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      • Reflections on infrastructure, Town and Country planning and intimations of SIA in the late 1970s and early 1980s
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      • Scoping in impact assessments for infrastructure projects: Reflections on South African experiences
      • Impact Assessment for Pacific Island Infrastructure
    • Issue #13 Health impact assessment: practice issues >
      • Introduction to health impact assessment: practice issues
      • International Health Impact Assessment – a personal view
      • Use of Health Impact Assessment to develop climate change adaptation plans for health
      • An integrated approach to assessing health impacts
      • Assessing the health and social impacts of transport policies and projects
      • Whither HIA in New Zealand….or just wither?
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      • Introduction
      • Risk Assessment and Impact Assessment : A perspective from Victoria, Australia
      • The New and Adaptive Paradigm Needed to Manage Rising Coastal Risks
      • Reflections on Using Risk Assessments in Understanding Climate Change Adaptation Needs in Te Taitokerau Northland
      • Values-Based Impact Assessment and Emergency Management
      • Certainty about Communicating Uncertainty: Assessment of Flood Loss and Damage
      • Improving Understanding of Rockfall Geohazard Risk in New Zealand
      • Normalised New Zealand Natural Disaster Insurance Losses: 1968-2019
      • Houston, We Have a Problem - Seamless Integration of Weather and Climate Forecast for Community Resilience
      • Innovating with Online Data to Understand Risk and Impact in a Data Poor Environment
    • Impact Connector #11 Climate Change Mitigation, Adaptation, and Impact Assessment: views from the Pacific >
      • Introduction
      • Climate change adaptation and mitigation, impact assessment, and decision-making: a Pacific perspective
      • Climate adaptation and impact assessment in the Pacific: overview of SPREP-sponsored presentations
      • Land and Sea: Integrated Assessment of the Temaiku Land and Urban Development Project in Kiribati
      • Strategic Environmental Assessment: Rising to the SDG Challenge
      • Coastal Engineering for Climate Change Resilience in Eastern Tongatapu, Tonga
      • Climate-induced Migration in the Pacific: The Role of New Zealand
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International Health Impact Assessment – a personal view

Martin Birley, PhD, HonMFPH, Director of
BirleyHIA consultancy services, York, England



​martin@birleyhia.co.uk
        https://birleyhia.co.uk/
Photo by Kelli Tungay on Unsplash
For these personal reflections on Health Impact Assessment (HIA) I start with the multilateral development institutions, such as the Asian Development Bank (ADB) and the World Bank in Washington. I'll use the ADB as an example of some mixed experiences.

A few years ago, the ADB commissioned a two-year programme on HIA from a team, of which I was a member. The origin of the programme was, perhaps, a little bit unusual as it came from special funding for malaria control in Southeast Asia. The malaria control programme had most of the usual components such as drug development, bed nets, rapid diagnosis and treatment, mapping resistance, and mosquito control. As the ADB is mainly concerned with large infrastructure development, there was a final small component – HIA.

Large infrastructure development changes the physical and social environment, and this can promote the conditions under which malaria infection rates either rise or fall. But HIA is a holistic discipline, intended to consider all the possible health outcomes of a development, and not just a single disease.  Furthermore, malaria in Southeast Asia tends to be restricted to the edges of forests zones while the infrastructure development is often urban or in deforested zones. Therefore, the HIA programme had a wider remit than just malaria.

​One of the main outputs of the programme was a free publication entitled "Health Impact Assessment: a good practice sourcebook" (2018), to which I was the main contributor.  The report is an update, in some ways, of the HIA Guidelines produced by ADB in 1992. Following the completion of the programme, and the publication of the report, is there evidence of the ADB producing many HIA statements? I would suggest that the answer is no. If not, why not? I cannot provide a direct answer as I do not have access to the thinking within the ADB institution. What I can offer is an analysis of the ADB's Consulting Services Recruitment Notices. These are published weekly by the consultant management system. There is rarely, if ever, a call for a HIA specialist. Instead, there are calls for environmental or social safeguards specialists. These safeguards specialists are assumed to have the capability to consider the health impacts as part of the other impacts of the project. They usually do not have any education or training in public health, environmental health, or in health impact assessment.
 
