Health Impact
Assessment
Through our health impact assessment (HIA) we are
aiming to integrate health impact assessment as a
systematic framework to enable decision makers to
take account of peoples’ health and well-being during policy,
programme or project developments.
Belfast Healthy Cities’ HIA programme builds on
experience gained through previous HIAs. Belfast Healthy
Cities is one of a limited number of organisations in
Northern Ireland to have carried out an HIA. We were
also the first in the region to pilot a community
led approach in the Community Health
Impact Assessment project.
Belfast Healthy Cities worked closely with HIA
specialist Erica Ison from Oxford University, who is
now the expert advisor to WHO on HIA.
What is Health Impact Assessment?
Health Impact Assessment (HIA) is a concept and practical
approach to assessing potential health impacts of a proposal. Its
main aim is to make recommendations for how positive
impacts can be maximised and harm to health reduced,
based on evidence from stakeholders affected by a proposal.
HIA is increasingly used in programme development particularly
in England, but also has a strong endorsement in the
public health strategy Investing for Health
in Northern Ireland. The World Bank and World Health
Organization (WHO), among others, have been at the forefront
of developing HIA, which has its origins in environmental
impact assessment.
Our HIA objectives
Our central objectives as defined by WHO are to:
- raise awareness and create a common understanding
of health impact assessment, the contribution it
can make to policies and plans for improved health
and provide convincing arguments to politicians and
administrators in cities of the usefulness of the
approach.
- identify entry points and to build on existing
skills, provide leadership and strengthen capacity
within cities to provide a firm foundation to apply
health impact assessments at the city level;
- provide results and evidence from HIA practice
in cities and share the learning with other European
cities and to provide evidence of the value of HIA’s
contribution to health development within cities
including strengthening healthy urban planning and
healthy ageing.
- work towards mainstreaming HIA as a systematic
framework to integrate the health and well being
impacts into all new city policies and projects and
improve health within cities.
Building capacity to conduct HIAs
Our current HIA programme at Belfast Healthy Cities
aims to integrate health impact assessment into organisations’ planning
and decision making processes. In particular, the
aim is to integrate HIA into non-health policies,
to provide a mechanism for considering health within
these. Policies in Northern Ireland currently undergo
a range of impact assessments, but health is not
an explicit consideration within most of these.
Our programme focuses on training staff in key organisations
on HIA to develop a basic understanding of the concept.
Selected staff have also participated in HIAs to provide
them with practical experience in conducting HIAs. Our
plan is to provide further training, to enable them
to become trainers within their organisations. Key
partner organisations for training have included EHSSB,
Belfast City Council, Northern Ireland Housing Executive
and the two Health and Social Services Trusts in the
city and Belfast Metropolitan Plan team.
The second major element of the programme is to carry
out HIAs. Since there is limited expertise
in Northern Ireland in conducting HIA in practice,
Belfast Healthy Cities will continue to conduct HIAs
using external support where appropriate and build
experience and expertise which can be shared in future.
In total six HIAs will be completed over the period
2006-2008. Proposals to be assessed will be identified
on a continuous basis and HIAs to be carried out will
be agreed with the developers of proposals.
A final element of the programme is to develop an online
evidence base for HIA, which organisations can use
for their own impact assessments. This work
has been initiated in the resources section below.
HIAs Conducted
HIA on the Government proposals
to reform liquor licensing
in Northern Ireland
A rapid
Health Impact Assessment workshop
was held on 10th April 2006.
The purpose of the day was
to undertake a Health Impact
Assessment in the approach
of a rapid health impact appraisal,
to ascertain the potential
health effects of the government
consultation document “Liquor
Licensing - The Way Forward”, a proposal to reform
the Liquor Licensing Law. It is envisaged that the
HIA process will add value to public health through
assessing the proposal and recommending how it can
be tailored to maximise positive and minimise negative
health effects
The aim of the HIA was to identify the positive and
negative impacts of the Liquor Licensing proposal.
The objective of the HIA was to produce clear comments
and recommendations about the development and implementation
Liquor Licensing legislation. In addition we
wished to gain the contribution of workshop participants
on the potential health impacts of the Liquor Licensing
proposal.
Belfast Healthy Cities staff facilitated the workshop
and completed the final report, HIA on the draft Green
Travel Plan of EHSSB.
