Health Impact Assessment and other impact assessments

Integrated Impact Assessment

Policy makers have a growing number of impact assessments to carry out as part of policy making and planning, including economic assessment, environmental impact assessment, sustainability appraisal, equality impact assessment, assessment of effect on families, assessment of effect on law and order and many more.

There is a clear need to reconcile and combine these various assessment processes to reduce the burden on policy makers and make any trade-offs between different development areas explicit.

This has led to growing interest in integrated assessments, or at least integrated assessment screening, which include environment, health, equality, economic and other impacts as appropriate. Including health within integrated assessment can ensure it is considered as part of a wider framework and reduce duplication of assessment.

An integrated screening approach has been adopted successfully in NHS Lothian, which is using the Rapid Impact Assessment (RIA) checklist to screen for impacts on both health and equality and diversity. It is Lothian NHS board policy for all new strategies and policies to undergo RIA. If significant issues are identified, a more detailed assessment is carried out, the nature of which depends on the impacts identified.

Some Scottish local authorities have adopted a similar approach incorporating health, equalities and environmental impacts. Examples include Fife and West Dunbartonshire. Community Planning Partnerships are an ideal forum to develop these approaches.

In 2008, Equally Well (external link), the report of the Scottish Ministerial Task Force on Health Inequalities, recommended the further development of Integrated Impact Assessment in which impact on health inequalities should be a clear component. This process led to the development of Health Inequalities Impact Assessment.

Strategic Environmental Assessment (SEA) and HIA

Strategic Environmental Assessment (SEA) is environmental impact assessment as applied to strategies, plans and programmes rather than projects. SEA aims to ensure that significant environmental effects are identified, assessed, mitigated, communicated to decision-makers, monitored and that opportunities for public involvement are provided.

The EU directive on SEA was introduced in July 2004 and includes a list of project proposals that must be subject to an SEA. In Scotland the scope of SEA was expanded to cover all public sector strategies, policies, plans and proposals in the Environmental Assessment (Scotland) Act 2005, which came into force in February 2006. Information about SEA in Scotland is available from the Scottish Government's SEA website (external link).

Under the European legislation, SEA requires explicit consideration of significant impacts on ´human health´. Involving health specialists in SEA can help to ensure health impacts are identified and considered.

Another option is to do an HIA in parallel so its findings can be incorporated in the SEA. The SEA process and format of the reports are laid down in the legislation and associated guidance. This does not currently mandate consideration of differential impacts, which can be a barrier to consideration of health inequalities in SEA.

The network produced a briefing paper on integrating HIA into SEA in 2005. Margaret Douglas, Hannah Carver and Vittal Katikireddi have published a paper in Public Health reviewing how health had been considered in 62 SEAs that were undertaken in Scotland during 2007-08. The subject matter of these SEAs included transport, spatial planning, paths/greenspace and environment.

Most SEAs had a health aim or objective. However, involvement of health stakeholders was limited and use of health evidence bases unclear. Furthermore, differential health impacts arising from policies were rarely considered. The paper can be read on the Public Health website (external link). 

Margaret Douglas has also contributed to the review of the Scottish SEA Toolkit (2011-12).

For more information about this research, please contact

Mental wellbeing

In 2008, the network undertook a comparison of the Mental Wellbeing Impact Assessment Toolkit and the Rapid Impact Assessment Checklist used in Lothian. We hoped this would allow us to assess whether mental wellbeing is addressed during HIAs which use a well-established approach.

The comparisons involved plans being developed in different parts of Scotland (Edinburgh, Dundee and Midlothian) on different subjects (homelessness, voluntary service development, reading referral scheme). It became clear that the RIA checklist would benefit from greater attention to control, resilience, participation and social inclusion, which are central to the MWIA approach.

Conversely, the MWIA workshop process was time-consuming and repetitious while the ability of the MWIA process to consider broader health impacts was, in some instances, unclear. There were two suggestions from the work:

  • It seems most productive to view MWIA as an approach to detailed impact assessment which provides excellent consideration of mental wellbeing rather than as a replacement for or alternative to HIA.
  • Screening tools for impact assessment should incorporate more triggers to assess mental wellbeing

The Mental Wellbeing Impact Assessment (MWIA) Toolkit (external link) is available to download from the Health Impact Assessment Gateway. The toolkit reflects (UK) government policy, international evidence and the successful National MWIA capacity building programme from about 2012. The toolkit is now published by the National MWIA Collaborative (England).

The National Mental Health Development Unit has funded a report on the National MWIA Capacity building programme 2010-11 (external link).


Reviewed 10 April 2015

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