Health Impact Assessment (HIA)

The HIA procedure


4. Developing recommendations to reduce hazards and/or improve of health.

A key output of HIA is the set of recommended changes to the proposal. An example of where recommendations were developed and key stakeholders were engaged is the the HIA of a proposal to substitute chopped tyres for some of the coal used in a cement kiln in Rugby, England. Recommendations were provided in a formal report to the decision-maker, and delivered in good time (before decisions were made on whether to grant a permit). The stakeholders views were clearly set out within the recommendations made. Decision makers were provided with recommendations that covered all of the possible decisions that they could have taken: keeping the status quo, a test burn, stopping the test burn, and permanent burn. For example, within ‘stopping a test burn’, recommendations were made about what success would look like, in this case ‘if the test burn showed no environmental detriment based on data fed into an Environment Agency formula’.

Conflicting impacts were acknowledged, with the test burn potentially reducing particulates (good), but with small increases in Nitrogen Oxides (bad). The use of the above mentioned formula was suggested as a way determining whether the overall balance was positive or negative. Consideration was also given to feeding back the outcome of the HIA to the community.


Cook, A, and Kemm, J. HIA report on proposal to substitute chopped tyres for some of the coal as fuel in a cement kiln. Birmingham: Health impact assessment research unit, University of Birmingham.