West Midlands Directors of Public Health Group

Using Health Impact Assessment

to make Better Decisions
A simple guide

Screening

Scoping

Assessment

Decision making

Implementation & Monitoring

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Introduction

We all recognise that matters such as housing, employment, physical environment and social
cohesion are far more important in determining the health of the population of the West Midlands
than health services which are usually called upon only after health has been undermined. It
follows that in making decisions in areas such as housing, transport, education, economic
development and law and order we should be taking into account their impacts on population
health. Health Impact Assessment is a method for predicting how policies, programmes and
projects will affect health. Local and Health Authorities should be making wider use of it in their
decision-making procedures.

If this is to happen it is the staff of the authorities who will have to make or commission the Health
Impact Assessments. Many may feel that this is too time consuming or too difficult for them. The
idea of this guide is to show that a great deal of Health Impact Assessment can be quick and
simple. Anyone should be able to undertake the “mini” HIA (or rapid appraisal) described in this
guide. Several good Health Impact Assessments have already been produced in the West
Midlands and I hope that before long we will have many more.

This guide has been written at the request of the Directors of Public Health. There is as yet no
agreed method for Health Impact Assessment and this document does not claim to be the one
right way. It is based on experience gathered so far in the West Midlands. I expect that a much
better guide will replace it when further experience has been gained. In the meanwhile I hope that
it will encourage and help people to get started with Health Impact Assessment.

Professor Rod Griffiths C.B.E.

Regional Director of Public Health,
NHS Executive, West Midlands Regional Office

Acknowledgements
We thank the Health Development Agency for help with the printing and publication of this guide.

The Welsh Collaboration for Health and the Environment is thanked for permission to reproduce
material from their document “How to do a Health Impact Assessment”.

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1. Why should an organisation do Health Impact Assessment?
Health Impact Assessment (HIA) will assist decision-makers to make better decisions by: -

• Making them more aware of how the decisions may affect health
• Identifying the indirect paths by which the decision will affect health
• Estimating how much the decision will affect health
• Informing trade offs between positive and negative consequences
• Allowing health benefits to be maximised and health hazards to be minimised
• Making the decision making process more transparent
• Involving the people who will be affected by the decision.

2. What is Health Impact Assessment?

The W.H.O. European Centre for Health Policy in their Gothenburg Consensus Paper on HIA,
defined HIA as:

“a combination of procedures, methods and tools by which a policy, program or project

may be judged as to its potential effects on the health of a population, and the distribution
of those effects within the population”.

And went on to suggest that the purpose of an HIA is

“to improve knowledge about the potential impact of a policy or programme, inform
decision-makers and affected people, and facilitate adjustment of the proposed policy in
order to mitigate the negative and maximize the positive impacts”

The source cited above and other useful references providing information about HIA can be found
on page 11.

2.1. Integrated Pollution Prevention and Control (IPPC)

One form of HIA that Health Authorities will be asked to undertake is response to consultation by
the Environment Agency on applications for a permit to operate an industrial process under the
IPPC regime. There are particular requirements for such responses and these are dealt with in a
separate guide “Guidance on Health Authority Responses to consultation under IPPC”.

3. Screening

Is a Health Impact Assessment needed?

Does this proposal look as if it will affect health and wellbeing in any way? Will there be health
consequences? Is there a trade-off to be made between good effects and harmful effects?

If the answer to all these questions is No - There is little point in doing an HIA
If the answer to any question is Yes - Read on.

What priority should it have ?

Given that you only have capacity to do a few health impact assessments is this proposal
sufficiently important to be one of them?
• Is it a big money project?
• Is the potential impact in health large?
• Are people worried about the project?

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4. Identifying intermediate factors that impact on health
Many proposals that are not intended to affect health directly have indirect effects on health and
well-being. Often these indirect effects have not been recognised. Proposals may affect things
such as employment, income, air quality or housing which in turn affect health. These factors
which are not health indicators but do influence health are referred to as intermediate factors.
(They may also be called determinants of health).

These intermediate factors may be considered to act at different levels, for example at the
individual level, the family level, within the workplace or within the general physical and socio-
economic environment.

BUILT ENVIRONMENT

PHYSICOCHEMICAL

AMENITY

PSYCHOSOCIAL

INCOME

UNEMPLOYMENT

UNKNOWN
HIA consists chiefly of identifying these intermediate factors and assessing their effect on health.
Some possible checklists are shown in Appendix 2.

Many of the intermediate factors that require consideration are shown in the box below. Although
each should be considered when assessing a proposal, the importance of each single factor will
vary in different HIAs. For example in some projects, the predominant effect will be to change
local employment and educational opportunities, whereas in other, the emphasis may be changes
in the transport network and in the nature and volume of traffic.