I see something similar in other institutions, for example the oil and gas corporations. These often carry out an Environmental Social and Health Impact Assessment (ESHIA), but again, the health component is subsumed under the social component. There are also Environmental Impact Assessments (EIA) that include a health chapter. I have observed this work being done by bright generalists who do not have any specific education or training in a health-related discipline. They can read the book and cut-and-paste from earlier reports. But in my opinion they do HIA a disservice and do not provide innovative thinking on impact identification, significance, or mitigation.
 
As this piece is being written for a New Zealand publication, some information about the situation in the United Kingdom is of interest. I won’t try to address all the activities in the devolved nations of England, Scotland, Wales, and Northern Ireland. Wales, as many will know, has a very active HIA unit and many associated publications.  

England and Scotland do not generally have a statutory requirement for a HIA, either stand-alone or as part of an EIA. Many will know that the updated European Commission Directive on EIA pays more attention to population health than the previous version. There is debate about the implications of this guidance, but I have no clear picture.

I had a recent project in Scotland where a health chapter was required as part of an EIA for a residential development of more than 50 houses in the administrative district called West Lothian. The owner of the land was seeking outline planning permission for the development. This would increase the value of the land and the owner would then sell it on to a developer at a profit. West Lothian Local Authority has issued non-statutory planning guidance on HIA and the pre-application had produced a response from the planning office indicating that an HIA chapter was advisable. The guidance was based on a checklist of 25 simple questions divided into the categories of physical infrastructure, connections, and services and facilities. In my view, the key part of an HIA is to make justifiable recommendations for healthy design. The justifications came from a review of Scottish national policy, public health priorities, standards, and West Lothian policy and guidance. For example, there is a West Lothian Strategic Environmental Assessment that has the objective of improving the quality of life and human health of communities. As the project was at the outline planning stage there was very little detail, so the recommendations were general. I divided my recommendations into environmental, social, and cumulative categories. I identified both local and global cumulative impacts. For example, I referred to the contribution the project would make to global carbon emissions and the consequent health impacts of climate breakdown. The source of the emissions would be fossil fuelled vehicles, poorly insulated homes, and poorly designed domestic heating and lighting systems. The recommendation was to minimise fossil fuel use for transport, cooking, heating, and lighting; and to maximise insulation.  One of the other chapters in the EIA was a transport assessment. But this was largely stating that the development would not add significantly to car density on the local roads. It had little to say about active transport. I tried to engage with the consultants writing the transport assessment, but they weren’t interested. This is a common challenge.

An interesting current example is an initiative taking place in the County of Essex, on the edge of London. Essex has long had a Design Guide to encourage high quality development. The latest iteration encourages developers to become accredited to the Livewell scheme. Accredited developers will presumably have an enhanced reputation and be more competitive. Under the scheme developers are encouraged to undertake a stand-alone rapid HIA at an early planning stage. Essex has produced a checklist of questions representing the determinants of health in the built environment. There are approximately 143 questions, which is about twice the number in the well-known HUDU guidance. The questions fall into the following categories: active environments and active design principles; design of homes and neighbourhoods; access to open green and blue space; supporting community participation and lifetime neighbourhoods; access to healthier food environments and locally sourced food; education, skills development and employment; access to health care infrastructure; and environmental sustainability. Essex officers have advertised a contract to produce a very short HIA training course for an audience of developers, urban designers, consultants, investors, public health professionals, and planners.
 
In conclusion, HIA struggles on as it has over the last 40 years with advances and retreats. In some settings there is evidence of health being buried in environmental and social assessments. This is likely to promote the medical model and reduce the quality of reports and recommendations. On the other hand, planners in the UK are taking a renewed interest in healthy urban design and see HIA as a useful promotional tool.
Acknowledgements 

The work referred to has been undertaken as part of different teams. I have refrained from naming other team members as they have not had an opportunity to comment on this paper and I don’t want to embarrass them. I do wish to express my appreciation to them for the work we have done and are doing together.

Download as a PDF

​References 


Asian Development Bank. Health Impact Assessment: A Good Practice Sourcebook. (Asian Development Bank, 2018). 

