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Health Impact Assessment

Training Course
Workbook

Developed by Dr Salim Vohra, Director, Centre for Health Impact Assessment 2003-08
1. What is Health and
Wellbeing?

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1.1 Health as a Relationship

What item did you pick from the health box?


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How do you see your item relating to health?


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How do you see your item relating to ill-health?


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1.2 Health as a Connection

Write down other words and phrases that you connect with health and disease?

health
wellbeing

disease
2. What is Evidence?
2.1 Information or Evidence Used

What different types and sources of information/ evidence do you generally tend to use
in your work ?

Type & sources of Used/ Why?


Information Not used

Professional journals

Local newspapers

Private sector surveys


e.g. MORI Polls

National government
reports, consultations e.g.
Department of Health

Your own and your


colleagues’ judgement &
experience

Business reports and


surveys, etc.

User
views/feedback/surveys

Local resident’s
views/surveys

National newspapers

Local government reports


and consultations

Others (please list below)


2.2 Information or Evidence Relied On and Trusted

How do you judge or assess this information/ evidence? Which do you rely on more? Rank
the information/evidence in terms of which you rely on/trust the most (rank 1) and
which the least (rank 10)

Type & sources of Rank Why?


Information

Professional journals

Local newspapers

Private sector surveys


e.g. MORI Polls

National government reports,


consultations e.g.
Department of Health

Your own and your


colleagues’ judgement &
experience

Business reports and surveys,


etc.

User views/feedback/surveys

Local resident’s
views/surveys

National newspapers

Local government reports


and consultations

Others (please list below)


3. What is Screening?
Screening

Which of the project, service, programmes and policies listed below is it worth doing a
HIA on and why?

Proposal – project, service, programme or policy Do a HIA? Yes/ No/ Not


Sure
Why?

The building of a small block of flats for key workers on a


brownfield site that will include landscaped gardens and
where the nearest houses will be more than 500 metres
from new block of flats.

A £20,000 a year three-year drop-in adult education


programme for refugees and asylum-seekers.

A proposed new public transport infrastructure project with


a new tram-link and re-configuration of some existing bus
services.

A local authority homelessness strategy.

A £5 million large commercial office development within an


existing commercial business park.

A mobile phone transmitter mast on the roof of a local


housing association residential block of flats of 20 storeys.

A £500,000 refurbishment of an existing leisure centre in a


run-down and deprived area to enhance the existing
facilities. These include a swimming pool, football courts, a
gym and fitness centre and an outdoor running track.

A credit union project to help local people to access small


loans and develop budgeting and saving skills.

A £250,000 ‘healthy living’ health promotion programme


aimed at educating people to eat more fruit and take more
exercise.

A £20 million regeneration programme involving the building


of a range of business, leisure and residential developments
including a range of programmes to tackle inequalities.

The replacement of an old waste-to-energy incinerator with


a new modern one in a sparsely populated area.

The setting up of a community-wide children in schools art


project run from a local community centre.

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What informal/implicit criteria did you use to make your judgement?

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What more information, if any, would you have liked to have had in order to make a
decision?

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4. A multi-layered case study
to explore HIA
Yourboro Renaissance
“Improving people’s lives through social, environmental and
economic action”

“Dear Colleague,

As you are aware this leading national


government directed local programme has
been working for many years with local
communities through local governments to improve and enhance urban
and rural neighbourhoods and environments.

The Yourboro Renaissance team include internationally renowned


economic, social, environmental, educational, regeneration and
community development experts.

They are currently working in urban-rural Yourboro to help deliver a


major €20 million (social, environmental and economic regeneration
and welfare programme based on the regional strategy “New Beginnings
– an opportunity for all” involving new business, leisure and housing
developments as well as educational, cultural and community
programmes and activities.

We need your help to ensure that we succeed in making Yourboro one of


the most successful areas in Youregion.

Below we provide some key information about Yourboro which we hope


you will use to help us assess the health aspects of some of the existing
and new initiatives which are outlined in this pack.”

Regards,

Sally Wright
Mayor

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Area Context
The development parts of the regeneration will occur in a ‘brownfield’ area which was originally the site
of mining works and heavy industry. The overall renaissance area straddles two adjoining local districts
(and hence two local government authority boundaries). The renaissance area also encompasses some
rural areas on the outskirts of Yourboro.

The renaissance area is divided and defined by a number of large roads which separate commercial and
residential areas. The area is a main thoroughfare for traffic, commercial and private into and out of
Yourboro.

