This document summarizes a review of health impact assessments (HIAs) conducted on health sector proposals. The review identified 14 HIAs from Australia, Korea, and the UK that assessed various health services, plans, and policies. The HIAs used a variety of evidence sources and methods. Most assessments were of projects or programs rather than policies. The quality of reporting varied and there is opportunity to strengthen documentation of scoping and monitoring/evaluation steps. While HIAs have been conducted in developed countries, there is limited evidence of their use to assess clinical services plans within the health sector.

1. Health impact assessments of health sector proposals
A review and narrative synthesis
NeliusWanjohi,1 Ben Harris-Roxas,2,3 Reema Harrison1
International Association for Impact Assessment Conference, Brisbane, 29 April-2 May 2019
1. School of Public Health & Community Medicine, University of New South Wales (UNSW), Sydney, 2052
Australia.
2. Centre for Primary Health Care and Equity University of New South Wales (UNSW), Sydney
3. Primary, Integrated and Communty Health, South Eastern Sydney Local Health District

2. The issue
Health impact assessment is widely used
to assess other sectors’ proposals but
may not be widely used within the health
sector itself.
If HIA is not seen as relevant to health
sectors, support for HIA and capacity
building will be limited.

3. The health
sector
Source: The Commonwealth Fund 2014 https://international.commonwealthfund.org/stats/percentage_gdp/

4. The health
sector
• Major employer
• Major projects
• Carbon footprint
• Plays a role in supporting intersectoral action for
health Health in All Policies
• But may not have used HIA widely on its own
proposals (Wright et al 2005, Lifsey et al 2015)
Wright, J., Parry, J., & Mathers, J. (2005). Participation in health impact assessment: Objectives, methods and core values. Bulletin of the
World Health Organization, 83(1), 58-63.
Lifsey, S., Cash, A., Anthony, J., Mathis, S., & Silva, S. (2015). Building the Evidence Base for Population-Level Interventions. Health
Education & Behavior, 42(1_suppl), 133S-140S.

5. The review question
To identify health impact assessment
reports (identified in peer reviewed and
grey literature) for HIAs conducted on
health sector proposals, in order to better
understand current use of HIAs in health
settings.

6. Databases
and websites
searched
Databases
• Medline
• Scopus
• Web of Science
• Global Health
Websites
• HIA Connect
• World Health Organization HIA microsite
• The Pew Charitable Trust’s Health Impact Project
• HIA Gateway
• Society of Practitioners of HIA
• US Centers for Disease Control and Prevention
• International Association for Impact Assessment

7. HIAs included

8. Characteristics
of the HIAs
• Australia, Korea, United Kingdom
• Health service plans, health services, carers’
services, place-based initiatives for health, primary
health care, health promotion initiatives, national
policies, hospital capital works, immunisation
programs
• 8 on projects
• 6 on programs and service plans
• 1 on policy
• Evidence used included literature reviews,
consultation, interviews, focus groups, population
profiling, expert group processes, case studies,
GIS analysis, surveys, data from other cohort
studies, and cost benefit analysis.
• 2003-2015

9. Quality of reports

10. Discussion
• The HIAs identified were from developed
countries.
• There was limited evidence that HIAs have been
conducted on clinical services plans.
• The HIA steps that were less well-described in
reports were scoping and monitoring/evaluation.
• The research rigor of the assessments was mixed,
as was the extent to which ethical issues were
identified.
• There may be opportunities to strengthen the use
of HIA in the health sector.

11. Limitations
• There are definitely HIAs that have been
conducted which were not identified for this review.
Our approach was to be systematic and
transparent, rather than exhaustive.
• The demise of many HIA report repositories is a
challenge for this type of review of completed
HIAs.
• Repositories have been enabling infrastructure for
HIA capacity building and research in the past –
how will this be done in future?
• Reports do not fully capture or describe HIA
processes; they are only part of the picture.

12. Implications
• There are opportunities to enhance reporting, as
has been noted elsewhere (Danenberg et al 2016,
Bhatia et al 2014, Fredsgard et al 2009).
• Need for clearer documentation of (i)
scoping/developing ToRs and (ii) monitoring,
evaluation, and health/environmental management
plans.
• Past approaches to promoting HIA’s use may not
work in the health sector.
• Agencies like WHO and IAIA may be able to play a
more active role in promoting IA’s use in the health
sector.
Bhatia R, F. L., Heller J, Lee M, Orenstein M, Richardson M and Wernham A. (2014). Minimum Elements and Practice Standards for Health
Impact Assessment. Version 3.
Dannenberg, A. L. (2016a). Effectiveness of Health Impact Assessments: A Synthesis of Data From Five Impact Evaluation Reports.
Preventing Chronic Disease, 13, E84-E84. doi:10.5888/pcd13.150559
Fredsgaard, M. W., Cave, B., & Bond, A. (2009). A review package for Health Impact Assessment reports of development projects, Ben
Cave Associates: Leeds.

13. Thank you
These slides are available at
https://www.slideshare.net/benharrisroxas/
Ben Harris-Roxas
Email b.harris-roxas@unsw.edu.au
Twitter @ben_hr