Table Of ContentHealth Impact Assessment
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Health Impact
Assessment
Past Achievement,
Current Understanding,
and Future Progress
Edited by
John Kemm
Director, JK Public Health Consulting,
Stoke Prior, Bromsgrove, England
1
1
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Chapter 31© World Health Organization 2013
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Dedication
This book is dedicated to the memory of Emma,
my darling daughter.
Preface
The idea of health impact assessment (HIA) really took root in the 1990s. The
idea that one should try to predict the health consequences of a proposal before
implementing it was obviously reasonable and if environmental impact assess-
ment had protected the environment could not HIA do the same for health?
This book describes how that simple idea has been developed.
The Gothenburg consensus statement published in 1999 summarized ideas
about HIA at that time. Five years later Health Impact Assessment: Concepts,
theories, techniques and application (Oxford University Press 2004) attempted
to map progress up to that time and showed that thinking about HIA had
developed and that HIA was being applied in many different situations. Ideas
and understanding have now moved on further, and much more experience
has been gained. Some former problems have been solved and new problems
have become apparent.
This book is not a manual on how to do an HIA and if it were it would be
misguided because one thing that has become very clear is that each HIA has
to be designed to match the questions it is seeking to answer and the circum-
stances in which it takes place. Instead the book attempts to describe a wide
range of methods that have been used in various HIAs so that the reader can
choose the mix of methods which best suits their situation. The book is not the
definitive description of HIA but a description of current knowledge. Ideas
about HIA continually evolve and improve as more people undertake them.
One area of progress is the realization that HIA is a decision support tool not
a decision-making tool. It exists to help decision makers, not to replace them.
One theme running through the book is therefore how those doing HIAs
should relate to the decision makers and how one should attempt to ensure
that decision makers find the HIA relevant and useful. Another theme is
whether HIA can be impartial rather than an advocacy tool. Such issues raise
questions of ethics and power.
HIA claims to be able to predict the future. This has been challenged by
some and assessors are becoming more aware of the audacity of their claim to
be able to predict. Certainly it is wise for assessors to think it possible that they
may be wrong. The book considers on what basis predictions can be made and
how one can reduce the likelihood of error with both quantitative and qualita-
tive methods.
PREFACE vii
This book is arranged in two parts. The first part is written by the editor
and gives his opinions based on his experience on the various issues in HIA.
There are of course many areas of controversy and where this is so the book
attempts to describe the alternative opinions. However, the first part of the
book is one person’s opinion.
The second part of the book covers experience of HIA in many different
parts of the world from many different authors, but although it has contribu-
tions from 20 different countries there are many more countries where HIA is
carried out that are not mentioned (New Zealand, other Scandinavian coun-
tries, many African countries, many South American countries, and many
South East Asian countries to name a few). This second part of the book illus-
trates how HIA has been adapted to fit different contexts and cultures. It also
makes clear that different authors have different opinions, which in many
cases are different to those of the editor. This should help the reader appreciate
the issues of disagreement in HIA and therefore the areas where there is likely
to be progress in the future.
Like its predecessor this book attempts to map out the current state of
knowledge about HIA. It is to be hoped that it will help to clarify the issues for
those working in the field and for those coming to it anew and will serve as a
stepping stone for those who in the future will make further advances in HIA.
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Contents
Contributors xi
Abbreviations xiv
Part 1 Introducing HIA
John Kemm
1 Origins and outline of health impact assessment 3
2 Screening and scoping 15
3 Quantitative assessment 25
4 Qualitative assessment: lay and civic knowledge 38
5 Recommendations and reports 51
6 Values and ethics of health impact assessment 62
7 Evaluation and quality assurance of health impact assessment 72
8 Health impact assessment of policy 81
9 Health in other impact assessments 90
1 0 Application of health impact assessment to various topics 97
11 Making health impact assessment happen 107
Part 2 HIA across the world
12 Devolution, evolution, and expectation:
health impact assessment in Wales 117
Eva Elliott, Gareth Williams, Chloe Chadderton, and Liz Green
13 Health impact assessment in Scotland 126
Margaret Douglas and Martin Higgins
14 Health impact assessment in the island of Ireland 135
Owen Metcalfe, Claire Higgins, and Teresa Lavin
15 Development of health impact assessment in
the Netherlands 141
Lea den Broeder and Brigit Staatsen
16 Health impact assessment in Spain 150
Elena Aldosoro, Carlos Artundo, and Ana Rivadeneyra
17 Health impact assessment in Germany 156
Rainer Fehr and Odile Mekel