Birley, M. H. . & Peralta, G. L. Guidelines for the Health Impact Assessment of Development Projects. (Asian Development Bank, 1992).

Birley, M. Health Impact Assessment, principles and practice. (Earthscan/Routledge, 2011).

Green, L., Gray, B. J. & Ashton, K. Using health impact assessments to implement the sustainable development goals in practice: a case study in Wales. Impact Assessment and Project Appraisal 0, 1–11 (2019).

WHIASU. New National Report examines how Brexit may affect health and well-being of people across Wales. Public health network for Cymru/Wales https://whiasu.publichealthnetwork.cymru/en/news/new-national-report-examines-how-brexit-may-affect-health-and-well-being-people-across-wales/ (2019).

EC. Directive 2014/52/EU. 124 vol. OJ L (2014).

West Lothian Council. Health Impact Assessment Planning Guidance. https://www.westlothian.gov.uk/media/2472/PG---Planning-Guidance--Health-Impact-Assessment-Adopted-March-2017/pdf/PG_Health_Impact_Assessment_FINAL.pdf (2017).

West Lothian Council. Strategic Environmental Assessment (SEA) for the LDP. https://www.westlothian.gov.uk/article/44185/Strategic-Environmental-Assessment-SEA-for-the-LDP.

Welcome - Deep Adaptation Forum. https://deepadaptation.ning.com/.

Introduction | Essex Design Guide. https://www.essexdesignguide.co.uk/about/introduction/.

Essex Planning Officers Association. Livewell Development Accreditation: Guidance for Developers, Planners and Designers. 28 (2019).

EPOA. Essex Healthy Places, advice notes for planners, developers and designers. 53 https://www.essexdesignguide.co.uk/media/2262/essex-healthy-places-advice-notes-for-planners-developers-and-designers.pdf (2019).