This HIA was conducted jointly by Belfast Healthy Cities
and the EHSSB to asses the potential impact of a travel
plan to reduce car use among EHSSB Staff. A cross section
of staff participated in this rapid appraisal workshop
which for some was their first introduction to the
HIA process. The recommendations from the HIA were
to be included in the EHSSB’s Travel Plan which
is to be implemented in the near future.
HIA on draft Belfast Air Quality Action Plan
 Belfast Healthy Cities supported Belfast City Council
to carry out an HIA of the draft Air Quality Action
Plan in spring-summer 2005. This HIA took the form
of three rapid appraisal workshops, two carried out
in communities within Air Quality Management Areas
and one overall stakeholder workshop. It also piloted
work with children in two primary schools, and the
P7 pupils who participated also provided their views
in an art competition.
Our Programme Director chaired the intersectoral steering
group for the HIA, and two staff members were also
responsible for arranging the community workshops for
the Westlink corridor and Ormeau Road Air Quality Management
Areas.
The final Air Quality Action Plan was launched in May
2006 which is available on the Belfast City Council with
the report on the HIA
of the Air Quality Action Plan
HIAs conducted on DSD Masterplans
In view of the rising importance of considering health
and well being as part of land use planning, we commissioned
Erica Ison, HIA specialist to conduct HIAs on the draft
North East and North West Masterplans issued by Department
of Social Development. The reports Health
Impact Assessment of the Draft North West Quarter Masterplan
for Belfast City Centre and Health
Impact Assessment of the Draft North East Quarter Masterplan
for Belfast City Centre were presented to DSD
during the consultation process on the draft plans.
Community Health Impact Assessment
Pilot
Project
Ards& Ballybeen
Community Health Impact Assessment (CHIA) is a variation
of HIA which combines HIA methods with a community
development approach. The main difference is that in
CHIA, the local community leads the process, and is
instrumental in choosing the proposal on which an HIA
should be carried out. Its key advantage to ordinary
HIA is that local people are central to the process,
while the community can be marginalised in an ordinary
HIA if the timescale is tight.
Belfast Healthy Cities developed the first pilot CHIA
model for Northern Ireland in 2003-04. The pilot areas
were Ballybeen and four wards in the Ards peninsula.
These areas were selected as they had a relatively
strong community sector, and they were willing to get
involved in the project.
The Community Health Impact Assessment; Pilot Project
Report
provides a summary of the full CHIA project.
The HIA report for the Ards area Health
Impact Assessment of the Proposal to Introduce
Charging for Water and Sewerage Services in Northern
Ireland conducted on the Water Reform specifically
linked the proposal to the introduction of charges
for water.
 The HIA report for Ballybeen, Health
Impact Assessment of the Proposal to Develop the
Enler Site on the Ballybeen Estate identifies
the health impacts of a proposal to develop a new
estate centre on the then vacant Enler Site.
In both areas detailed Community Profiles were produced
in partnership with the local HIA Steering Groups. The
Ballybeen and
Ards profiles collated quantitative and qualitative
information on a range of health determinants in the
areas and were considered a useful and lasting resource
for both communities.
Developing a community profile:GUIDELINES (link) was
also produced as a response to the identified need
of other communities requesting the collation of similar
profiles.
WHO Health Impact Assessment Sub network
Belfast is the lead city for the sub network on HIA. The
HIA sub network is co-chaired by Belfast Healthy Cities
and the Institute
of Public Health in Ireland,
which develops HIA training programmes on an all-island
basis. The network has seven member cities in addition
to Belfast: Bologna (Italy), Brighton and Hove (UK),
Copenhagen (Denmark), Geneva (Switzerland), Helsingborg
(Sweden), Ljubljana (Slovenia), Turin (Italy), Turku
(Finland) and Yalova (Turkey). Erica Ison, HIA
specialist is the WHO expert advisor to the group.
The sub network has concentrated on arranging training
events across the European Network, particularly for
HIA beginners. More recently a HIA Practice Development
workshop was held for cities that have gained some
experience in conducting HIAs. Until
summer 2006, training events have been arranged in
Paris (France), Lodz (Poland) and Turku, with further
sessions planned to enable all cities in the network
to be trained in HIA.
The HIA sub network is also exploring ways of making
links with the HUP Sub network and the Healthy Ageing
Subnetwork to develop ways of cross linking work on
the core themes.
