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
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.
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.