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All the countries of the UK now have community health andwellbeing as a key policy objective.

The UK Public Health Association (UKPHA) strongly supports the use of

HIA as a means to achieving better health outcomes in all areas of policy, strategy and development.

The UKPHA advocates the use of Health Impact Assessment (HIA) as animportant and effective approach to ensuring that community healthand wellbeing is being protected and improved.

The UKPHA recommends that HIA should become a mainstreamapproach, and considers that the uptake, quality and standing of HIAshould be enhanced through a consistent application.

The UKPHA believes that the promotion of HIA and HIA techniques canprovide a valuable focal point for greater interaction between health andstrategic and development planning bodies, and help to bring about thewider application of good practice in this area.

Current Standing of HIAsThe use of HIA is widely seen as good practice across the UK at national andregional levels in the development of new policies, plans, programmes andprojects. However, experience on the ground suggests that the use of HIAsat local level is variable. Even where HIAs have been completed, therecommendations from them are not consistently taken forward or monitored.

Local DirectionWhere local HIAs have been carried out successfully they have often had thegreatest effect in contexts where there is significant input from local strategicpartners. These could include local authorities (LA), primary care trusts or health boards (PCT/HB), regeneration bodies, police, etc. This enables theassessments to focus on locally relevant health issues and priorities.The UKPHA therefore recommends that Local Strategic Partnerships (LSP)

build upon existing work to identify local health priorities. HIA is a usefulapproach to bring these partners together to identify changes (for example inprocesses, policies and structures) that may be necessary to deliver thedentified improvements in health and wellbeing.

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The UKPHA identify three key methods by which the uptake, quality, rele-vance and standing of HIAs might be enhanced:

1) Embedding of HIA at the strategic policy and decision-making level acrossall key local policies and plans by members of Local Strategic Partnershipsand other key agencies and partners in the public, private and "third" sectors.This should be done either by commissioning standalone HIAs or by

integrating HIAs into other assessments where these are already beingundertaken. These could include Strategic Environmental Assessments(SEAs), Sustainability Appraisals (SAs), Integrated Impact Assessments (IIAs)and Equalities Impact Assessments.

2) Embedding HIA at programme and project level at the planning stageeither as standalone HIAs or integrated HIAs within other assessments (suchas Economic Impact Assessment, Equalities Impact Assessment andEnvironmental Impact Assessment) where these are already beingundertaken.

3) Involving Directors of Public Health, and more generally PCTs/HBs, earlyin the strategic policy and plan making process. Involving health bodies onlyin the later stages of policy and plan making can make it difficult toincorporate important changes. Early involvement can help to maintain focuson locally identified priorities resulting in improved outcomes.

HIA of Policies and PlansThe UKPHA believes that Health Impact Assessments should be undertakenalongside, or as part of, other assessments for strategic plans. Examplesfrom the English system include (but are not confined to):

Local Area Agreements, Community Plans, Housing and HomelessnessStrategies, Health and Wellbeing Strategies, Community CohesionStrategies, Economic Development Strategies, Regeneration Strategies,Sustainability Strategies, Local Development Frameworks, Core SpatialStrategies, Local Transport Plans, Local Waste Plans, Local MineralsPlans and Air Quality Action Plans.

These should be undertaken by, or on behalf of, the relevant authorities.Carrying out HIA at this strategic level will provide a much stronger foundation for the HIA process; bringing together local policy, planning andhealth bodies, helping to focus on key strategic themes, and embeddinghealth concerns within the on-going strategic policy and decision makingprocess.

These strategic level HIAs will then provide the detailed strategic context to

inform individual programme and project HIAs.

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HIA of Programmes and ProjectsProgrammes and projects encompass a wide range of service programmesand developments, including new services, housing, regeneration, wastefacilities, transport infrastructure, etc. The UKPHA identify three key methodsby which the uptake, quality, relevance and standing of HIAs might beenhanced:

1) HIAs should be commissioned jointly by the local authority and PCT/HB,either as standalone assessments, or integrated within other assessments for key public programmes and projects.

2) Locally focussed checklists and toolkits for HIA should be developed andused to initially 'screen' proposals in terms of whether key public healthissues have been considered in the proposed programme or project, andwhether there is a need for a rapid or in-depth standalone or integrated HIA.

3) Local authorities should be encouraged to develop SupplementaryPlanning Documents on Health or HIA in partnership with local PCTs/HBs aspart of the new spatial planning process. These will help determine when aHIA would be considered necessary for new developments, provide terms of reference for any HIA undertaken, and ensure that locally relevant health andwellbeing issues are appropriately considered. The SPD should indicatewhere responsibility lies for commissioning of HIA, for example, whether theyshould be commissioned by the applicant for a development project. In somecases, this may be the local authority/PCT/HB, but in many cases this will bea private sector organisation. SPDs should encourage HIA to be undertakenas part of the Environmental Impact Assessment (EIA) where an EIA isrequired as part of the planning process.

The need for stronger guidance and leadershipThe lead agencies for health and planning in England and the DevolvedAdministrations should encourage and support the up take of HIA, and HIAtechniques at a local level, so that they are seen as being normal goodpractice, and not as optional add-ons that are only employed in a limitednumber of situations.

HIA in relation to other forms of health assessmentThe UKPHA strongly recommends the use of Health Impact Assessment(HIA) as the overarching term to describe all current and future forms of assessing the health and wellbeing impacts of the full range of policies, plans,programmes and projects. Therefore, terms and approaches such as "HealthEquity Impact Assessment", "Mental Health and Well-being Assessment","Health Risk Assessment" or "Environmental Health Impact Assessment"should be seen as being encompassed by HIA rather than being something

different or separate from HIA. However, the UKPHA recognises that withincertain contexts it can be useful to have an in-depth focus on one or morethemes or methods that make up a HIA, such as equity or mental health andwellbeing or quantifying the particular health risks of exposure to air pollutionor certain chemicals.

Written by the UK Public Health

Association's Healthand Sustainable

EnvironmentsSpecial Interest

Group, February 2010

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