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Centre for Health Impact Assessment .
Comprehensive
Health Impact Assessment
Toolbox
IOM CHIA2 Toolbox
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The IOM is a major independent centre of scientific excellence in the fields of occupational andenvironmental health, hygiene and safety. We were founded as a charity in 1969 by the UK coalindustry in conjunction with the University of Edinburgh and became fully independent in 1990. Our
mission is to benefit those at work and in the community by providing quality research, consultancyand training in health, hygiene and safety and by maintaining our independent, impartial position asan international centre of excellence. The IOM has more than seventy scientific and technical staffbased in Edinburgh, Chesterfield, London, and Stafford. Consultancy work is undertaken throughIOM Consulting Limited which is a wholly owned subsidiary.
Dr Salim Vohra is the Director of the IOMs Centre for Health Impact Assessment based in London.
The vision of IOM CHIA is to be a Centre of Excellence in:
Health impact assessment theory and practice
Healthy public policy Evidence-based analysis and evaluation of the impacts
of policies and programmes on health
Researching the wider determinants of health and
wellbeing
Tackling environmental and health inequalities
Healthy urban planning and development
Urban and rural regeneration and health
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Contents
Page1. Screening 12. Scoping (scope and terms of reference) 33. Methodology 54. Baseline Assessment 85. Policy Context (and policy evidence) 106. Appraisal Rapid 127. Health Appraisal Detailed 158. Consultation Plan 199. Evaluating The Evidence 2110. Key Conclusions 2211. Mitigation And Enhancement 2512. Monitoring And Evaluation 2613. Recommendations 2714. HIA Evaluation 29
Developed by Salim Vohra (2005-08)
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Introduction
This toolbox has been
developed to help health
organisations, local
authorities, private sector
businesses and
communities understandwhat health impact
assessments on plans,
programmes and projects
are all about.
"Health is a state of completephysical, mental and socialwellbeing and not merely theabsence of disease orinfirmity
Health is therefore a resource
for everyday life, not theobjective of living; it is apositive concept, emphasizingsocial and personal resources,
as well as physical capacities."
World Health Organisation,
1947 and 1984.
It follows the eight core
steps that generally make
up a health impactassessment process:
Screening
Scoping
Baseline and community profile
Stakeholder involvement
Evidence and analysis
Mitigation and enhancement
Health impact statement(HIA reporting)
Follow-up
(monitoring & evaluation)
What is health
impact
assessment
(HIA)
HIA is a public healthscience.
It is a systematic approach
to identifying the differential
health impacts of proposed
plans and projects so that
positive health impacts are
maximised and negative
health impacts are
minimised within a givenpopulation. It aims to work
within an explicit
democratic, equitable,
sustainable and ethical useof evidence framework and
uses a range of structured
and evaluated sources ofevidence that includes
public and other
stakeholders' perceptions
and experiences as well aspublic health,
epidemiological,
toxicological and medical
knowledge.
Whereas health needs
assessment starts fromanalysing the health needs
of a population and then
develops plans and
projects to meet those
needs; health impact
assessment appraises plans,
programmes and projects
in terms of their healthimpacts on a population.
Why this
toolbox
This toolbox highlights all thekey issues and questions
that need to be answered
by a health impact
assessment. Its our "almostevery question youever
need toask in a HIA
toolbox.
We use this toolbox with
clients and communities as
a prompt and a systematic
way of ensuring that all the
important health and
wellbeing issues are
addressed when we carryout a HIA. It helps us to
ensure that clients andcommunities understand
what we are doing andhow we are doing it every
step at every of a HIA.
HIA is not a linear process
but an iterative, dynamic
and non-linear one with
issues from later stagessometimes feeding into
earlier ones.
How we have
used this
toolbox
We use this toolbox in four
ways:
To work through the
health and wellbeing
concerns of local
communities.
To carry out a rapid or
comprehensive HIA.
To develop shorter
health impact screening
tools for specific local
proposals for particularclients.
As a tool for training
people in HIA practice.
HEALTH IMPACT ASSESSMENT
HEALTH NEEDS ASSESSMENT
Population Proposal
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Page 1
1. Screening
Assess whether an proposal (plan, policy programme, project or service) should have a health
impact assessment undertaken by answering as honestly as you can the following questions.
Name of Proposal:
Answers
favouring
doing a HIA
From your knowledge and/or
in your judgement
Answers
favouring not
doing a HIA
Health Impacts
Yes / not sure
Yes / not sure
Does the proposal affect health directly?
Does the proposal affect health indirectly?
No
No
Yes / not sure Are there any potentially serious negativehealth impacts that you currently know of?
