This document summarizes findings from the first phase of an Australia-New Zealand study on the effectiveness of health impact assessments (HIAs). It presents data on levels of community involvement and controversy in HIAs. The data show that most HIAs involved community participation but also faced some level of controversy. HIAs that involved communities and faced higher controversy were less likely to directly influence decisions but more likely to raise general awareness. The relationship between participation, controversy and effectiveness is complex with many trade-offs to consider. An example from Lithgow, Australia is provided to illustrate these trade-offs.

1. Popular or Political?
Trade-offs in HIA
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. Draws on the findings of the first phase of the
Australia-New Zealand HIA effectiveness study
Harris E, Baum F, Harris-Roxas B, Kemp L, Spickett J, Keleher H, HarrisM, Morgan
R, Dannenberg A, Sukkumnoed D, Wendel A. The effectiveness of health impact
assessments conducted in Australia and New Zealand; Australian Research Council
Discovery Project Grants; 2010-2011. [DP1096211]

3. Harris E, Baum F, Harris-Roxas B, Kemp L, Spickett J, Keleher H, HarrisM, Morgan R, Dannenberg A, Sukkumnoed
D, Wendel A. The effectiveness of health impact assessments conducted in Australia and New Zealand; Australian
Research Council Discovery Project Grants; 2010-2011. [DP1096211]

4. Was there community involvement in the HIA?
Yes n = 33 (73%)
No n = 12 (27%)

5. Was there any controversy and/or opposition to
the proposal?
Yes n = 26 (58%)
No n = 19 (42%)

6. If yes, what was the level of controversy? (n = 30)
Column1
10 9 9
8
6 6
6
4
2
0
Low Some Medium High

7. Comparing community involvement and controversy (n = 45)
25
21
20
12
15
7
10
5 5
No Controversy
0
Controversy
Community
Involvement No Community
Involvement

8. Comparing community involvement and
level of controversy (n = 30)
9
8 8
8
7
6
5
5
4
3
3
2
1
0
Low Some Medium High
Community Involvement No Community Involvement

9. Comparing controversy by proposal type (n = 45)
16 15
14
12
10
8
6
4 4
4 3
2
0
Plan Policy Program Project
Controversy No Controversy

10. Modification of pending decisions
Yes No
Direct Effectiveness General Effectiveness
Health adequately acknowledged
HIA-related changes in the Reasons provided for not
decision following HIA recommendations
Yes
Due to the HIA the project was Health consequences are
dropped negligible or positive
Decision was postponed HIA has raised awareness among
policy-makers
Opportunistic Effectiveness No effectiveness
The decision would have been The HIA was ignored
No
made anyway The HIA was dismissed
Source: 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. ISBN 978 92 890 7295 3

11. Comparing controversy by
type of effectiveness (n = 45)
25
20
20
15
10
5
5
1
0
0
Direct General Opportunistic No
Controversy No Controversy

12. Murky picture
Does community involvement lead to controversy,
or vice versa
And does it matter?

13. An example of trade-offs: Lithgow

14. Some important trade-offs are never public

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