The Lincolnshire Health

Impact Assessment Process and Tool

Working from the definition of Health Impact Assessment: -

Health Impact Assessment is a technique, which provides decision-makers with

insight into the health consequence of their decision-making (BMA 1998). When
we then look at the areas of work and policy making that has the greatest impact
on the determinants of health, we see that this is predominantly to be found within
local government.

It is envisaged that the majority of HIA being undertaken would actually be on a

smaller scale than those published within the academic press. A “Process” and
“Tool” which was user friendly is what colleagues asked for.

The Lincolnshire Health Impact Assessment Process and Tool have been created
by working closely with colleagues from local government, health organisations
and universities. This material is still being developed, piloted and modified. A
‘reference’ group has been formed that will continue the process of reflection,
action, implementation and evaluation. This process will enable us to adapt the
tool as expertise in undertaking Health Impact Assessment (HIA) grows.

A ‘Toolkit’ to support colleagues involved with HIA is being developed. This will
initially be in a document format, but will shortly be available on Trent Regional
Observatory Web site( ) This ‘Toolkit’ will contain useful references and links
to web sites providing ward level data and examples of good practice.

Modules on HIA are currently being developed with the University of Lincolnshire
and Humberside. It is envisaged that they will make up a PostGraduate Certificate,
which can then be incorporated, into a Masters in Professional Practice.

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 The Lincolnshire Health
Impact Assessment Process

Introduction

The process of undertaking an HIA is as important as the ‘Tool’ you use to

quantify your data. The outcome of the assessment can be undermined if the
process is not thorough and inclusive. The involvement of stakeholders and the
transparency of the decision-making increases the validity of the HIA

The following guidelines are designed to take you through the HIA process in a
sequential manner. They are particularly intended for those colleagues who have
not been involved in HIA before and need help with where to start. We hope they
will lend themselves to a variety of applications and settings. Feedback with regard
to any problems in applying the tool and process would be very useful and will
enable the reference group to make the necessary modifications.

The HIA that have been published have tended to be on very-large scale projects.
We do not envisage that organisations can be involved in very many such HIA.
They are too costly and time consuming. However, we do hope that from a good
practice point of view organisations will consider undertaking HIA in order to
maximise the benefits of their proposals and to minimise the negatives.

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 Lincolnshire Health Impact Assessment Process

Guidance Notes

“Health Impact Assessment is a technique, which provides decision makers with

insight into the health consequences of their decision making” (BMA ’98)

1. What is the project/ policy to be developed?

It may seem obvious, but it is absolutely essential that the aims and objectives are
very clear; the simpler the better. It may also be useful to describe the background
to the project, for instance; what was the original thinking/ motivation and who
were the key players.

If the project/policy was as a consequence of a needs assessment or a policy

directive then this needs to be pointed out.

Maybe the project/policy is a part of a major piece of work, i.e. An SRB bid or
something similar. Again it is useful to include this in the background information.

The overall vision of the project/policy should also be described.

(N.B. Objectives are simply ‘at the level of operational tasks, which have to be
accomplished in order to meet aims’ St. Leger et al 1992)

2. Apply screening tool

We recommend that you apply a screening tool (Sue Milner DOH/ University of
Northumbria) at this stage to identify whether the project will have an impact on
health.

3. Identify and bring partners together

These will be the people with an interest in the project and a responsibility in
seeing it come to fruition. At this stage you will need to: -

• Present the project

• Identify who is missing
• Determine whether you can proceed
• Agree a common definition of health
• Identify the populations affected by the piece of work

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4. Apply tool of your choice

It may be that the HIA, depending on the scale of the project will be a quick
tabletop exercise that you conduct on your own or with a small team with whom
you work. However, it may at this stage of a much larger scale piece of work to
quickly sit down and work through an HIA. This will give you an idea of: -

• The scale of the exercise

• Who needs to be involved (stakeholders)
• Possible time scales
• Evidence you need to be collating
• Amendments that can be made at this stage

When identifying the stakeholders it is important to understand that this could be a

very biased exercise. One of the advantages of undertaking an HIA is that it makes
the decision making process transparent. It is important to ensure that as many
people as possible are identified at this stage, this will save time and political
problems later

5. Conduct literature search

The extent of this search will depend upon the size of the project. It is important
to know of any research, evidence of good practice or examples of similar work
that are relevant to what you want to achieve. This is particularly important if you
are interested in applying for funds from grant making bodies. It can only help an
application if you can demonstrate that what you are proposing is built on evidence
of success elsewhere. Alternatively, the opposite may be true, you may need to
demonstrate that what you are proposing fills a gap. But again you have to prove
there is a gap.