No
Yes / not sureIs further investigation necessary because
more information is required on the potential
health impacts?
No
No / not sureAre the potential health impacts well known
and is it straightforward to suggest effective
ways in which beneficial effects are
maximised and harmful effects minimised?
Yes
No / not sureDo you (or others) judge the identified healthimpacts as being small in effect?
Yes
Community
Yes / not sure Is the population affected by the proposallarge?
No
Yes / not sure Are there any socially excluded, vulnerable or
disadvantaged groups likely to be affected?
No
Yes / not sure Are there community concerns about any
potential health impacts?
No
Proposal
Yes / not sure Is the size of the proposal large? No
Yes / not sure Is the cost of the proposal high? No
Yes / not sure Is the nature and extent of the disruption
caused by the proposal likely to be major?
No
Organisation
Yes Is the proposal a high priority/ important for
the organisation/ partnership?
No
For = TOTAL Against =
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1. Screening contd
Assess what kind of HIA should be done on your proposal by answering as honestly as you
can the following questions.
Rapid Type of HIA Comprehensive
Yes Is there only limited time in which to conduct
HIA?
No
Yes Is there only limited opportunity to influence the
decision?
No
Yes Is the timeframe for the decision-making processset by external factors beyond your control?
No
Yes Are there only very limited resources available to
conduct HIA?
No
Assess who should do the HIA on your proposal by answering as honestly as you can the
following questions.
External Assessors Internal
No Do personnel in the organisation or partnershiphave the necessary skills and expertise to
conduct the HIA?
Yes
No Do personnel in the organisation or partnership
have the time to conduct the HIA?
Yes
Adapted from a screening tool developed by Erica Ison in Resources for Health Impact Assessment, 2000,
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Page 3
2. Scoping (scope and terms of reference of the HIA)
Question Answer
Who will lead on the project management of
your HIA?
Will you have a HIA steering group, if yes, who
will make up the members, what will be its terms
of reference?
Are there other professional or community
stakeholders - not included on your steering
group who should be involved in the design of
your HIA?
When do the decision-makers you are aiming to
influence make their decision and hence when
does your HIA report need to be completed by?
Why is the proposal being undertaken? What
are the proposals aim and objectives?
Why do you want to do this HIA?
What are your HIAs aim and objectives?
What geographical area will your HIA cover?
What population group will your HIA
encompass?
Will the population assessed reside within the
geographical area described above or include
workers living outside the area,travelling families, etc?
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2. Scoping contd
Question Answer
What definition of health will you use
for your HIA?
What HIA model/approach do you want to use?
Are there any specific health impacts that you
want your HIA to focus on?
Do you know which specific population sub-
groups/ community groups will be directly
affected by the proposal under consideration?
Will your HIA give specific detailed
recommendations or will you just detail the
potential health impacts so that your steering
group and other decision-makers can then
separately think about the implications and
recommendations?
Other issues relevant to your local or
organisational setting
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2. Scoping notepad
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2. Scoping notepad
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3. Methodology
Question Answer
Depending on what HIA model you chose in
scoping,will you use a quantitative, qualitative
or mixed approach?
Why?
What health evidence and research sources will
you use?
What sources wont you be able to use?
Why?
Current evidence on health needs (public
health, local authority, etc)Research review evidence on health impacts
Will you do an informal windscreen or
walkabout observation of the geographical
area and community?
Will your HIA include a formal consultation of
professional and community stakeholders?
Why?
What method/s are you thinking of using?
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4. Baseline Assessment
Question Answer
What are the characteristics of the
local people age, gender, ethnicity?
What is the health situation like
of local people?
What is the social situation like?
What is the economic situation like?
What is the local environment like?
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4. Baseline Assessment contd
Question Answer
What health & social care services are there in
the area/serving local people?
What voluntary sector and charity services are
there?
What retail, shopping and banking services are
there?
What culture and leisure services are there e.g.
cinemas, theatres, sports centres?
What urban/rural regeneration or other area or
health improvement programmes
are there?
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Page 10
5. Policy context (and policy evidence)
Question Answer
What international health and non-health
policies does the proposal link into?
Which parts of these policies does the proposalfollow and which parts does it ignore?
What are the reasons for this?
What national and regional health and non-
health policies does the proposal link into?
Which parts of these policies does the proposal
follow and which parts does it ignore?What are the reasons for this?
What local health and non-health policies does
the proposal link into?
Which parts of these policies does the proposalfollow and which parts does it ignore?
What are the reasons for this?
