Health impact assessment (HIA) originated from environmental health, social views of health, and health equity. HIA has evolved differently than environmental impact assessment, expanding to include strategic assessment processes. There are several approaches countries take to institutionalizing HIA, including requiring health be considered in environmental impact assessments, requiring stand-alone HIAs for certain project types, and giving health authorities rights to conduct HIAs when deemed necessary. HIA practice has spread worldwide over the past several decades.

1. Health Impact Assessment
An Overview of Practice Worldwide
Centre for Primary Health Care and Equity
Ben Harris-Roxas
Consultant, Harris-Roxas Health
Conjoint Lecturer, University of New South Wales, Sydney
Health Section Co-Chair, International Association for Impact Assessment

2. 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

3. 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

4. HIA
Health Equity
Social View of Health
Environmental Health
Regulatory Environmental Impact Assessment
Environmental Disasters
1950s 1960s 1970s 1980s 1990s 2000s
1956 Clean Air Act (UK) 1962 Silent Spring 1972 Lake Pedder Dam 1980 The Black Report 1990 Concepts & 2004 Equity Focused HIA
controversy (UK) Principles of Equity Framework
(Australia) in Health (Australia)
1959 Minamata Bay 1969 Santa Barbara
1980 International
(Japan) Channel (USA) 1990 Environmental
1972 The Indian Wildlife Association for 2005 Health included in
Protection Act (UK)
(Protection) Act Impact Assessment IFC Performance
1969 US National formed
Environmental Standards
1992 Asian Development
1974 Lalonde Report
Policy Act (USA) Bank HIA
(Canada) 1984 Bhopal (India) 2005 Guide to HIA in the
Guidelines
Oil and Gas Sector
1969 Cuyahoga River
1974 Environmental 1986 Ottawa Charter
Fire (USA) 1994 Framework for
Protection (Impact 2007 1st Asia-Pacific HIA
Environmental and
of Proposals) Act 1986 Chernobyl Conference
Health IA
(Australia) (Ukraine) (Australia)
(Australia)
1978 Seveso (Italy) 2007 HIA’s use included
1989 Exxon Valdez Oil 1997 Jakarta
in Thailand’s
Spill (USA) Declaration
1978 Love Canal (USA) Constitution
1998 Independent
1978 WHO Seminar on 2008 WHO Commission
Inquiry into
Environmental on the Social
Inequalities in
Health Impact Determinants of
Health (UK)
Assessment Health: Closing the
(Greece) Gap in a
1998 Merseyside Generation
Guidelines for HIA
Source: Harris-Roxas B, Harris E. Differing forms, 1978 Declaration of
2009 Montara West
differing purposes: A typology of health impact Alma Ata
1998 The Solid Facts Atlas Oil Spill
assessment, Environmental Impact Assessment (Australia)
Review, 31(4): 396-403. 1979 Three Mile Island
doi:10.1016/j.eiar.2010.03.003 (USA) 1999 Gothenburg
2010Marmot Review
Consensus Paper
on HIA

5. 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)

6. 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

7. 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

8. 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.

9. 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

10. 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

11. These slides are available at
www.slideshare.net/benharrisroxas
ben@harrisroxashealth.com
@ben_hr or @hiablog
healthimpactassessment.blogspot.com
linkedin.com/in/benharrisroxas