Do Health Impact Assessment Frameworks Work?

by Jon Scaccia August 12, 2024

When policies and plans are made outside the healthcare sector, they often have unanticipated effects on public health. Enter Health Impact Assessment (HIA), a vital tool for predicting these impacts and guiding decision-makers to foster better health outcomes. But how well do current HIA frameworks actually support best practices? Let’s look at a recent systematic review to find out.

Understanding Health Impact Assessments

Imagine you’re planning a new urban development. You want it to promote active transportation, social connectivity, and economic inclusion. How can you ensure it will have a positive impact on public health? This is where an HIA comes in. It’s an evidence-based approach that assesses the potential health effects of a policy, program, or project before it’s implemented.

This is happening right around me, with the township supervisors discussing the implications for a few housing developments.

HIA follows six steps: screening, scoping, appraisal, recommendations, reporting, and monitoring and evaluation. Although these steps are generally agreed upon, the methods and frameworks used to complete them can vary widely. This is where the systematic review steps in, examining how well these frameworks uphold the principles of best practice.

The Study: A Systematic Review of HIA Frameworks

The recent review looked at 24 HIA frameworks, evaluating them against best practice principles defined by the International Association for Impact Assessment (IAIA). These principles include equity, participation, ethical use of evidence, a comprehensive approach to health, and sustainability.

What Did the Review Find?

Good Practices

The review found that many frameworks scored well in some areas but fell short in others. Here’s a closer look:

1. Ethical Use of Evidence and Comprehensive Approach to Health: Most frameworks (15 out of 24) scored high here. They recommended using diverse types of evidence—both quantitative and qualitative—from various disciplines. This helps ensure that all potential health impacts are considered comprehensively.
2. Participation: Eight frameworks scored well in this area. Participation involves including stakeholders at every step of the HIA process, from defining the scope to making recommendations. However, none met all the criteria for stakeholder involvement fully.

Areas for Improvement

Despite some strengths, the review highlighted significant gaps:

1. Equity: Only two frameworks were rated ‘good’ for equity, and ten were rated ‘poor’. Many frameworks mentioned equity as a value but did not provide practical advice on how to achieve it throughout the HIA process. This is a crucial oversight because equity ensures that health benefits and burdens are distributed fairly among different population groups.
2. Sustainability: The principle for which the highest number of frameworks (11) scored ‘poor’ was sustainability. Given the growing recognition of HIA’s role in supporting sustainable development and addressing climate change, this is a critical area needing improvement.

Why Should We Care?

The findings of this review are significant for several reasons:

1. Improving Public Health: By highlighting gaps in current HIA frameworks, this review helps practitioners select and combine elements from different frameworks to better meet best practice principles. This can lead to more effective HIAs and, ultimately, better health outcomes for communities.
2. Supporting Health Equity: Ensuring that HIAs address equity comprehensively is vital. Policies and plans often affect different population groups in various ways. A robust focus on equity helps mitigate health disparities and promotes fairness.
3. Sustainability and Health: Addressing sustainability in HIAs is increasingly important in the face of climate change. Incorporating long-term environmental impacts into health assessments ensures that developments are both healthy and sustainable.

Moving Forward

This review suggests that instead of relying on a single framework, HIA practitioners might benefit from using elements from multiple frameworks. By doing so, they can better address the varied best practice principles.

Future reviews could expand this work by examining other elements, such as governance and timing of HIA. These factors are crucial for the success of an HIA, particularly in supporting cross-sector partnerships for ‘health in all policies.’ Additionally, developing competency frameworks for HIA practitioners could ensure they have the necessary knowledge, skills, and competencies to meet best practice standards.

Join the Conversation

1. Have you ever been involved in a Health Impact Assessment? What was your experience like?
2. How do you think HIA frameworks can be improved to better address equity and sustainability?

We’d love to hear your thoughts! Share your experiences and suggestions in the comments or join the conversation on social media.

Conclusion

Health Impact Assessments are powerful tools for predicting the health effects of policies and plans. While current frameworks have strengths, especially in using diverse evidence and promoting participation, there is significant room for improvement in addressing equity and sustainability. By selecting and combining the best elements from various frameworks, practitioners can enhance the effectiveness of HIAs, ensuring they foster better health outcomes for all.

Be Part of the Change – Get Weekly Updates! 

Stay informed and connected. Subscribe for free and share this blog to make a difference in public health with others.