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Determinants of
Health & Wellbeing
Lifestyle
Environment
Economic
conditions
Availab
age
sex
genetic
effects
leisure
activities
exercise
sexual
behavioursmoking
alcohol
prescriptiondrugs
substance
misuse
Biological
factors
familyrelationsh
social
contac
discrimination
health & socialcare services
emadviceservices
voluntary &
charity groups
public
transport
shops andbanking services
job
creation
distribution of
incomes
availability oftraining
quality of
employment
availability of
employment
business
activity
research & technologicaldevelopment
land use &
planningnatural
resourcesgreen
spacewastemanagement
public &
environmental
health services
natural
hazards
civic design
smell noise
vibration
air
quality
waterquality
soilquality
Adapted from Rapid Health Impact Assessment: a guide to research by Amanda Harris, 2002
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6. Appraisal rapid adapted from the British Columbia HIA model as described by Erica Ison in Resources for H
Yes,
No,
Not Sure
If Yes,
is the health impact
likely to be positive
or negative (+/-)?
Who or what people
or group(s) will it
potentially affect?
How is the impact likely
occur?
How do you know this?
Will the proposal affect the
creation and distribution of
income or wealth levels?
Will the proposal affect
employment opportunities?
Will the proposal affect
learning opportunities?
Will the proposal createhealthier beginnings for
children?
Will the proposal affect the
number and quality of
personal connections?
Will the proposal affect
crime and safety?
Will the proposal affect
peoples ability to influencetheir lives and locality?
Will the proposal affectthe local environment?
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7. Health appraisal detailed adapted from the BMA and Merseyside HIA models
Themes
What are the potential
effects on ..?
Will the
change
be +/-
for
peopleshealth?
What stakeholder/s
(individuals & groups)
are likely to be
affected?
When is the impact
likely to occur
(start, during or end of
the proposal)
EVIDENCE OF IMPACT
- TYPE
(reports, reviews,surveys, experiences)
EVID
(aex
infectious diseasese.g. TB, measles, food
poisoning, salmonella, BSE,
SARS
non-infectious/
chronic diseasese.g. heart disease, cancer,
accidents & physical
injuries
mental health &
wellbeing
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7. Health appraisal detailed contd
Themes
What are the potential
effects on ..?
Will the
change
be +/-
for
peopleshealth?
What stakeholder/s
(individuals & groups)
are likely to be
affected?
When is the impact
likely to occur
(start, during or end of
the proposal)
EVIDENCE OF IMPACT
- TYPE
(reports, reviews,surveys, experiences)
EVID
(aex
housing &
accommodation
education & learning
employment &
economy
transport &
connections
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7. Health appraisal detailed contd
Themes
What are the potential
effects on ..?
Will the
change
be +/-
for
peopleshealth?
What stakeholder/s
(individuals & groups)
are likely to be
affected?
When is the impact
likely to occur
(start, during or end of
the proposal)
EVIDENCE OF IMPACT
- TYPE
(reports, reviews,surveys, experiences)
EVID
(aex
crime & safety
social capital &
community cohesion
health & social care
services
retail shops and other
amenities
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7. Health appraisal detailed contd
Themes
What are the potential
effects on ..?
Will the
change
be +/-
for
peopleshealth?
What stakeholder/s
(individuals & groups)
are likely to be
affected?
When is the impact
likely to occur
(start, during or end of
the proposal)
EVIDENCE OF IMPACT
- TYPE
(reports, reviews,surveys, experiences)
EVID
(aex
culture & leisure
lifestyle & daily
routines
energy & waste
land & spatial
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8. Consultation plan
Stakeholder
Aim of consultation Key issues to be discussed Consultation method/s Pote
Public
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8. Consultation plan contd
Stakeholder
Aim of consultation Key issues to be discussed Consultation method/s Pote
Professionals
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9. Evaluating the evidence
Assess how strong the evidence of positive or negative health impacts is likely to be by
answering as honestly as you can the following questions.
Answers showing
the evidence is
more likely to be of
good quality
To your knowledge
Answers showing
the evidence is less
likely to be of good
quality
Research
Yes Does the evidence for each impact come from more
than one source?
No
Yes Is the evidence for each impact of more than one type
(i.e. both quantitative and qualitative and/or a range ofquantitative and qualitative studies/reports)?
No
Yes Has some or all the evidence for each impact been
reviewed by other research experts (peer-reviewed
and/or published)
No
No Is the evidence for each clear and consistent or are
there areas of ambiguity and differences of emphasis in
the different types and sources of evidence?
Yes
Front-line experts and professionalsYes Is there broad consensus among front-line experienced
experts and professionals that the impacts can/do
occur in these kinds of proposals?
No
Yes Is there broad consensus among experienced front-line
experts and professionals that the evidence for each
impact is sound?
