Health Impact Assessment (HIA)

Glossary of terms used

Special thanks to Ruth Barnes and the Health Development Agency (HDA) for creating this glossary.

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Appraisal (assessment)

Appraisal or assessment follows on from the scoping stage of a HIA, where the potential health impacts which have been identified are assessed and evaluated using the available evidence base.

Best available evidence

Conclusive evidence of the links between, for example, socio-environmental factors and health or the effectiveness of interventions is not always available. In such cases, the best available evidence – that which is judged to be the most reliable and compelling – can be used, but with caution.

Capital investment

Funding for resources such as buildings or other “one-off” purchases such as computer hardware and software and other office equipment.

Commissioning services

The process of identifying the need for services and making a contract with those able to provide them.

Community participation

Involving the community in an activity such as the planning of projects or carrying out a HIA. There are a number of models of community participation, some of which are outlined in the Gothenburg consensus paper on HIA (WHO, 1999).

Comprehensive (maxi) HIA

A comprehensive or “maxi” HIA is a much more detailed rigorous exercise than either a rapid or intermediate HIA. It usually involves the participation of the full range of stakeholders, an extensive literature search, secondary analysis of existing data and the collection of new data. “Control” populations may also be used (Parry and Stevens, 2001).

Concurrent HIA

Concurrent HIA is carried out whilst a policy, programme or project is being implemented.

Decision making

The process of reviewing the findings and recommendations of a HIA and making choices about how they should be taken forward.

Determinants of health

Determinants of health are factors which influence health status and determine health differentials or health inequalities. They are many and varied and include, for example, · natural, biological factors, such as age, gender and ethnicity; x behaviour and lifestyles, such as smoking, alcohol consumption, diet and physical exercise; x the physical and social environment, including housing quality, the workplace and the wider urban and rural environment; and x access to health care. (Lalonde, 1974; Labonté 1993) All of these are closely interlinked and differentials in their distribution lead to health inequalities.

Disadvantaged / vulnerable / marginalized groups

These terms are applied to groups of people who, due to factors usually considered outside their control, do not have the same opportunities as other, more fortunate groups in society. Examples might include unemployed people, refugees and others who are socially excluded.

Economic impact assessment

Economic impact assessment involves exploring and identifying the ways in which the economy in general, or local economic circumstances in particular, will be affected by a policy, programme or project.

Employment Zone

15 Employment Zones (EZs) were launched in March 2000 in areas experiencing high levels of long term unemployment in order to help long term unemployed people get and keep work. Employment Zones pool funds for training, Employment Service support and the equivalent of benefit to maximise flexibility and choice. The areas selected were amongst the worst 150 unitary authorities or local authority districts in Great Britain when ranked by a composite measure of the share of unemployed claimants aged 25+ who were long term unemployed, the employment rate and the number of people unemployed for over two years as a percentage of the working age population based on 1997 data. Participants in the EZ schemes work with a personal adviser to establish their needs and identify any barriers preventing them from moving into sustainable work. A costed action plan is then drawn up between adviser and participant. Once the participant has started work, they continue to be supported to ensure that their move into employment is sustained where possible. A range of different organisations were contracted through a tendering process to administer the zones and their performance is monitored and linked to the funding process (Department for Work and Pensions, 2002).

Environmental impact assessment

Environmental impact assessment (EIA) is a well developed discipline, both in terms of theory and practice, having been in operation for nearly 30 years in the United States (Glasson et al. 1994). Its origins lie in the US National Environmental Policy Acts of 1969. In the same way that HIA explores the effect of policies, programmes and projects on health, EIA does the same in terms of environmental effects. In many countries, including those of the European Union, there is now a statutory requirement for EIA to be undertaken under certain circumstances. The rules vary from country to country but generally EIA should lead to proposals which are likely to have any significant adverse effects on the environment being abandoned or modified (Hendley et al., 1998). There are numerous definitions of EIA, including the following an assessment of the impact of a planned activity on the environment (UN Economic Commission for Europe, 1991 in Glasson et al, 1994) the process of evaluating the likely environmental consequences of a proposed major action significantly affecting the natural and man-made environment (Walthern 1988, cited in Wood 1995) a technique and a process by which information about the environmental effects of a project is collected, both by the developed and from other sources, and taken into account by the planning authority in forming their judgements about whether the development should go ahead (Department of the Environment, Welsh Office 1989)

Equity in health

Inequity – as opposed to inequality – has a moral and ethical dimension, resulting from avoidable and unjust differentials in health status. Equity in health implies that ideally everyone should have a fair opportunity to attain their full health potential and, more pragmatically, that no one should be disadvantaged from achieving this potential if it can be avoided. (WHO EURO, 1985) More succinctly, Equity is concerned with creating equal opportunities for health and with bringing health differentials down to the lowest possible level. (Whitehead, 1990). HIA is usually underpinned by an explicit value system and a focus on social justice in which equity plays a major role so that not only both health inequalities and inequities in health are explored and addressed wherever possible (Barnes and Scott-Samuel, 1999).

Evidence base

The evidence base refers to a body of information, drawn from routine statistical analyses, published studies and “grey” literature, which tells us something about what is already known about factors affecting health. For example, in the field of housing and health there are a number of studies which demonstrate the links between damp and cold housing and respiratory disease and, increasingly, the links between high quality housing and quality of life (Thomson et al., 2001).


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