 HUDU Planning for Health. Rapid Health Impact Assessment Matrix Self-completion Form. 15 http://www.healthyurbandevelopment.nhs.uk/wp-content/uploads/2019/11/HUDU-Rapid-HIA-Tool-Oct-2019-self-completion-form.pdf (2019).
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  • Home
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  • About Us
    • Core Group >
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    • AGMs
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    • Proceedings from Past Conferences >
      • 2022 - Wellbeing, Sustainability and Impact Assessment: towards more integrated policy-making
      • 2021 - Social Impact Assessment >
        • Posters
        • 2021 Students
      • 2019 - Climate Change >
        • Posters
        • 2019 Students
        • Conference Photos
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      • 2018 - Regional Development
      • 2016 - Strategic Environmental Assessment
      • 2015 - Where to for Impact Assessment?
      • 2014 - Transport Infrastructure
      • 2013 Fresh Water Management
      • 2012 - Mineral Extraction
  • Impact Connector
    • Issue #14 Impact assessment for infrastructure development >
      • Impact assessment for infrastructure development - an introduction
      • Place Matters: The importance of geographic assessment of areas of influence in understanding the social effects of large-scale transport investment in Wellington
      • Unplanned Consequences? New Zealand's experiment with urban (un)planning and infrastructure implications
      • Reflections on infrastructure, Town and Country planning and intimations of SIA in the late 1970s and early 1980s
      • SIA guidance for infrastructure and economic development projects
      • Scoping in impact assessments for infrastructure projects: Reflections on South African experiences
      • Impact Assessment for Pacific Island Infrastructure
    • Issue #13 Health impact assessment: practice issues >
      • Introduction to health impact assessment: practice issues
      • International Health Impact Assessment – a personal view
      • Use of Health Impact Assessment to develop climate change adaptation plans for health
      • An integrated approach to assessing health impacts
      • Assessing the health and social impacts of transport policies and projects
      • Whither HIA in New Zealand….or just wither?
    • Issue #12 Risk Assessment: Case Studies and Approaches >
      • Introduction
      • Risk Assessment and Impact Assessment : A perspective from Victoria, Australia
      • The New and Adaptive Paradigm Needed to Manage Rising Coastal Risks
      • Reflections on Using Risk Assessments in Understanding Climate Change Adaptation Needs in Te Taitokerau Northland
      • Values-Based Impact Assessment and Emergency Management
      • Certainty about Communicating Uncertainty: Assessment of Flood Loss and Damage
      • Improving Understanding of Rockfall Geohazard Risk in New Zealand
      • Normalised New Zealand Natural Disaster Insurance Losses: 1968-2019
      • Houston, We Have a Problem - Seamless Integration of Weather and Climate Forecast for Community Resilience
      • Innovating with Online Data to Understand Risk and Impact in a Data Poor Environment
    • Impact Connector #11 Climate Change Mitigation, Adaptation, and Impact Assessment: views from the Pacific >
      • Introduction
      • Climate change adaptation and mitigation, impact assessment, and decision-making: a Pacific perspective
      • Climate adaptation and impact assessment in the Pacific: overview of SPREP-sponsored presentations
      • Land and Sea: Integrated Assessment of the Temaiku Land and Urban Development Project in Kiribati
      • Strategic Environmental Assessment: Rising to the SDG Challenge
      • Coastal Engineering for Climate Change Resilience in Eastern Tongatapu, Tonga
      • Climate-induced Migration in the Pacific: The Role of New Zealand
    • Impact Connector #10 Climate Change Mitigation and Adaptation >
      • Introduction
      • Is a “just transition” possible for Māori?
      • Adapting to Climate Change on Scale: Addressing the Challenge and Understanding the Impacts of Asia Mega-Cities
      • How responding to climate change might affect health, for better or for worse
      • Kanuka, Kereru and carbon capture - Assessing the effects of a programme taking a fresh look at the hill and high country land resource
      • Wairoa: Community perceptions of increased afforestation
      • Te Kākahu Kahukura Ecological Restoration project: A story within a story
    • Issue #9 Impacts of Covid-19 >
      • Introduction to Impact Connector Issue 9 – Impact assessment and Covid 19
      • Covid-19 fast-track consenting: climate change legacy key to success
      • Tourism – the long haul ahead
      • Making sense of the impact of Covid-19: planning, politics, and the public good
    • Issue #8 Social Impact Assessment >
      • Challenges for Social Impact Assessment in New Zealand: looking backwards and looking forwards
      • Insights from the eighties: early Social Impact Assessment reports on rural community dynamics
      • Impact Assessment and the Capitals Framework: A Systems-based Approach to Understanding and Evaluating Wellbeing
      • Building resilience in Rural Communities – a focus on mobile population groups
      • Assessing the Impacts of a New Cycle Trail: A Fieldnote
      • The challenges of a new biodiversity strategy for social impact assessment (SIA)
      • “Say goodbye to traffic”? The role of SIA in establishing whether ‘air taxis’ are the logical next step in the evolution of transportation
    • Issue #7 Ecological Impact Assessment >
      • The future of Ecological Impact Assessment in New Zealand
      • Ecological impact assessment and roading projects
      • EcIA and the Resource Management Act
      • Professional Practice and implementation of EcIA
      • EcIA in the Marine Environment
    • Issue #6 Landscape Assessment >
      • Introduction
      • Lives and landscapes: who cares, what about, and does it matter?
      • Regional Landscape Inconsistency
      • Landscape management in the new world order
      • Landscape assessment and the Environment Court
      • Natural character assessments and provisions in a coastal environment
      • The Assessment and Management of Amenity
      • The rise of the THIMBY
      • Landscape - Is there a common understanding of the Common?
    • Issue #5 Cultural Impact Assessment >
      • Introduction
      • Potential of Cultural Impact Assessment
      • The Mitigation Dilemma
      • CIA and decision-making
      • Insights and observations on CIA
      • Achieving sustainability through CIA
      • CIA - Enhancing or diminishing mauri?
      • Strategic Indigenous Impact Assessment?
    • Issue #4 Marine Environment >
      • Introduction
      • Iwi, Impact Assessment and Marine Environment
      • Sea-Bed Mining Application in Taranaki
      • The wreck of the MV Rena
      • High Court RMA Controls on Fishing
      • Initiatives in the Pacific Islands
      • SEA in an NZ context
    • Issue #3 Strategic Environmental Assessment
    • Issue #2
    • Issue #1
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