Both local districts have pockets of affluence. The regeneration area encompasses some of these pockets
of affluence from one of the local districts but not the other. There are also areas with high levels of
poverty which have a high rating on the national Index of Deprivation. Services within the area are poor,
there is only one large supermarket, very few local shops and public transport links are via buses only.

The population is diverse with large numbers of ethnic minority residents, a mobile population, large
numbers of young people and some refugees and asylum-seekers. The pockets of affluence are made up
of newly arrived families and older couples while the social housing is mainly comprised of long-standing
families and residents of the area.

There are large numbers of community and voluntary sector organisations within the area but most, if not
all, tend to operate in isolation and therefore are not well organised and not influential.

Fig. 1: High Level Map of the Area

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Historical Context

The area still has a strong mining and rural identity even though all the
mines have shut and there are only a few large farms in the area. The area
has become increasingly urbanised with Yourboro having a population of over
250,000.

Social Context
There are substantial concentrations of poverty, largely in the south-east of
both districts. The districts have areas of significant deprivation and there
are ‘crime hotspots’ with high levels of personal crime e.g. muggings and
burglaries.

There is also a well established ethnic minority community. Overall, the


population of the area is young with very few people of middle age and small pockets with a high
concentration of older residents. There are significant gaps in primary health care provision. `Parts of one
of the districts have poor child health outcomes. There has been a recent influx of refugees and asylum
seekers. Numbers of children from more affluent backgrounds attend fee paying schools outside the area
for both primary and secondary education. All secondary age children travel outside the area to attend a
secondary school.

Economic Context
There are no major businesses in the area and a high ratio of economically active
residents work outside the districts. In the rural areas there are high levels of
unemployment especially among young people.

Since the closing of the mines and the heavy industries the area’s economy has been
stagnating. The rural areas had a thriving number of small farms which over the years
have amalgamated so that now there are only a few large sheep and cattle farms.
Tourism has been increasing in the area with people coming to enjoy the outdoors,
walking and camping.

Environmental Context

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The old mining and heavy industrial areas are brownfield sites with significant surface and soil
contamination. Some of the rural parts have areas of outstanding beauty with rare species of flora and
fauna.

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Key Initiatives of the Renaissance Programme

1. ‘New Waves’ Call Centre


Part of a broader information technology and communications business development programme
funded from national regeneration funding. The proposed site is on the border of the two local
districts. It will become a call centre for a number of large companies and public agencies. One
thousand part-time jobs, including call operators and call handlers, as well as ancillary staff e.g.
cleaners, caterers, maintenance and management staff. The site is bounded by roads with a large
social housing estate nearby. There are no existing local amenities near the site and the transport
links to the site are currently by bus. All the staff will be newly recruited and the majority of
posts will be part-time shift work, 24 hours a day, 7 days a week.

2. ‘Enhancing Community Care’ One-stop Primary Care Centre


This will involve the relocation of the three major primary care practices from existing
accommodation into a single purpose-built facility that will include a minor surgery unit, podiatry,
community nursing, children’s and family planning services. Current primary care services are
based in converted residential accommodation. Public transport services to the proposed site are
currently very limited. The site for the proposed new facility will be a high density residential
area with a mix of social and owner occupied housing.

3. ‘Kids in the Community’ Summer School


The activities are free to all young people aged 14-25 years who live in the renaissance area. This
will include the cost of weekly outings and all equipment. The programme aims to meet a range of
young people's needs: school curriculum revision and enhancement, the opportunity to try
subjects not studied at school and taster sessions for further education. Projects and courses
giving young people the opportunity to immerse themselves in a creative art project for a week
e.g. producing your own theatre performance, exhibitions and films will also be on offer. Courses
and seminars offering information and advice on training and employment will be available. There
will be varied opportunities to acquire and develop ICT skills, and to enjoy sport and fitness
activities both to improve sports skills and to try something new. Young people will be directed to
year round provision or specialist agencies as appropriate as part of the programme.

4. ‘Open Access - Equal Access’ Community Café


Community consultation showed strong support for a community café. There are no multi-purpose
community facilities where people with physical and learning disabilities can have access to and
participate in a range of social and leisure activities. The lack of opportunity for disabled
residents to access and participate in such activities has meant that they are amongst the most

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excluded people in the area. Access to such facilities is vital to improving the quality of life,
health status and social inclusion of disabled residents. The community café will have a coffee
shop and restaurant as well as a range of indoor and outdoor leisure activities including a
swimming pool. The café will also provide a range of outreach health, social care, education,
training, employment support and welfare services.

