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There are many situations where HIA would be useful but is not used. At the moment there is no readily available pool of trained manpower to do HIA. The skills needed for HIA are not exclusively found in public health experts and more training capacity for HIA would be helpful. There is no accreditation system for HIA practitioners and no clear mechanism for paying for HIA. Many have suggested that HIA should be mandatory for some proposals but until there is more HIA capacity and understanding this is unlikely to be successful. In order to promote HIA there needs to be improvements in its practice, and an increase in the number of people willing and able to undertake it. Further decision makers need to be made more aware of the benefits of using HIA and more convinced of its value.

This chapter discusses the planning of a health impact assessment (HIA). Topics covered include models of HIA, stages in HIA, factors to consider when choosing outcomes to examine in an HIA, assessing effects on inequalities in health, and literature searching and involving technical experts.

Chapter 18 describes the development of health impact assessment (HIA) in Denmark at the local, regional and national levels. The Danish Healthy Cities Network plays an important role in the dissemination of the concept and the methods to be used. A survey that identified the use of HIA in Danish municipalities and regions in 2004 showed that many municipalities did not routinely implement HIA, but many had prepared HIA or HIA-like assessments. A survey (2010) shows that most municipalities know about HIA, and more than half use some form of HIA. Quantitative HIA modelling tools have been used to support national public health policy. The possibilities for linking nationwide registries offer exceptional opportunities to carry out registry-based HIA. HIA is still considered costly and time-consuming and is not a routine part of decision-making. Further, municipal HIA reports are not currently generally publicly available and therefore cannot contribute to a more transparent basis for policy-making.

Health impact assessment (HIA) is a set of tools, methods, and processes for policy making. It does this by examining potential consequences for health of policy options. This chapter explores HIA as applied to globalization. It outlines what HIA is, points to debate about its nature, and gives an example of its use in the European Union. The European Union's use of HIA provides opportunities to examine consequences for less powerful players in global policy formation. Migrant communities in high-income regions such as the European Union can be key participants in HIAs relating to global policy.

This chapter traces the development of health impact assessment (HIA) for ten years up to 2003. Topics covered include early origins of HIA, the development of methods for HIA, the development of the evidence base of HIA, and the development of the HIA community.

This chapter focuses on appraisal using rapid appraisal techniques. There are two types of rapid appraisal techniques: participatory, in which as many as possible of the stakeholders for an health impact assessment (HIA) are involved; and non-participatory, in which only a small number (one or more) of stakeholders are included. Rapid appraisal can be used in two types of situation: during the third step of the classic HIA process; and embedded during normal working practice where an HIA approach is used to explore the potential for health protection and improvement in a proposal.

Health impact assessment (HIA) for the purpose of community development is not a new idea. For instance, many communities in the Healthy Cities movement have used HIAs to examine how local environmental conditions influence community health and functioning. Findings from HIAs of this type are useful both in planning and in citizen advocacy for better community living conditions. This type of HIA (referred to hereafter as HIA-CD) is different from usual HIA practice, in which pre-specified policies, programmes, or projects are the objects of assessment. This chapter sketches the rationale for HIA-CD and provides some illustrative examples.

This chapter begins with a discussion of the development of health impact assessment (HIA) in the Netherlands. It then considers the building of HIA into the political process, timing of the HIA, HIA and inequalities, and who has responsibility for HIA. The Netherlands experience shows that the reality of HIA differs from the theory. It is difficult to assess how HIA influenced policy in the Netherlands since the programme has attempted to apply and to develop better methods of HIA at the same time.

The development of health impact assessment (HIA) in Wales has taken place within a context of significant constitutional change and a new approach to policy making. This has provided opportunities to explore the usefulness of HIA and to identify the practical issues around its application. This chapter describes the Welsh Assembly Government's work to develop the use of HIA. It highlights issues that are relevant to its use in policy making by government and by other organizations both nationally and locally.

This chapter describes the Wales Health Impact Assessment Support Unit (WHIASU) and the evolution of HIA in the context of Wales as a devolved nation with its particular approach to public health. The character of WHIASU can only properly be understood in terms of its history and the wider social, policy, and political context of which it is a part. WHIASU's emphasis on involving people potentially affected by a proposal in HIA mirrors the emphasis in Welsh policy documents on citizen engagement as a mechanism for policy and service development. This was intended to contrast markedly with individual choice as the driver for change in England as well as resonating with a sociological theory of knowledge that supports the value of deliberative processes that involve lay people in dialogue with professionals.

