A Comparison of 42 Local, National, and International

HIA Guidelines

Andrew L. Dannenberg, MD, MPHKatherine Hebert, MCRP

Arthur M. Wendel, MD, MPHSarah H. Kennedy, MPH

Healthy Community Design InitiativeCenters for Disease Control and Prevention, USA

International Health Impact Assessment ConferenceGranada, Spain, April 2011

Background

• HIAs have been conducted for 20+ years

• No one standard procedure established

• Many guidelines developed over past decade

• This study reviews existing guidelines

• Builds on prior work by Mindel et al

Methods

• Search for existing HIA guidelines– Authors’ knowledge of existing

guidelines– HIA Gateway, HIA Connect,

IMPACT, WHO, and others– 2008 article by Mindell et al*– Networking with HIA colleagues– Literature search

*Mindell JS et al. A review of health impact assessment frameworks. Public Health. 2008; 122:1177-1187

Methods (continued)• Inclusion:

– Intent of document to guide HIA conduct • Exclusion:

– Old guide for which newer version available

– Sector-specific (eg, only for mining or for greenspace)

– Step-specific (eg, describes only screening step)

• Extract key information from documents

Number of HIA Guides by Year of Publication (N=40*)

*Date not available for two guidesYear

HIA Guides by Number of Pages (N=42)

Median 34, range 4 - 198 pages

Number of pages

Source of HIA Guidelinesby Region (n=42)

International (WHO, etc) N= 4

UK and Ireland N = 16

Rest of Europe N = 7

Australasia N = 7

North America N = 7

Asia N = 1

HIA Guidelines by Source (n=42)

Government agency N= 16

Working group, council, board

or committee N= 10

Academic institute N= 7

Public or private sector health

organization or association N= 5

International agency N= 4

Feature Percent Including Feature (N)

Encourages community engagement 98% (41)Considers equity/ inequalities across population 95% (40)

Includes a list/ diagram of health determinants 88% (37)Includes a steering committee/ group 88% (37)

Includes examples, case studies, resources, etc. 86% (36)Multiple levels of HIA (rapid, intermediate, etc.) 81% (34)

Applicable to policy, project, and program 76% (32)Recommends a community profile 74% (31)Recommends prospective HIA only 74% (31)

Voluntary approach/ not tied to policy 74% (31)Includes list of principles 64% (27)

Discusses integration with other impact assessments 62% (26)

Specific Features of 42 HIA Guidelines

Step Percent Including Step (N)

Screening 100% (42)Scoping 100% (42)Assessing Risks and Benefits 100% (42)Recommendations/ Implementation Plan 74% (31)Reporting 74% (31)Evaluation/ Monitoring 90% (38)

Steps Described in 42 HIA Guidelines

• Describes selection process for projects and policies that should undergo an HIA (95%)

• Intended to be a quick and efficient process (69%)

• Includes a checklist of questions to be transparent in proposal selection (64%)

• Indicates availability of specific screening step tools

Screening

• Describes process for establishing a framework or work plan and selecting impacts to study (98%)

• Identifies which level or type of HIA to conduct (69%)

• Sets geographic and population boundaries (90%)

• Identifies stakeholders and/or forms a steering committee (93%)

Scoping

• Describes step as quantitative and qualitative methods to organize information on current population status and possible health impacts (100%)

• Prioritizes potential impacts based on strength of evidence, likelihood and scale of impact, contribution to reducing inequalities, and relevance (74%)

• Includes a tool for prioritizing impacts/ organizing information (60%)

Assessment

• Describes step as formulating ways to improve a proposal to maximize positive health impacts and minimize negative impacts (100%)

• States that recommendations should be practicable, achievable, acceptable to stakeholders, and supported by evidence (76%)

• May include a detailed Health Action Plan

Recommendations

• Step described as providing stakeholders and decision-makers with information about the process, findings, and recommendations of the HIA (95%)

• May provide guidance on what to include in a report and on matching type of report to type of audience

Reporting

• Step described as reflecting on the HIA process, impact, and health outcomes (86%)

• Considered an important step to building the HIA field (71%)

• Recommends talking with decision-makers as part of evaluation

Monitoring/Evaluation

Study Limitations

• Some guidelines may have been missed in search

• Predetermined terminology in search and in analysis may have reduced diversity of findings

• Components of guidelines may be interpreted differently by different users

Conclusions

• Guidelines for HIAs are similar in many areas of the world although some variations exist

• How closely the practice of HIA follows the published guidelines is unknown

• Further work is needed to determine if one set of common guidelines could be written for use in numerous countries and regions

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