Some Intermediate Factors

Employment Family cohesion Housing

Income Social cohesion Built Environment
Workplace Parenting Air Pollutants
Traffic and transport Education Water Pollutants
Lifestyle Law and Order Noise
(Physical activity, Eating, Amenity and natural environments
Smoking, Drinking, Etc.) Other cause of public concern
Access to services (health, social and other)

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5. A Step-by-Step Guide to Doing an HIA
Getting Started

1. Clarify the proposal whose impact is to be assessed.

ƒ Be clear about the exact scale and nature of the proposal

2. Is it the right time for an assessment of this proposal?

Is it too early?
ƒ Is the nature of the problem, which the proposal is intended to address clear?
ƒ Has the general direction of the proposal been set?

Is it too late?
ƒ Have all the options been chosen and all the decisions been made?
ƒ Is there still opportunity to influence the decision?

3. Who is making the decision about the proposal?

ƒ What are their concerns?
ƒ What issues would they want the HIA report to address?

4. Clarify what are the alternatives to the proposal

ƒ Do nothing (Carry on as usual) or is there some other proposal?
ƒ Each alternative will need to be considered in the HIA.

5. Who are the stakeholders?

ƒ People who will be affected by the proposal
ƒ People who are concerned about the proposal
ƒ People who will be expected to act on the HIA Report

6. Set up a steering group

ƒ Stakeholders should be represented on this steering group. When the report is complete
the stakeholders will be expected to own the report.

7. Hold a Scoping Meeting of the steering group

And completing the job…….

8. Undertake an assessment of impacts on intermediate factors and health

9. Write the report

10. Communicate the report to the decision-maker(s).

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6. The scoping meeting – what does it have to consider?

1. What are the alternative options to be assessed? These should include at least the ‘do
nothing’ option.

2. Who is included in community to be considered?

ƒ Residents of the particular area
ƒ People in other parts of West Midlands
ƒ People in other parts of UK
ƒ People in other parts of world
ƒ Visitors to the area
ƒ People travelling through area and commuters into the area

3. What will be changed by the proposal ? (i.e. what are the effects on intermediate factors?)
ƒ Which of these do people think might benefit health?
ƒ Which do they think might harm health?
ƒ What are peoples hopes for the proposal?
ƒ What are their concerns over the proposal?

4. How will changes in intermediate factors effect health?

ƒ What do you need to find out about the intermediate factors - remember to consider
the good and the bad effects?
ƒ How much will these factors change?
ƒ Which people will be affected by these changes?
ƒ How much will they be affected?
ƒ How much is already known about these things?
ƒ Which of these intermediate factors look as if they are the most important (i.e., which
have the largest impact)?

5. Are there any groups who require special consideration

ƒ because they will be particularly heavily exposed (e.g. because they live close to a
proposed development)
ƒ because they will be particularly susceptible (e.g. people with respiratory disease
may be affected more than others by air pollution)

6. Are there criteria or guidelines indicating levels below which health impacts are not expected?
ƒ air quality and water quality guidelines
ƒ occupational exposure limits.

7. When must the report be produced?

In order to be useful the assessment has to be able to influence the decision.
ƒ When will the decision be made?
ƒ At what point in the process will the report have to be available to influence that
decision?

8. What resources have you available to do the assessment?

ƒ Time
ƒ Expertise – for example data collection, manipulation and analysis
ƒ Access to specialised knowledge – for example knowledge of the area or community,
and information about local services,
ƒ Funding

9. What type of HIA will you carry out?

• Mini HIA – Rapid appraisal
• Standard HIA
• Maxi HIA – Extensive enquiry

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 7. Different ‘types’ of Health Impact Assessment

The box below describes three levels of HIA but in reality these are merely points on a
continuum of increasing effort and complexity.

An HIA can range from a desktop exercise lasting less than an hour to a major enquiry
requiring legions of researchers, massive data collection and years of work.

Levels of HIA

Mini HIA Desk top exercise

Reliant on information already known
Minimum quantification
Limited consultation

Standard HIA Limited literature search

Mostly reliant on routine data
Quantify where possible
Full participation of stakeholders

Maxi HIA Extensive literature search

Secondary analysis of existing data
Collection of new data
Extensive quantification
Full participation of stakeholders

Mini HIA – Rapid appraisal

This is usually a desktop exercise. It is unlikely to involve much data gathering or literature
review. The output will consist simply of a summary table and a conclusion. The summary table
will list the intermediate factors and their likely impacts with minimal quantification (see examples
in Appendix 1). The conclusion should state whether the net impact of the proposal is likely to be
positive or negative. The scoping meeting may well provide all the information needed to
complete this task. Depending on the size of the proposal a rapid appraisal may take as little as
one hour or as much as one day.

Standard HIA
A standard HIA is likely to involve looking for relevant literature and examining routinely collected
data. It will probably require three or four meetings to monitor progress and last a few weeks.

Maxi HIA
This is a major exercise, which is likely to require a considerable investment of resource and
involve specialised research staff. It falls outside the scope of this document.

