and the distribution of potential impacts (Tamburrini et al. 2011, Esteves et al. 2012). HIA can be seen as originating from three distinct but related areas of public health activity: environmental health, the wider determinants of health and health equity (Harris-Roxas and Harris 2011). All three are linked by an overarching theme of broader, though at times incremental, engagement by the public health sector with non-health sector activities. Each of these is considered in turn below. HIA activity within the area of environmental health has had a strong focus on potential health risks of major projects stretching back several decades (Morris and Novak 1976, Birley 2005, 2011). The focus has often been on ensuring threats to human health are considered as part of regulatory EIA processes (Birley and Peralta 1995, Martuzzi and Bertollini 2005). Over time, there has been an increasing recognition that non-health sectors’ activities play a major role in determining health outcomes (Lalonde 1974, Mechanic 2000); hence the term ‘wider determinants of health’ which recognizes that the factors which determine health outcomes can be environmental, social, economic and/or institutional. This is not new; the very origins of public health lie in the recognition that environmental factors such as water, waste and air quality affect human health (Davies 2001, Corburn and Bhatia 2007). What has been new in the past several decades is an increased appreciation that social factors play an important role in determining health outcomes, as well as often determining the distribution of health risks (Kasperson 1983). These are known as the social determinants of health but are also referred to as ‘the causes of the causes’ (Wilkinson and Marmot 2003) because they are often the underlying causes of health conditions (WHO 2008a). HIA activity based on the wider view of health has tended to focus on voluntary assessment of public sector policies and strategies (Bos 2006). This is perhaps best exemplified by the Health in All Policies (HiAP) agenda, which requires consideration of the health implications of policies. HiAP has gained traction in Europe and elsewhere over the past five years and is being actively promoted by the World Health Organization (WHO) (Sta°hl et al. 2006, Kickbusch and Buckett 2010, WHO & SA Government 2010). HIA has been identified as a practical activity that can underpin a HiAP approach (Collins and Koplan 2009, Quigley 2010, Sta°hl 2010). Those concerned with health equity (WHO 2008a, 2012) have over the past decade identified HIA as an intervention that can address health inequalities in policy development and planning, that is, before inequalities come about (WHO 1997a, 2006, 2008a, 2008b, Acheson 1998). This approach is quite similar to activity related to the wider view of health but it is possible to look at the social determinants of health without looking at differential impacts and vulnerabilities (Harris-Roxas et al. 2004, Harris and Harris-Roxas 2010). Health equity-related HIA activity often involves more explicit discussion about the values and goals that underpin planning and decisionmaking (Harris-Roxas and Harris 2011). These three areas of activity are complementary and over the past decade their combined efforts have led to a rapid growth in the use of HIA, but given their different emphases there have at times been differing views about what the focus of HIA should be (Krieger et al. 2010, Vohra et al. 2010, Haigh et al. 2012). This is illustrated in Figure 1. The Gothenburg Consensus Paper (ECHP 1999) was one of the earliest attempts to bring together the disparate HIA activity introduced above. This document was developed at a conference of European HIA practitioners that was held in Gothenburg, Sweden, in 1999. It sought to define the procedural aspects of HIA and also set out principles that should guide the practice of HIA. Four values-based principles were identified – democracy, equity, sustainable development and the ethical use of evidence (ECHP 1999). In many ways these values reflect the context in which the Consensus Paper was developed, principally by European practitioners with an interest in the use of HIA from the wider view of health perspective. Since the time the Consensus Paper was developed HIA has expanded to markedly different contexts and countries and the extent to which these values inform actual HIA practice, rather than being rhetoric, now warrants attention. International perspectives Many if not most HIAs are currently conducted outside legislative or regulatory requirements (Wismar et al. 2007), though this varies markedly depending on the context. Currently most voluntary HIAs are being undertaken by the public sector on their own proposals, though increasingly the private sector is also adopting HIA, stimulated by industry best practice standards (IPIECA 2005, Quigley et al. 2006, Bhatia et al. 2009, Fredsgaard et al. 2009, ICCM 2010) and internal organisational standards. Where HIA is supported by policy or regulation, different jurisdictions have taken different approaches to developing legal and policy frameworks to support the use of HIA. These fall into two broad categories, as shown in Box 1. The first approach is to create specific provisions for the use of HIA through laws, regulatory mandates or supportive policies. The second approach emphasizes the consideration of health within whole-of-government decision-making processes, which may or may not include HIA per se (see Box 1). This may involve looking at health impacts in other assessment and governance tools such as target setting, interdepartmental committees, public health or environmental legislation, public policy formulation processes, public hearings, cross-departmental spending reviews, and crossgovernmental analytical and intelligence services (Puska and Sta°hl 2010, Wismar and Ernst 2010). 