Health impact assessment (HIA) is defined as "a combination of procedures, methods, and tools by which a policy, program, or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population." ( ECHP 1999 , p. 4)
Population health has been defined as "the health outcomes of a group of individuals, including the distribution of such outcomes within the group". It is an approach to health that aims to improve the health of an entire human population. This concept does not refer to animal or plant populations. It has been described as consisting of three components. These are "health outcomes, patterns of health determinants, and policies and interventions". A priority considered important in achieving the aim of Population Health is to reduce health inequities or disparities among different population groups due to, among other factors, the social determinants of health, SDOH. The SDOH include all the factors that the different populations are born into, grow up and function with throughout their lifetimes which potentially have a measurable impact on the health of human populations. The Population Health concept represents a change in the focus from the individual-level, characteristic of most mainstream medicine. It also seeks to complement the classic efforts of public health agencies by addressing a broader range of factors shown to impact the health of different populations. The World Health Organization's Commission on Social Determinants of Health, reported in 2008, that the SDOH factors were responsible for the bulk of diseases and injuries and these were the major causes of health inequities in all countries. In the US, SDOH were estimated to account for 70% of avoidable mortality.
HIA is intended to produce a set of evidence-based recommendations to inform decision-making ( Taylor & Quigley 2002 , p. 2). HIA seeks to maximise the positive health impacts and minimise the negative health impacts of proposed policies, programs or projects.
Evidence, broadly construed, is anything presented in support of an assertion. This support may be strong or weak. The strongest type of evidence is that which provides direct proof of the truth of an assertion. At the other extreme is evidence that is merely consistent with an assertion but does not rule out other, contradictory assertions, as in circumstantial evidence.
In psychology, decision-making is regarded as the cognitive process resulting in the selection of a belief or a course of action among several alternative possibilities. Every decision-making process produces a final choice, which may or may not prompt action.
Health, as defined by the World Health Organization (WHO), is "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." This definition has been subject to controversy, as it may have limited value for implementation. Health may be defined as the ability to adapt and manage physical, mental and social challenges throughout life.
The procedures of HIA are similar to those used in other forms of impact assessment, such as environmental impact assessment or social impact assessment. HIA is usually described as following the steps listed, though many practitioners break these into sub-steps or label them differently:
Policy Impact Assessments (IAs) are formal, evidence-based procedures that assess the economic, social, and environmental effects of public policy. They have been incorporated into policy making in the OECD countries and the European Commission.
Environmental assessment (EA) is the assessment of the environmental consequences of a plan, policy, program, or actual projects prior to the decision to move forward with the proposed action. In this context, the term "environmental impact assessment" (EIA) is usually used when applied to actual projects by individuals or companies and the term "strategic environmental assessment" (SEA) applies to policies, plans and programmes most often proposed by organs of state. Environmental assessments may be governed by rules of administrative procedure regarding public participation and documentation of decision making, and may be subject to judicial review.
Social impact assessment (SIA) is a methodology to review the social effects of infrastructure projects and other development interventions. Although SIA is usually applied to planned interventions, the same techniques can be used to evaluate the social impact of unplanned events, for example disasters, demographic change and epidemics.
The main objective of HIA is to apply existing knowledge and evidence about health impacts, to specific social and community contexts, to develop evidence-based recommendations that inform decision-making in order to protect and improve community health and wellbeing. Because of financial and time constraints, HIAs do not generally involve new research or the generation of original scientific knowledge. However, the findings of HIAs, especially where these have been monitored and evaluated over time, can be used to inform other HIAs in contexts that are similar. An HIA's recommendations may focus on both design and operational aspects of a proposal.
Community health is a major field of study within the medical and clinical sciences which focuses on the maintenance, protection, and improvement of the health status of population groups and communities. It is a distinct field of study that may be taught within a separate school of [public health] or [environmental health]. The WHO defines community health as:
environmental, social, and economic resources to sustain emotional and physical well being among people in ways that advance their aspirations and satisfy their needs in their unique environment.
