Why Projects Need a Health Impact Assessment

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A health impact assessment makes people healthier and projects more effective.


Sustainable development is possible only with a healthy population

Human health and well-being is at the heart of economic and social development. Sustainable development is possible only with a healthy population. Population health is determined by environmental, social and economic factors—determinants of health, that are shaped by developments from all sectors such as agriculture, education, energy, transport, water and sanitation. Therefore, promoting and protecting population health requires action across all sectors. Addressing determinants of health requires intersectoral action for health and a health in all policies approach.

Policies as well as infrastructure projects can affect population health, creating both opportunities and risks. This means development planning needs to consider all options to protect and promote human health at the earliest possible stages. In doing so, it serves the economic strength of national development (preventing the transfer of hidden costs to the health sector), the social face of development (protecting vulnerable groups), and the sustainability of development (no sustainable projects without a healthy human resource base).

What Is HIA and Why It Matters

A health impact assessment (HIA) is an established evidence-based method for identifying, rating and managing the positive and negative, intended and unintended impacts of development actions (from policies to projects) on human health. It is a structured process that combines scientific evidence and community engagement to inform decision-makers about how they can maximize the health benefits and minimize the adverse health impacts of development.

A key aim of these assessments is to ensure that benefits of development can be shared more equitably across all affected communities and that negative impacts do not fall disproportionately on the most vulnerable. HIA can produce quantitative estimates of potential health outcomes (e.g., modeled increases/decreases in the concentration of air pollutants can be converted into modeled increases/decreases in hospital admissions for cardio-respiratory illnesses), with potential to inform project economic internal rate of return, but only for a limited number of impacts (the exception). Most impacts are assessed qualitatively whereby evidence (both scientific and community) is gathered to establish probable causal pathways linking projects/policies to health determinants and health outcomes.

Some key drivers for undertaking HIA

  • HIA is good for public health. Prevention is more cost-effective than treatment.
  • HIA is good for economics. It prevents health externalities of development that place an additional economic burden on health systems (cost of treatment) and society (loss of productivity and social welfare costs).
  • HIA promotes project sustainability. It helps achieve and maintain social license to operate.
  • HIA contributes to health security. It identifies and manages the causes of health security issues that arise from developments in other sectors.

Moreover, HIA looks at how infrastructure development is contributing to attaining Sustainable Development Goal (SDG) 3: “Ensure healthy lives and promote well-being for all at all ages.” Other SDGs also cover a range of key environmental and social determinants of health, such as food security and nutrition, access to water, sanitation, clean energy, good-quality built environments, sustainable transport, and road safety. HIA can support the realization of additional health benefits from achieving these SDGs. 

What Is an Ideal HIA Process?

An overview of the HIA process is depicted below. The procedure is the management process by which the technical specialist uses the method. Main components include:

  • Screening the project and assigning to a potential impact category.
  • Scoping the impact assessment.
  • Scheduling the assessment.
  • Project description with components that will impact health during construction and operation
  • Summarizing applicable legislative, policy, and regulatory frameworks and standards.
  • Preparing a baseline report of health conditions in the project location.
  • Performing the HIA guided by terms of reference.
  • Preparing the impact assessment report.
  • Reviewing and appraising the impact assessment report.
  • Formulating the public health management plan, with a comparison of options and negotiation of resources.
  • Implementing the public health management plan, with a strong monitoring component.

Susann Roth
Advisor, Office of the Principal Director, Department of Communications and Knowledge Management, Asian Development Bank

Susann Roth launched ADB’s first Futures Thinking and Foresight Program and ADB’s first Technology Innovation Challenge and led the design of ADB’s new Knowledge Management Action Plan. She advises the World Health Organization on foresight, digital health, innovation, and knowledge management.

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