44 B. Harris-Roxas et al. Downloaded by [115.64.3.252] at 03:28 19 November 2015 State of the field The following section outlines the current strengths and weaknesses of HIA practice and the potential opportunities and threats associated with future practice. Strengths There is now a broad consensus on the procedural aspects of HIA, for example screening, scoping, assessment of impacts, recommendations, and evaluation and follow-up (Quigley et al. 2006, National Research Council 2011, Wernham 2011). This has led to recognition that improving the practice standards around each step of HIA will lead to an overall improvement in the quality of HIAs (Fredsgaard et al. 2009). The development of HIA as a discrete, stand-alone impact assessment process has afforded the opportunity to expand its use to a diverse range of applications (Mahoney et al. 2004, Coggins et al. 2007, Wernham 2011). Figure 1. Some historical landmarks in HIA. Adapted from Krieger et al. (2010). Impact Assessment and Project Appraisal 45 Downloaded by [115.64.3.252] at 03:28 19 November 2015 Box 1. Regulatory and legislative approaches to using HIA Broad approach 1: Requiring, supporting and promoting the use of HIA . Requiring that human health be considered as part of EIAs or broader impact assessment processes such as SEAs or environmental, social and health impact assessments (ESHIAs). This approach can be seen in many countries’ national or regional environmental protection legislation across the developed and developing world. Increasingly, multilateral and international agencies also require that health be considered within their mandated assessment processes. For example, the International Finance Corporation (IFC) and Equator Principles’ signatories require health be explicitly considered as part of the assessment of projects that they finance (Utzinger et al. 2005, Equator Principles 2006, IFC 2006, 2009). This has been an important driver of HIA practice in Sub- Saharan Africa in particular. An example of this is the Rio Tinto Simandou project in Guinea, where the IFC has a 5% share in the project (Winkler et al. 2010). The USA’s National Environmental Policy Act also includes reference to human health and this has been used as a basis for initiating health assessments in EIAs in Alaska and other parts of the country (Wernham 2007, Bhatia and Wernham 2008, Tamburrini et al. 2011). . Requiring that stand-alone HIAs be conducted on specific types or categories of proposals. For example, the Thai National Health Act (2007) requires discrete HIAs to be conducted for certain major projects beyond a certain scale and in specific sectors. The Lao PDR National Policy on Health Impact Assessment (2006) decreed by the Prime Minister requires that HIAs be conducted and that the terms of reference for the HIA and the final HIA report be endorsed by the Ministry of Health. In the state of Tasmania in Australia there is a standing requirement that HIAs be conducted by project proponents on all major projects of a certain scale that are referred to the Director of Public Health (NPHP 2005). . Legislating for health authorities to have the power to require an HIA at their discretion. For example, the Vietnamese Law on Prevention and Control of Infectious Diseases (2007) mentions that HIA can be conducted for investment projects on construction of industrial parks, urban centres and residential areas and overseen by the Ministry of Health. Another example is under state legislation in Victoria, Australia (Victorian Public Health and Wellbeing Act 2008), where the Minister for Health has the power to require an HIA be undertaken. . Legislating that potentially affected communities have the right to request discrete HIAs be conducted on proposal and to be involved in the HIA process (beyond the mere inclusion of health in EIAs or integrated assessments). This rightsbased approach was introduced into the Thai Constitution in 2007 and subsequently generated considerable concern from the business sector about how such a right would be brought into operation. Guidance has been developed by the Thai National Health Commission that sets out the procedures required, which include a more transparent public scoping process and a public review period following the completion of the draft HIA report (NHCO 2010). . Regulations or policies that support the use of HIA but do not require it. This approach can be seen in many municipal and regional government regulations across Europe, Asia and increasingly the Americas. Many health agencies internationally, ranging from the World Health Organization to local health authorities (WHO 2008b, Kang et al. 2011) explicitly identify HIA as an important tool to facilitate collaboration with other sectors (such as land use and transport planning) in developing their strategic plans and documents (WHO 1997b, Dora and Racioppi 2003). An example is the San Francisco Department of Public Health, which has undertaken numerous HIAs and has identified HIA as a key activity in its strategic planning process (Corburn and Bhatia 2007, Bhatia and Corburn 2011). A number of National Environmental Health Action Plans (NEHAPs), whose development has been promoted by WHO, now refer to HIA (Gopalan 2003). Recent examples of this include China and Mongolia’s NEHAPs (Government of Mongolia 2005, People’s Republic of China 2007). The Alaskan state government in the USA has also recently released a toolkit to support the use of HIA (State of Alaska 2011). Broad approach 2: Health within government processes The following approaches are not necessarily requirements for HIA per se but may be related or may promote the use of HIA: . Requiring a health review or screening of all government policies. For example, the Netherlands had a requirement that all government policies be screened to determine whether an HIA was required, which led to a number of HIAs being undertaken on national policies (den Broeder et al. 2003). Similarly the Quebec provincial government in Canada has a requirement that government proposals be appraised for their health effects (Gagnon and Michaud 2008). The state of New South Wales in Australia 46 B. Harris-Roxas et al. Downloaded by [115.64.3.252] at 03:28 19 November 2015 This might not have happened if HIA were conducted within an integrated assessment process restricted to defined activities. For