I wrote this textbook because there wasn’t one and I wanted to record my knowledge and experience, what I knew and didn’t know. I did not intend that it would cover all, or even most, of the vast field of HIA. I do not expect it to satisfy all my peers. If I had set my own expectations so high, then I would not have written it.
HIA: Principles and PracticeMartin2020-08-07T13:19:06+00:00
HEALTH IMPACT ASSESSMENT
Health Impact Assessment (HIA) is primarily concerned with the future consequences of plans, proposals and policies on the health of communities. It is a rapidly growing complement to Environmental Impact Assessment, increasingly mandated by national and international requirements. Guidelines have been produced by many national and international organizations and it is being introduced in a number of undergraduate or postgraduate university curricula. However, there has been until now no broad-based, introductory text of international scope to the subject, suitable for both these courses and for professional training.
The purpose of this book is to fill this gap and to introduce the subject of Health Impact Assessment using plain language, in both general and specific contexts and with reference to both market and less developed economies. As a result, the reader should be able to describe what HIA can and cannot achieve, identify the components of a successful HIA and participate in an assessment as a member of a team. Examples are provided from a number of planning and development sectors, including extractive industry, water resource management, and housing. The reader, whether student or professional, need not be a health specialist, although prior knowledge of some public or environmental health would be an advantage.
ABOUT THE AUTHOR
Dr Martin Birley is an independent international consultant in Health Impact Assessment, former Senior Lecturer at the University of Liverpool, UK, and former Senior Health Advisor on HIA at Shell. He has been at the forefront of global health impact assessment for over 30 years. He was involved in the development of the discipline since its early days in tropical medicine, to its later emergence as an instrument both for healthy public policy in the UK and Europe, and for community safeguards by international development banks.
He has personal experience of many sectors including water resource development, agriculture, oil and gas, housing and planning. He has written guidelines for health agencies, development banks and multinational corporations. He continues to work all across the globe as well as in the UK. He runs training courses for institutions worldwide. He currently heads up a London based consultancy, www.BirleyHIA.co.uk .
Martin’s depth of experience places him in an ideal position to provide an introduction to the rapidly expanding field of health impact assessment, for the benefit of newcomers and experienced practitioners alike.
1. Introduction 2. Health and its determinants 3. History of HIA 4. HIA Management 5. Methods and tools 6. Baseline 7. Prioritization 8. Recommendations 9. Water resource development 10. Extractive industries 11. Housing and spatial planning 12. Current and future challenges 13. Sources of further information 14. Glossary and acronyms
Aslo available as E-book from Kindle, Acrobat and perhaps other formats.
HIA: Principles and Practice – Preface I have watched HIA grow from an off-the-wall, cranky kind of idea to a mainstream pursuit. I am reminded of Schopenhauer’s dictum that all truth passes through three stages: first it is ridiculed; then it is violently opposed; finally it is accepted as being self-evident. In the early days I was told that I was wasting my time, and later I was told it was an inappropriate academic pursuit. Now I am told it is self-evident. The material for the book grew from teaching and training material that have been used and tested in many introductory lectures or courses on the subject. The audience for those courses have been drawn from many cultures and have included both postgraduate students and professionals. About half have had some form of health background such as medicine, nursing, occupational safety or community health. I have observed the bewilderment of experts without health backgrounds when presented with the question “what is health?”, as well as the bewilderment of those with health backgrounds when presented with the proposition that health is largely determined by decisions made outside the health sector. Many of the training courses have had an inter-sectoral focus. Experts from widely different disciplines do not always have skills in framing questions or explanations to colleagues in other disciples. I hope I have included enough explanation and examples to make my meaning clear to readers from many different disciplines.
HIA is now conducted in such widely different settings and contexts that they seem to be speaking a different language and have very different aims and objectives. Finding the common thread is getting harder. For example, there are civil servants in the UK who seek to maximise the health gain of local public sector policies. On the other hand, there are managers of transnational corporations who seek to safeguard the reputation of their company while implementing a project in a rural area of a least developed country. There are policy makers in the European Commission who seek to ensure that new social policy conforms to treaty agreements.
There are still vast and unexplored territories in the area of expertise covered by HIA. These await discovery by the next generation of practitioners. I try to map out some of the issues that have yet to be resolved and to put them in the context of examples based on my own, and others, experience.
Typing and similar errors persist despite detailed editing. Here are the ones I’ve spotted. please let me know of others: P60: Replace /m² with /m³
Chapter 10 Extractive industries. Section 10.8.1 Case study from Wales, UK.
The case study examined a successful community led HIA of an opencast coal mining proposal in Wales. The outcome was in marked contrast to another, unsuccessful, community led objection to the Ffos-y-fran mine, on the outskirts of Merthyr Tydfil. For adverse comment see the artice by George Monbiot “A vast new opencast pit will ruin local people’s lives and wreck the government’s climate change policies. How was it allowed to happen?” here.
The association between the resource curse and the spread of HIV/AIDS 1990-2008 has been explored by Ismene Gizelis in an unpublished paper entitled “ A quiet killer” presented at the Annual Convention of the International Studies Association (ISA), Montreal, Canada, March 16–19, 2011. “Using the latest available estimates of HIV/AIDS infected populations per total population size (WHO/UNAIDS 2006), we find that countries that gain a higher share of national wealth from oil extraction tend to have higher levels of infected populations, net of a host of relevant controls, such as per capita income, regime type, the rate of prevalence in the neighbourhood, and the history of political violence”.