5. ‘Homes for All’ Extending Housing Choice


This is a new national government initiative to extend housing choice. Local authority owned and
maintained properties across the area will be transferred to a number of social landlords who will
then have responsibility to maintain and develop this housing stock. The selection process for
social landlords has started and various housing associations are presenting their business cases to
the local community. As yet there has been no detailed national guidance on how this initiative
will work and no national or local authority monies have been earmarked. Additionally, the
initiative will involve the refurbishment of existing housing, the demolition of housing that is
judged as not worth refurbishing and the buying of new houses to supplement the housing
associations housing portfolio. The aim is for the housing associations to create more balanced and
mixed communities than has been the case in the past.

6. ‘Culture into Communities’ Theatre, Music, Gallery and Museum Complex


There is no theatre, music venue, art gallery or museum in the area. The ‘Culture into
Communities’ complex will provide a state-of-the-art theatre, music venue, art gallery and
museum for the renaissance area. The events proposed will include national and international
theatre performances, opera, classical music, pop music events, international and national art
exhibitions and a museum recording and archiving the historical, social and cultural changes to the
area over the last one hundred years. The complex will be managed by a national art and heritage
charity that has a strong international presence.

7. ‘Transport for the New Millennium’ Tram-link


The aim of ‘Transport for the New Millennium’ is to improve the roads from the renaissance area
to the major urban conurbation of Yourboro as well as to extend the existing tram-link network in
Yourboro into the renaissance area. This will substantially improve the public transport
infrastructure of the area and increase the economic benefits of companies locating here. The
construction of the tram-link network will take ten years and involve the purchase of, used and
unused, rural and urban land.

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Using a HIA tool

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Screening
Assess whether an proposal (plan, policy programme, project or service) should have a health impact
assessment undertaken by answering as honestly as you can the following questions.

Name of Proposal: ……………………………………………………………

Answers From your knowledge and/or Answers


favouring favouring not
in your judgement
doing a HIA doing a HIA

Health Impacts
Yes / not sure Does the proposal affect health directly? No
Yes / not sure Does the proposal affect health indirectly? No

Yes / not sure Are there any potentially serious negative health No
impacts that you currently know of?
Yes / not sure No
Is further investigation necessary because more
information is required on the potential health
impacts?
No / not sure Yes
Are the potential health impacts well known and
is it straightforward to suggest effective ways in
which beneficial effects are maximised and
harmful effects minimised?
No / not sure Yes
Do you (or others) judge the identified health
impacts as being small in effect?
Community
Yes / not sure Is the population affected by the proposal large? No

Yes / not sure Are there any socially excluded, vulnerable or No


disadvantaged groups likely to be affected?

Yes / not sure Are there community concerns about any No


potential health impacts?
Proposal
Yes / not sure Is the size of the proposal large? No

Yes / not sure Is the cost of the proposal high? No

Yes / not sure Is the nature and extent of the disruption caused No
by the proposal likely to be major?
Organisation
Yes Is the proposal a high priority/ important for the No
organisation/ partnership?

= For TOTAL Against =

Screening contd…

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Assess what kind of HIA should be done on your proposal by answering as honestly as you can the
following questions.

Rapid Type of HIA Comprehensive

Yes Is there only limited time in which to conduct HIA? No

Yes Is there only limited opportunity to influence the No


decision?

Yes Is the timeframe for the decision-making process set No


by external factors beyond your control?

Yes Are there only very limited resources available to No


conduct HIA?

Assess who should do the HIA on your proposal by answering as honestly as you can the following
questions.

External Assessors Internal

No Do personnel in the organisation or partnership have Yes


the necessary skills and expertise to conduct the
HIA?

No Do personnel in the organisation or partnership have Yes


the time to conduct the HIA?

(Adapted from a screening tool developed by Erica Ison in Resources for Health Impact Assessment, 2000)

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5. What is Scoping?

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Scoping
Question Answer 

Who will lead on the project management


of your HIA?

Will you have a HIA steering group, if yes,


who will make up the members, what will
be its terms of reference?

Are there other professional or community


stakeholders - not included on your
steering group – who should be involved in
the design of your HIA?

When do the decision-makers you are


aiming to influence make their decision and
hence when does your HIA report need to
be completed by?

Why is the proposal being undertaken?


What are the proposal’s aim and
objectives?

Why do you want to do this HIA?


What are your HIA’s aim and objectives?

What geographical area will your HIA cover?

What population group will your HIA


encompass?
Will the population assessed reside within the
geographical area described above or include
workers living outside the area,
travelling families, etc?