example, less than 0.1% of planning applications in the UK are subject to EIA (Weston 2002) which, if HIA were integrated with EIA, presupposes that 99.9% of development has no significant health implications. Work has begun on practice standards and reviewcriteria forHIA, thoughmore is required (Quigley et al. 2006,Bhatia et al. 2009, Fredsgaard et al. 2009). This is an important mechanism for improving practice quality but also an important way to demonstrate that improvement has, in fact, occurred. This approach is distinct from critical appraisal or general critique through peer review, which are the more common HIAapproaches at present (Fredsgaard et al. 2009). Review criteria involve setting clear parameters for what constitutes an acceptable HIA and are an important step in the development of the field. This approach will also involve clarifying the broader goals and values ofHIA, and howthese should be put into operation. For example, how should broader goals of sustainability and equity be practically addressed in HIA? (Harris-Roxas et al. 2004). Part of this may involve developing application-specific HIA guidance, though there are already good examples of this (IPIECA 2005, ICMM 2010). Weaknesses Equity and the consideration of the differential distribution of impacts and vulnerabilities within HIA remains a challenge for two principle reasons. One is complexity associated with scoping and assessing differential impacts; that is, which groups are chosen (e.g. gender, age, socioeconomic status, ethnicity etc.) and on what basis? (Povall et al. 2010, Haber 2011, Harris-Roxas et al. 2011, Gunther 2011). Basing decisions more objectively on population profile data is also important but may be difficult to do where those data do not exist (Birley 2003). HIAs undertaken in resource-poor settings are particularly challenged by limited baseline population health data (Winkler et al. 2010) and limited information about existing health, social and environmental vulnerabilities (Kværner et al. 2006). The resourcing of HIAs, particularly within integrated impact assessment processes, remains a challenging practical issue (Birley 2007). An implied rationale for the application of HIA is often economic – that it is better to invest in preventing health problems now rather than ‘paying a larger bill later’ (Quigley and Taylor 2004, Wilkinson 2007). HIA requires resources and has to be detailed to be credible, but also has to be responsive to decision-making and budgetary requirements (Lester and Temple 2004, Harris-Roxas and Harris 2011). In practice, this has meant that HIAs are frequently rushed and often conducted after other impact assessment processes, with limited scope for the collection of new data upon which to base an assessment. Meaningful community engagement, for example, is a time-consuming and potentially resource intensive process, which is at odds with the time constraints that are often placed on HIAs (Parry and Wright 2003, Kearney 2004). Workshops conducted at IAIA conferences in 2006 and 2007 suggested that within the context of integrated assessments (incorporating socioeconomic, environmental and health issues) of major projects there should be a target of between 10 and 20% to be spent on the health component, though this appears to be an aspiration rather than a reflection of current funding levels. Capacity has been a critical factor in determining the extent to which the different approaches outlined in Box 1 have resulted in HIAs being undertaken. This refers to capacity not only to conduct HIAs but also to commission and review them (Nilunger Mannheimer et al. 2007, Harris and Spickett 2011, Harris-Roxas et al. 2011). The focus in many settings remains on introductory HIA training but the greatest demand is for (i) HIA practitioners who have conducted several HIAs and (ii) people with experience in commissioning and reviewing HIAs. Professional associations, such as the IAIA and other national associations, have an important role to play in supporting the development of practitioners, as do the agencies that are requiring or promoting HIA practice. Despite its increasing use, HIA lacks evidence to demonstrate that it is effective in changing decisions and the implementation of policies, programmes and projects (O’Reilly et al. 2006, Wismar et al. 2007, Dannenberg et al. 2008, Mathias and Harris-Roxas 2009), an issue which is equally relevant to other forms of impact assessment (Sadler 1996, Cashmore et al. 2004). The benefits of undertaking HIA need to be ascertained and requires that an Aboriginal Health Impact Statement be completed on all new health sector initiatives to ensure potential differential impacts on Aboriginal populations are identified and redressed prior to implementation (NSW Health 2003). These procedures bear some similarity to screening procedures in impact assessment more generally. . Discretionary use of non-HIA processes to look at health issues. For example, the state of South Australia, a world leader in developing the HiAP approach, has promoted the selective and strategic use of a ‘health lens’ (Health SA 2008, Kickbusch and Buckett 2010). This is a structured process for intra-governmental engagement that is similar to HIA. It aims to inform other sectors about the potential health impacts of their policies as part of government planning and implementation processes. These approaches are being driven at three levels: through national or state legislation (Soeberg 2006, Vohra 2007); through international agencies and mechanisms such as the IFC and the Equator Principles (IFC 2009); and through the use of voluntary practice principles by industry and assessors (IPIECA 2005, Quigley et al. 2006, Bhatia et al. 2009, ICMM 2010). Impact Assessment and Project Appraisal 47 Downloaded by [115.64.3.252] at 03:28 19 November 2015 then weighed against the costs of undertaking HIA, which include developing a skilled workforce, funding for consultation and evidence gathering, and opportunity costs associated with potential delays to decision-making and implementation (Dannenberg et al. 2008, Mathias and