Health Inequalities,

Power Inequalities
&
Health Impact Assessment
Emerging Themes from an integrated EIA and HIA

Work undertaken by Salim Vohra, Ben Cave,

Leigh Rampton and Stephanie McGibbon & colleagues.
Introduction
“ Residents often feel short changed by statutory appraisal processes.

“ The perspectives and priorities of external ‘expert-professionals' are very

often different from those of the local residents.

“ This presentation will explore how issues of current and future health
inequalities were addressed in an integrated environmental impact
assessment (EIA) and health impact assessment (HIA).
Background Context
“ The development site is located in a densely populated urban environment.

“ The population has high levels of need with newly moved refugees and
asylum seekers living alongside a core of long-term residents with strong
ties to the area.

“ The long term residents feel that they and the areas had been neglected and
abandoned for many years.

“ The site is bordered by a dense network of transport infrastructure, high

rise housing blocks as well as public and private services and amenities.

“ At the time of the appraisal the development site had an extensive area of
leisure space with all weather play courts as well as some local authority
offices.
Definition of Health Impact Assessment
“ The definition of HIA we used…

“ HIA is a key systematic approach to identifying the health impacts of

proposed and implemented policies, programmes, projects and
services within a democratic, equitable, sustainable and ethical
framework, so that negative health impacts are reduced and positive
health impacts increased (within a given population).

“ It uses a range of structured and evaluated sources of evidence that

includes public and other stakeholders' perceptions and experiences
as well as public health, epidemiological, toxicological and medical
knowledges.
Integrating EIA and HIA
“ The local authority had set up a community forum that met regularly.

“ They appointed independent impact assessors to carry out a preliminary

assessment of the proposed designs.

“ Our HIA methodology involved:

“ structured observation ‘walkabout’ survey of the area
“ assessment of current health and social welfare provision
“ extensive stakeholder involvement including visiting and talking to residents in their own homes
“ analysis of existing reports and evidence on health needs
“ development of an appraisal matrix comparing each option – including for the development
options effects during the construction and implementation phases
“ suggested mitigation and enhancement measures

“ Incorporating residents ‘voices’ and ‘stories – as experiential knowledge and

evidence NOT as ‘perceptions’ - into the integrated EIA-HIA report.
Power, Values and Identity
“ Many residents felt a sense of powerlessness and helplessness that
exacerbated their current community concerns, material deprivation and
their sense of abandonment.

“ They had had bad experiences of previous redevelopment in the area and
were therefore distrustful of the local authority and any future developer of
the site.

“ Residents felt that the local authority did not have the values of caring and
concern that they expected from a public body whose role was to protect
their health and wellbeing.

“ Residents felt threatened by the changes brought by the proposed new

development in terms of privacy, peace and quiet and community ways of
life.
Outcomes
“ The consultation picked up on issues and concerns which fell outside the
remit of the EIA but were captured by the HIA.

“ The report concluded that while there were major short-term negative
health effects on local residents there were future long-term positive health
benefits for the local and the wider community.

“ Residents felt empowered by the process. They felt that they had been
heard for the first time in a long while and were willing to continue engaging
with the process despite the reports’ conclusions.

“ The employment of external independent assessors who listened and valued

residents experiential knowledges and understandings reduced the mistrust
of the local authority and enhanced their reputation in residents’ eyes.

“ Residents disagreed with the conclusions but felt that the EIA-HIA process
and resulting report were fair and transparent.
Conclusions
“ HIAs helps tackle health inequalities directly…
“ By highlighting and describing the negative (and positive) health effects of
any proposed development, project, service, programme or policy.

“ HIAs helps tackle health inequalities indirectly…

“ by making explicit the power inequalities and in a small but significant way
helping to reduce them by listening to residents and incorporating their
‘voices’ and experiential knowledge into the impact assessment process and
resulting report.