24 November 2006

Where does HIA fit best within the policy and planning cycle?

I’d like to stimulate some debate about where people see HIA best fitting within the planning cycle (following on from the interesting recent blog discussion on HIA as a scientific tool).

In New South Wales, HIA is seen as adding most value as a prospective tool at a specific point in the planning cycle; after a draft proposal has been developed but before implementation.

However, recently we’ve been approached to use HIA as a tool to assist with planning for health earlier in the cycle. This raises a number of issues:

First, should or can HIA be a substitute for good needs assessment and problem identification? Or can HIA become a useful needs assessment / problem identification tool? Work with communities on regeneration projects in Victoria has indicated this may be the case.

Second, developing a draft proposal takes time and effort. How can HIA be integrated with this time and effort while planning decisions are being made rather than afterward as a check on those decisions? Would this be a better way of ensuring health impacts are considered? At a recent training course Ben and I attended in Thailand, it was suggested that HIA can stretch itself earlier in the planning cycle to assist with developing different options and their potential impacts before the proposal is drafted.

Third, what are some other approaches and methods the HIA can use or add to earlier on in the planning cycle? For example, at a recent meeting we had with Urban Planners, it was suggested that as Health professionals we need to understand how private sector developers plan and develop proposals (i.e. through market analysis).

Finally, while I am open to HIA being used earlier in the planning cycle, I would take more convincing concerning the use of HIA as a retrospective tool that replaces evaluation.

What do others think?


  1. I completely agree with you that there is a definite and urgent need for public health to feed in at a much earlier stage in the planning and development cycle.

    Similarly there is a greater need to engage with developers and business in relation to land use and development.

    Given the lack of detail during early stages of plan and project development, I think the screening tools developed within HIA can enable planners and developers to identify, discuss and debate, early on, the potential health and wellbeing issues and community concerns that a plan or project might generate.

    However, there are two important caveats:

    1. Given the lack of plan/project detail the health impact screening will inevitably be at a very general and broadbrush level. There is, therefore, a danger of making assertions about potential impacts that are not based on a detailed understanding of the local community and plan/project context.

    2. There is also a potential for this screening HIA to be done once rather than each time the plan or project undergoes a significant revision during the development stage.

    In the UK context, the trend seems to be to do just this kind of screening assessment/appraisal. However, in the UK this is not seen as solely being a health impact assessment/appraisal but an integrated assessment/appraisal approach that also incorporates sustainability and equalities issues in the screening checklist.

    Two suggestions for addressing the limitations I mentioned above would be to:

    a) potentially link health impact screening with a health needs screening/assessment;

    b) embed the health impact screening within the plan/project development process so that it is carried out at three or four points in the plan/project development cycle;

    c) involve planning, environment and health professionals who have a detailed knowledge of the local context in the screening process

    Lastly, I think we need to be careful about getting too caught up in semantics. HIA can provide a different and very useful approach to evaluating plans and project retrospectively. An evaluation can be informed by the ethos, methodology and methods of HIA. Whether you call the results an evaluation or a retrospective HIA doesn’t matter so long as you have stated your objectives clearly, justified your approach and achieved some/all of your hoped for evaluation outcomes.

  2. These are really useful points for discussion. They really seem to suggest the critical role that screening will play if HIA is to be more widely used.

    There is a clear demand for checklist approaches that can be used early in the process but as Salim points out there is a very real danger that these will be superficial in practice. More worrying still, is the prospect that very comprehensive triple bottom line checklists may still gloss over health issues (see Earles et al 2005), rather than placing them at the forefront of decision-making as many HIA and health practitioners might desire.

    This highlights on of the core challenges that integrated assessment faces: what impacts do we think are most important?

    I think this conflict that underpins that question is the real challenge facing integrated approaches to screening. Still, a superficial consideration of health impacts may be better than none at all and I don’t think we're necessarily consigning ourselves to a checklist-only approach to impact assessment. In a sense it comes back to what we think we’re trying to accomplish:

    - consideration of health impacts in decision-making? or
    - doing more HIAs? or
    - healthy public policy?

    Salim's other point about transparency is crucial to HIA's contribution to decision-making and good governance. Too often we forget that we're trying to make a meaningful contribution to the way decisions are made, as much as we're trying to influence a specific decision.

    Eales et al. Emerging approaches to integrated appraisal in the UK, Impact Assessment and Project Appraisal, 23(2): 113–123, 2005.

  3. I agree that there is a definite need for public health being one of the criterion for any development.

    I believe it should be introduced in a staged manner,so that the issue is not glossed over as stated in a post before.

    Initially it should be part of community consultation process.As and when the tools are made more adequate and tested,it can be put into practise with the Developers encouraged to use it and advertise the benefits accrued.Finally it could be legislated.

    In the meanwhile I believe more research needs to go into the linkages between built environmnet and public health to get the planners and developers on board.