Harris-Roxas 2009). While it is important to demonstrate HIA’s value, it is equally important to recognize that at a more basic level HIA simply seeks to correct a fundamental problem: many decisions have health consequences, and these should be considered before decisions are made. The field would be supported by a more robust evidence base, both to demonstrate the value of its use and to improve practice standards (Wismar et al. 2007). If HIA is to become more routine in the already complex set of planning and assessment processes of the government and the private sectors, the field will need to demonstrate how conducting an HIA is likely to add new information and improve the outcomes of the decision. Opportunities There is an opportunity to change the current norms where decision-makers often insist on quantified and certain evidence of potential impacts before committing resources to acting on an HIA’s recommendations (Winkler et al. 2012). Realising opportunities requires practitioners to be more transparent in stating the degree of uncertainty associated with predicted impacts, and assumptions that underpin these predictions (National Research Council 2011, Hoshiko et al. 2012). Predicting many important impacts may often involve weaker and more speculative evidence (Veerman et al. 2006, 2007) but this information can still usefully inform decision-making. The focus on alternatives in HIA (or in an integrated assessment within which it is embedded) has often been limited to date, and where there is consideration of alternatives they are usually narrowly defined and restricted to siting alternatives, such as the location or route of a development, or technological alternatives, which involve applying new technological approaches or procedures. The opportunity exists to improve HIA through paying greater attention to other forms of alternatives, such as knowledge alternatives, institutional alternatives or goal alternatives. Knowledge alternatives involve looking at different ways of understanding the issue or problem. For example, where malaria is endemic, the problem can be viewed as being environmental (standing water), social (barrier to use of preventive schemes like bed-nets), economic (lack of access to treatment), or cultural (agricultural practices leading to standing water, or cultural practice leading to proximity to standing water), among many others. Institutional alternatives involve new partnerships or different ways of working at an organisational level, while goal alternatives involve consideration of what is trying to be achieved and whether alternative approaches could be used to achieve those overall goals (Sukkumnoed 2007, Sukkumnoed et al. 2007). The reasons for the narrower range of alternatives being considered is linked to understandings of the role of HIAs and what will come out of conducting them, and these are often closely linked to the perceived purpose of HIAs (Steinemann 2001). In many settings there is an expectation that HIAs will recommend minimal changes or tweaks to a proposal, rather than radical reconsideration of goal alternatives, and this necessarily limits the nature of the alternatives that can be examined (Fiorino 2001, Cashmore et al. 2004, Harris- Roxas and Harris 2011). There are now a number of examples of communitycontrolled HIAs that have been undertaken in Canada, India, Thailand and Australia (Gillis 1999, Cameron et al. 2011, Harris-Roxas and Harris 2011). These offer a markedly different perspective on HIA’s purpose and role in decision-making compared with its more technocratic applications that have more limited scope for public participation. The issues involved in community participation are not unique to HIA (Western and Lynch 2000, Wright et al. 2005). Most forms of impact assessment deal with them and there is potential for learning between impact assessment practitioners. The debates about HIA often reflect its diverse origins, uses and purposes – but most of all its adaptability. For example, HIA may benefit from better and more widespread integration with other assessment processes (Noble and Bronson 2005, Bhatia and Wernham 2008). At the moment the consideration of health is often limited to environmental health risk assessments that are conducted within larger assessment processes, with limited emphasis on potential health benefits from a proposal or the social determinants of health (Harris et al. 2009). The move towards sustainability assessment may represent an opportunity for HIA in that it suggests a more integrated, holistic approach to assessment (Bond et al. 2012), in which health is a key consideration, though as noted earlier there are some tensions with integration and there are risks of health considerations being overwhelmed. Threats Government health agencies currently view HIA as a novel activity rather than as a core capability. In plain terms, at present health systems around the world are consumed with providing medical services and core public health functions such as sanitation and infection control, and there is little or no routine or formalized interaction with other sectors. This means the health sector often does not get involved when a road is being planned, a mine is being permitted, or an educational policy is being revamped. This also underscores the importance of international efforts to evaluate the effectiveness of HIA (O’Reilly et al. 2006, Wismar et al. 2007, Dannenberg et al. 2008). The lack of partnership between sectors, for example health professionals and spatial planners, is a threat to the design of healthier environments (France 2004, Burns and Bond 2008). Conclusions HIA has come a long way as a field in relatively short time. Seventeen years ago Birley and Peralta wrote that ‘at 48 B. Harris-Roxas et al. Downloaded by [115.64.3.252] at 03:28 19 November 2015 present HIA is a blunt tool with the rudiments of an accepted methodology’ (1995). This is no longer the case. There is greater consensus about the procedural elements of HIA (e.g. screening, scoping etc.) as well as when it is most useful. Challenges remain, however. The authors believe