Design can have different connotations in different fields of application, but there are two basic meanings of design: as a verb and as a noun.
HIA has also been identified as a mechanism by which potential health inequalities can be identified and redressed prior to the implementation of proposed policy, program or project ( Acheson 1998 ).
A number of manuals and guidelines for HIA's use have been developed (see further reading).
The proposition that policies, programs and projects have the potential to change the determinants of health underpins HIA's use. Changes to health determinants then leads to changes in health outcomes or the health status of individuals and communities. The determinants of health are largely environmental and social, so that there are many overlaps with environmental impact assessment and social impact assessment.
Three forms of HIA exist:
It has been suggested that HIAs can be prospective (done before a proposal is implemented), concurrent (done while the proposal is being implemented) or retrospective (done after a proposal has been implemented) ( Taylor, Gorman & Quigley 2003 , p. 1). This remains controversial, however, with a number of HIA practitioners suggesting that concurrent HIA is better regarded as a monitoring activity and that retrospective HIA is more akin to evaluation with a health focus, rather than being assessment per se ( Kemm 2003 , p. 387). Prospective HIA is preferred as it allows the maximum practical opportunity to influence decision-making and subsequent health impacts.
HIA practitioners can be found in the private and public sectors, but are relatively few in number. There are no universally accepted competency frameworks or certification processes. It is suggested that a lead practitioner should have extensive education and training in a health related field, experience of participating in HIAs, and have attended an HIA training course. It has been suggested and widely accepted that merely having a medical or health degree should not be regarded as an indication of competency.
The International Association for Impact Assessment has an active health section.
A HIA People Directory can be found on the HIA GATEWAY.
HIA is currently being used or developed around the world, most notably in Europe, North America, Australia, New Zealand, Africa and Thailand.
The new safeguard policies and standards of the International Finance Corporation (IFC), part of the World Bank, were established in 2006. These contain a requirement for health impact assessment in large projects. The standards have been accepted by most of the leading lending banks who are parties to the Equator Principles. Health impact assessments are becoming routine in many large development projects in both public and private sectors of developing countries. There is also a long history of health impact assessment in the water resource development sector - large dams and irrigation systems.
The 13th International HIA Conference was held in Geneva in 2013.
The 12th International HIA Conference was held in Québec City in 2012.
Broadly speaking, a risk assessment is the combined effort of 1. identifying and analyzing potential (future) events that may negatively impact individuals, assets, and/or the environment ; and 2. making judgments "on the tolerability of the risk on the basis of a risk analysis" while considering influencing factors. Put in simpler terms, a risk assessment analyzes what can go wrong, how likely it is to happen, what the potential consequences are, and how tolerable the identified risk is. As part of this process, the resulting determination of risk may be expressed in a quantitative or qualitative fashion. The risk assessment is an inherent part of an overall risk management strategy, which attempts to, after a risk assessment, "introduce control measures to eliminate or reduce" any potential risk-related consequences.
In social science, the term built environment, or built world, refers to the human-made surroundings that provide the setting for human activity, ranging in scale from buildings to parks. It has been defined as "the human-made space in which people live, work, and recreate on a day-to-day basis." The "built environment encompasses places and spaces created or modified by people including buildings, parks, and transportation systems." In recent years, public health research has expanded the definition of "built environment" to include healthy food access, community gardens, mental health, "walkability", and "bikeability".
Life-cycle assessment is a technique to assess environmental impacts associated with all the stages of a product's life from raw material extraction through materials processing, manufacture, distribution, use, repair and maintenance, and disposal or recycling. Designers use this process to help critique their products. LCAs can help avoid a narrow outlook on environmental concerns by:
The World Health Organization Framework Convention on Tobacco Control is a treaty adopted by the 56th World Health Assembly held in Geneva, Switzerland on 21 May 2003. It became the first World Health Organization treaty adopted under article 19 of the WHO constitution. The treaty came into force on 27 February 2005. It had been signed by 168 countries and is legally binding in 181 ratifying countries. There are currently 15 United Nations member states that are non-parties to the treaty.