In 2002, HIA in Scotland was described as ‘still on the runway’. This chapter describes how since then it has slowly taken off but also describes why there have been problems developing HIA activity. The Scottish HIA Network has existed since 2001 and has produced guidance and training with minimal budget. Different approaches to HIA are used in different parts of the country. There have been some successful, high-profile HIAs and there is now a wider pool of HIA expertise. But it is still not public health ‘core business’. Competing priorities, requirements for other mandatory impact assessments, and a lack of political support, have limited its use. HIA is not an end in itself, it is a way to influence and improve policy to achieve better health outcomes. Integrating health into other assessments may prove a more successful approach.

This chapter discusses the development of health impact assessment (HIA) in The Netherlands. HIA in The Netherlands began in the early 1990s and developed along two different lines: one shaped by the public health approach and the other stemming from the environmental field. Public health-based HIA evolved according to the paradigm presented by the Lalonde model of health. The HIAs mainly concerned national policies and addressed a variety of policy fields, ranging from tobacco discouragement and health insurance policy to national housing policy and the high-speed rail link. The environmental-based HIA focused on preventing environmentally related health risks and did not consider health in a broader sense. There is no legal obligation for environmental impact assessments to consider health impacts outside an environmental scope. If a first screening of the planned activity points to large health impacts or many concerns about potential health effects, a more detailed quantitative health impact assessment should be carried out.

This chapter begins with a brief history of HIA. It then considers different definitions of HIA and how it relates to other activities such as evaluation, monitoring and community development. It explains the benefits of HIA and how it is used to support decision makers in relation to policy, programmes and projects. It lists the various steps in HIA and the different types of HIA. It then explains stakeholders and the different roles in HIA and decision making before briefly exploring the legal framework for HIA. Finally it introduces the content of the remainder of the book.

This chapter describes the first two steps in HIA. It considers how to decide whether an HIA should be done for any proposal (screening). The discussion of scoping considers how to map stakeholders and form a steering group. It then considers the setting of geographic and temporal scope and the importance of deciding what is in-scope and what out-of-scope. The causal diagram is introduced as an aid to planning the assessment. The resources and skills needed for an HIA are then discussed. Lastly the gathering of baseline evidence for the HIA is reviewed.

This chapter first distinguishes evaluation of a decision from evaluation of the HIA which informed it. It then discusses the meaning of effectiveness pointing out that there are ways other than influencing the decision in which and HIA can be effective. Evaluation has to consider the usefulness of the HIA to decision makers, the accuracy of its predictions and its effect on participation. For all of these there can be outcome evaluation or process evaluation. Case study and reflection are important aids to improving the quality of HIA. Checklists are a good method of quality assurance and peer review can also be useful.

This chapter discusses the development of health impact assessment (HIA) in Spain. The Spanish state is currently made up of a central administration and seventeen highly decentralized regions or autonomous communities (ACs), with their own governments and parliaments. Health competences have been transferred to the ACs and their health departments hold primary responsibility for healthcare policy, planning, and regulation within their territory. Until very recently there was no statutory requirement for HIA in Spain. The situation is currently evolving in the context of a wider process of public health reforms launched by central and regional health administrations over the last few years. As part of the reforms, a new generation of public health laws is being introduced to support the modernization, reorganization, and strengthening of public health.

The potential of HIA for health promotion and protection was recognized early in Germany. Case studies of HIA projects were conducted and some infrastructure was developed. Contributions from Germany to international HIA research, include an integrative view of HIA and efforts towards health impact quantification. In Germany, up to now, the potential of “explicit” HIA for health protection and promotion is under-utilized. Recently, there are indications of a growing interest in HIA and the topic is now covered in a variety of sources, but Germany may still be regarded as a country on the “threshold” of HIA. Experience shows that HIA needs to be seen here as a flexible tool, which has to be adjusted to different. Mapping both the legal basis and current practice of HIA would make a welcome contribution to further development of HIA in Germany.

This chapter discusses the development of health impact assessment (HIA) in Italy. HIA is not obligatory at the national or regional level, except in limited situations. The Italian National Health Service is responsible for public health as well as cure and rehabilitation. In this domain, there is potential interest in adopting HIA as a formalized process for evaluating programmes and policies. However, progress on legislation on HIA is slow and faces cultural barriers. Researchers have to surmount the difficulties of working with the many disciplines that are relevant to the HIA of policy. Nonetheless, more HIAs are being performed in Italy and HIA is being applied to more complex settings. The Italian experience confirms that HIA is a useful tool for informing the debates at the interface of research and policy, and the difficult questions around uncertainty and the precautionary principle.