that there is need for an updated international consensus on HIA to be developed (Krieger et al. 2010, Vohra et al. 2010). HIA practice has evolved since Birley and Peralta’s chapter was written (Birley and Peralta 1995) but also since the development of the Gothenburg Consensus Paper (ECHP 1999). There is a pressing need to revisit, at an international level, the governing values and standards that apply to HIA’s use in order to ensure they are relevant to the current diverse range of HIA practice. As we have outlined in this paper, HIA has established itself as a widespread, credible and useful activity that is conducted in increasingly sophisticated ways. This field’s focus has moved beyond describing HIA and how it can be used, to more nuanced understandings of HIA methods and their impacts on decision-making an implementation. The current diversity of HIA practice will continue to enable a disparate range of HIA-related activities to achieve similar end goals: protecting and promoting public health. Acknowledgements This paper draws on discussions held at a series of workshops at IAIA conferences between Seoul, Korea, in 2006 and Puebla, Mexico, in 2011. It also draws on ideas presented at the 2011 meeting of the WHO Western Pacific Regional Office’s Thematic Working Group on Health Impact Assessment, which was supported by the Korean Institute for Health and Social Affairs. We would like to thank Dr Jenny Pope, Ms Michaela Pfeiffer and Associate Professor Pat Bazeley for their constructive comments. References Acheson, D., 1998. Independent inquiry into inequalities in health [online]. London: The Stationery Office, Available from: http://www.archive.official-documents.co.uk/do cument/doh/ih/ih.htm. Bhatia, R., and Corburn, J., 2011. Lessons from San Francisco: health impact assessments have advanced political conditions for improving population health. Health Affairs, 30 (12), 2410–2418. Bhatia, R., and Wernham, A., 2008. Integrating human health into environmental impact assessment: an unrealized opportunity for environmental health and justice. Environmental Health Perspectives, 116 (8), 991–1000. Bhatia, R., et al., 2009. Practice standards for health impact assessment (Version 1) [online]. Oakland, CA: North American HIA Practice StandardsWorking Group, Available from: http://www.hiaconnect.edu.au/files/HIA_Practice_ Standards.pdf. Birley, M., 2003. Health impact assessment, integration and critical appraisal. Impact Assessment and Project Appraisal, 21 (4), 313–321. Birley, M., 2005. Health impact assessment in multinationals: a case study of the Royal Dutch/Shell Group. Environmental Impact Assessment Review, 25 (7–8), 702–713. Birley, M., 2007. A fault analysis for health impact assessment: procurement, competence, expectations, and jurisdictions. Impact Assessment and Project Appraisal, 25 (4), 281–289. Birley, M., 2011. Health impact assessment: principles and practice. London: Routledge. Birley, M., and Peralta, G., 1995. Health impact assessment of development projects. In: F. Vanclay and D. Bronstein, eds. Environmental and social impact assessment. Chichester: Wiley, 153–170. Bond, A., 2004. Lessons from EIA. In: J. Kemm, J. Parry and S. Palmer, eds. Health impact assessment. Oxford: Oxford University Press, 131–142. Bond, A., et al., 2005. Evaluation in impact assessment areas other than HIA [online]. London: National Institute for Health and Clinical Excellence, Available from: http://www. nice.org.uk/download.aspx?o¼503409. Bond, A., et al., 2011. Addressing health impacts in SEA. In: B. Sadler, ed. Handbook of strategic environmental assessment. London: Earthscan, 369–379. Bond, A., Morrison-Saunders, A., and Pope, J., 2012. Sustainability assessment: the state of the art. Impact Assessment and Project Appraisal, 30 (1), DOI: 10.1080/ 14615517.2012.661974. Bos, R., 2006. Health impact assessment and health promotion. Bulletin of the World Health Organization, 84 (11), 914–915. Burns, J., and Bond, A., 2008. The consideration of health in land use planning: barriers and opportunities. Environmental Impact Assessment Review, 28 (2–3), 184–197. Caldwell, L. K., 1988. Environmental impact analysis (EIA): origins, evolution, and future directions. Policy Studies Review, 8, 75–83. Cameron, C., Ghosh, S., and Eaton, S. L., 2011. Facilitating communities in designing and using their own community health impact assessment tool. Environmental Impact Assessment Review, 31 (4), 433–437. Cashmore, M., et al., 2004. The interminable issue of effectiveness: substantive purposes, outcomes and research challenges in the advancement of environmental impact assessment theory. Impact Assessment and Project Appraisal, 22 (4), 295–310. Coggins, T., et al., 2007. Mental wellbeing impact assessment: a toolkit [online]. Cheshire: Care Services Improvement Partnership (CSIP), Available from: http://www.northwest. csip.org.uk/silo/files/mwia-toolit.pdf. Collins, J., and Koplan, J. P., 2009. Health impact assessment: a step toward Health in All Policies. Journal of the American Medical Association, 302 (3), 315–317. Corburn, J., and Bhatia, R., 2007. Health impact assessment in San Francisco: incorporating the social determinants of health into environmental planning. Journal of Environmental Planning and Management, 50 (3), 323–341. Dannenberg, A. L., et al., 1999. Use of health impact assessment in the US: 27 case studies, 1999–2007. American Journal of Preventive Medicine, 34 (3), 241–256. Davies, J. K., 2001. Back to the future: prospects for healthy public policy. Public Health Medicine, 3 (2), 62–66. den Broeder, L., Penris, M., and Put, G. V., 2003. Soft data, hard effects. Strategies for effective policy on health impact assessment – an example from the Netherlands. Bulletin of the World Health Organization, 81 (6), 404–407. Dora, C., and Racioppi, F., 2003. Including health in transport policy agendas: the role of health impact assessment analyses and procedures in the European experience. Bulletin of the World Health Organization, 81 (6), 399–403. ECHP, 1999. Gothenburg Consensus Paper on health impact assessment: main concepts and suggested approach [online]. Brussels: European Centre for Health Policy, WHO Regional Office for Europe, Available from: http://www.euro.who.int/ document/PAE/Gothenburgpaper.pdf. Equator Principles, 2006. The Equator Principles: a financial industry benchmark for determining, assessing and managing social & environmental risk in project financing [online]. Washington, DC: Equator Principles Financial Impact Assessment and Project Appraisal 49 Downloaded by [115.64.3.252] at 03:28 19 November 2015 Institutions, Available from: http://www.equator-principles. com/documents/Equator_Principles.pdf. Esteves, A. M., Franks, D., and Vanclay, F., 2012. Social impact assessment: the state of the art. Impact Assessment and Project Appraisal, 30 (1), DOI: 10.1080/14615517. 