WHO HIA Toolkit
The WHO European Healthy Cities Network secretariat,
has developed its own HIA toolkit under the PHASE project
(Promoting and Supporting Integrated Approaches
for Health and Sustainable Development at the Local
Level across Europe) funded by the EU.
The overall objective of PHASE was to promote the
integration of health and sustainable development at
the local level. PHASE worked in direct cooperation
with experts and the Italian and Slovak national Healthy
Cities networks to develop and test these products. The
cities of Bologna (Italy) and Trnava (Slovakia) piloted
the project's draft HIA toolkit in spring 2004.
The toolkit consists
of a guidance document, a training module, a brochure
outlining how HIA can support decision making and case
studies of the pilot projects.
HIA Resources
There is now a large and growing body of literature
on HIA as well as reports on completed HIAs. Significant
resources are also available on the Internet and
a selection of links is listed below. Please note
that these links lead to external sites which are
not the responsibility of Belfast Healthy Cities
and may not reflect the views and values of Belfast
Healthy Cities.
International Websites
The European Centre for Health Policy
http://www.euro.who.int/echp
The Netherlands Public Health RIVM
This site contains online HIA database run by the Dutch
Public Health to
Research for Man and Environment which contains 150
HIA related
documents. Excellent resource on examples of
European and world wide research and case studies HIAs.
http://www.rivm.nl/en/
New South Wales HIA Connect
http://chetre.med.unsw.edu.au/hia/index.htm
Health Impact Assessment Unit, Deakin University,
Canada
This website provides tools, methodologies and case
studies from a Canadian perspective.
http://www.deakin.edu.au/hbs/hia/index.php
The Canadian Handbook on Health Impact Assessment
http://www.phac-aspc.gc.ca/ph-sp/phdd/implement/implementation2.html
UK/Republic of Ireland Websites
Institute of Public Health
www.publichealth.ie/hia
London Health Observatory
http://www.iho.org.uk/HIA.htm
London’s Health Developing a Vision together, 2000,
Erica Ison,
www.doh.gov/london/resource
HIA Gateway (National Institute for Health
and Clinical Excellence)
www.hiagateway.org.uk
This site provides tools , methodologies case
studies and links. It is an excellent resource
for those seeking information on HIAs or those conducting
HIAs.
Department of Health and Children – website
of Department of Health & Children providing information,
tools etc on HIAs in Ireland as well general information
on policies procedures and legistation on health in
the Republic.
www.dohc.ie
Health Impact Assessment Research Unit – Birmingham
University One of the longest established HIA reseach
centres in England
http://pcpoh.bham.ac.uk/publichealth/hiaru/index.htm.
Welsh Health Impact Assessment Support Unit
Based at Cardiff University the Unit provides support
advice and case studies on HIA s undertaken in Wales.
It also has links to the Welsh Assembly which proactively
supports the HIA process
http://www.whiasu.cardiff.ac.uk
Scotland Public Health Information
General information on HIAs in Scotland
http://www.phis.org.uk/about/enet.asp
Northern Ireland
Investing for Health
www.investingforhealthni.gov.uk
Office of the First Minister and Deputy First Minister – Explanation
of good practice Integrated Impact Assessment (IIA)
tool aimed at assisting policy makers in such area
as SEA, EQUIAs and Rural proofing. This IIA tool is
however being redeveloped to make it more accessible
and it will be in a ‘work book’ like format
www.ofmdfmni.gov.uk/iia
HIA EVIDENCE SITES
The following sites provide information on a number
of different subject areas to assist in gathering evidence
for HIA , for example, transport, health and regeneration.
Ireland’s Population Health Observatory
(INIs PHO) http://www.inispho.org/
The Cochrane Library
http://www.cochrane.org/index0.htm
British Medical Journal
http://bmjjournals.com/
PubMed
http://www.ncbi.n1,.nih.gov/entrez/query.fcgi
National Institute for Health and Clinical Excellence
http://www.publichealth.nice.org.uk/page.aspx?0=home
National Institute for Health and
Clinical Excellence – Evidence
Base (UK)
http://www.hda.nhs.uk/html/research/evidencebase.html
WHO Health Evidence Network
http://www.euro.who.int/HEN
WHO- Health effects and risks of transport systems
(HEARTS)
http://www.euro.who.int/hearts
WHO European Centre for Environment and Health,
Rome Office
http://www.euro.who.int/ecehrome
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