How To Conduct An HIA

How To Conduct An HIA

A Health Impact Assessment (HIA) has a general framework involving the six key steps explained below.

Step 1 - Screening

The object of the initial screening step is to determine if conducting an HIA is warranted and will be useful to the decision-making process. Factors considered during this process are: 

  • Potential effects on the public health as a result of the plan, project or policy 
  • Potential for impacts on vulnerable populations 
  • Potential for the HIA to add value to the decision-making process 
  • Availability of data, methods, resources and capacity to conduct analysis 
  • Buy in from decision-makers 

Potential questions to consider when reviewing the drafted proposal during the screening step: 

  • Will this proposal impact the public’s health? 
  • Will the impacts reduce health inequity? 
  • What vulnerable groups (e.g. children, older people, people with low income) may be affected? 
  • Is the project or plan occurring in a place where other local health problems have been identified? 
  • How will the HIA be used? 
  • Assessing time and budget needs, which HIA type will work best?
Step 2 - Scoping

During the scoping step, determine which health impacts to evaluate. Collaborate with subject matter experts or community stakeholders to examine community health concerns or potential benefits the plan, policy or project raises. Develop causal diagrams to outline how the plan, policy or project could directly or indirectly affect specific health issues. The diagram will assist in prioritizing which health effects to include in the assessment and in the development of research questions. Data needs will also be identified in this step. 

As a result of the scoping process, a plan will be developed that describes the health effects that will be considered in the assessment phase, outlines the research questions and methods that will be used to answer those questions, and describes the roles and responsibilities of the team conducting the HIA and the stakeholders.

Step 3 - Assessment

Once the focal issue(s) of the HIA have been identified, the next step is to describe the current conditions using quantitative and/or qualitative data related to the health issues identified during the scoping step. The assessment activities are dependent on the HIA process selected; tasks range from limited data collection to comprehensive community and stakeholder engagement. 

A mixed method approach can be utilized to evaluate the potential risk factors and health outcomes of the drafted plan, policy or project. This approach can include some or all of the following, depending on the given timeframe and funding: 

  • a systematic literature review
  • primary and secondary data collection
  • an analysis of existing health data 
  • spatial analysis; and 
  • stakeholder and community engagement 

A variety of existing data, as well as local data for descriptive and analytical purposes, is used throughout the report to best represent the health conditions of the affected population. Data is essential to describing the demographic and socioeconomic makeup, health status, health behaviors and health risks of a community. Data can also help to explain the built environment conditions. Guidance from experts, for example, transportation and/or planning, is utilized, as needed, to better understand certain components of the plan, policy or project. Key-informant interviews and focus groups are incorporated to understand local knowledge and expert opinions into the HIA process.

Step 4 - Recommendations

The assessment findings are developed into actionable recommendations that can be adopted and implemented. Depending on the process selected, consider the highest priority health impacts and associated recommendations in the event time may be limited.

Step 5 - Reporting

A report will be provided that documents the HIA process and methods, analysis, findings and recommendations. The report can serve as a resource to the decision-makers, stakeholders and community members.

Step 6 - Monitoring and Evaluation

Evaluation and monitoring is a key step in the HIA process. This step includes developing a plan to monitor changes in health and assess the efficacy of the measures that are included. The plan will involve assigning responsibilities for monitoring with the HIA team and partners, as well as creating a timeline and evaluation processes. 

HIA has broad relevance to wide-ranging policies, plans, and projects, making it a practical tool for informing decision makers.

Additional Resources

For more detailed information about the steps of a Health Impact Assessment, please visit the links below.