Scoping contd…

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Question Answer 

What definition of health will you use


for your HIA?

What HIA model/approach do you want to


use?

Are there any specific health impacts that


you want your HIA to focus on?

Do you know which specific population sub-


groups/ community groups will be directly
affected by the proposal under
consideration?

Will your HIA give specific detailed


recommendations or will you just detail the
potential health impacts so that your
steering group and other decision-makers
can then separately think about the
implications and recommendations?

Other issues relevant to your local or


organisational setting

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Methodology
Question Answer 

Depending on what HIA model you chose in


scoping,
will you use a quantitative, qualitative
or mixed approach?

Why?

What health evidence and research sources


will you use?

What sources won’t you be able to use?


Why?

Current evidence on health needs (public health, local


authority, etc)
Research review evidence on health impacts

Will you do an informal ‘windscreen’ or


‘walkabout’ observation of the
geographical area and community?

Will your HIA include a formal consultation


of professional and community
stakeholders?

Why?

What method/s are you thinking of using?

Baseline Assessment
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Question Answer 

What are the characteristics of the


local people – age, gender, ethnicity?

What is the health situation like


of local people?

What is the social situation like?

What is the economic situation like?

What is the local environment like?

Baseline Assessment contd…

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Question Answer 

What health & social care services are


there in the area/
serving local people?

What voluntary sector and charity services


are there?

What retail, shopping and banking services


are there?

What culture and leisure services are there


e.g. cinemas, theatres, sports centres?

What urban/rural regeneration or other


area or health improvement programmes
are there?

Policy context (and policy evidence)


Question Answer 

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What international policies does the
proposal link into?

Which parts of these policies does the proposal


follow and which parts does it ignore?
What are the reasons for this?

What national/regional policies does the


proposal link into?

Which parts of these policies does the proposal


follow and which parts does it ignore?
What are the reasons for this?

What local policies does the


proposal link into?

Which parts of these policies does the proposal


follow and which parts does it ignore?
What are the reasons for this?

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6. What is Analysis?

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housing
conditions
genetic housing employment
effects sexual tenure status
sex smoking
behaviour
alcohol family working
exercise relationships Personal condition
Biological prescriptio
age circumstances s
factors Lifestyle n
drugs income
leisure
activities substance means of
misuse transport education

smell noise
soil
qualit
vibration water
y
quality
public & community
environmental social
air social support participation
health quality contact
services
Environment Determinants of peer
pressure
civic design Health & Wellbeing Social influences
natural land use & fear of
hazards natural planning discrimination crime &
green fear of crime &
resources discrimination anti-social
waste space anti-social behaviour
management behaviour
research & technological
development
community
business job voluntary & facilities
childcare
activity Economic creation charity groups leisure
facilities
conditions health & social
availability of distribution
of incomes care services Availability & access
employment housing
quality of
availability shops and
employmen education
of training banking services
t workplaces, & training
public
Page 20 advice employment opportunities
transport
Adapted from ‘Rapid Health Impact Assessment: a guide to research’ by Amanda
services & services
Harris, Mar 2002
Health appraisal – rapid adapted from the British Columbia HIA model as described by Erica Ison in Resources for HIA, 2000

Yes, If Yes, Who or what people How is the impact likely to If the impacts are negative
No, is the health impact or group(s) will this occur? What possible mitigation
likely to be positive impact potentially measure(s) would reduce the
Not Sure negative affects?
or negative (+/-)? affect? How do you know this?

Will the proposal affect the


creation and distribution of
income or wealth levels?

Will the proposal affect


employment opportunities?

Will the proposal affect


learning opportunities?

Will the proposal create


healthier beginnings for
children?

Will the proposal affect the


number and quality of
personal connections?

Will the proposal affect crime


and safety?

Will the proposal affect


people’s ability to influence
their lives and locality?

Will the proposal affect


the local environment?

Health effects and pathways of impact adapted from the Westminster Toolkit: Health and Wellbeing, 2004

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Impact Effects on health and wellbeing Pathway of impact If the impacts are negative
What possible mitigation
measure(s) would reduce the
negative effects?

Employment Leads to poverty and a reduction in personal and social esteem. Through reducing employment Ensuring that existing employment,
opportunities, affecting there social education, training, amenities and public
Poverty excludes people from: and welfare entitlements, affecting the transport are not reduced.
• being able to afford quality and variety of foods viability of the organisations they work
for, reducing their opportunities for
• engaging in opportunities for leisure and physical recreation
education and training, reducing their Increasing and promoting the range of
• enhancing their education and learning ability to travel and access employment, education, training,
• having warm and comfortable homes
amenities, public transport and welfare.
It also increases their
• difficulties in travelling and therefore accessing other services and
amenities
• levels of stress
All leading to poorer physical growth and development, reduced
immunity to disease and reduced physical and mental health wellbeing.
• Affects all age groups but greatest effects on those already on low
incomes, those with disabilities and children.

