Core Health Impact Assessment (HIA) Guidance

Introduction

Almost every aspect of our lives impacts our health and ultimately how long we will live. This includes our jobs and homes, communities, access to education and public transport and whether we experience poverty or discrimination. These factors are often referred to as the ‘wider determinants of health’.

We have a duty to improve the health of the local population in Staffordshire. In effect this means that health is everyone’s business. Therefore, the potential health and health inequalities impact of new strategies, policies, plans and programmes should always be carefully considered to maximise the positive impacts.

Health is also both an enabler and opportunity for us all.  A healthier population will mean more people in work, a stronger economy, better attainment at school, and less demand on health and care services.

What is a Health Impact Assessment and why do we use them?

A Health Impact Assessment (HIA) is a tool to assist people to work together to improve health and reduce health inequity and inequality. 

A HIA will consider individual factors, like lifestyle, as well as the wider determinants of health such as education, housing, green spaces, environment and employment. 

A HIA can create “win-win” solutions e.g. good spatial planning has many non-health benefits but if designed appropriately it can increase physical activity, improve mental health and reduce carbon emissions, all of which improve health. 

HIAs give invaluable information not only about potential effects on health, but also how to manage them. It therefore provides the opportunity to amend the design of a proposed plan, strategy, policy, or project if necessary.  

It can be used to assess the positive aspects of a proposal (e.g. the creation of good jobs), and the negative effects (e.g. air pollution impacting vulnerable groups). It is particularly focused on looking at how disadvantaged groups may be affected, to minimise the risk of widening inequalities.

Ultimately the purpose of a HIA is to inform decisions on how we can maximise the positive and minimise the negative health impacts. It informs decisions as to whether the impact on health of a particular proposal is acceptable or not. It assists the decision-makers by giving them better information, but it does make the decision for them. The approach uses a range of quantitative, qualitative, and participatory techniques. 

This guidance will take you through the steps to complete a HIA and it is designed to be completed by you and your department, with support from colleagues and other stakeholders.

Aims and objective of HIAs

A HIA should:

• Identify the potential positive and negative health and well-being impacts of the proposed development on planned new communities and neighbouring existing communities in vicinity of the development.
• Highlight any differences in health impacts on sub-population groups - sub-population groups include:
  • BAME communities
  • People of any gender
  • LGBT individuals
  • People of any age, including children, young people, working age adults and older people
  • Disabled people or people suffering from poor health
  • Religious or faith group
  • Pregnant women
  • Any other key population groups locally such as people suffering from socio-economic deprivation
• Make recommendations to mitigate against any potential negative health impacts and maximise potential positive health impacts, highlighting where possible the most affected vulnerable groups.

6 Stages of a Core HIA

This tool is based on a 6-stage model as set out below. You are advised to follow each of the stages in turn.

Stage 1 – Screening

• Do we need to do a HIA for the strategy/policy/project (proposal)?
• What sort of HIA is needed?

Not all proposals require a HIA. This will depend on the type, scale and location of the strategy, policy or programme. Issues such as timing and the likely impact on residents should be considered here. Most strategies, policies or programmes will require a Core HIA to be completed. In some cases, a Comprehensive (or full) HIA is required. The latter is typically co-led or supported by Staffordshire County Council’s Public Health and Prevention Team. 

Slightly different paths are followed depending on the strategy, policy or programme you are developing or reviewing. The extent of the HIA undertaken will depend on the type and size of the proposal. For example, most Planning projects are likely to require Core HIAs, with only nationally significant proposals or large-scale developments or projects expected to undertake a Comprehensive HIA.

Using planning policies as an example, the diagram below gives an indicative guide of the type of HIA that may be suitable depending on the nature of the proposal. The likely scale of impact should be determined through discussion with stakeholders at this stage rather than as a data led exercise. The same approach should be considered for other strategies, policies or programmes. 

Stage 2 – Scoping

• What are the objectives of the proposal?
• Who are the key stakeholders?
• What is the geography?
• What data do we need?

The following key questions need to be considered when determining the scope of the HIA:

What are the objectives?

These should be set out in plain language that reflects the reality of the situation. The following examples may be chosen:

• To establish whether and to what degree this strategy / policy / programme will impact on the health and health inequalities (of the defined population)
• To establish whether the impacts will be positive, negative or neutral and the scale of same
• To establish whether different population groups (e.g. based on ethnicity or levels of deprivation) will experience different health effects. Consider the risk of creating or increasing a health inequality.

