Types of HIAs and the HIA

A bicycle and a bicycle image on a sidewalk

There are many approaches to using HIA. These approaches are outlined below and can help you determine what type of process may work for you. 
Read more about HIA and see more HIA resources at the bottom of this page.
Desktop

As the name implies, this HIA focuses mainly on existing research and remote contact with a few stakeholders. It would probably be carried out by one or two people, and may take between two to six weeks.1

Rapid
A rapid HIA uses both existing research and rapid assessment techniques, so it includes some fieldwork. Although it could be carried out by one or two researchers, it may also involve more and can take up to three months.2


See the Rapid HIA Toolkit from LA County for additional guidance.
Intermediate
An intermediate HIA may combine a workshop with key stakeholders followed by desk-based work to build up a more detailed picture of the potential health impacts than would typically be identified during a rapid or "mini" HIA. It may involve a limited literature search, usually non-systematic, and relies mainly on surveillance or routine, readily available data.3
Comprehensive

A comprehensive HIA examines as much evidence as possible, using:

  • An extensive search of the literature and other existing information
  • In-depth interviews
  • Community surveys
  • Some original research if appropriate
  • Input from experts and agencies

This type of HIA can take six months or more, and can require a team to conduct it.4

See Minimum Elements and Practice Standards for Health Impact Assessment published by the North American HIA Practice Standards Working Group.

 

Steps of HIA

HIA has a general framework involving six key steps:5

Screening
The object of the initial screening step is to determine if conducting an HIA is warranted and will be useful to the decision-making process. Factors considered during this process are:

  • Potential effects on the public health as a result of the plan, project or policy 
  • Potential for impacts on vulnerable populations
  • Potential for the HIA to add value to the decision-making process
  • Availability of data, methods, resources and capacity to conduct analysis
  • Buy in from decision-makers

Potential questions to consider when reviewing the drafted proposal during the screening step:

  • Will this proposal impact the public’s health?
  • Will the impacts reduce health inequity?
  • What vulnerable groups (e.g. children older people, people with low income) may be affected?
  • Is the project or plan occurring in a place where other local health problems have been identified?
  • How will the HIA be used?
  • Assessing time and budget needs, which HIA type will work best?

Scoping
During the scoping step, determine which health impacts to evaluate. Collaborate with subject matter experts or community stakeholders to examine community health concerns or potential benefits the plan, policy or project raises. Develop causal diagrams to outline how the plan, policy or project could directly or indirectly affect specific health issues. The diagram will assist in prioritizing which health effects to include in the assessment and in the development of research questions. Data needs will also be identified in this step.

As a result of the scoping process, a plan will be developed that describes the health effects that will be considered in the assessment phase, outlines the research questions and methods that will be used to answer those questions, and describes the roles and responsibilities of the team conducting the HIA and the stakeholders.

Assessment
Once the focal issue(s) of the HIA have been identified, the next step is to describe the current conditions using quantitative and/or qualitative data related to the health issues identified during the scoping step. The assessment activities are dependent on the HIA process selected, tasks range from limited data collection to comprehensive community and stakeholder engagement. 

A mixed method approach can be utilized to evaluate the potential risk factors and health outcomes of the drafted plan, policy or project. This approach can include some or all of the following, depending on the given timeframe and funding: 

  1. a systematic literature review;
  2. primary and secondary data collection
  3. an analysis of existing health data
  4. spatial analysis; and
  5. stakeholder and community engagement

A variety of existing data, as well as, local data for descriptive and analytical purposes is used throughout the report to best represent the health conditions of the affected population. Data is essential to describing the demographic and socioeconomic makeup, health status, health behaviors and health risks of a community. Data can also help to explain the built environment conditions. Guidance from experts, for example, transportation and/or planning, is utilized, as needed, to better understand certain components of the plan, policy or project. Key-informant interviews and focus groups are incorporated to understand local knowledge and expert opinions into the HIA process.

Recommendations
The assessment findings are developed into actionable recommendations that can be adopted and implemented. Depending on the process selected, consider the highest priority health impacts and associated recommendations in the event time may be limited.

Reporting
A report will be provided that documents the HIA process and methods, analysis, findings and recommendations. The report can serve as a resource to the decision-makers, stakeholders and community members. 

Monitoring and Evaluation
Evaluation and monitoring is a key step in the HIA process. This step includes developing a plan to monitor changes in health and assess the efficacy of the measures that are included. The plan will involve assigning responsibilities for monitoring with the HIA team and partners, as well as creating a timeline and evaluation processes.

HIA has broad relevance to wide-ranging policies, plans, and projects, making it a practical tool for informing decision makers. 

For more detailed information about the steps of a health impact assessment, please visit the links below.

Resources

NEXT: HIA Case Studies

Resources

1. KU Work Group.
2. KU Work Group.
3. Adapted from: UCLA Health Impact Assessment Project. (n.d.). Glossary.
4. Adapted from: KU Work Group for Community Health and Development. (n.d.). Community Tool Box Chapter 2 Section 11. Health Impact Assessment. Retrieved from http://ctb.ku.edu/en/table-of-contents/overview/models-for-community-health-and-development/health-impact-assessment/main
5. Adapted from: The Pew Charitable Trusts. (2014, August 26). Retrieved from http://www.pewtrusts.org/en/research-and-analysis/analysis/2014/08/28/the-hia-process