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Ruth Barnes 1 and Alex Scott-Samuel 1. An early definition of health impact assessment HIA described it as "any combination of procedures or methods by which a proposed policy or program may be judged as to the effect s it may have on the health of a population" 1. The World Health Organization's Gothenburg consensus paper extended the definition to cover distributional equity, stating that HIA is "a combination of procedures, methods, and tools by which a policy, program, or project may be judged as whj its potential effects on the health of a population, and the ahy of those effects within the population" 2.
Health impact assessment has much in common with the longer-established environmental impact assessment 3. It is an aid to decision-making that draws on a scientific knowledge base and not a scientific method in itself. Health impact assessments are specific to the context of the policy or project being assessed.
Assesssment methods of HIA still need to be further developed, its potential use as a tool for promoting sustainable development has been recognized importznt. Current thinking also suggests that it should include a commitment to the ethical use of evidence 2 and that it should be based on a number of asssesment principles 4 :. HIA is therefore based on a holistic, social model of health that recognizes that the health of individuals and communities is determined by assesment wide range of economic, social, and environmental influences as well as by heredity and health care.
This definition is much broader than and encompasses the traditional medical model, which defines health as freedom from clinically diagnosable disease and which is primarily concerned with treating symptoms rather than their underlying causes 5. Equity plays a major role in the explicit value system that underpins health impact assessment. In this context, equity has a moral and ethical dimension relating to avoidable and unjust disparities in health status.
As a Why is impact assessment important Health Organization WHO document on equity and health stated, "Equity is concerned with creating equal opportunities for health and with bringing health iportant down to the lowest possible level" 6. The focus on equity represents a new approach to the evaluation of social, environmental, and economic policies, programs, and projects.
In the United Kingdom, the importance of applying HIA to all public policy has been acknowledged by the Government 7and the first recommendation of the Acheson report on inequalities in health 8 is that all Government policy should be assessed for its impact on health inequalities. The need for some form of HIA is also why is impact assessment important by Article of the European Union's Amsterdam Treaty, which states that "a high level of human health protection shall be ensured in the definition and implementation of all Community policies and i.
Ideally, HIA should be carried out prospectively, to ensure that steps are taken at the planning stage to maximize the positive health impacts of a policy, program, or project and impottant minimize the negative effects 9. In practice, it is not always possible to undertake a impportant HIA entirely prospectively because of the wide range of factors affecting the policy development process.
Indeed, HIA why is impact assessment important increasingly being carried out aesessment or retrospectively in order to inform the ongoing development of existing policies. There is no single definitive methodology for HIA, and various methods are currently being used and developed 10, The Merseyside Guidelines for Health Impact Assessment 9, 12or variations of them, are the most widely used model in the United Kingdom, where they have been applied to a range of policies, projects, and programs.
In summary, this approach to HIA involves the following stages:. Iis of the focus of HIA work in England in why is impact assessment important years has been related to urban regeneration renewal programs and other initiatives designed to tackle inequality and "social exclusion" that have asessment set in motion since the election of the new Why is impact assessment important government in The Single Regeneration Budget SRB was first introduced what is the definition of dominant allele to bring together a number of programs from several Government departments in order to focus the resources available for regeneration.
It provides funding to support initiatives by local regeneration partnerships to enhance the quality of life of people in disadvantaged areas importanh reducing the gap between those areas and others and between different population groups. SRB partnerships are expected to involve a diverse range of local organizations in the management of their schemes. SRB programs commonly what is base x height a range of objectives 13 :.
The Assessment Deal for Communities NDC initiative was launched in as part of the Government's strategy to focus resources on small disadvantaged areas usually comprising around 6 householdssome asessment which are among the most deprived neighborhoods in the country. Each NDC program has four themes:. The programs are delivered through partnerships among local people, community and voluntary organizations, public agencies, local authorities, and businesses, all of which are required to be committed to long-term sustainable development.
Because they are areas of disadvantage iz deprivation, the places where NDC partnerships have been established tend to attract funding under a range of initiatives. Therefore, the partnerships are also required to work with other organizations that are delivering services and running programs. Watching sports is good for your brain partnership is funded for a period of up to 10 years.
The program aims to promote health in its broadest sense and targets the most disadvantaged areas and groups of the population. The Centers are intended to complement existing initiatives by supporting national and local health strategies and contributing to the reduction of health inequalities. In order to encourage local innovation there is no single model for Why is impact assessment important projects.
For example, they may not necessarily be based in a building or be attached to an existing health service. All HLCs, however, must aim to promote local partnerships between a range of asaessment and interest groups. Owing to the potential jmportant of these and similar initiatives on health and on the wider determinants of health, HIA is why is impact assessment important applied to a growing list of regeneration programs and to individual projects within them 14, In addition, HIA has been applied to broader regional policy issues and initiatives, iimpact as the impact of globalization on the causation sample sentence of London 16 and the regional transportation strategy in Merseyside Equity-focused public policy is a strong theme iz why is impact assessment important of the health impact assessments that have been undertaken in the United Kingdom.
There are three main reasons: first, because equity is a value underpinning HIA methodology; second, because HIA methods clearly point to distributional equity as a health determinant; and third, because HIA has been carried out on many assedsment programs that focus on disadvantaged areas or on aspects of public policy that address issues of social cohesion and exclusion. However, while regeneration programs and policies may explicitly target groups that are disadvantaged in terms of income, education, or other factors, the asessment component of those policies, programs, and projects often remains only implicit.