Housing Poor housing that is damp, cold with poorly maintained water, electric Construction work that causes vibration Ensuring housing meets ‘decent homes’
and gas appliances has an effect on physical growth and development, and subsidence in existing homes. standards especially social housing.
reduced immunity to infections and mental health and wellbeing.
Poor maintenance of social housing. Building more cheap and affordable homes.
• Affects all age groups but greatest effects on older people, those
Homes where large families live in Improving the access to housing
with disabilities and children.
overcrowded conditions. maintenance services.

Education Access to education improves the life chances and opportunities of Direct changes to an education or Ensure that existing education and training
people in terms of access to employment, uptake of health promotion training programme e.g. closure of a opportunities are not reduced or affected.
and disease prevention information and being able to articulate need and school and move to a new one.
hence access services more effectively. Increase educational opportunities.
Disruption to access to an education or
• Affects all age groups but greatest effects on children and young training facility or disruption of their
people. ability to deliver e.g. construction.

Impact Effects on health and wellbeing Pathway of impact If the impacts are negative
What possible mitigation
measure(s) would reduce the
negative effects?

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Transport Can lead to traffic which leads to poorer outdoor air quality which in New roads, greater flows of traffic Reduce the outdoor air pollution caused by
turn leads to respiratory problems. because of new or denser housing motor vehicles and industrial factories.
developments, greater flows of heavy
• Affects all age groups but greatest effects on those with pre- traffic because of new or expanded Ensure that residential and outdoor play
existing chronic illnesses and children. business/ industrial facilities. areas are not built near roads with heavy
motor traffic.
Can lead to improved access to services and amenities e.g. health and
social care, parks, leisure centres, etc. which leads to increased health Increase public transport provision
and wellbeing. Increased opportunities for business expansion leading to wherever possible.
more employment opportunities.
• Affects all age groups but greatest effects on older people, those
with disabilities and those with very young children.

Crime and safety Fear of crime causes stress which reduces immunity to disease and Construction and changes in a locality Use ‘designing out crime’ building design
mental wellbeing. can bring in new people and new principles.
routines in a community which can
Actual experience of crime causes stress and physical injury which make crime easier to commit and less Improve local people’s relationships with
reduces physical and mental health and wellbeing. easy to notice. the Police. Build neighbourhood community
networks e.g. neighbour-hood watch.
Buildings that do not have natural Ensure schools, youth facilities and others
• Affects all age groups but fear of crime greatest among women. surveillance from neighbours can create are brought together to develop a
isolated areas where crime can occur collaborative strategy.
without being noticed.

Access to health and social care Reduced access to health services leads to ill-health becoming worse, Disruption to or reduction of public Appropriate planning and communication
services less amenable to treatment and more likely to lead to a permanent transport – buses, tube trains, trams, about disruption to access.
physical or mental impairment. Reduced access to social care services cycle routes, pedestrian paths, etc.
leads to stable chronic conditions becoming worse and the loss of Ensuring alternatives are developed.
independent living skills which in turn lead to greater physical and Closure of local facilities or disruption
mental impairment. during a move to a new facility.

Social cohesion and capital Disruption and reduction in the quality of the social relationships and An proposal that is disliked and not Ensuring that there is acceptance of an
social networks that local people and communities have can lead to wanted by the community. proposal by local people and affected
feeling isolated and excluded which in turn can lead to depression and groups. Ensuring that everyone benefits
poor mental wellbeing. It can also make individual more vulnerable to An proposal that benefits some people and those that don’t are compensated.
crime and to reduce their access to health and social care services. at the expense of others.

Environment Dirty and poor quality built environments as well as little or poor quality Reduction in street cleaning amenities Ensuring that green space is
green space have a negative effect on mental wellbeing. and park officers, etc. looked after and managed.