An IMF working paper by Atsushi Iimi (2006) entitled “Did Botswana escape the resource curse?” argues that good governance tends to link natural resources positively with high capital growth. Botswana is cited as an example.
On the other hand, Botswana also has a very high rate of HIV infection. This raises the question, as yet unanswered, as to whether Botswana’s economic success has nevertheless been bought with a health impact.
Book update: Steps to Healthy Planning: Proposals for Action
Chapter 11: Housing and spatial planning; 11.2 Spatial planning in England;
New report published: Steps to Healthy Planning: Proposals for Action.
In recent years much evidence has accumulated which shows just how important the physical, social and economic environment in which we live and work is for our health. Many of the issues that spatial planners are responsible for, interact with human health and can, if we get them right, contribute to improving our physical and mental health, and diminish inequalities in health. Decisions about local transport and open space, for example, can have long-term consequences on health.
A report, called Steps to Healthy Planning: Proposals for Actionsuggests 12 Action Points for how town planning can improve public health. These identify practical actions that would improve health outcomes and the people or groups that should carry out such actions. It provides a clear and concise way for planning and health professionals to work together.
The foreword to the report, written by eminent health inequalities expert, Professor Sir Michael Marmot, highlights the importance of spatial planning to health outcomes, pointing out the potential for town planning to make a difference for those with the poorest health.
The Spatial Planning and Health Group was formed from the NICE (National Institute for Health and Clinical Excellence) Spatial Planning and Health Programme Development Group (PDG), appointed by NICE to examine the available evidence related to spatial planning and health. SPAHG began after the PDG ended in November 2010.
Book update: published in Chinese (2017) With many thanks to my publisher, and Chinese colleagues who were supportive during an earlier lecture tour.
‘Martin Birley was a pioneer of health impact assessment, working first in low income countries and more recently also in the UK. This book is the crystallisation of these years of experience. It is ambitious in scope, being designed primarily as a practical guide for those wanting to do HIA and including detailed explanations of key concepts, approaches and methods, with case studies and exercises.
There are chapters on the issues to consider in HIAs of three key sectors – water resource management, extractive industries and housing and spatial planning – which will give practitioners insight into specific sectoral issues. My own favourite section is on the history of HIA, which challenged my understanding of how different approaches to HIA developed and the assumptions underpinning these.
This book will be invaluable to those already working on HIAs as well as those wanting an introduction to the basic steps. ‘
Margaret Douglas, Consultant in Public Heath, Edinburgh, Scotland
“It is a comprehensive description and discussion of an important area of public health where there are few/no alternative texts. The quality of the arguments is very high. This is a key text in an undersupplied and important area for public health practice”.
British Medical Association, September 2012
With many practical examples from throughout the world, teamed with thoughtful discussion and considered theory, this book provides a bridge for all people interested in the art and science of impact assessment to further develop their understanding and knowledge.’
Robert Quigley, Director, Quigley and Watts Ltd; Co-Director, HIA Research Unit, University of Otago, New Zealand
‘This is an excellent handbook on international HIA by one of the pioneers of HIA theory and practice. It has something for new and experienced HIA practitioners alike. The case study examples, his tips on how to avoid common pitfalls and his insights into how to enhance the value of a HIA are outstanding. This is a must-have book that should be on the desk of anyone who undertakes, commissions or teaches HIA in both developed and, especially, developing countries.’
Salim Vohra, Director, Centre for Health Impact Assessment, Institute of Occupational Medicine, London
‘This is a very comprehensive overview of Health Impact Assessment from a UK and international perspective and will be most useful for both beginners and experienced practitioners. The structure makes it easy to use as a reference book and the wealth of examples bring it to life. It is an excellent contribution to ensuring that HIA continues to develop as an internationally recognised and valued methodology for assessing new developments for their impact on people’s lives and the environment we live in.’
Colleen Williams, former HIA Policy lead at Department of Health, London
‘I warmly commend this book. Apart from being by far the most useful work on how to operationalize Health Impact Assessment, the book is brilliantly comprehensive and a profoundly wise distillation of the author’s unparalleled experience worldwide.’
Robert Goodland, former Senior Environmental Advisor to the World Bank Group in Washington, DC, and former president of the International Association for Impact Assessment
To many people, Health Impact Assessment is a new concept requiring new skills. A pioneer and global expert in the subject, Dr Birley has been grappling successfully with this challenge for many decades. His book reveals extraordinary experience and insight, providing depth and context to existing HIA guidelines, invaluable to those who are trying to use them.’
Professor Sir Michael Marmot, professor of Epidemiology and Public Health, University College London, Chair Commission on Social Determinants of Health and the Strategic Review of Health Inequalities in England post 2010 (Marmot Review) and current president of the BMA
Water-associated infectious diseases claim up to 3.2 million lives each year, approximately 6% of all deaths globally.
The extractive industry significantly transforms environments, communities and economies and may manifest in conflicts between a resource developer and local communities
Poor housing and indoor environments cause or contribute to many preventable diseases and injuries, such as respiratory, nervous system and cardiovascular diseases and cancer.
Growing rates of obesity worldwide are linked to a rise in chronic diseases such as cancer, cardiovascular disease and diabetes Healthy urban design is part of the solution and can depend on health impact assessment of plans and policies.
BirleyHIA – safeguarding community health
BirleyHIA consultants undertake HIA for Local Authorities, private & public sector organisations in collaboration with project sponsors, regulatory authorities, local communities, and other stakeholders; and within internationally accepted professional codes of practice. The firm also runs HIA training and workshops for individuals and organisations.