Health Impact Assessment and Communities
The health concerns of community members most likely to be affected by plans, policies and developments sometimes do not reach the relevant decision-makers in time to be fully considered. Health Impact Assessment (HIA) was first developed and supported by the World Health Organisation (WHO) to counter this failing and community perspectives and knowledge are critical to making a full assessment of potential health impacts.
Communities can be engaged in HIA in a number of ways:
- As leaders and instigators of an HIA
- As steering group members overseeing an HIA
- As participants in a stakeholder workshop, focus group or interviews gathering evidence for an HIA
In a HIA or MWIA members of communities affected by a proposal/policy/development are asked in a facilitated workshop to give their view on how they think the proposal will impact on the determinants of health and mental health of the defined population. So they might give their views on how they think a new housing development will impact on social relationships in the area, levels of physical activity, and employment and education opportunities, for example. They will identify both positive and negative impacts. Once impacts are identified community members are engaged in coming up with ideas and solutions to address or mitigate negative impacts and maximise positive impacts. HIA is a practical methodology that seeks achievable actions. HIA and MWIA workshops also give the opportunity for a dialogue between different perspectives by bringing communities together with developers, planners, commissioners, housing managers and this can enable more creative and potentially more effective policy and plan making.
The important role of communities in HIA
A strength of Health Impact Assessment is the co-production of findings and recommendations through the involvement of stakeholders and experts (including the public) who may be affected by new policies, services or developments. “Members of the public are crucial to the success of policy implementation and the holders of local knowledge and personal experience that make a valuable contribution” to the evidence used to make an assessment of health impact (Chadderton et al 2008 p.6).
A recent definition of HIA takes into account the value of different types of evidence in HIA:
“Health impact assessment is a process through which evidence (of different kinds), interests,
values and meanings are brought into dialogue between relevant stakeholders ( politicians, professionals and citizens) in order imaginatively to understand and anticipate the effects of change on health and health inequalities in a given population” (Elliott et al., 2010).
The participatory nature of HIA and Mental Wellbeing Impact Assessment mean that these methodologies have a lot to offer in terms of:
- Delivery of the sustainable development principles of collaboration, involvement, integration and prevention
- Co-production in the design and development of public policy and services
- Planning and commissioning health and social care services
- The development of Local Wellbeing Plans and Local Development Plans
Community led HIA
When a land use (or any other) development, plan or policy is proposed, some in local communities may believe that there will be certain positive and negative health and wellbeing impacts in their local communities. The Wales Health Impact Assessment Support Unit (WHIASU) can assist communities in using the HIA methods. This will typically include the local population’s health profile data as well as a balanced and structured range of opinions that comes out of stakeholder workshops which WHIASU can facilitate with partners.
So long as a deadline for objections has not passed, communities can submit their own HIAs of development proposals and plans to their local council’s planning team. In this way, community health and wellbeing concerns are formally placed before decision-makers for review.
Learning from community participation in HIA in Wales
Chadderton et al (2008) reviewed five case studies of HIAs completed in Wales in order to gain an in depth understanding of the issues involved in community participation in HIA. Their key findings were:
- Key benefits of public involvement in HIA are the contribution of local knowledge and personal experience, the building of relationships, empowerment and advocacy.
- Key risks are the raising of expectations, consultation fatigue, upsetting the balance of the process, only engaging with the ‘usual suspects’ and managing input.
- The weight and status awarded to lay views and knowledge differs depending on the HIA in question
- Enablers of public involvement include utilising existing links, the use of appropriate facilitation techniques and providing updates on the HIA
- Inhibitors include lack of time, lack of confidence, and apathetic attitude, the use of jargon and terminology that may not be user friendly, existing community tensions and mis-selling of HIA.
- Sensitivity of the issue, lack of awareness and cognitive dissonance were suggested as inhibitors from the statutory sector perspective.
- Community initiated HIA brings communities together for a common cause and helps to build relationships both between communities and between the public and statutory organisations
- Community initiated HIA requires some level of statutory sector involvement in order for it to be a material consideration in the planning process
- When conducted in a reliable and balanced manner, community HIA can provide a valuable evidence base and support for existing protest campaigns
Examples of HIAs with strong community engagement
Other Community focused HIAs
HIA Report of the Draft Community Cohesion Strategy. Wrexham County Borough Council (2008)
Other useful reports and guidance
Chadderton C, Elliott, E, Williams G (2008) Involving the Public in HIA: An evaluation of current practice in Wales Cardiff University/Wales Centre for Health
Elliott, E., Harrop, E. and Williams, G. (2010) Contesting the science: public health knowledge and action in controversial land developments. In Bennett, P., Calman, K., Curtis, S. and Smith, D. (eds), Risk Communication in Public Health, 2nd edition. Oxford University Press, Oxford.
Elliott, E. and G. Williams (2004). Developing a civic intelligence: local involvement in HIA. Environmental Impact Assessment Review 24: 231-243.