Health appraisal – detailed adapted from the East London and Merseyside HIA models

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What are the potential Will the What stakeholder/s When is the impact EVIDENCE OF IMPACT EVIDENCE OF IMPACT Mitigations
effects on …..? change be are likely to be likely to occur - TYPE - SOURCE (how can the negative
+/- affected? (start, during or end of impacts be reduced)
Themes for the proposal)
people’s (reports, reviews, (agency, institution,
surveys, experiences) expert, community)
health? Enhancements

infectious diseases
e.g. TB, measles, food
poisoning, salmonella, BSE,
SARS

non-infectious/ chronic
diseases
e.g. heart disease, cancer,

accidents & physical


injuries

mental health &


wellbeing

Health appraisal – detailed contd…

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What are the potential Will the What stakeholder/s When is the impact EVIDENCE OF IMPACT EVIDENCE OF IMPACT Mitigations
effects on …..? change be are likely to be likely to occur - TYPE - SOURCE (how can the negative
+/- affected? (start, during or end of impacts be reduced)
Themes for the proposal)
people’s (reports, reviews, (agency, institution,
surveys, experiences) expert, community)
health? Enhancements

housing &
accommodation

education & learning

employment & economy

transport & connections

Health appraisal – detailed contd…

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What are the potential Will the What stakeholder/s When is the impact EVIDENCE OF IMPACT EVIDENCE OF IMPACT Mitigations
effects on …..? change be are likely to be likely to occur - TYPE - SOURCE (how can the negative
+/- affected? (start, during or end of impacts be reduced)
Themes for the proposal)
people’s (reports, reviews, (agency, institution,
surveys, experiences) expert, community)
health? Enhancements

crime & safety

social capital &


community cohesion

health & social care


services

retail shops and other


amenities

Health appraisal – detailed contd…

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What are the potential Will the What stakeholder/s When is the impact EVIDENCE OF IMPACT EVIDENCE OF IMPACT Mitigations
effects on …..? change be are likely to be likely to occur - TYPE - SOURCE (how can the negative
+/- affected? (start, during or end of impacts be reduced)
Themes for the proposal)
people’s (reports, reviews, (agency, institution,
surveys, experiences) expert, community)
health? Enhancements

culture & leisure

lifestyle & daily routines

energy & waste

land & spatial

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Blank Page for Notes

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Evaluating the evidence
Assess how strong the evidence of positive or negative health impacts is likely to be by
answering as honestly as you can the following questions.

Answers showing Answers showing


the evidence is the evidence is less
To your knowledge
more likely to be of likely to be of good
good quality quality
Research
Yes Does the evidence for each impact come from more than No
one source?

Yes Is the evidence for each impact of more than one type (i.e. No
both quantitative and qualitative and/or a range of
quantitative and qualitative studies/reports)?

Yes Has some or all the evidence for each impact been reviewed No
by other research experts (peer-reviewed and/or published)

No Is the evidence for each clear and consistent or are there Yes
areas of ambiguity and differences of emphasis in the
different types and sources of evidence?
Front-line experts and professionals
Yes Is there broad consensus among front-line experienced No
experts and professionals that the impacts can/do occur in
these kinds of proposals?
Yes Is there broad consensus among experienced front-line No
experts and professionals that the evidence for each impact
is sound?
Lay publics
Yes Is there broad consensus among resident and communities No
who have experienced the impacts (lay experts) that these
impacts can/do occur in these kinds of proposals?
Yes Is there broad consensus among the public (non-experts) No
that the evidence for each impact is sound?
Assessors/Evaluators
Yes Do the assessors/evaluators of the evidence of impact have No
experience and expertise in reviewing health and social
care evidence?
Social Context
No Is there current heightened public concern and/ or local, Yes
regional or national political issues surrounding some or all
the impacts?

More likely = TOTAL Less likely =

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7. What is Consultation?

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7.1 Who to consult?

Write down the key individuals and groups you have consulted in the past.

Stakeholder Why did you want to consult them?

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7.2 How to consult?

Write down the key methods you have used to consult these individuals and groups.

What methods have you used to talk to them?

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8. Developing a
Consultation Plan

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Consultation plan

What group/s of people is the proposal aimed at?

…………………………………………………………………………………………………………

…………………………………………………………………………………………………………

What group/s of people does the proposal not target or exclude from benefiting?

…………………………………………………………………………………………………………

…………………………………………………………………………………………………………

What public, voluntary and private sector organisations will the proposal benefit or work
with?

…………………………………………………………………………………………………………

…………………………………………………………………………………………………………

What public, voluntary and private sector organisations will the proposal not benefit or
work with?

…………………………………………………………………………………………………………

…………………………………………………………………………………………………………

What do other influential stakeholders think e.g. journalists, local politicians,


professional groups?

…………………………………………………………………………………………………………

…………………………………………………………………………………………………………

What is the overall aims/objectives of the consultation?

