Health Impact Assessment (HIA)

Glossary of terms used

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Health gain

Improvement in health status.

Health impact

A health impact can be positive or negative. A positive health impact is an effect which contributes to good health or to improving health. For example, having a sense of control over one’s life and having choices is known to have a beneficial effect on mental health and well being, making people feel “healthier” (Wilkinson, 1996). A negative health impact has the opposite effect, causing or contributing to ill health. For example, working in unhygienic or unsafe conditions or spending a lot of time in an area with poor air quality is likely to have an adverse effect on physical health status.

Health inequality and inequity

Health inequalities can be defined as differences in health status or in the distribution of health determinants between different population groups. For example, differences in mobility between elderly people and younger populations or differences in mortality rates between people from different social classes. It is important to distinguish between inequality in health and inequity. Some health inequalities are attributable to biological variations or free choice and others are attributable to the external environment and conditions mainly outside the control of the individuals concerned. In the first case it may be impossible or ethically or ideologically unacceptable to change the health determinants and so the health inequalities are unavoidable. In the second, the uneven distribution may be unnecessary and avoidable as well as unjust and unfair, so that the resulting health inequalities also lead to inequity in health.

Healthy public policy

Healthy public policy is a key component of the Ottawa Charter for Health Promotion (1986). The concept includes policies designed specifically to promote health (for example banning cigarette advertising) and policies not dealing directly with health but acknowledged to have a health impact (for example transport, education, economics) (Lock, 2000).

Impact assessment

Impact assessment is about judging the effect that a policy or activity will have on people or places. It has been defined as the “prediction or estimation of the consequences of a current or proposed action” (Vanclay and Bronstein, 1995)

Inequalities audit / equity audit

A review of inequalities within an area or of the coverage of inequalities issues in a policy, programme or project, usually with recommendations as to how they can be addressed.

Integrated impact assessment

Integrated impact assessment brings together components of environmental, health, social and other forms of impact assessment in an attempt to incorporate an exploration of all the different ways in which policies, programmes or projects may affect the physical, social and economic environment.

Integrated Pollution Prevention Control regulations

In October 1996 the European Commission published a Directive on Integrated Pollution Prevention and Control (IPPC) which came into effect on 30 October 1999. As a result, European Union Member States were required to introduce a regulatory system to ensure that particular industries take action to ensure “an integrated approach to pollution control” in order to achieve “a high level of protection for the environment as a whole” when considering both routine and accidental releases. The definition of pollution in the Directive includes releases to air, land or water “which may be harmful to human health”. In the UK, Pollution Prevention and Control regulations were introduced in 2000 and they require that health authorities are consulted on IPPC. Three are around 7,000 sites affected across the country and the types of activity which are covered by the regulations include the energy, metals, oil, chemical and waste management industries, paper production, food production and some intensive livestock rearing (University of Birmingham, 2002).

Intermediate HIA Monitoring and evaluation

An intermediate HIA may combine a workshop with key stakeholders followed by desk based work to build up a more detailed picture of the potential health impacts than those which would be identified during a rapid or “mini” HIA. It may involve a limited literature search, usually non-systematic, and is mostly reliant on routine, readily available data (Parry and Stevens, 2001).

Monitoring and evaluation

Monitoring is the process of keeping track of events. For example, the monitoring of a project may involve counting the number of people coming into contact with it over a period of time or recording the way in which the project is administered and developed. Evaluation involves making a judgement as to how successful (or otherwise) a project has been, with success commonly being measured as the extent to which the project has met its original objectives. Both the “process” (activities) and “outcomes” (what is produced, for example in terms of changes in the health of those targeted by the project) can be monitored and evaluated.


HIA is not the preserve of any one disciplinary group. Instead, it draws on the experience and expertise of a wide range of “stakeholders”, who are involved throughout the process. These may include professionals with knowledge relevant to the issues being addressed, key decision makers, relevant voluntary organisations and – perhaps most importantly – representatives of the communities whose lives will be affected by the policy (Barnes and Scott-Samuel, 1999).


The term neighbourhood usually refers to a local area which is defined in some way physically (for example, an estate or an area bounded by major roads) or by people’s perceptions of what constitutes their local area. Neighbourhoods are usually fairly small. For example, neighbourhoods designated for New Deal for Communities funding are usually made up of around 4,000 households or around 10,000 people.


The effect the process has had on the people targeted by it. These might include, for example, changes in their self-perceived health status or changes in the distribution of health determinants, or factors which are known to affect their health, well-being and quality of life.


The products or results of the process. These might include, for example, how many people a project has affected, their ages and ethnic groups or the number of meetings held and the ways in which the findings of the project are disseminated.


A group of people or organisations brought together with a common purpose such as developing a regeneration programme or undertaking .


A policy can be defined as an agreement or consensus on a range of issues, goals and objectives which need to be addressed (Ritsatakis et al., 2000). For example, “Saving Lives: Our Healthier Nation” can be seen as a national health policy aimed at improving the health of the population of England, reducing health inequalities and setting objectives and targets which can be used to monitor progress towards the policy’s overall goal or aims.


A course of action or series of activities.


The term programme usually refers to a group of activities which are designed to be implemented in order to reach policy objectives (Ritsatakis et al., 2000). For example, many Single Regeneration Budget programmes and New Deal for Communities initiatives have a range of themes within their programmes – often including health, community safety (crime), education, employment and housing – and within these themes are a number of specific projects which, together, make up the overall programme.


A project is usually a discrete piece of work addressing a single population group or health determinant, usually with a pre-set time limit. For example, “Private Rented Dwellings” was a three year project in Southport, Merseyside which provided money to private landlords in order to bring their rented properties up to housing fitness standards (Hirschfield et al., 2001).

Prospective HIA

Prospective HIA is carried out before any action has been taken, either in terms of drafting a policy, putting together an action plan or implementing it so that steps can be taken, at the planning stage, to maximise the positive health impacts of a policy, programme or project and to minimise the negative effects (Scott-Samuel et al., 1998).

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