Health impact assessment is a way of assessing the effects of a policy, strategy, programme or project on the health of a given population. It comprises a combination of procedures, methods and tools according to the context and circumstances in which the HIA is being undertaken. The need for local authorities to undertake HIAs, both retrospectively and prospectively, on major policies was signalled in Our Healthier Nation .
1In Saving Lives: our healthier nation , the government extended the arena for action, and outlined the role of health authorities, local authorities and other local agencies as being to encourage 'all local agencies to make HIAs when planning investment in, for example, buildings or local communities and in the location of services'.
2In 1997, the directors of public health for Berkshire, Buckinghamshire, Northamptonshire and Oxfordshire commissioned the public health resource unit to lead a project to improve the quality of partnership working on the public health.
In 1999, in response to requests from colleagues in local government, we decided to develop a simple rapid appraisal tool for HIA as an integral part of the interagency work to improve public health. We conducted a survey of directors of public health in order to learn from others and to obtain a more detailed picture of previous and current work.
Post haste In September 1999, a postal questionnaire was sent to all public health directors in the UK (123 in total).We asked if the HA/board had undertaken HIA on any of its policies, and if so which type (retrospective/ prospective; rapid/ comprehensive).We also asked whether the public health directors knew of any trusts, primary care groups, local authorities, and other statutory or voluntary organisations which had undertaken HIA, and if so which type.
Sifting the responses From all the responses received 15 HAs and two health boards had already undertaken, or been involved in, HIA, either alone or in conjunction with various partners (box 1); 13 HAs, one health board and the all- Wales group were in the process of planning HIA, either alone or with partners. Five HAs were developing a tool and/or the methodology - Brent and Harrow, East Sussex, Brighton and Hove, Manchester, Newcastle and North Tyneside (as part of Tyne and Wear group), and South Essex. Five HAs had run workshops on HIA, mainly in collaboration with their local authority partners (County Durham, East Kent, Leicestershire, Redbridge and Waltham Forest, and Wolverhampton).One-third of respondents overall reported no activity on HIA within their own organisation or, to their knowledge, in that of their partners.
From the returns, there appear to be seven main centres for work on the development and application of HIA:
Merseyside, Tyne and Wear, London region, Trent region, Eastern region, Scotland and Wales.
Most of the prospective comprehensive appraisals reported have been undertaken within the Merseyside HIA programme. The only reported comprehensive retrospective appraisal was by Dr Jenny Mindell, holder of a joint post between Kensington, Chelsea and Westminster HA and Imperial College London. The number of rapid prospective appraisals reported is almost the same as that for rapid retrospective appraisals. Some did not say whether HIA was rapid or comprehensive.
Some HAs were undertaking HIA with other agencies as an integral part of their work in a health action zone : Brent and Harrow, Newcastle and North Tyneside, Sheffield, and those in Merseyside. West Hertfordshire had undertaken a prospective rapid appraisal of their health improvement programme. Calderdale and Kirklees HA, which has a joint post for HIA with the local authority, has developed its HIA methods from previous work done by Dr Judith Hooper on health needs assessment. Two health boards in Scotland reported that HIA had been undertaken as part of the Scottish needs assessment programme. East and North Hertfordshire is working with Hertfordshire county council to develop an HIA tool from environment impact assessment techniques the council already has experience in using. The most popular topic was transport (box 2).
For other topics see box 3.
Local government We also surveyed the environmental health departments of district councils and unitary authorities about HIA via EHnet - a network of environmental health officers at district councils. We identified several local authorities that had undertaken HIA. Local government in Merseyside is actively involved in the HIA programme there. Sheffield city council planning and environmental protection departments are involved in the HIA programme for the Sheffield health action zone. Stockport metropolitan borough council has done HIA on a regeneration project.
Croydon reported that the local authority was the lead for the regeneration strategy group and that HIA had been agreed to in principle.
Redbridge and Waltham Forest work with their local authorities on HIA, and South Essex is encouraging local government to consider the health impact of its decisions.
South Staffordshire district council had done assessments on quarrying, and landfill, and North East Lincolnshire council had incorporated a health component into the sustainability appraisal of the local plan. North and Mid Hampshire said that the local district council had considered HIA for the effects of an incinerator, but had been deterred by cost .
Local government in Lothian had conducted two HIAs, one retrospective and one prospective, in conjunction with the public health department. In Lanarkshire, the health board had explored the possibility of HIA in a priority partnership area with North Lanarkshire council.
Conclusion It would be beneficial to establish a national network of interested parties to share experience and achieve a core consistency among the tools being used.
Box 1. State of play: current HIA activity HAs/boards which have undertaken/ been involved in HIA (end 1999)
Calderdale and Kirklees
Ealing, Hounslow and Hammersmith
Kensington, Chelsea and Westminster
Leicestershire (reported as a 'dummy run')
St Helens and Knowsley
Wiltshire, as commissioners of HIA
Wirral, as facilitators
Lanarkshire, as part of the Scottish needs assessment Programme
HAs/boards planning to undertake HIA (end 1999)
Bexley and Greenwich
Bury and Rochdale
Ealing, Hounslow and Hammersmith
East and North Hertfordshire
East Kent, invited to do HIA by Kent county council
Leicestershire North and East Devon
Sunderland, as part of Tyne and Wear Group
West Pennine, in conjunction with Oldham MBC
Ayrshire and Arran
All Wales Group
Box 2. HIAs undertaken in relation to transport
Local transport plan (3)
Safe routes to schools (1)
Air pollution (1)
Traffic calming scheme (1)
Second runway at Manchester airport (2)
Proposed airport in Doncaster area (1) - Bassetlaw district council also involved
Transport, development and planning policy framework (1)
Potential HIAs in relation to transport
Air traffic from Luton airport (1)
Part of regional M1/M62 multi-modal study (1)
Box 3. HIAs undertaken in relation to issues other than transport
Regeneration (single regeneration budget) programmes (3)
Housing developments within a regeneration programme (3)
Regeneration strategy (1)
Regeneration projects (1)
Major development (1)
New leisure complex (1)
Housing strategy (1)
Health action zone programme (1)
Health improvement programme (1)
Health authority policies (2)
Community safety (1)
Local plan (1)
Landfill site (1)
Services for older people (1)
Services for the elderly who have mental health problems (1)
Services for children (1)
Reconfiguration of acute services (1)
Review of management arrangements for acute services (1)
Service configuration review (1)
Government policy requires that health authorities and local authorities assess the effects of a policy, strategy, programme or project on the health of their community.
A survey of current activity in health impact assessments indicated considerable interest across the UK, with a range of activity already under way.
HIA can be conducted in a variety of ways in order to meet local needs.
It would be beneficial to establish a national network to share experiences and achieve consistency in HIAs.
1 Department of Health. Our Healthier Nation: A Contract for Health .The Stationery Office, 1998.
2 Department of Health. Saving Lives: Our Healthier Nation .The Stationery Office, 1999.
Erica Ison is project officer at the public health resource unit, Oxford; Sian Griffiths is director of public health and health policy at Oxfordshire health authority.