Our Community Health Impact Assessment

Centric Lab & Clean Air for Southall & Hayes are sharing their CHIA.

It is the result of our collaboration and is being shared to support and inspire others.

“Our experience has been that the trickle-down nature of turning NGO guidance into local government policy has resulted in vested interests influencing the approach and outcomes of such guidance.

This can be evidenced by poor health outcomes resulting in the people of Southall from the overt levels of brownfield development sites.

The current HIA methodology fails to recognise the susceptibility of communities like ours who have experienced chronic and disproportionate exposure to physiological and psychological stressors from the places where we live and work and our histories as marginalised and racialised people.

Had health science informed systems been in place it would have noted the high risk to stress related health on the people of Southall, namely the emitting of carcinogenic chemicals from contaminated land at the former gasworks site

This Community Informed Health Impact Assessment has been designed, reviewed, and consented by us for use by others like us. It is intended to ensure that all considerations towards people’s health is taken when reviewing potential impacts as a result of construction or a new development. It has been designed in good faith to allow for effective, intentional, and important dialogues happen between communities like ours and those looking to make changes in our neighbourhoods.”

— Clean Air for Southall & Hayes

Members of Clean Air for Southall & Hayes campaigning in their local area.

To download our CHIA please fill out the following form

Community Health Impact Assessment Toolkit

This toolkit is intended to guide grassroots and community oriented organisations through a series of exercises to create their own CHIA.

• More About this Toolkit

  This justice-led toolkit is designed to support grassroots community groups co-producing a community informed Health Impact Assessment (HIA).

  This toolkit is designed to be used by grassroots organisations without the interference of domineering authorities. This is to give space and time for people to imagine a way something could be done, rather than being shoehorned into what’s permitted.

  As a toolkit it provides a framework for going on a journey of co-production. There are different stages to the process, encouraging points of reflection, research, and engagement with different people, organisations and stakeholders. The framework is designed to ensure a healthy amount of time and space is given so that democracy, equity, and lived experience sit at the heart of the outcome.

It has been modelled on the co-design process used by Centric Lab and Clean Air for Southall & Hayes who developed their own CHIA in 2023.

• Who Are We?

  Centric Lab, a research lab prototyping ways to use health-based scientific evidence to support justice movements, surface and socialise non-western epistemologies and create language to articulate the injustices felt by many communities in our health.

  Clean Air Southall & Hayes, a grassroots organisation from Southall, west London advocating for the right to breathe clean air against the systemic polluters enabled by insufficient policy.

  Our experience has been that the trickle-down nature of turning NGO guidance into local government policy has resulted in vested interests influencing the approach and outcomes of such guidance. The current HIA methodology fails to recognise the susceptibility of communities who have experienced chronic, multi- generational and disproportionate exposure to physiological and psychological stressors from the places where we live and work and our histories as marginalised and racialised people.

To access the toolkit please fill in the form below

p.s. to save the pdf to your computer choose a print as pdf or save as option from your computer.

The Making of a Community Health Impact Assessment (and Toolkit)

There is no defined HIA template, only guidance; the London NHS HUDU template greatly differs from the Public Health Wales HIA on the health impacts of climate change . This means that it is malleable as opposed to other technical guidance - perhaps an ironic benefit of there being no definition of health in the context of urban planning (via the National Planning Policy Framework).

Getting Started

We wanted to let our imaginations and lived experiences determine what would make a successful HIA. We then would use what we have created and hold it up against what is produced to see any alignments or discrepancies.

To guide our collaboration we reviewed a number of articles and studies on co-design, such as this piece and this, as well as looking at service design models - given the output of this work questioned how a system operates with the various stakeholders.

The project was made possible by a small grant from the Community Knowledge Fund to run a pilot project with capacity for a stage 2 funding opportunity to grow the work. Therefore we designed a programme of work that was relevant to the resources (time/money) we had available. Below is the programme.

The Vale of Scheduling and Creating Boundaries

The project leads from CL & CASH agreed on a schedule of work and presented it to wider members of our respective organisations in an evening virtual call. We then agreed on a calendar of activities that were inclusive of people’s needs and boundaries.

We also agreed that there would be some shared responsibilities in the group but they would match each other's respective capabilities as to not overburden people - this was after all something being done in evenings and spare time . It must be noted that everyone received remuneration for their time equivalent to that of a professional.

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we are all experts of our lived experiences, people shouldn’t need acronyms at the end names to be paid for their expertise 

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Within the programme schedule we designed a number of exercises that would guide our thinking in what would make a successful HIA.