Health promotion is as stated in the 1986 WHO Ottawa Charter on Health Promotion "the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy life-styles to well-being".
The impact of nanotechnology extends from its medical, ethical, mental, legal and environmental applications, to fields such as engineering, biology, chemistry, computing, materials science, and communications.
The Healthy Development Measurement Tool (HDMT), developed by the San Francisco Department of Public Health, provides an approach for evaluating land-use planning and urban development with regards to the achievement of human health needs. The HDMT provides a set of baseline data on community health metrics for San Francisco and development targets to assess the extent to which urban development projects and plans can improve community health. The HDMT also provides a range of policy and design strategies that can advance health conditions and resources via the development process.
mHealth is an abbreviation for mobile health, a term used for the practice of medicine and public health supported by mobile devices. The term is most commonly used in reference to using mobile communication devices, such as mobile phones, tablet computers and PDAs, and wearable devices such as smart watches, for health services, information, and data collection. The mHealth field has emerged as a sub-segment of eHealth, the use of information and communication technology (ICT), such as computers, mobile phones, communications satellite, patient monitors, etc., for health services and information. mHealth applications include the use of mobile devices in collecting community and clinical health data, delivery of healthcare information to practitioners, researchers and patients, real-time monitoring of patient vital signs, the direct provision of care as well as training and collaboration of health workers.
Patient participation is a trend that arose in answer to perceived physician paternalism. However, only rarely can unchecked physician paternalism be justified, and unlimited patient autonomy would presumably be equally abhorrent.
Environmental social science is the broad, transdisciplinary study of interrelations between humans and the natural environment. Environmental social scientists work within and between the fields of anthropology, communication studies, economics, geography, history, political science, psychology, and sociology; and also in the interdisciplinary fields of environmental studies, human ecology and political ecology, social epidemiology, among others.
In analytical chemistry, biomonitoring is the measurement of the body burden of toxic chemical compounds, elements, or their metabolites, in biological substances. Often, these measurements are done in blood and urine.
This article is about the economics of climate change mitigation. Mitigation of climate change involves actions that are designed to limit the amount of long-term global warming. Mitigation may be achieved through the reduction of greenhouse gas (GHG) emissions or through the enhancement of sinks that absorb GHGs, for example forests.
Climate change and poverty link a process and a condition that are interrelated. While climate change and global warming affect the natural environment, especially agriculture, it also affects humans. Climate change globally impacts poverty, particularly in low-income communities.
Human Rights Impact Assessment is a process for systematically identifying, predicting and responding to the potential human rights impacts of a business operation, capital project, government policy, or trade agreement. It is designed to complement a company or government’s other impact assessment and due diligence processes and to be framed by appropriate international human rights principles and conventions. It is also rooted in the realities of the particular project by incorporating the context within which it will operate from the outset, and by engaging directly with those peoples whose rights may be at risk.
The health impact of light rail systems has both positive and negative effects.
Health in All Policies (HiAP) was a term first used in Europe during the Finnish presidency of the European Union (EU), in 2006, with the aim of collaborating across sectors to achieve common goals. It is a strategy to include health considerations in policy making across different sectors that influence health, such as transportation, agriculture, land use, housing, public safety, and education. It reaffirms public health's essential role in addressing policy and structural factors affecting health, as articulated by the Ten Essential Public Health Services, and it has been promoted as an opportunity for the public health sector to engage a broader array of partners.
This page uses Harvard referencing. References are sorted alphabetically by author surname.
This page uses Harvard referencing. Further reading categories are sorted alphabetically; citations are sorted by year (newest to oldest), then alphabetically by author surname within years. If citations are included in the references section they are not listed in the further reading section.
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