HIA is a developing approach that has started to provide evidence that it positively influences policies, programmes and projects. Beyond the countless number of positive anecdotes about the success of HIA, practitioners are now providing evaluation data to show the effectiveness of HIA. Like all public health interventions, little formal evaluation has been done and ‘proving’ HIA works is very difficult, but the three examples given show how the HIA community is now beginning to engage with evaluation.
London Mayoral Strategies HIA (England)
What was the HIA on?
An independent retrospective evaluation of two HIAs carried out on the London Mayoral Strategies and a concurrent evaluation of another two.
How did they evaluate it?
The methodology was used a qualitative approach with interviews with workshop attendees, observation of the HIA workshops and preparation meetings, and use of self-completed questionnaires. Work to track what recommendations the respective strategy development teams will take forward was undertaken.
What did it show?
The HIAs raised the awareness of the social model of health amongst those whose roles were not primarily health related. This resulted in the strategy development teams taking greater account of public health issues when drafting the strategies. HIA played a role in public health considerations becoming embedded within the development of the Mayoral strategies. Most importantly, the HIAs have influenced strategy. The strategy development staff report that they have taken health into account during the drafting stages because they knew it would be subjected to HIA and they have revised the strategy as a result.
Finningley Airport HIA (England)
What was the HIA on?
An HIA undertaken on a proposed development of a former RAF airbase at Finningley in Doncaster into a large commercial airport. This was the first time for an HIA to be undertaken as part of the planning process for an airport in the UK.
How did they evaluate it?
A descriptive process evaluation was undertaken. The source of data was a document analysis of the minutes of Working Group and Steering Group meetings. An impact evaluation is currently underway. This uses Theory of Change modeling to predict future health outcomes.
What did it show?
The process evaluation showed that the HIA had been systematic and comprehensive. The Merseyside model for comprehensive HIA lent itself particularly well for an HIA on a planning application.
Useful lessons were identified from the evaluation:
- The technical information in the environmental impact assessment was used to predict health impacts. Experts were commissioned to fill gaps in local expertise.
- WHO guidelines were used in the HIA which, in some instances, were more stringent than statutory levels.
- Recommendations were made to maximise positives and minimise health risks, without needing to quantify or rank the predicted impacts.
- Ensuring planners and developers recognised the importance of the HIA (and were informed of its progress) helped take the recommendations forwards.
The Health Authority worked proactively with planners and the airport developers to implement the recommendations, and influence the regulatory agreement between planners and developers. It is planned that an Airport Health Impact Group will continue HIA activities throughout the lifetime of the airport.
The impact evaluation demonstrates how the HIA has added value to the planning process, and predicts the future health outcomes expected.
Alconbury HIA (England)
What was the HIA on?
An HIA was carried out on the redevelopment of Alconbury airfield. The proposal was to turn the old airport into a large rail and freight distribution centre (no use of the runway was planned).
How did they evaluate it?
An external auditor undertook a concurrent evaluation. The auditor was given full access to all relevant meetings and documents and a good working relationship was developed. Constructive notes were sent from the auditor to the steering group after each meeting, which offered the opportunity for on-going improvements to the process.
What did it show?
The recommendations from the evaluation were very helpful – both during the process and to follow up after the process (Process Evaluation). The Airfield Development has been delayed, and so the impact of the HIA on the decision making process is still awaiting investigation (Impact Evaluation).