What is HIA?
HIAs provides a way to engage with different groups affected by a particular proposal. It helps decision-makers to consider alternatives and recommendations which may help to improve or promote health, or reduce or mitigate against ill-health, disease or injury.
The HIA framework is based on the four interlinked values of democracy (promoting stakeholder participation), equity (considering the impact on the whole population), sustainable development and the ethical use of evidence.
The HIA framework has been adapted to suit a range of projects varying in nature and complexity. There are full and rapid HIAs depending on what suits your project. The HIA has also been adapted for planning purposes.
There are five main steps to HIAs and, while some may regard it as a linear process, HIAs are most useful and effective when the process is iterative:
The screening stage selects an intervention, a policy or a project for which an HIA would be beneficial. Potential effects on the determinants of health, health outcome and population groups are identified. Screening results in three types of decisions 1) HIA is needed; 2) HIA is not needed, as the effects are already known; 3) HIA is not needed, as the effects are negligible.
The screening stage selects an intervention, a policy or a project for which an HIA would be beneficial. Potential effects on the determinants of health, health outcome and population groups are identified. Screening results in three types of decisions 1) HIA is needed; 2) HIA is not needed, as the effects are already known; 3) HIA is not needed, as the effects are negligible.
The second step is the planning of the HIA and identifying what health risks and benefits to consider. A steering group is created and to develop and adopt the terms of reference for the HIA.
Scoping involves bringing together the major stakeholders of the proposal by creating a steering group and developing and adopting terms of reference for the HIA. In the development of the HIA to reduce the risk of presenting only one side of the evidence, it is important to be systematic.
The second step is the planning of the HIA and identifying what health risks and benefits to consider. A steering group is created and to develop and adopt the terms of reference for the HIA.
Scoping involves bringing together the major stakeholders of the proposal by creating a steering group and developing and adopting terms of reference for the HIA. In the development of the HIA to reduce the risk of presenting only one side of the evidence, it is important to be systematic.
An appraisal is the core of any HIA activity. All the data and evidence are gathered and analysed, affected populations are identified, and health impacts are estimated. The impact estimates allow giving suggestions and recommendations for actions that promote positive health effects and minimize negative health effects.
Depending on the context, an HIA can be conducted with a rapid appraisal or with a comprehensive appraisal.
An appraisal is the core of any HIA activity. All the data and evidence are gathered and analysed, affected populations are identified, and health impacts are estimated. The impact estimates allow giving suggestions and recommendations for actions that promote positive health effects and minimize negative health effects.
Depending on the context, an HIA can be conducted with a rapid appraisal or with a comprehensive appraisal.
Presenting clear results to communities and decision-makers is an important step in HIA. The contents of the report should include a description of the scope, the priorities identified at the beginning of the process, the views expressed by the stakeholders, the evidence available from the various sources, the overall findings, and any recommendations.
Presenting clear results to communities and decision-makers is an important step in HIA. The contents of the report should include a description of the scope, the priorities identified at the beginning of the process, the views expressed by the stakeholders, the evidence available from the various sources, the overall findings, and any recommendations.
It is the final step in the HIA process and allows to evaluate the process and the effectiveness of the HIA.
Evaluating whether the HIA has influenced the decision-making process (and the subsequent proposal) is an important component of HIA. As with any intervention, evaluation is required to see if it has worked.
Monitoring the implementation of the proposal is critical to ensure that any recommendations that decision-makers agreed to, actually occur. Longer-term monitoring of the health of populations is sometimes a component of larger proposals. This long-term monitoring can be used to see if the predictions made during the appraisal were accurate, and to see if the health, or health-promoting behaviours, of the community, have improved.
It is the final step in the HIA process and allows to evaluate the process and the effectiveness of the HIA.
Evaluating whether the HIA has influenced the decision-making process (and the subsequent proposal) is an important component of HIA. As with any intervention, evaluation is required to see if it has worked.
Monitoring the implementation of the proposal is critical to ensure that any recommendations that decision-makers agreed to, actually occur. Longer-term monitoring of the health of populations is sometimes a component of larger proposals. This long-term monitoring can be used to see if the predictions made during the appraisal were accurate, and to see if the health, or health-promoting behaviours, of the community, have improved.
Gloucestershire County Council has developed a local rapid HIA template for colleagues across the system to download, save and work on. The template provides a simplified version of the tool and some guidance to get you started.
We have amended the tools locally so that they are easier to use, and whilst we have tested these (as demonstrated in the case studies tab), we need to continue to test these and learn from these experiences to find out how they are working and how they can be improved.
Download the Gloucestershire HIA tool template (DOCX, 36.8 KB)
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