2012.660356. Fiorino, D. J., 2001. Environmental policy as learning: a new view of an old landscape. Public Administration Review, 61 (3), 322–334. France, C., 2004. Health contribution to local government planning. Environmental Impact Assessment Review, 24 (2), 189–198. Fredsgaard, M. W., Cave, B., and Bond, A., 2009. A review package for health impact assessment reports of development projects. Leeds: Ben Cave Associates. Gagnon, F., and Michaud, M., 2008. Health impact assessment and public policy formulation [online]. Montreal: Group d’etude sur le politiques publiques et la sante, Available from: http://netedit.enap.ca/GEPPS/docs/eis14nov08_vfang. pdf. Gillis, D. E., 1999. The ‘People Assessing Their Health’ (PATH) project: tools for community health impact assessment. Canadian Journal of Public Health, 90 (pages S53–S56). Gopalan, H., 2003. Environmental health in developing countries: an overview of the problems and capacities. Environmental Health Perspectives, 111 (9), A446–A447. Government of Mongolia, 2005. National Environmental Action Plan [online]. Ulan Bator: Government of Mongolia, Available from: http://www.environment-health.asia/userfil es/file/Mongolia%20NEHAP%281%29.pdf [Accessed 1 January 2012]. Gunther, S., 2011. A rapid review of enhancing the equity focus on policy orientated health impact assessment. Birmingham: EU Joint Action on Health Inequalities. Haber, R., 2011. Health equiy impact assessment: a primer [online]. Toronto: Wellesley Institute, Available from: http://www.threesource.ca/documents/March2011/health_ equity.pdf. Haigh, F., Harris, P., and Haigh, N., 2012. Health impact assessment research and practice: a place for paradigm positioning? Environmental Impact Assessment Review, 33 (1), 66–72. Harris, E., and Harris-Roxas, B., 2010. Health in All Policies: a pathway for thinking about our broader societal goals. Public Health Bulletin South Australia [online], 7 (2), Available from: http://www.dh.sa.gov.au/pehs/publications/ public-health-bulletin.htm. Harris, P., and Spickett, J., 2011. Health impact assessment in Australia: a review and directions for progress. Environmental Impact Assessment Review, 31 (4), 425–432. Harris, P., 2009. Human health and wellbeing in environmental impact assessment in New South Wales, Australia: auditing health impacts within environmental assessments of major projects. Environmental Impact Assessment Review, 29 (5), 310–318. Harris-Roxas, B., and Harris, E., 2011. Differing forms, differing purposes: a typology of health impact assessment. Environmental Impact Assessment Review, 31 (4), 396–403. Harris-Roxas, B., Simpson, S., and Harris, E., 2004. Equity focused health impact assessment: a literature review [online]. Sydney: CHETRE on behalf of the Australasian Collaboration for Health Equity Impact Assessment, Available from: http://www.hiaconnect.edu.au/files/Harr is-Roxas_B_(2004)_Equity_Focused_HIA.pdf. Harris-Roxas, B., et al., 2011. A rapid equity focused health impact assessment of a policy implementation plan: an Australian case study and impact evaluation. International Journal for Equity in Health [online], 10 (6), Available from: http://www.equityhealthj.com/content/10/1/6. Health SA, 2008. South Australia’s Strategic Plan . . . through a health lens. Adelaide: South Australian Department of Health. Hoshiko, M., Hara, K., and Ishitakea, T., 2012. Assessing the validity of health impact assessment predictions regarding a Japanese city’s transition to core city status: a monitoring review. Public Health, 126 (2), 168–176. in press. ICMM, 2010. Good practice guidance on health impact assessment [online]. London: International Council on Mining and Metals, Available from: http://www.icmm.com/ document/792. IFC, 2006. Performance standards on social & environmental sustainability [online]. Washington, DC: International Finance Corporation, World Bank Group, Available from: http://www.ifc.org/ifcext/sustainability.nsf/Attachments ByTitle/pol_PerformanceStandards2006_full/$FILE/IFCþ Performance þ Standards.pdf. IFC, 2009. Introduction to health impact assessment [online]. Washington, DC: International Finance Corporation, Available from: http://www.ifc.org/ifcext/sustainability.nsf/ AttachmentsByTitle/p_HealthImpactAssessment/$FILE/ HealthImpact.pdf. IPIECA, 2005. A guide to health impact assessments in the oil and gas industry [online]. London: International Petroleum Industry Environmental Conservation Association, Available from: http://www.ipieca.org/activities/health/downloads/ publications/hia.pdf. Joffe, M., 2008. The need for strategic health assessment. The European Journal of Public Health, 18 (5), 439–440. Kang, E., Park, H. J., and Kim, J. E., 2011. Health impact assessment as a strategy for intersectoral collaboration. Journal of Preventive Medicine and Public Health, 44 (5), 201–209. Kasperson, R., 1983. Acceptability of human risk. Environmental Health Perspectives, 52, 15–20. Kearney, M., 2004. Walking the walk? Community participation in HIA: a qualitative interview study. Environmental Impact Assessment Review, 24 (2), 217–229. Kickbusch, I. and Buckett, K., eds., 2010. Implementing Health in All Policies: Adelaide 2010. Adelaide: Department of Health, Government of South Australia. Krieger, G. R., et al., 2010. Barbarians at the gate: storming the Gothenburg Consensus. The Lancet, 375 (9732), 2129–2131. Kværner, J., Swensen, G., and Erikstad, L., 2006. Assessing environmental vulnerability in EIA: the content and context of the vulnerability concept in an alternative approach to standard EIA procedure. Environmental Impact Assessment Review, 26, 511–527. Lalonde, M., 1974. A new perspective on the health of Canadians [online]. Ottawa: Government of Canada, Available from: http://www.hc-sc.gc.ca/hcs-sss/alt_formats/hpb-dgps/pdf/ pubs/1974-lalonde/lalonde-eng.pdf. Law on Prevention and Control of Infectious Diseases, 2007. 