…………………………………………………………………………………………………………

…………………………………………………………………………………………………………

…………………………………………………………………………………………………………

…………………………………………………………………………………………………………

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…………………………………………………………………………………………………………

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Consultation plan
Aim of consultation Key issues to be discussed Consultation method/s Potential difficulties
Stakeholder in doing the Options
consultation

Public

Consultation plan contd…


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Aim of consultation Key issues to be discussed Consultation method/s Potential difficulties
Stakeholder in doing the Options
consultation

Professionals

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9. Consultation
Role Play Exercise

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Stakeholder Consultation Meeting

The occasion
The scene is a stakeholder consultation meeting to discuss the implications of the proposed
developments/projects.

The stakeholders
The following stakeholders are represented at the meeting
 Residents
 Media
 Private Developer
 Local Authority
 Health Agency
 Existing Businesses
 Local Voluntary Group

The issues
Each stakeholder sees things from a range of perspectives, have different priorities and see a lot to gain
and lose. Some issues are described in the prompts below. You may identify other and more interesting
issues that you would like to bring up.

The task
Each stakeholder group has 15 minutes to think through what the key issues are for them before the
meeting starts.

The meeting will be chaired and facilitated by a community development and stakeholder engagement
officer from one of the local district authorities (the trainers).

The agenda
1. Introductions (going round the table with each stakeholder group saying who they are and why
they are here).

2. Each stakeholder then tells the others what their key concerns/ objections are (max 3min)

3. A round table discussion ensues with the group aiming to reach some consensus on the way
forward and how key objections and issues can/ should be dealt with.

4. Five key recommendations on what should be done next are developed by the group as a whole.

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Blank Page for Notes

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10. Key Conclusions,
Mitigations
and Enhancements

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Key conclusions

IMPLEMENTATION OR CONSTRUCTION PHASE

Question Answer 

What are the key potential positive


impacts?

What are the key potential negative


impacts?

What groups are likely to be affected


positively?

How?
Will this widen existing health inequalities?

What groups are likely to be affected


negatively?

How?
Will this widen existing health inequalities?

How strong is the evidence for the positive


effects?

Do the affected communities agree?

How strong is the evidence for the negative


effects?

Do the affected communities agree?

Key conclusions contd…


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OPERATION OR WORKING PHASE (short & long term)

Question Answer 

What are the key potential positive


impacts?

- short term
- long term

What are the key potential negative


impacts?

- short term
- long term

What groups are likely to be affected


positively?

How?
Will this widen existing health inequalities?

What groups are likely to be affected


negatively?

How?
Will this widen existing health inequalities?

How strong is the evidence for the positive


effects?

Do the affected communities agree?

How strong is the evidence for the negative


effects?

Do the affected communities agree?

Key conclusions contd…

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END OF PROPOSAL PHASE

Question Answer 

What are the key potential positive


impacts?

What are the key potential negative


impacts?

What groups are likely to be affected


positively?

How?
Will this widen existing health inequalities?

What groups are likely to be affected


negatively?

How?
Will this widen existing health inequalities?

How strong is the evidence for the positive


effects?

Do the affected communities agree?

How strong is the evidence for the negative


effects?

Do the affected communities agree?

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Mitigation and enhancement
Question Answer 

What are the key options to reduce


(mitigate) the potential negative impacts
for each stage:

implementation/ construction phase

operation/ working phase (short & long term)

end of proposal phase

What are the key options to increase


(enhance) the positive impacts?

implementation/ construction phase

operation/ working phase (short & long term)

end of proposal phase

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11. What is Monitoring
and Evaluation?

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11.1 Outputs

What health and wellbeing (or other) outputs are you currently measuring in your work ?

Area Output Why?

Diseases

Crime

Employment

Education

Transport

Housing

Health & social care


services

Social capital

Culture & leisure

Quality of life

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11.2 Outcomes

What health and wellbeing (or other) outcomes are you currently measuring in your work
?

Area Outcome Why?

Diseases

Crime

Employment

Education

Transport

Housing

Health & social care


services

Social capital

Culture & leisure

Quality of life

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Monitoring and evaluation
Question Answer 

What monitoring processes will you put in


place to ensure that negative health
effects are reduced?

What indicators will you use?

What monitoring processes will you put in


place to ensure that positive health effects
are enhanced?

What indicators will you use?

How will you evaluate the proposal in


terms of health outputs and health
outcomes?

- process evaluation
- impact evaluation
- outcome evaluation

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Process evaluation
Did the proposal have explicit values to guide its design and implementation and what were they?

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

To what extent did the proposal work to these values?