Over the course of 4 months we met through fortnightly virtual calls in the evenings. For the most part we met as a group but there were daytime sessions for certain members to research specific issues that didn’t merit inclusion of all people’s time. 

Starting the Work

Our approach to ensuring this was justice and lived-experience led was to centre conversations by looking at the problem holistically. We did this by starting the first session on sharing all the blockers the members of CASH had experienced in advocating for their health, including engaging with health systems and all related departments.

We felt that this would shed light on how the HIA could work in a multi-stakeholder and cross departmental framing rather than just looking at improving the margins of the current status quo within planning policy.

The following is an outline of the work sessions that followed, in order:

• Reviewing what an HIA is via the current literature, guidance documents, and language to see how it works and reflects recent experiences.

• Reviewing the number of HIAs performed for planning applications to the local planning authority, and regrouping for sharing findings.

• Coworking to discuss what the HIA process and system misses about health in community oriented life.

• Developing a series of principles to guide how our HIA would be developed and performed

• Developing a theory of change model for how our HIA would work to have success.

• Lastly explored whether the HIA should interlink to other planning conditions such as obligations from S106 Agreements and Community Infrastructure Levy however we opted to not go further with this work as it would open up additional bureaucratic and political layers that would likely impair the success of community-led action.

Through all sessions we allowed for questions to be answered in an open manner. For example, when asking what “good” looked like there was no parameter on whether this was explicitly about the process or outcome. This ensured that a full range of ideas were brought forward and discussed.

Results

For this section we’re going cover what we discovered and learnt through the research phase.

• The members of CASH experienced various levels of gaslighting, being told that it was “only them” experiencing these issues, “no-one” else is complaining, and “it’s more likely a result of other factors in their lives”. Their requests for help and claims of injustice were brushed away as authorities could not point to other data sources, such as GPs, to verify that this was a public health issue. However, using a very metric of GP visits be local residents complaining directly of air pollution related problems is problematic, Southall is a predominantly working class area with many parents working shift-work meaning accessing GPs can be difficult; childcare can be complex if taking a child out of school for a GP appointment; there are internalised stigmas in taking children out of school or taking sick days from work in order to keep up appearances in a racially prejudiced society. This institutionally led to an erasure of their lived experiences and a prejudicing of their lifestyles.

• Over time the members of CASH experienced what can be described as being “cancelled” - they were excluded from a variety of public engagement activities despite them being an active organisation concerned with health and placemaking matters. According to the Oxford Dictionary, being cancelled is ‘ a systemic approach to removing someones agency to express their views that challenge an orthodoxy’. This can be seen in their exclusion from public engagement events due to their challenging of the local authority and developer’s agenda. Therefore, community consultation continues to be seen as a one-directional process parading as equity.

• When given a platform to discuss and present their informed criticism of the real estate housing development it felt that this was just deference politics at play, that they were being placated through a thin veil of ‘democracy’ through participation when in reality the concerns they were raising could not be actively acted upon by the authorities who would need to act on their behalf, meaning little was done from the feedback.

• Academic institutions offered support but the length of work, perceived extractive nature of research, and lack of control over research methods presented another frustrating avenue in aiming to demonstrate their injustices through “legitimate” evidence. Grassroots organisations around the world are forever told to present legitimate evidence and hard data beyond their own views. This is knowledge supremacy and a suppression tactic. Knowledge supremacy is a knowledge pool that self-identifies as supreme to systematically dictate the knowledges that are valuable, trusted, and acknowledged, resulting in hegemonic policies that affect our health.. Legitimate evidence often means something that is produced by “professional” researchers or academics. Therefore, the only accepted avenues to demonstrating ones cause for concern are met with impractical realities resulting in grassroots groups and citizens impotent in fighting their case on equal, or even equitable, terms. 

• Poor governance was rife, there was a perception that local government figures, such as councillors, were easily manipulated through investments in initiatives they were keen on and increases in their own levels of power, such as being invited to sit on new committees and representative boards in the borough. A major frustration was the lack of public oversight in how this unfolded over time and that this was a perceived infiltration of local systems by foreign actors with vested interests.

• Early planning documentation demonstrates a distinct awareness of the problems related to contaminated land and the need for high levels of due diligence and compliance in remediation techniques if works were to take place - contrary to personal stories on the quality control of soil hospitals where tarpaulins would be seen flailing in the air at times.