Who are the key stakeholders and how to consult them?

• A stakeholder mapping exercise will help you to identify those stakeholders who need to be properly engaged in the HIA process. Equally, you need to identify those who only require updates for information.
• You may wish to undertake a small consultation exercise in certain circumstances (for example, hold a focus group with local population). This process can be used to demonstrate to those who challenge a proposal or policy that sufficient consultation was carried out in a robust manner.

What is the geography?

It is crucial that the geography affected by the strategy, policy or programme is well defined and recorded on the HIA Template. This may be the whole of Staffordshire, at a district / parish level or wards or part of wards but should be clearly identified. The HIA should also consider the impacts to any geography not initially affected by the proposal but likely to be affected in the future, for example a population migrating to another village to use facilities.

What data/evidence do we need to be aware of?

Are we aware of any evidence that leads us to believe that the proposed strategy, policy or programme will impact on health and health inequalities?

Consider the current and projected demographics of the population potentially affected, including profiles of deprivation, education and economic status.

Also consider current state of the population's health and wellbeing and future trends and the main issues affecting health in the population.

Seek information on evidence of health inequalities and the communities' perceptions of their health.

Stakeholders will be key to this element of the scoping and may have access to evidence, data and other sources of information that prove invaluable to the production of the HIA. 

Stage 3 – Assessment

• How will the proposal affect health in different groups?
• What is the impact, if any, on health?
• Will it be positive/negative/neutral?

This stage includes analysing information and prioritising potential health impacts. 
Consider how the overall proposal will impact health in different groups during the assessment stage and identify groups that may be more adversely affected and record clearly on the HIA Template.

What is the likely impact, if any, on health?

Using any evidence that we are aware of that may lead us to believe that the proposed strategy, policy or programme will impact on health and health inequalities, consider what would be the scale and likelihood of the impact?

Each of the following categories should be considered in turn;

• Housing• Diet and Nutrition • Physical Activity
• Transport, travel and connectivity
• Employment and Income
• Education and skills
• Environment and Air Quality
• Climate Change
• Community Safety
• Equality and Social Cohesion
• Access to Public Services

The HIA does not need to be limited to the themes provided above. It should focus on the wider determinants of health, but other categories could be added if appropriate to be determined by the Lead Officer.

Consider if the proposal will have an impact relating to each of the categories and if this impact will be positive, negative or neutral. Remember an explicit aim of the impact assessment is to reduce inequalities wherever possible. 

Give a description of the impacts / issues that you have identified, including if the proposal will impact on a specific group or population. Briefly describe how the proposal affects the health and wellbeing of the existing and future residents/users of the site/local area.

You will need to consider health inequalities as well as absolute/overall impact. Also consider demographic, socio-economic and geographical contexts e.g. is the impact worse in the south compared to the north, worse for a particular ethnicity or worse in deprived communities? 

Highlight recommendations detailing and giving practical suggestions, how positive impacts could be maximised, and negative impacts minimised. These may be from previous experience or research into best practice from elsewhere.

Stage 4 - Recommendations

Following completion of Stage 3 (above), you should discuss the recommendations and suggestions, to remove or mitigate adverse health impact and to enhance positive health impact, with the relevant stakeholders to explore those that should be taken forward from the HIA.

These should then be presented / reported to the relevant decision maker(s) for consideration and action as appropriate. Where there are any doubts regarding the interpretation of a HIA, additional support is available from the Staffordshire County Council Public Health and Prevention Team.  

Requests for assistance can be made using the following email: publichealth@staffordshire.gov.uk    

Stage 5 - Monitoring

Evaluation following implementation of recommendations.

Following submission of the HIA recommendations and implementation of the proposals it requires, the extent to which the HIA has influenced the decision-making process should be evaluated. You can follow the framework below:

• Inputs/Process
  How are the activities that the HIA is looking to impact changing over time?
• Impacts
  Are health-related outcomes changing? For example, are cardiovascular disease rates changing following a green space initiative or a plan to reduce numbers of fast-food outlets?
• Review and Act
  Once you have completed the steps above, you can discuss with stakeholders, any possible further actions to take. 

Stage 6 – Communication

Once the evaluation is complete it is imperative to widely communicate to a variety of stakeholders the impacts identified, the subsequent recommendations and the success in implementation, so that further learning can be replicated, and best practice is shared.