Health Impact Assessments

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A health impact assessment (HIA) is a process that strategically evaluates the potential effect on health of a policy, plan or project. The assessment generally takes place in a series of steps, each using a mixture of procedures and tools that provide decision makers and stakeholders with information about the intended and unintended consequences arising from an activity. The process may also result in recommendations to maximize positive and mitigate negative health impacts for affected populations (World Health Organization, 2021). HIAs may be conducted as part of environmental and other assessments or on a stand-alone basis and are recognized as an instrument that can support frameworks such as Health in All Policies (St. Pierre 2017). In Canada, HIA practice has been guided by the determinants of health approach and the World Health Organisation's holistic definition of health:

"… a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity" (Health Canada, 2004).

Public health professionals may be involved in one or more steps of an HIA (e.g., screening, scoping, assessment, recommendation, reporting, and monitoring and evaluation). Canada requires environmental assessments for many types of undertakings under federal, provincial, territorial, and municipal legislation, but until 2019, health assessments were not universally required except in the province of Quebec under its Public Health Act of 2002 (Gagnon, Turgeon, & Clemence, 2008). With the passage of the Federal Impact Assessment (IA) Act on August 28, 2019, this situation changed (Government of Canada, 2019). The Practitioner's Guide related to this Act outlines the manner in which health criteria are to be included in IAs (Government of Canada, 2020). The main requirements are that best practices in HIA must be employed, and the Public Health Agency of Canada's recommendation to apply the social determinants of health approach should be followed (Government of Canada, 2020).

The resources listed here are intended to assist public health practitioners to:

  • Understand what HIAs are and the contexts in which they may be used;
  • Outline the steps, methods, and tools used to conduct an HIA;
  • Provide examples of how HIAs influence projects, plans, and policies; and
  • Provide case studies and guides relevant for the Canadian context.

For examples of provincial and territorial requirements for EAs, see: BC, ABSK, MBON, QCNLNB, NS, PEIYTNTNU. Current documents related to federal requirements can be found on the Impact Assessment Agency of Canada's website

NCCEH Resources

Selected External Resources

General background, guides, and courses

  • Practitioner's Guide to Federal Impact Assessments under the Impact Assessment Act (Impact Assessment Agency of Canada, 2020)
    This guide provides instruction for stakeholders involved in Canadian IA. Sections relevant for PH professionals outline the implementation of Public Health of Canada recommendations regarding the Determinants of Health, HIA to assessing baseline health conditions (sections 1.2, 1.3) and potential health impacts from the proposed project (section 5.1), and monitoring criteria once a project is operating.
  • Scoping Population Health in Impact Assessment Realist Review: Identifying Best Practices for Equity in Scoping of Major Natural Resource and Large-Scale Infrastructure Projects (Brown et al. 2020)
    This report addresses the inclusion of health criteria in the IA process under Canada's new IA Act. The findings of 185 sources are synthesized, and recommendations are made for the planning phase of the IA process.
  • Health Impact Project (The Pew Charitable Trusts, 2020)
    This project webpage contains a range of documents including case studies, a practitioner survey, and evidence-informed guidance and tools.
  • Online Course-Health Impact Assessment, step by step (National Collaborating Centre for Healthy Public Policy, 2019)
    This nine-module, self-guided, online course aims to familiarize participants with the HIA process. The target audience includes public health practitioners interested in understanding the fundamentals of HIA for public policies, the steps of a high-quality HIA and the favourable conditions for successful HIA implementation.
  • Public Health and Environmental Assessments (Ontario Public Health Association 2018-9)
    This four-part webinar series introduces public health professionals to the environmental assessment process and the role of public health within the process. The series includes case studies in integrated transportation planning, health assessment within environmental assessment and steps for the effective engagement of the public health sector.
  • Health impact assessment (World Health Organization, 2017)
    This webpage offers a wealth of HIA resources, from basic HIA information, tools and methods, HIA for policy change, HIA networks, to examples of HIAs across various sectors (e.g., agriculture, mining, tourism etc.).
  • Health equity impact assessments: Situational and resource analysis (Alberta Health Services, 2017)
    This purpose of this report is to provide decision-making information for the development of health equity impact assessment (HEIA) to help relevant AHS partners embed a health equity lens into their planning, development, implementation, and evaluation activities. An extensive literature review and overview of assessment types is included.
  • Health Considerations in Impact Assessment (Viliani, 2017)
    This presentation provides a high level, international overview of HIA practice with a focus on local communities, health impacts and their determinants. Numerous Canadian and international examples are provided. Particular attention is given to distinguishing health from social assessments, the timing of incorporating health aspects and the role of health experts and triggers for HIA.
  • Health impact assessment: a guide for the oil and gas industry (International Petroleum Industry Environmental Conservation Association, 2016)
    This guide presents the perspective of the oil and gas sector, highlighting the purpose of conducting an HIA and outlining the six step HIA process.
  • Health impact assessment (HIA) of transportation and land use activities: guidebook and toolkit (Metro Vancouver, 2015)
    This webpage includes downloadable PDF versions of both the HIA guidebook and toolkit. The guidebook provides a background and introduction to HIA as well as tools and resources. The toolkit provides checklists and questions for each step in the process and a tool to help complete an HIA terms of reference.
  • Health impact assessment (National Collaborating Centre for Healthy Public Policy, 2015)
    This webpage provides information on the foundations of HIA, and its growing popularity in Canada and internationally. Links on the page present numerous resources e.g., HIA basics; guides and tools such as a cost calculator, screening grid, and scoping tools; options for continuing education in HIA; upcoming HIA events; and case studies.
  • Health in impact assessments: opportunities not to be missed (World Health Organization, 2014)
    This publication provides a balanced view on five different types of impact assessments (environmental, strategic environmental, social, sustainability, and health impact assessments). It uses four key questions to examine how these assessments protect human health.

Case Studies

  • Growing Healthier: A Health Equity Impact Assessment for Saskatoon’s Growth Plan. (Sharpe et al. 2016)
    This report applies a health equity lens to the City of Saskatoon’s Growth Plan. It focuses on community health and well-being within the context of land-use and transportation planning (with an emphasis on public transit and active transportation). It develops 13 recommendations that are compatible with the core initiatives of the Growth Plan.
  • Health Impact Assessment of the TOD Neighbourhood Project in Sainte-Catherine. Report on potential impacts and recommendations (Tremblay et al. 2014)
    This report presents the results from an HIA conducted for a residential, Transit-Oriented Development (TOD) in the Montreal suburb, Sainte-Catherine. The analyses and recommendations focus on aspects of the project that are likely to affect a number of health determinants, including the configuration of public roadways and other project elements that can encourage or discourage use of active modes of travel, such as walking and cycling.

Peer-Reviewed Publications

This list is not intended to be exhaustive. Omission of a resource does not preclude it from having value.


Last updated Feb 24, 2021