• Language in current literature is opaque and to be justice-led need stronger definitions - e.g. social determinants of health only looks at downstream outcomes rather than upstream causes and actions. The NPPF offers no definition of health in context to the built environment other than some macro objectives of safety, natural environments, food options, etc., however this ignores the biological relationship to the built environment as well as how cultural differences influence matters. This means that “health” is open to interpretation by local planning policy officers resulting in unintended consequences of exclusionary practices or at worse discriminatory practices due to a person’s personal views on what makes a person healthy.

• In the cold light of day there appears to be low-to-no accountability on what is produced via an HIA. Without different indicators, metrics, and outcomes measurements the results of an HIA are not ‘material considerations’ and therefore have no legislative or policy powers to ensure accountability. 

• There is an apparent lack of connection of HIA to other authority departmental policy initiatives. It was hard to identify how a HIA through the planning system related to initiatives from other departments such as social care. CASH felt that given the power that local health boards, like Primary Care Trusts and Integrated Care Boads, have they should be a stakeholder in the process - whether that be developing HIAs, being connected to the activity, reviewing applications alongside stakeholders, or being connected to and holding to account the outcomes.

• Accessing information about HIAs at the local planning authority levels was very difficult. Local planning authority websites do not allow for the easy identification of this information. This demonstrates a lack of democratic transparency.

Conclusion

Having reviewed documentation there is an overwhelming feeling that assessments such as the HUDU template are self-serving and designed to support policy rather than people. In the document September 2023 Rapid Health Impact Assessment for The Green Quarter by planning consultancy Lichfields a project that has repeatedly caused harm to local community members has scored overwhelmingly positive. Make of that what you will.

We however see this as a form of corruption; a system designed to advantage one party through “organised” means. Rather than a scoring system it was beleved that any indicator and metric should be looked at independently and used as a discussion point within planning with relevant stakeholders (namely, local residents) for a solution co-design process - and not a box-ticking one that currently exists.

Learnings and Insights from the Work

A Short Review of Community Health Impact Assessments

Community-led HIAs are not a new thing, they have history and precedence. Based on desktop research it has been clear to us that a higher proportion of community-led/-driven HIA work has taken place in North America.

Researcher Maureen Coady examined the Community-Driven form of Health Impact Assessment (CHIA) practised in rural Nova Scotia, Canada between 1997 and 2014 and noted:

“informal learning in these processes is often transformative; ordinary citizens learn to identify factors that influence their health, to think beyond the illness problems of individuals, and to consider how programs and policies can weaken or support community health. They learn that they can identify directions for future action that will safeguard the health of their community.”

One of the projects analysed was on the community-driven health impact assessment of the Keppoch-Beaver Mountain Project. A report from 2009 about this project titled Influencing Healthy Public Policy with Community Health Impact Assessment summarised their findings that it “has resulted in a new level of legitimacy for PATH [People Assessing Their Health Network] and HIA within the municipal government sector, school boards, and other community organizations.”

Other Examples

There are several examples of community-led health impact assessments (HIAs) where communities take an active role in assessing how proposed policies, projects, or developments might impact their health and well-being. These assessments often involve local residents, community organisations, and other stakeholders working together to identify potential health impacts and advocate for changes to protect or improve public health.

San Francisco, California: Eastern Neighborhoods HIA

• Background: This HIA was conducted to assess the potential health impacts of a large-scale land-use and redevelopment plan in the Eastern Neighbourhoods of San Francisco. The area faced issues related to housing, transportation, and environmental justice.

• Process: Community organisations, residents, and public health professionals collaborated to identify key health concerns, such as access to affordable housing, safe transportation, and pollution exposure. The HIA included workshops, surveys, and public meetings to gather input from local residents.

• Outcome: The HIA influenced the planning process by highlighting the need for affordable housing, improved public transportation, and measures to reduce exposure to industrial pollution. The findings were used to advocate for policies that better aligned with the health needs of the community.

Wales, UK: Merthyr Tydfil Health Impact Assessment

• Background: In Merthyr Tydfil, Wales, a community-led HIA was conducted in response to a proposed opencast coal mine development. The community was concerned about the potential health impacts of air pollution, noise, and other environmental factors associated with the mining project.

• Process: Local residents, health professionals, and environmental organisations came together to conduct the HIA. The assessment included community surveys, health data analysis, and discussions with experts. The community played a central role in defining the scope of the assessment and identifying potential health impacts.

• Outcome: The HIA provided evidence of the potential negative health impacts of the coal mine, which was used to challenge the development proposal. The community's efforts contributed to greater scrutiny of the project and raised awareness of the health risks associated with such developments.