………………………………………………………………………………………………………………………………

If the proposal did not have explicit values what values should have been used to guide the design and
implementation and to what extent did the proposal work to these values?

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

Impact evaluation
What were the objectives of the proposal in the short term?

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

To what extent did it achieve those objectives? What enhanced and what hindered the achievement of
those objectives?

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

Were these the right objectives for the proposal?

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

Outcome evaluation
What were the objectives of the proposal in the long term?

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

To what extent did it achieve those objectives? What enhanced and what hindered the achievement of
those objectives?

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

Were these the right objectives for the proposal?

………………………………………………………………………………………………………………………………

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………………………………………………………………………………………………………………………………

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12. What can we do?
What should we do?

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Upstreamers versus Downstreamers

“Once upon a time in a land far, far away.


Villagers living in a village on the banks of a river
began to find drowning people being washed away by the river
and calling out for help.

1. As a villager what 3 things would you do in the short term?

Short term options

Questions

1. Why did you choose the options that you did?

………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………

2. Did you use any criteria if so what were they?

………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………

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2. What 3 things would you or could you do in the long term?

Long term options

Questions

3. Why did you choose the options that you did?

………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………

4. Did you use any criteria if so what were they?

………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………

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Recommendations
Question Answer 

What key recommendations emerge from


your assessment?

Should the proposal go ahead?

How should the proposal be taken forward so that


it is provides the greatest health benefits?

Which mitigation and enhancement options will


local people and/or other key stakeholders find
most acceptable?

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Blank Page for Notes

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13. To Do of Not to Do
That is the Question?

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On the horns of an ethical dilemma or two!

The following are amalgamations of real life situations faced by HIA practitioners during
the course of planning, implementing and writing up a HIA.

Case

1 You are asked to undertake a rapid HIA which the client – a local authority -
wants to keep confidential for their use only on an issue of local community
concern. However as part of the HIA you have talked to many local residents who
will be affected by the proposal and who have expressed a strong desire to read
the report.

2 You are asked to undertake a HIA to help in a planning inquiry - involving legal
representation - to present a case that one development option is better than
another for a private sector developer. The client wishes to present the best
case possible for the positive health benefits of their case.

3 You are doing an HIA on a new proposed proposal and are asked to identify only
the positives to help support the business case for the proposal to be funded by a
national government department.

4 You are asked to undertake a HIA on the siting of a mobile phone transmitter
mast on a run-down council estate. This has upset and angered many local
residents especially those with children who are opposed to the siting. The
income from the mast siting will be used to refurbish the estate.

5 You have presented your HIA statement/report and while some aspects of the
recommendations have been actioned many of the key issues have not been
taken forward or even discussed. You are keen to help to move forward the
programme but other organisational priorities and the uncertainty around when
and if the proposal will go ahead has made the HIA less pertinent and relevant to
the organisation.

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What’s the key ethical dilemma is How would you resolve this and
involved here? what would the likely
consequences of your decision be?

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HIA evaluation
Question Answer 

What was the proposal that was assessed?

What type of HIA did you undertake?


What HIA model/method did you use?
Why?

What were the costs (financial, human, time)


involved and could these have been better spent
elsewhere?

Did you use a wide range of evidence sources to


make the assessment and did they inform the HIA’s
recommendations?

Were health inequalities assessed and if so how


were they assessed?

How were recommendations formulated and


prioritised?
What factors influenced this decision-making
process?

Were decision-makers involved and engaged in the


process and if so how was this done?
What were their expectations and were they
fulfilled?

Were the recommendations delivered in a form and


within a timescale that was relevant and
appropriate to decision makers?

What did the steering group, consultees and others


involved in the HIA think about the HIA process and
the
method used?

HIA evaluation contd…


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Question Answer 

Were all or some of the recommendations accepted


and implemented by the decision makers?

What factors contributed to their


acceptance or rejection?

Were the aim and objectives


of the HIA met?

What other impacts were associated with the HIA?

- improved partnership working,


- raising the profile of local health needs and
putting health on partner agencies’ agendas,
- organisational development
- new ways of working within and across the
organisations involved

(Adapted from the Health Development Agency Learning from Practice Bulletin ‘Evaluating Health Impact Assessment’
by Taylor, L., Gowman, N., Quigley, R. 2003.)

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Centre for Health Impact Assessment, Institute of Occupational Medicine
Research House Business Centre, Fraser Road, Perivale, Middlesex. UB6 7AQ

Tel: 020 8537 3491/2 Fax: 020 8537 3493

Website: www.iom-world.org