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About HIA


Health Impact Assessment is a method of estimating the potential health effects of the implementation of a plan, which may or may not be aimed at influencing the health of the population. The likely positive effects are weighed up against the negative effects. A detailed guide and more information about HIA in London is available from the London Health Strategy website

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Information sources
What is a health impact assessment? (HIA)

At its simplest HIA is a way of looking at the health consequences of a wide range of policy, programme, or project decisions. Thus it may be applied to looking at transport, economic development, education, housing, regeneration etc - in fact just about anything that affects the way people live their lives will have some sort of effect on their health.

The assessment may be carried out prospectively, such that its conclusions can inform the decision as to whether the plan should go ahead. It can be carried out concurrently to influence decision makers during the life of the programme or policy. The assessment can also be carried out retrospectively, at a suitable time after the implementation of the plan, to assess the impact on health. If the plan is aimed at influencing health, a retrospective health impact assessment is a form of evaluation. However, in most cases, health is not the primary objective of a plan; whereas evaluation compares outcomes with what was intended, HIA examines a broad range of positive and negative effects.

The approach has its origins in environmental impact assessment. The difference is that influences on health other than the environment are considered. There are many models available which consider possible health effects. An example is Lalonde's health fields:

Health 'field' Possible determinant of health
Biology Genetics, Nutrition, Age, Gender, Special Senses
Environment Physical environment: Air, Water, Nutrition, Housing, Land Use, Waste, Energy Socio-economic Environment: Employment, Social Class, Poverty, Education, Culture, Families, Social Support, Mental-Wellbeing
Lifestyle Diet, risk-taking behaviour, occupation, culture, education
Organisation of healthcare and other services Primary Care, Community & Hospital Services, Health Policy, Local Authority Services, Relationship With Other Statutory or Non-Statutory Agencies & With The Local Community, Local & National Priorities

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Overall the aim of health impact assessment is to allow a systematic consideration of likelyoutcomes regarding the health of a population to be incorporated into decision-making. Obviously the scale of any proposed plan can influence its likely effect on health, and therefore the need for a full health impact assessment. Hence the idea of 'screening' proposals to identify those for which a health impact assessment would be most useful.

The steps involved in an HIA are outlined in Introducing health impact assessment (HIA):

Stage 1: Often called screening - is the stage when you decide whether an HIA is likely to be the best way to ensure health and equity issues are address appropriately in a given situation.

Stage 2: Often referred to as scoping - is the when you decide how to undertake your HIA and begin to do your planning.

Stage 3: Often called the appraisal or assessment stage - is when you identify and consider a range of evidence about what the likely impacts of health may be, including research evidence and the qualitative evidence from stakeholders.

Stage 4: Often called developing and prioritising recommendations - is when you formulate and prioritise specific recommendations for the decision makers based on best available evidence.

Stage 5: There needs to be continued work with decision makers after the HIA is completed to reinforce the value of evidence based recommendations and to support the implementation of recommendations they agree to adopt within the proposal.

Stage 6: ongoing evaluation and monitoring to assess whether recommendations were adopted and to look at ways of monitoring long-term health and equity outcomes.

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HIA cost calculator

Click Here to use our HIA calculator to help work through how much money and time your HIA might take to do. As this is a new resource, we are interested in your comments to help us develop it further in future. Please forward any feedback to at the LHO.

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London congestion charge HIA report

The LHO was commissioned by Transport for London in October 2004 to conduct HIA on the proposed western extension to the central London congestion charging zone. Click Here for the final HIA report.

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The contacts listed below have expertise in the field of HIA. They are not all available to be commissioned to conduct HIA. Click Here for a list of HIA consultants available to be commissioned to conduct HIA.

Click Here for points to consider and things to ask for when commissioning an HIA consultant.

  • Ruth Barnes
    Tel: +44 (0)208 893 0114
  • Andy Beckingham
    Tel: +44 (0)1273 478 908
  • Kate Benson
    Independent Public Health Specialist
    Tel: 01377 217 255
  • Jane Biddulph
  • Ben Cave
    Tel: +44 (0)1273 723 400
  • Anthea Cooke
    Tel: +44 (0)20 8521 5872
  • Professor Sarah Curtis
    Geography of Health and Health Care
    Tel: +44 (0)20 7882 5420
  • Professor Jack Dowie, Health Impact Analysis, London School of Hygiene and Tropical Medicine, Tel: +44 (0)207 927 2034, E-mail:
  • Dr. Mike Joffe
    Department of Epidemiology & Public Health, Imperial College London
    Tel: +44 (0)20 7594 3338
  • Dr Karen Lock
    Health Policy, London School of Hygiene and Tropical Medicine
    Tel: +44 (0) 207 612 7810
  • Professor Mark McCarthy
    University College London
  • Fiona Sawney
    Tel: 07855952505

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Further reading
HIA - About HIA - Datasets

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