Los Angeles, California: South Central Farm HIA

• Background: The South Central Farm, a 14-acre urban farm in Los Angeles, was threatened with closure and redevelopment. The farm served as an important source of fresh food and a community gathering space in a low-income, predominantly Latino neighbourhood.

• Process: Community members and activists conducted an HIA to assess the potential health impacts of losing the farm. The assessment involved community surveys, focus groups, and health data analysis to document the farm's role in promoting physical and mental health, food security, and community cohesion.

• Outcome: The HIA findings highlighted the critical role of the farm in supporting community health and were used to advocate for its preservation. Although the farm was eventually closed, the HIA helped raise awareness of the importance of urban agriculture in promoting public health.

Dundee Central Waterfront Redevelopment HIA, Scotland

• Context: The redevelopment of the Dundee Central Waterfront was a major urban regeneration project aimed at transforming the city’s waterfront area.

• Process: The HIA was community-led, with local residents and community organisations playing a significant role in identifying potential health impacts and shaping the redevelopment plan. The assessment focused on issues such as accessibility, the quality of public spaces, and the potential for increased physical activity.

• Outcome: The HIA helped influence the final design of the waterfront area, ensuring that it promoted physical and mental health by enhancing walkability, creating green spaces, and improving public transport options. The community's involvement ensured that the redevelopment met local needs and priorities.

Luton Airport Expansion HIA, Bedfordshire

• Context: The expansion of Luton Airport in Bedfordshire prompted concerns about the potential health impacts on local communities, particularly related to noise pollution, air quality, and traffic congestion.

• Process: Local residents, supported by community organisations and public health experts, conducted an HIA to assess the health implications of the airport's expansion. They used a combination of community surveys, health data analysis, and public consultations.

• Outcome: The HIA findings were used to advocate for measures to mitigate the negative health impacts, such as improved noise insulation for homes, enhanced air quality monitoring, and better transportation planning. The process also helped to raise public awareness and put pressure on decision-makers to consider health impacts more seriously.

Conclusion

Community-led health impact assessments are powerful tools for empowering communities to shape decisions that affect their health and well-being. These examples demonstrate how by actively participating in the assessment process, communities have been able to highlight health risks, advocate for necessary changes, and influence policy and planning decisions in ways that promote healthier, more equitable environments.

Reading the Marie Michael Library of the Coady Institute at St. Francis Xavier University shows that community driven/led HIA shows that this is not something new. There is precedence for participatory research, impact, and change. Yet, for the most part in the United Kingdom this has not been an institutionalised approach. Perhaps that’s because it gets in the way of building more homes by any means necessary, and that rhetoric has gone well over the past 20 years, hasn’t it?

What is a Health Impact Assessment?

Health Impact Assessment (HIA) is a practical approach used to judge the potential health effects of a policy, programme or project on a population, particularly on vulnerable or disadvantaged groups. Recommendations are produced for decision-makers and stakeholders, with the aim of maximising the proposal's positive health effects and minimising its negative health effects. The approach can be applied in diverse economic sectors and uses quantitative, qualitative and participatory techniques. HIA provides a way to engage with members of the public affected by a particular proposal. It also helps decision-makers make choices about alternatives and improvements to prevent disease or injury and to actively promote health. It 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.

- World Health Organisation

The WHO go on to say that “Health impact assessment can be a valuable tool for helping to develop policy and assisting decision-makers in these (transport, agriculture and housing) and other areas. Because HIA provides a way to engage with members of the public affected by a particular proposal, it can show that an organization or partnership wants to involve a community and is willing to respond constructively to their concerns. The views of the public can be considered alongside expert opinion and scientific data, with each source of information being valued equally within the HIA. “

“Health impact assessments begin by identifying the relevant stakeholders. This usually produces a large number of relevant people and organizations. HIA is a framework to implicate stakeholders in a meaningful way, allowing their messages to be heard. The process draws on all resources in the project and wider community to help guide decision making, including developers and planners, employers and unions, local and national health workers, and those living in the community— particularly the most vulnerable members of the community and those directly impacted by the programme or project.” 

source: https://www.who.int/health-topics/health-impact-assessment#tab=tab_1

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Why do we feel HIAs are meaningful ways to enact health justice?

• Some feel that Local Plans are the ideal place to instil health-led actions. However, Local Plans overwhelmingly address spatial concerns, take multiple years to deliver and review, and can often be dated and unspecific to a community. Whereas, we feel that a CHIA allows a contemporary, locally-specific, approach to involving community and real life into planning decisions. Local Plans should advocate for the use of CHIAs.

