9 October 2012

Health Impact Assessment: A triumph over common sense?

I'm giving a plenary talk at the 4th Asia Pacific Health Impact Assessment Conference in Seoul this week. I've attached the slides, a detailed paper and abstract below. It may be a little niche but hopefully some of you will be interested.

Download the detailed paper of the talk (21 pages PDF)

Abstract Evaluations of health impact assessments (HIAs) have highlighted its potential impacts on decision-making, implementation and broader factors such as intersectoral collaboration (Harris-Roxas et al. 2011, Harris-Roxas et al. 2012b, Wismar et al. 2007). Tensions often arise between stakeholders about the outcomes of HIAs however. Studies that have looked at this have found that there are:
  • Often disagreements between stakeholders about the perceived purpose of the HIA and what form it should take (Harris-Roxas et al. 2012a, Harris-Roxas & Harris 2011); and
  • The perception that an HIA’s recommendations could have been identified through normal planning and implementation processes and that the HIA didn’t necessarily have to be conducted (Harris-Roxas et al. 2011). In other words, that an HIA’s recommendations are “common sense”.
These two issues, about the perceived purpose of HIA and the “common sense” nature of HIAs’ recommendations, lie at the heart of any discussion of the HIA effectiveness. These issues have also been under-explored in the literature to date. This plenary will present initial findings from a study that looked at two decision-support equity-focused HIAs of similar health sector proposals (local health service obesity prevention and treatment service plans) longitudinally. This involved conducting 23 semi-structured interviews with key stakeholders before, during and after the HIAs, and document reviews. One of the HIAs was completed while the other one was screened and determined to be unnecessary. This study is unique in relation to HIA to the authors’ knowledge, because it looks at expectations and perceptions of effectiveness before and after the HIAs were completed. It also compares two similar planning situations, one in which an HIA was conducted and one in which the HIA was screened out.

The study’s findings highlight that while many of the recommendations and distal impacts of an HIA (Harris-Roxas & Harris 2012) could notionally be anticipated through common sense analysis, in practice they are rarely foreseen. A similar phenomenon has been demonstrated in other fields such as organisational psychology and management (Orrell 2007, Watts 2011). This study also highlights the critical role that learning plays in impact assessment practice (Morgan 2012, Bond & Pope 2012). This learning takes three forms: technical, conceptual and participatory (Harris & Harris-Roxas 2010, Glasbergen 1999). Learning may also take place at individual, organisational and social levels. This suggests that “common sense” is anything but common in the real world of planning and decision-making, and for good reasons. What seems obvious in hindsight is rarely apparent in advance. HIA, as a structured process for looking at under-considered impacts, has an important role to play in moving beyond common sense towards broader learning and more nuanced analyses of alternatives.


Bond A, Pope J (2012) The State of the Art of Impact Assessment in 2012, Impact Assessment and Project Appraisal, 30(1):1-4. doi:10.1080/14615517.2012.669140

Glasbergen P (1999) Learning to Manage the Environment in Democracy and the Environment: Problems and Prospects (Eds Lafferty W and Meadowcroft J), Edward Elgar: Cheltenham, p 175-193.

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

Harris-Roxas B, Harris E (2012) The Impact and Effectiveness of Health Impact Assessment: A conceptual framework, Environmental Impact Assessment Review: accepted, in press. doi:10.1016/j.eiar.2012.09.003

Harris-Roxas B, Harris P, Harris E, Kemp L (2011) A Rapid Equity Focused Health Impact Assessment of a Policy Implementation Plan: An Australian case study and impact evaluation, International Journal for Equity in Health, 10(6), doi:10.1186/1475-9276-10-6. http://www.equityhealthj.com/content/10/1/6

Harris-Roxas B, Harris P, Wise M, Haigh F, Ng Chok H, Harris E (2012a) Health Impact Assessment in Australia: Where we’ve been and where we’re going in Past Achievement, Current Understanding and Future Progress in Health Impact Assessment (Ed Kemm J), Oxford University Press: Oxford, accepted - in press.

Harris-Roxas B, Viliani F, Bond A, Cave B, Divall M, Furu P, et al. (2012b) Health Impact Assessment: The state of the art, Impact Assessment and Project Appraisal, 30(1):43-52. doi:10.1080/14615517.2012.666035

Harris E, Harris-Roxas B (2010) Health in All Policies: A pathway for thinking about our broader societal goals, Public Health Bulletin South Australia, 7(2):43-46. http://www.dh.sa.gov.au/pehs/publications/public-health-bulletin.htm

Morgan RK (2012) Environmental impact assessment: the state of the art, Impact Assessment and Project Appraisal, 30(1):5-14. doi:10.1080/14615517.2012.661557

Orrell D (2007) The Future of Everything: The science of prediction. Basic Books: New York.

Watts D (2011) Everything Is Obvious (Once you know the answer). Crown Publishing: New York.

Wismar M, Blau J, Ernst K, Figueras J (Eds.) (2007) The Effectiveness of Health Impact Assessment: Scope and limitations of supporting decision-making in Europe, European Observatory on Health Systems and Policies, World Health Organization: Copenhagen. International Standard Book Number 978 92 890 7295 3.


  1. Ben, thanks for sharing! it is really an interesting presentation. Did the presentation generate discussion at the conference? keep us posted

  2. Nicely said, this is a classic issue that 10 years on from when I first started doing HIAs continues to be a recurring theme from professionals who haven't used or come across HIA before.

  3. Yes, but I knew all that. Well, I thought I did anyway ...

  4. I didn't read these comments yet because O knew what you were going to say anyway ;)