UKPHA Health Impact Assessment Position Paper

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All the countries of the UK now have community health and wellbeing as a key policy objective. The UK Public Health Association (UKPHA) strongly supports the use of HIA as a means to achieving better health outcomes in all areas of policy, strategy and development. The UKPHA advocates the use of Health Impact Assessment (HIA) as an important and effective approach to ensuring that community health and wellbeing is being protected and improved. The UKPHA recommends that HIA should become a mainstream approach, and considers that the uptake, quality and standing of HIA should be enhanced through a consistent application. The UKPHA believes that the promotion of HIA and HIA techniques can provide a valuable focal point for greater interaction between health and strategic and development planning bodies, and help to bring about the wider application of good practice in this area. Current Standing of HIAs The use of HIA is widely seen as good practice across the UK at national and regional levels in the development of new policies, plans, programmes and projects. However, experience on the ground suggests that the use of HIAs at local level is variable. Even where HIAs have been completed, the recommendations from them are not consistently taken forward or monitored. Local Direction Where local HIAs have been carried out successfully they have often had the greatest effect in contexts where there is significant input from local strategic partners. These could include local authorities (LA), primary care trusts or health boards (PCT/HB), regeneration bodies, police, etc. This enables the assessments to focus on locally relevant health issues and priorities. The UKPHA therefore recommends that Local Strategic Partnerships (LSP) build upon existing work to identify local health priorities. HIA is a useful approach to bring these partners together to identify changes (for example in processes, policies and structures) that may be necessary to deliver the dentified improvements in health and wellbeing.

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The UKPHA identify three key methods by which the uptake, quality, relevance and standing of HIAs might be enhanced: 1) Embedding of HIA at the strategic policy and decision-making level across all key local policies and plans by members of Local Strategic Partnerships and other key agencies and partners in the public, private and "third" sectors. This should be done either by commissioning standalone HIAs or by integrating HIAs into other assessments where these are already being undertaken. These could include Strategic Environmental Assessments (SEAs), Sustainability Appraisals (SAs), Integrated Impact Assessments (IIAs) and Equalities Impact Assessments.

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2) Embedding HIA at programme and project level at the planning stage either as standalone HIAs or integrated HIAs within other assessments (such as Economic Impact Assessment, Equalities Impact Assessment and Environmental Impact Assessment) where these are already being undertaken. 3) Involving Directors of Public Health, and more generally PCTs/HBs, early in the strategic policy and plan making process. Involving health bodies only in the later stages of policy and plan making can make it difficult to incorporate important changes. Early involvement can help to maintain focus on locally identified priorities resulting in improved outcomes. HIA of Policies and Plans The UKPHA believes that Health Impact Assessments should be undertaken alongside, or as part of, other assessments for strategic plans. Examples from the English system include (but are not confined to): Local Area Agreements, Community Plans, Housing and Homelessness Strategies, Health and Wellbeing Strategies, Community Cohesion Strategies, Economic Development Strategies, Regeneration Strategies, Sustainability Strategies, Local Development Frameworks, Core Spatial Strategies, Local Transport Plans, Local Waste Plans, Local Minerals Plans and Air Quality Action Plans. These should be undertaken by, or on behalf of, the relevant authorities. Carrying out HIA at this strategic level will provide a much stronger foundation for the HIA process; bringing together local policy, planning and health bodies, helping to focus on key strategic themes, and embedding health concerns within the on-going strategic policy and decision making process. These strategic level HIAs will then provide the detailed strategic context to inform individual programme and project HIAs.

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HIA of Programmes and Projects Programmes and projects encompass a wide range of service programmes and developments, including new services, housing, regeneration, waste facilities, transport infrastructure, etc. The UKPHA identify three key methods by which the uptake, quality, relevance and standing of HIAs might be enhanced: 1) HIAs should be commissioned jointly by the local authority and PCT/HB, either as standalone assessments, or integrated within other assessments for key public programmes and projects. 2) Locally focussed checklists and toolkits for HIA should be developed and used to initially 'screen' proposals in terms of whether key public health issues have been considered in the proposed programme or project, and whether there is a need for a rapid or in-depth standalone or integrated HIA. 3) Local authorities should be encouraged to develop Supplementary Planning Documents on Health or HIA in partnership with local PCTs/HBs as part of the new spatial planning process. These will help determine when a HIA would be considered necessary for new developments, provide terms of reference for any HIA undertaken, and ensure that locally relevant health and wellbeing issues are appropriately considered. The SPD should indicate where responsibility lies for commissioning of HIA, for example, whether they should be commissioned by the applicant for a development project. In some cases, this may be the local authority/PCT/HB, but in many cases this will be a private sector organisation. SPDs should encourage HIA to be undertaken as part of the Environmental Impact Assessment (EIA) where an EIA is required as part of the planning process. The need for stronger guidance and leadership The lead agencies for health and planning in England and the Devolved Administrations should encourage and support the up take of HIA, and HIA techniques at a local level, so that they are seen as being normal good practice, and not as optional add-ons that are only employed in a limited number of situations. HIA in relation to other forms of health assessment The UKPHA strongly recommends the use of Health Impact Assessment (HIA) as the overarching term to describe all current and future forms of assessing the health and wellbeing impacts of the full range of policies, plans, programmes and projects. Therefore, terms and approaches such as "Health Equity Impact Assessment", "Mental Health and Well-being Assessment", "Health Risk Assessment" or "Environmental Health Impact Assessment" should be seen as being encompassed by HIA rather than being something different or separate from HIA. However, the UKPHA recognises that within certain contexts it can be useful to have an in-depth focus on one or more themes or methods that make up a HIA, such as equity or mental health and wellbeing or quantifying the particular health risks of exposure to air pollution or certain chemicals.

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Written by the UK Public Health Association's Health and Sustainable Environments Special Interest Group, February 2010
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