No
Lay publics
Yes Is there broad consensus among resident and
communities who have experienced the impacts (lay
experts) that these impacts can/do occur in these kinds
of proposals?
No
Yes Is there broad consensus among the public (non-experts) that the evidence for each impact is sound? No
Assessors/Evaluators
Yes Do the assessors/evaluators of the evidence of impact
have experience and expertise in reviewing health and
social care evidence?
No
Social Context
No Is there current heightened public concern and/ or
local, regional or national political issues surrounding
some or all the impacts?
Yes
More likely = TOTAL Less likely =
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10. Key conclusions
IMPLEMENTATION OR CONSTRUCTION PHASE
Question Answer
What are the key potential positive impacts?
What are the key potential negative impacts?
What groups are likely to be affected positively?
How?
Will this widen existing health inequalities?
What groups are likely to be affectednegatively?
How?
Will this widen existing health inequalities?
How strong is the evidence for the positive
effects?
Do the affected communities agree?
How strong is the evidence for the negative
effects?
Do the affected communities agree?
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10. Key conclusions contd
OPERATION OR WORKING PHASE (short & long term)
Question Answer
What are the key potential positive impacts?
- short term
- long term
What are the key potential negative impacts?
- short term
- long term
What groups are likely to be affected positively?
How?
Will this widen existing health inequalities?
What groups are likely to be affectednegatively?
How?
Will this widen existing health inequalities?
How strong is the evidence for the positive
effects?
Do the affected communities agree?
How strong is the evidence for the negative
effects?
Do the affected communities agree?
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10. Key conclusions contd
END OF PROPOSAL - DECOMMISSIONING PHASE
Question Answer
What are the key potential positive impacts?
What are the key potential negative impacts?
What groups are likely to be affected positively?
How?
Will this widen existing health inequalities?
What groups are likely to be affectednegatively?
How?
Will this widen existing health inequalities?
How strong is the evidence for the positive
effects?
Do the affected communities agree?
How strong is the evidence for the negative
effects?
Do the affected communities agree?
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11. Mitigation and enhancement
Question Answer
What are the key options to reduce (mitigate)
the potential negative impacts for each stage:
implementation/ construction phase
operation/ working phase (short & long term)
end of proposal phase
What are the key options to increase (enhance)
the positive impacts?
implementation/ construction phase
operation/ working phase (short & long term)
end of proposal phase
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12. Monitoring and evaluation
Question Answer
What monitoring processes will you put in place
to ensure that negative health effects arereduced?
What indicators will you use?
What monitoring processes will you put in place
to ensure that positive health effects are
enhanced?
What indicators will you use?
How will you evaluate the proposal in terms of
health outputs and health outcomes?
- process evaluation
- impact evaluation
- outcome evaluation
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13. Recommendations
Question Answer
What key recommendations emerge from your
assessment?
Should the proposal go ahead?
How should the proposal be taken forward sothat it is provides the greatest health benefits?
Which mitigation and enhancement options will
local people and/or other key stakeholders findmost acceptable?
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The End
except for evaluating the HIA itself see next page
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14. HIA evaluation
Question Answer
What was the proposal that was assessed?
What type of HIA did you undertake?
What HIA model/method did you use?
Why?
What were the costs (financial, human, time)
involved and could these have been better
spent elsewhere?
Did you use a wide range of evidence sources
to make the assessment and did they inform the
HIAs recommendations?
Were health inequalities assessed and if so how
were they assessed?
How were recommendations formulated and
prioritised?
What factors influenced this decision-makingprocess?
Were decision-makers involved and engaged in
the process and if so how was this done?
What were their expectations and were theyfulfilled?
Were the recommendations delivered in a form
and within a timescale that was relevant and
appropriate to decision makers?
What did the steering group, consultees and
others involved in the HIA think about the HIA
process and the
method used?
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14. HIA evaluation contd
Question Answer
Were all or some of the recommendations
accepted and implemented by the decisionmakers?
What factors contributed to their acceptanceor rejection?
Were the aim and objectives of the HIA met?
What other impacts were associated with the
HIA?
- improved partnership working,
- raising the profile of local health needs andputting health on partner agencies agendas,
- organisational development
- new ways of working within and across theorganisations involved
Adapted from the Health Development Agency Learning from Practice Bulletin Evaluating Health Impact Assessmentby Taylor, L., Gowman, N., Quigley, R. 2003.
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For more information on health impact assessment consultancy, training and research contact us at:
Centre for Health Impact Assessment, Institute of Occupational Medicine
Research House Business Centre, Fraser Road, Perivale, Middlesex. UB6 7AQ
Tel: 020 8537 3491/2 Fax: 020 8537 3493