Centre for Primary Health Care and Equity

Health Impact AssessmentAn Overview of Practice Worldwide

Ben Harris-Roxas

Consultant, Harris-Roxas Health

Conjoint Lecturer, University of New South Wales, Sydney

Health Section Co-Chair, International Association for Impact Assessment

History• The evolution of HIA can be viewed as a little different from EIA

• EIA has been strongly focused on major project assessment in many jurisdictions

• In recent decades it has expanded to encompass other strategic assessment processes such as strategic environmental assessment (SEA)

Harris-Roxas B, Viliani F, Bond A, Cave B, Divall M, Furu P, Harris P, Soeberg M, Wernham A, Winkler M. Health Impact Assessment: The state of the art, Impact Assessment and Project Appraisal, 30(1): 43-52. doi:10.1080/14615517.2012.666035

History• HIA can be seen as originating from three separate areas of

activity

• Environmental health

• Social view of health

• Health equity

• Each bring with them their own disciplinary beliefs, values, support base and baggage

• The role of health risk assessment

Harris-Roxas B, Harris E (2011) Differing Forms, Differing Purposes: A Typology of Health Impact Assessment, Environmental Impact Assessment Review, 31(4):396-403. doi:10.1016/j.eiar.2010.03.003

1950s 1960s 1970s 1980s 1990s 2000sEnvironmental Disasters

Regulatory Environmental Impact Assessment

Environmental Health

Health EquityHIA

1956 Clean Air Act (UK)

1969 Santa Barbara Channel (USA)

1969 US National Environmental Policy Act (USA)

1978 Love Canal (USA)

1984 Bhopal (India)

1986 Ottawa Charter

1990 Concepts & Principles of Equity in Health

1997 Jakarta Declaration

1998 Independent Inquiry into Inequalities in Health (UK)

1999 Gothenburg Consensus Paper on HIA

2008 WHO Commission on the Social Determinants of Health: Closing the Gap in a Generation

Social View of Health

1972 Lake Pedder Dam controversy (Australia)

1974 Environmental Protection (Impact of Proposals) Act (Australia)

2005 Health included in IFC Performance Standards

1994 Framework for Environmental and Health IA (Australia)

2007 1st Asia-Pacific HIA Conference (Australia)

1978 Seveso (Italy)

1990 Environmental Protection Act (UK)

1980 The Black Report (UK)

1972 The Indian Wildlife (Protection) Act

1974 Lalonde Report (Canada)

1998 Merseyside Guidelines for HIA

1978 WHO Seminar on Environmental Health Impact Assessment (Greece)

2004 Equity Focused HIA Framework (Australia)

1978 Declaration of Alma Ata

1992 Asian Development Bank HIA Guidelines

1959 Minamata Bay (Japan) 1980 International

Association for Impact Assessment formed

1969 Cuyahoga River Fire (USA)

1962 Silent Spring

2007 HIA’s use included in Thailand’s Constitution

1998 The Solid Facts

1979 Three Mile Island (USA)

2005 Guide to HIA in the Oil and Gas Sector

1986 Chernobyl (Ukraine)

1989 Exxon Valdez Oil Spill (USA)

2009 Montara West Atlas Oil Spill (Australia)

2010Marmot Review

Source: Harris-Roxas B, Harris E. Differing forms, differing purposes: A typology of health impact assessment, Environmental Impact Assessment Review, 31(4): 396-403. doi:10.1016/j.eiar.2010.03.003

International Perspectives• There are currently several approaches to legislating and

institutionalising HIA’s use:

• Requiring health be considered as party of EIAs or broader impact assessment (many countries’ EIA legislation; IFC Performance Standards; Equator Principles; EIA legislation in other regions)

• Requiring stand-alone HIAs on a type/category of proposals(Thai National Health Act; Lao PDR; Tasmania, Australia)

• Giving health authorities the right to conduct HIAs where they deem it necessary or appropriate (Victoria, Australia)

• Legislating the right for communities to request HIAs be conducted or to be involved in them (Thai Constitution)

• Regulations or policies that support HIA’s use but do not require it (many local governments and authorities in Europe; New South Wales, Australia; New Zealand)

International Perspectives• Capacity has been a critical factor in determining the extent to

which these legislative mechanisms have been actually implemented

• The broader Health in All Policies agenda has helped to promote HIA’s use

Opportunities and Threats• The opportunities and threats to HIA and its use are often the

same

• Better integration of health and HIA into other assessment processes

• At the moment health is often limited to health risk assessment that are conducted as stand-alone assessments within larger assessment processes

• There’s scope for better integrated assessment of health benefits

Where to next?• We’ve actually come a long way as a field in relatively short time

• In 1995 Birley and Peralta wrote that:

“At present HIA is a blunt tool with the rudiments of an accepted methodology”

• This is no longer the case. There is greater consensus about the procedural elements of HIA (e.g. screening, scoping, etc) and when it is most useful. There is also better evidence about its effectiveness.

Briley M, Peralta G (1995) Health Impact Assessment of Development Projects in Environmental and Social Impact Assessment (Eds Vanclay F and Bronstein D), Wiley: Chichester, p 153-170.

Where to next?• Potential activity:

• Industry-specific HIA guidance, eg mining, wind power, etc (some already exists)

• Better professional development for advanced practice

• Improved methods for economic appraisal of health impacts

Acknowledgements• Enviros for organising this session

• The International Association for Impact Assessment’s Health Section for their help and ideas

• The University of New South Wales Centre for Primary Health Care and Equity for their ongoing collaboration

ben@harrisroxashealth.com

@ben_hr or @hiablog

healthimpactassessment.blogspot.com

linkedin.com/in/benharrisroxas

These slides are available at

www.slideshare.net/benharrisroxas