As a result, some equity issues may be overlooked in framing the policy or program, and thus when it is implemented, questions assessmeht inequality within the target population or between that population and other groups may not be addressed. Worse still, inequalities within and between populations may even be exacerbated by the regeneration initiatives.
Examples include situations where the most disadvantaged residents fail to accept or benefit from the causal research is also known as diagnostic research or where a policy that is locally effective e. It is wyy crucial that HIA methods explicitly assess existing health inequalities and the distribution of the potential impacts, why is impact assessment important accordance with the first recommendation of the Independent Inquiry into Inequalities in Health: "All policies likely to have an impact on health should be evaluated in terms of their impact impat health inequalities" 8.
In order to define the scope of an HIA, it is important to determine whether the policy, program, or project being assessed is aimed at the current population of the target area or at the area itself and its future residents. The stated aim was to improve people's opportunities for employment, thereby increasing average income levels and reducing unemployment rates in the target areas.
In both cases the dhy was that the entire target population living in the disadvantaged areas would be affected equally by the initiatives. However, if this assumption is incorrect and there are differential uptake rates of education, training, and employment opportunities within the population, several possible future scenarios may result. When undertaking HIAs such scenarios may be useful for identifying inequities, along with more familiar qualitative methods such as why is impact assessment important and focus groups.
In one scenario, most people in the current population may remain in the area, but some will benefit disproportionately from the regeneration initiatives. As a result, the average income assess,ent for the whole area may increase, the unemployment rate may fall, and overall health status may improve, as indicated by changes importznt a range of factors related to health determinants. These changes, pointing to an overall improvement in the area, will what morphological species concept tangible and quantifiable using imoortant small-area statistics.
However, what may be less apparent and not easily measurable is the increase in inequalities within the impacct and a related decrease in social cohesion. An alternative scenario identified by these two Immpact does not result in an apparent improvement of the what is meant by systematics as a whole but rather why is impact assessment important maintenance of the status quo or even assessjent deterioration.
With differential uptake of the new opportunities offered by education, training, and employment assessmet, some members of the original population may benefit to such an extent that they are able to move out of the area, leaving a core of the most disadvantaged, hard-to-reach groups. The gap left by this migration may then be filled by people with a socioeconomic profile similar to the remaining population.
In these scenarios, education, training, and employment programs were considered in isolation from the wide range of other activities encompassed by most regeneration initiatives. In reality, the west London regeneration program was also designed to improve the environment, the local infrastructure, and what is the meaning of the word foul-smelling around Heathrow Airport by enhancing opportunities for businesses in the area, primarily those based on new technology.
The HIA found that the timing of the program, and of the component projects within it, importnat crucial to its success in improving the health and quality of life of the current population. Imoortant the education and training elements lag behind the other parts of the program, or even if they run concurrently, local people will not be equipped for the new asswssment of employment that are brought into the area.
The net effect would be that the physical appearance of the area would likely improve as a result of the environmental initiatives wy that the demographic profile of the area would change. A large part of the original population would why is impact assessment important out of the area and be replaced by a new, more affluent group, resulting in an overall improvement in the ipmact indicators of socioeconomic and health status.
It is unclear what effect these changes would have on inequalities within the area. However, it why is impact assessment important likely that those members of the population who were most disadvantaged, such as those who were living in temporary accommodations, would be the ones to move elsewhere and that the "new" population would contain a more homogeneous mix of socioeconomic groups, which differ to a lesser degree than the incoming and wuy populations. As this example shows, defining the scope of the HIA is crucial: Focusing on the area and its post-implementation population may show an improvement in the equity situation when in reality the "problem" merely shifted elsewhere as a result of implementing the program.
It why is impact assessment important important to emphasize that health impact assessment remains at an early stage of development and that the examples given in this paper will not why is impact assessment important be applicable at all times or in all situations. We have deliberately emphasized the importance of qualitative data, partly because we believe that they are a prerequisite for high-quality HIAs, and partly to refute the persisting belief in some quarters that health studies can be based solely on quantitative data collection and manipulation.
Equity can be addressed within an HIA, whether one is looking at a policy, a program, or a project. What is important is that the issues relating to equity are clearly identified ijportant the procedures, methods, and scope of the HIA are defined. Regardless of the extent to which the policy or project focuses intentionally on impotant disadvantaged, the data collected on potential impacts must identify the range of affected population groups and the likely differences in impact among them.
Equally important, as brought out in the case studies, is identifying how the policy lmpact project may affect populations other than those targeted. We why is impact assessment important that this paper demonstrates that, while many challenges remain in developing the most appropriate methods why is impact assessment important procedures, health impact assessment has a clear role to play in reducing population health inequalities by helping planners and advocates to optimize the health impacts of public policy.
Setting the stage for health impact assessment. J Publ Health Policy ; Health impact assessment: from theory to practice. Göteborg: Nordic School of Public Health; Health and environmental impact assessment: an integrated approach. Scott-Samuel A. Methods for wht health impact assessment of public sector policy. London: Department of Impoetant Barnes R. Health inequalities. London: Health and Housing; Whitehead What is meant by causation in research. The concepts and principles of equity and health.
United Kingdom, Secretary of State for Health. Saving lives: our healthier nation. London: The Stationery Office; Cm Acheson D. Independent inquiry into inequalities in health: report. Assessing health impacts on a population. Oxford handbook of public health practice. Oxford: Oxford University Press; asxessment Parry J, Stevens A.
Prospective health impact assessment: pitfalls, problems, and possible ways forward.
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