03/2007/QH12 Government of Vietnam Lester, C., and Temple, M., 2004. Rapid collaborative health impact assessment: a three-meeting process. Public Health, 118 (3), 218–224. Mahoney, M., et al., 2004. Equity focused health impact assessment framework [online]. Newcastle: Australasian Collaboration for Health Equity Impact Assessment, Available from: http://www.hiaconnect.edu.au/files/ EFHIA_Framework.pdf. Mahoney, M., Potter, J. L., and Marsh, R., 2007. Community participation in HIA: discords in teleology and terminology. Critical Public Health, 17 (3), 229–241. Martuzzi, M., and Bertollini, R., 2005. The precautionary principle, science and human health protection. Human and Ecological Risk Assessment, 11 (1), 63–68. Mathias, K., and Harris-Roxas, B., 2009. Process and impact evaluation of the Greater Christchurch Urban Development 50 B. Harris-Roxas et al. Downloaded by [115.64.3.252] at 03:28 19 November 2015 Strategy Health Impact Assessment. BMC Public Health, 9 (1), 97. Mechanic, D., 2000. Rediscovering the social determinants of health. Health Affairs, 19 (3), 269–276. Morris, S. C., and Novak, E. W., 1976. Environmental health impact assessment. Journal of Environmental Engineering, 102 (3), 549–554. National Environmental Policy Act, 1969. 83 Stat. 852 (1969) United States Congress National Health Act, B.E.2550, 2007. Bangkok: The Kingdom of Thailand. National Policy on Health Impact Assessment, 2006. 365/MOH and 54/PM Lao PDR Ministry of Health National Research Council, 2011. Improving health in the United States: the role of health impact assessment [online]. Washington, DC: National Academies Press, Available from: http://www.nap.edu/catalog.php?record_id¼13229. NHCO, 2010. Thailand’s rules and procedures for the health impact assessment of public policies [online]. Nonthaburi, Thailand: Health Impact Assessment Coordinating Unit, National Health Commission Office, Available from: http:// en.nationalhealth.or.th/sites/default/files/RulesAndProcedur esHIA-Eng.pdf. Nilunger Mannheimer, L., Lehto, J., and O¨ stlin, P., 2007. Window of opportunity for intersectoral health policy in Sweden: open, half-open or half-shut? Health Promotion International, 22 (4), 307–315. Noble, B., and Bronson, J., 2005. Integrating human health into environmental impact assessment: case studies of Canada’s northern mining resource sector. Arctic, 58 (4), 395–405. NPHP, 2005. Health impact assessment: legislative and administrative frameworks [online]. Melbourne: National Public Health Partnership, Available from: http://www.dhs. vic.gov.au/nphp/workprog/lrn/hia_legframe.htm. NSW Health, 2003. Aboriginal health impact statement and guidelines: incorporating Aboriginal health needs and interests in health policies and programs [online]. Sydney: NSW Health, Available from: http://www.health.nsw.gov.au/ pubs/a/pdf/ab_impact_state_book.pdf. O’Reilly, J., et al., 2006. Cost–benefit analysis of health impact assessment. York: York Health Economics Consortium. Parry, J., and Wright, J., 2003. Community participation in health impact assessments: intuitively appealing but practically difficult. Bulletin of the World Health Organization, 81 (6), 388. People’s Republic of China, 2007. National Environmental Action Plan 2007–2015 [online]. Beijing: People’s Republic of China, Available from: http://www.environment-health.a sia/userfiles/file/China%20NEHAP.pdf [Accessed 1 January 2012]. Povall, S., et al., 2010. Health equity impact assessment: project report [online]. Liverpool: IMPACT, University of Liverpool, Available from: http://www.liv.ac.uk/health-inequalities/ Research/HEIA_Project_Report_-_FINAL_-_20_July_ 2010a_(2).pdf. Puska, P., and Sta°hl, T., 2010. Health in All Policies – the Finnish initiative: background, principles and current issues. Annual Review of Public Health, 31 (1), 315–328. Quigley, R., 2010. Role of health impact assessment in Health in All Policies. In: I. Kickbusch and K. Buckett, eds. Implementing Health in All Policies: Adelaide 2010. Adelaide: Department of Health, Government of South Australia, 101–110. Quigley, R., and Taylor, L., 2004. Evaluating health impact assessment. Public Health, 118 (8), 544–552. Quigley, R., et al., 2006. Health impact assessment international best practice principles [online]. International Association for Impact Assessment, Available from: http://www.iaia.org/ Non_Members/Pubs_Ref_Material/SP5.pdf. Sadler, B., 1996. Environmental assessment in a changing world: evaluating to improve performance – final report of the International Study of the Effectiveness of Environmental Assessment [online]. Ottawa: Canadian Environmental Assessment Agency and the International Association for Impact Assessment, Available from: http://www.unece.org/ env/eia/documents/StudyEffectivenessEA.pdf. Scott-Samuel, A., Birley, M., and Ardern, K., 2001. The Merseyside Guidelines for Health Impact Assessment. Liverpool: International Health Impact Assessment Consortium (IMPACT). Soeberg, M., 2006. Health impact assessment in New Zealand. Epidemiologia e prevenzione., 30 (1), 41–45. Sta°hl, T. P., 2010. Is the increasing policy use of impact assessment in Europe likely to undermine efforts to achieve healthy public policy? Journal of Epidemiology and Community Health, 64 (6), 476. Sta°hl, T. P., et al., 2006. eds. Health in All Policies: prospects and potentials. Helsinki: Ministry of Social Affairs and Health. State of Alaska, 2011. Alaska Health Impact Assessment (HIA) program [online]. Anchorage: Department of Health and Social Services, State of Alaska, Available from: http://www. epi.alaska.gov/hia/ [Accessed 10 January 