Health Impact Assessments

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A health impact assessment (HIA) is a combination of procedures, methods, and tools that allow for the strategic evaluation and assessment of the potential effects on health related to a policy, plan, or project. HIAs provide information to decision-makers and stakeholders about the intended and unintended consequences arising from an activity, and make recommendations to maximize positive and mitigate negative health impacts for affected populations (US Centers for Disease Control, 2016). HIAs may be conducted as part of environmental and other assessment processes or on a stand-alone basis. The principles of HIA incorporate the holistic definition used by the World Health Organization:

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

Public health professionals may be involved in one or more of the six steps of an HIA (screening, scoping, assessment, recommendation, reporting, and monitoring and evaluation). Within Canada, environmental assessments are required for many types of undertakings under federal, provincial, territorial, and municipal legislation but until 2019, health assessments were not. With the passage of the Impact Assessment Act on August 28, 2019, this situation changed. The practioner’s guide related to this Act specifies the manner in which health criteria are to be included in impact assessments. 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.

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

  • Understand what an HIA is and why it is useful;
  • Outline the steps and provide tools to conduct an HIA;
  • Provide examples of how HIAs influence projects, plans, and policies; and
  • Provide case studies and guides for the Canadian context.

For examples of provincial and territorial requirements for EAs, see: BCABSK,  MBONQCNLNBPEINSYTNTNU. 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

  • 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 (US Centres for Disease Control, 2016)
    This webpage gives a brief explanation of HIA and provides multiple links to related HIA resources, such as an HIA toolkit specific to transportation; “stories from the field”; and different types of health assessments.
  • 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.
  • The International Finance Corporation Introduction to HIA (International Finance Corporation, 2009).
    This guidance document provides an introduction to HIA and an in-depth overview of the HIA process that will be particularly relevant for assessments having a strong community health focus. The document features an HIA roadmap and guidance for HIAs with different scopes. The appendices include useful examples of mitigation measures, common issues, and a checklist for the screening stage.
  • Canadian handbook on health impact assessment (Health Canada, 2004)
    This four-volume handbook (hosted on the World Health Organization website) examines ways of incorporating human health into environmental assessments, including criteria for conducting a HIA and examples of project impacts. The four volumes cover 1) The Basics; 2) Approaches and Decision-Making; 3) The Multidisciplinary Team; and 4) Health Impacts by Industry Sector.

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 Nov 19, 2019