• HIAs are maleable given there is not definitive template, meaning there is scope for justice-led influence and impact.

• HIAs can cover a wide range of topics - in a macro sense it can address a policy action such as a Local Plan, and in a micro sense it can analyse a specific project like a property development.

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UK Planning Context

The Health and Social Care Act 2012 (‘the Act’) states that the Secretary of State’s (‘SoS’) duty is to promote a comprehensive health service designed to secure the improvement of the physical and mental health of people in England and the prevention, diagnosis, and treatment of physical and mental health.

The National Planning Policy Framework (‘NPPF’) is guidance provided by the Ministry for Homes, Communities and Local Government for planning authorities. It’s designed to allow a coherent and nationally set agenda of goals to be achieved whilst allowing for local planning authorities to have autonomy in how the issues are addressed to reflect local needs and realities. As a framework it is heavily focused on economic, social, and environmental objectives however section 8 of the NPPF places significant emphasis on using planning policies and decisions on promoting health and safe communities. This is currently seen through the lenses of promoting social interaction, creating safe and accessible places to minimise crime and disorder, and enabling healthy lifestyles through the provision of community space, access to healthy food, and safe and accessible green infrastructure. 

The Planning Practice Guidance (‘PPG’) highlights the need to consider the impact of the built and natural environment on health and well-being and to “undertake positive planning to create environments that support and encourage healthy lifestyles” (Reference ID: 53-001-20190722). The PPG sets out the Government’s vision of a ‘healthy place’ as a place that supports and promotes healthy behaviours, reduces health inequalities, and supports community engagement and social interaction. It emphasises the importance of meeting the needs of children and young people, the increasingly elderly population, and those with dementia and other sensory or mobility impairments (Reference ID: 53-003-20191101). The PPG also refers to HIAs as “a useful tool” in the consideration of planning applications where there are expected to be significant impacts (Reference ID: 53-005-20190722). 

The National Model Design Code 5 (‘NMDC’) provides detailed guidance on the production of design codes, guides, and policies to promote successful (as well as a healthy) design. This places a greater emphasis on development supporting wider health outcomes, such as: 

• How the design of new development should enhance the health and wellbeing of local communities and create safe, inclusive, accessible and active environments; 

• How landscape, green infrastructure and biodiversity should be approaches including the importance of streets being tree-lined; and

• The environmental performance of place and buildings ensuring they contribute to net zero targets.

Public Health England’s guide, Health Impact Assessments in Spatial Planning, describes the health and well-being outcomes that can be influenced or optimised as part of the plan- making and planning application process. 

The guide sets out an evidence-based approach for preparing HIAs, which includes establishing the baseline for the project, identifying HIA health outcomes, identifying specific population groups that could be affected, assessing the potential impacts of wider determinants of health as part of the scheme, and identifying recommendations for implementation and monitoring that will support positive health outcomes. It sets out that the extent of assessment within HIAs should be proportionate to the significance of impact of a proposed development. This HIA follows the approach set out in this document.

There are also Regional and Local context’s to the use of HIAs. The NHS London Health Urban Development Unit advise in their guidance:

Community engagement can provide the contextual knowledge that is often missing from purely quantitative evidence. It allows people to become involved in assessing the potential impact of a development proposal on their own health and wellbeing while also providing key information on the way in which impacts may be distributed across a whole population. Engagement should be ongoing, particularly during the different phases of large developments. 

There are different methods to engage community and stakeholder groups, which vary according to the type of HIA used and the amount of time and resources available.

- Participatory workshops

- Interviews and focus groups

- Recruiting public members to HIA steering groups

- Surveys

- A community led HIA, for example on a neighbourhood plan.

Development proposals and local plans are subject to statutory consultation. It may be beneficial to link HIA consultation and engagement with pre-application consultation on development proposals and early consultation on a Local Plan at the issues and options stage. The Council’s Statement of Community Involvement provides the minimum standards for public consultation on planning applications and local plans, including details of who should be consulted as well as techniques of community involvement. Community engagement may be linked to wider regeneration programme, for example a Council estate regeneration scheme. In such instances, engagement on the HIA may form part of wider consultation and engagement. The use of regeneration ballots and charters may encourage community engagement and highlight issues and concerns to be addressed in a HIA.

Despite all of this, recent research by TRUUD, an academic-led collaborative in South West England, showed that as of February 2023 only 38% of local planning authorities had an explicit HIA policy in their Local Plans. Cearly, there has been a failure to incorporate the guidance to have meaningful influence in local policy.

The CHIA Programme