2012]. Steinemann, A., 2001. Improving alternatives for environmental impact assessment. Environmental Impact Assessment Review, 21 (1), 3–21. Sukkumnoed, D., 2007. Better power for health: healthy public policy and sustainable energy in the Thai power sector, Thesis (PhD). Aalborg University Sukkumnoed, D., et al., 2007. Health impact assessment training manual: a learning tool for healthy communities and society in Thailand, Southeast Asia, and beyond. Bangkok: Research and Development Program on Healthy Public Policy and Health Impact Assessment, Health Systems Research Institute. Tamburrini, A., Gilhuly, K., and Harris-Roxas, B., 2011. Enhancing benefits in health impact assessment through stakeholder consultation. Impact Assessment and Project Appraisal, 29 (3), 195–204. Utzinger, J., 2005. Assessing health impacts of the Chad– Cameroon Petroleum Development and Pipeline Project: challenges and a way forward. Environmental Impact Assessment Review, 25 (1), 63–93. Vanclay, F. and Bronstein, D., eds., 1995. Environmental and social impact assessment. Chichester: Wiley. Veerman, J. L., Bekker, M. P., and Mackenbach, J. P., 2006. Health impact assessment and advocacy: A challenging combination. Sozial-und Praventivmedizin, 51 (3), 151–152. Veerman, J. L., Mackenbach, J. P., and Barendregt, J. J., 2007. Validity of predictions in health impact assessment. Journal of Epidemiology and Community Health, 61 (4), 362–366. Victorian Public Health and Wellbeing Act, 2008. 46 Parliament of Victoria Vohra, S., 2007. International perspective on health impact assessment in urban settings. New South Wales Public Health Bulletin, 18 (9–10), 152–154. Vohra, S., et al., 2010. New international consensus on health impact assessment. The Lancet, 376 (8751), 1464–1465. Wernham, A., 2007. Inupiat health and proposed Alaskan oil development: results of the first integrated health impact assessment/environmental impact statement for proposed oil development on Alaska’s North Slope. EcoHealth, 4 (4), 514. Wernham, A., 2011. Health impact assessments are needed in decision making about environmental and land-use policy. Health Affairs, 30 (5), 847–956. Western, J., and Lynch, M., 2000. Overview of the social impact assessment process. In: L. R. Goldman, ed. Social impact analysis: an applied anthropology manual. Oxford: Berg, 35–62. Weston, J., 2002. From Poole to Fulham: a changing culture in UK environmental impact assessment decision making? Impact Assessment and Project Appraisal 51 Downloaded by [115.64.3.252] at 03:28 19 November 2015 Journal of Environmental Planning and Management, 45, 425–443. WHO, 1979. Environmental health impact assessment: report on a WHO seminar, Argostoli, Kefalonia, Greece, 2–6 October, 1978. Geneva: World Health Organization. WHO, 1997a. The Jakarta Declaration on Leading Health Promotion into the 21st Century [online]. Geneva: World Health Organization, Available from: http://www.who.int/ hpr/NPH/docs/jakarta_declaration_en.pdf. WHO, 1997b. Report on a Conference on Intersectoral Action for Health: A Cornerstone for Health-for-All in the 21st Century, 20–23 April 1997, Halifax, Nova Scotia, Canada [online]. World Health Organization and the Canadian Public Health Association, Available from: http://whqlibdoc.who.int/hq/ 1997/WHO_PPE_PAC_97.6.pdf. WHO, 2006. The Bangkok Charter on health promotion in a globalized world [online]. Geneva: World Health Organization, Available from: http://www.who.int/healthpromotion/ conferences/6gchp/bangkok_charter/en/. WHO, 2008a. Closing the gap in a generation: health equity through action on the social determinants of health [online]. Geneva: Commission on the Social Determinants of Health, World Health Organization,Available from: http://whqlibdoc. who.int/publications/2008/9789241563703_eng.pdf. WHO, 2008b. World Health Report 2008: primary health care – now more than ever [online]. Geneva: World Health Organization, Available from: http://www.who.int/entity/ whr/2008/whr08_en.pdf. WHO, 2012. Commission on social determinants of health [online]. Geneva: World Health Organization, Available from: http://www.who.int/social_determinants/en/ [Accessed 1 January 2012]. WHO & SA Government, 2010. Adelaide Statement on Health in All Policies: moving towards a shared governance for health and wellbeing. Geneva: World Health Organization and South Australian Government. Wilkinson, R., 2007. The challenge of prevention: a response to Starfield’s ‘Commentary: Pathways of influence on equity in health’. Social Science & Medicine, 64 (7), 1367–1370. Wilkinson, R., and Marmot, M., 2003. The solid facts: social determinants of health, 2nd ed [online]. Geneva: World Health Organization, Available from: http://www.euro.who. int/document/e81384.pdf. Winkler, M. S., et al., 2010. Assessing health impacts in complex eco-epidemiological settings in the humid tropics: advancing tools and methods. Environmental Impact Assessment Review, 30 (1), 52–61. Winkler, M. S., et al., 2012. Assessing health impacts in complex eco-epidemiological settings in the humid tropics: modular baseline health surveys. Environmental Impact Assessment Review, 33 (1), 15–22. Wismar, M., and Ernst, K., 2010. Health in All Policies in Europe. In: I. Kickbusch and K. Buckett, eds. Implementing Health in All PolicIes: Adelaide 2010. Adelaide: Department of Health, Government of South Australia, 53–64. M. Wismar, et al., 2007. eds. The effectiveness of health impact assessment: scope and limitations of supporting decisionmaking in Europe. Copenhagen: European Observatory on Health Systems and Policies, World Health Organization. Wright, J., Parry, J., and Mathers, J., 2005. Participation in health impact assessment: objectives, methods and core values. Bulletin of the World Health Organization, 83 (1), 58–63. Wright, J., Parry, J., and Scully, E., 2007. Institutionalizing policy-level health impact assessment in Europe: is coupling health impact assessment with strategic environmental assessment the next step forward? Bulletin of the World Health Organization, 83 (6), 472–477. 52 B. Harris-Roxas et al. Downloaded by [115.64.3.252] at 03:28 19 November 2015