The role of Health Impact Assessment (HIA) in decision-making

20 June 2007 | Q&A

Health Impact Assessment (HIA) can be a valuable tool for helping to develop policy and assisting decision-makers.

HIA has mostly been used on projects, but it has been used on policies and programmes also. This ability to be used in a wide variety of settings is one of the strengths of the HIA approach. However the use of HIA at the strategic level, during the development of policies is one of the most exciting aspects of HIA. It can be used for policy development at local, regional, national, or international levels. Funders can also use HIAs to ensure that projects and programmes consider health, for example, the Asian Development Bank has guidelines for HIA use (Birley 1992).

Within the policy process, HIA is best used early on, while there is still maximum time to influence the policy as it develops. Many of the changes that occur within a policy occur during its development, well before it is put out for formal consultation. A close and trusting relationship with policy makers is obviously required to achieve this. The HIA influences development simply by the policy makers knowing that health will be assessed, and therefore they consider health issues more explicitly when developing the policy, and the policy maker having access to people with health knowledge on a regular basis to discuss issues with (both formally and informally).

HIA is a crosscutting approach that requires many stakeholders to be involved. This helps to develop partnerships between people and organisations – getting people together from diverse backgrounds to begin talking about health (and subsequently other topics!). Partnership working is strengthened by the HIA approach. This way of working also encourages people to see links between the policy being assessed, and other policies being implemented or developed. Often, time and resources are saved when such linkages are made, and policies are strengthened.


Decision-makers can also use the HIA to help decide between multiple policy options that are put forward to them, or to assist in deciding on policy changes based on the HIA recommendations.

The local community is a stakeholder that is included within most HIAs. Decision-makers often want to include the perceptions and opinions of the local community within policies [link to why use hia] and an HIA can help to address any community concerns. Decision-makers can then act secure in the knowledge that community views have been represented in the information they have been provided.

There are many requirements that policy makers must meet, at international, national and local levels. There is guidance/requirements to work across sectors; consider sustainability; reduce inequalities; and consider the health impact/well-being/quality of life on local communities. HIA has the ability to assist policy makers with these requirements.

There are many influences on the policy process and many different information sources feeding in, with HIA being just one of these. This is why it is so important to involve decision-makers early on in the HIA process, to alert them to the upcoming HIA recommendations and ensure there are no surprises for decision-makers.

Other than by HIA, health can be taken into account in the development of policies and programmes by:

  • Joint committees, inter-sectoral councils, working groups, etc,
  • Audits, providing auditors understand the link between health and other policy areas),
  • Strategies and programmes that cut across policy areas (and include health),
  • Within environmental impact assessment (if health is addressed),
  • Budget and planning processes (if health is considered),
  • Individual action of officials to influence other policies,
  • Memorandum of understandings, and
  • Integrated appraisal and screening tools.


HIA looks for negative impacts of developments (to prevent or reduce them) and because HIA is often undertaken prospectively – looking into the future – it offers the unique advantage of preventing damage from occurring. But HIA also looks for positive health impacts of proposals. This often provides decision-makers with options to strengthen and extend these features of the proposal.

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