Which national and local policies are relevant to this area of work?

This is more important than it may seem; the current government has a particular
interest in closer working relationships of statutory and voluntary sector
organisations. Now more than ever we have to be aware of the policies which
influence the work of these organisations and the cross over that exists between
them.

It will be very important to place your project/policy within this context and to
identify where it fits in to local plans/policies/strategies.

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Profiling

An in depth analysis of the communities who may be affected by this project also
needs to take place. This will include such things as demographic trends and
deprivation indices etc.

6. Identify the stakeholders

Having undertaken the above it should be possible to identify whom the

stakeholders will be. It is essential to understand that one of the strengths of HIA
is its openness. Bias is normal and cannot be completely avoided, however very
effort must be made to ensure all the appropriate partners are identified; the
consequence of not doing so will invalidate the work you eventually undertake.

7. Bring stakeholders together

• Present the project

• Identify who is missing
• Determine whether you can proceed

There are many different ways of involving people in the process. As pointed out
earlier, decision-making is very political. If you have not identified everyone who
should be involved at this point; you either need to halt and wait until they are on
board; or establish how their voice will be heard and their contribution recognised.

8. Agree a common definition of health

This is vital; “health” means different things to different people. Agreeing what
you mean by the term health at this stage prepares the ground for any future
activity. Here are some suggestions: -

• “Health is a state of complete physical, mental and social well being and not
merely the absence of disease or infirmity.” W.H.O. 1946

• “Health is a state of feeling sound in body, mind and spirit, with sense of
reserve power.” Hayman 1965

• “Health is the persons capacity to function to the greatest capacity, to maintain

a balance appropriate to age and social needs; to be reasonably free of gross
dissatisfaction, discomfort, disease or disability; and to behave in ways that
promote survival as well as self-fulfilment or enjoyment” Blurn 1981

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• “Health is a resource for living” Ingredients need to include opportunities for
individuals to identify and to realise aspirations, satisfy needs, and to change or
cope with the environment.” Ottawa Charter 1986

As the tools vary somewhat in the way they are structured it is necessary to create
some commonality. Therefore it is proposed that the stakeholders also agree: -

• The populations affected by the piece of work (Are profiles available? If not
you may not be able to proceed until the relevant piece of work is undertaken)
• Identify and rank the relevant determinants of health

The above will provide some degree of consensus and a useful basis for any future
discussions. If facilitated well, this will also enable people from a variety of
backgrounds to participate fully.

9. Identify the impact assessment tool to be used

This again could be a group activity; however, it may be that you recommend a
particular tool having undertaken the earlier work. Proceed with the impact
assessment

10. Is greater involvement/expertise necessary?

Having applied a tool, you may have identified that you do not have the necessary
information. You can take one of two routes at this stage: -

• Agree to reconvene with the necessary people or information

• Gather the missing data and circulate this to stakeholders

11. Does another impact assessment need to be done in light of this

information?

12. Review the project proposal

The original proposal now needs to be amended in light of the HIA, remembering
that you are attempting to increase the positives and limit the negatives. It is now
timed to collate your findings.

13. Circulate the findings

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 Health Impact Assessment – Process Summary.

1. What is the project/policy to be developed?

2. Apply Screening Tool (Sue Milner/DOH/University of Northumbria)

3. Identify and bring together partners

4. Apply tool of your choice

A) Lincolnshire
B) Liverpool Guidelines
C) Kirklees Metroplitan Council Model
D) Swedish County Council
E) Bielefeld Model
F) British Columbia Model

5. Do literature search

6. Identify stakeholders?

7. Bring Stakeholders together

A) Present the project

B) Identify who is missing
C) Determine whether you can proceed

8. Agree:-

A) a common definition of health

B) the populations you feel are affected by the project
C) the relevant determinants of health

9. Identify the impact assessment model to be used

10. Is greater involvement/expertise necessary to make the work undertaken more

valid?

11. Does another impact assessment need to be done?

12. Review the project proposal and amend in light of the impact assessment.

13. Circulate the findings

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