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8. From where do we get the evidence for HIA?

Use all the evidence you can get. This might be: -

• Local concerns and anxieties

• Information about similar proposals implemented elsewhere
• Views of residents and people with local knowledge
• Views of people with specialist knowledge
• Information from literature on determinants of health
• Routinely collected local statistics on health, unemployment, benefits, crime, air
quality etc.
• Opinion surveys
• Special literature searches
• Surveys of local conditions
• Secondary analysis of existing data
• Predictions from models
• Resources held by West Midlands agencies, for example the Health Impact
Assessment Research Unit (see section 14)

It is extremely rare that anyone can be certain how a proposal will affect a community. All that can
be done is to

• Look at all the evidence available to you, recognising that is probably very
incomplete,
• Form the best judgement you can on that evidence
• Explain why you have reached the conclusion that you have.

The experts do no more than this.

Advice from people with specialist knowledge

People with specialist knowledge may be helpful on narrow technical questions such as, what
levels of pollutants a process will produce, how smoke will be distributed, how a particular
chemical is likely to affect humans, what traffic flows will be along a road, how many jobs a
particular proposal will create and so on. However no one is infallible and experts often disagree
among themselves. Advice from specialists may be expensive. If it is available to you use it, but if
it is not do not be inhibited, just do the best you can.

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9. The report

The final outcome will be a written report.

The purpose of this report is to help those who have to make a decision on the proposal,
appreciate how it is likely to impact on health and the nature of the trade-offs involved in the
decision.

The report should therefore include the following:

1. Description of proposals and options under consideration

2. Background situation
ƒ What is the current situation like?
ƒ What is the current health state of the community?
ƒ What are the determinants of health in the community? – for example housing,
employment, pollution, smoking etc
ƒ Are there particular vulnerable groups in the community? – for example the elderly,
children, Black and Minority Ethnic groups
ƒ How will these things develop under the no change option?

3. List of intermediate factors

For each intermediate factor in the list
• How much will it change under the proposal? (This may well be different for different
sectors of the community.)
• How people will be affected by changes.

For each factor indicate

• The estimated size of the impact. If possible give a numerical estimate, otherwise
rate the impact as ‘major’, ‘intermediate’, or ‘minor’.
• The uncertainty attached to the estimate – rate these as ‘certain’, ‘probable’, or
‘possible’.

4. Table summarising impacts - see examples in Appendix 1.

5. Statement of how proposal will effect equity.

ƒ Who are the gainers – Who are the losers?

ƒ How will different groups (e.g. geographical, ethnic, income) be affected?
ƒ Do the least favoured sectors of the community benefit?

6. Recommendations to maximise benefit and minimise harm. Are there ways in which the
proposal can be modified to maximise beneficial impacts and minimise harmful ones?

7. Monitoring

ƒ What should be monitored after implementation of the proposal to check the predictions
of the HIA?
ƒ Are there any aspects that need to be watched particularly carefully in case early
intervention is needed?

8. Reflections on the HIA process. Are there any lessons for future HIAs to be learned from this
one?

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10. Influencing the Decision Making
Remember this is the whole purpose of the exercise.

At the scoping stage you should have identified who the decision-makers are and when and how
they needed the decision to be communicated to them. If the decision-makers have been
intimately involved in making the impact assessment it is more likely that they will be influenced
by the results.

Ensure the impact assessment report is:

• Presented to the appropriate people (Those who make the decision and those who can
influence it).
• Produced at the right time.
• In the right form (Do they want one side of A4 or four volumes of detailed argument?)

11. Values and Knowledge

HIAs always involve value judgements as well as knowledge judgements. Whether one form of
harm is worse than another, whether a particular benefit outweighs a particular harm, the weight
to be attached to different forms of evidence and what constitutes an acceptable risk are all
examples of value judgements. Professionals frequently confuse judgements based on their
expert knowledge and judgement based on their values. A properly participative HIA should take
account of the values of all stakeholders. Value judgements are a proper part of HIA but should
always be acknowledged for what they are.

HIA should be informed by values:

Openness HIA should be a transparent process and people affected by a proposal should
have an opportunity to participate in the process of assessing it
Impartiality All available evidence should be considered with equal rigour. Where there is
uncertainty this should be acknowledged.

In assessing impacts two other values apply.

Equity There should be a presumption in favour of reducing health inequalities.

Where possible, losers should be compensated.
Sustainability HIA should consider not only the short-term impacts but also the long term
including future generations.

12. Reducing Health Inequalities

• Who are the gainers?

• Who are the losers?

Any HIA should pay particular attention to how the proposal will affect health inequalities. With
most proposals there will be gainers and losers, or at least some people will gain more than
others. The assessment should try to identify which groups are gaining and how and which
groups are losing and how. It will then be possible to assess whether the proposal increases or
decreases inequality and if it could be modified in some way to further reduce health inequalities.

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13. Share your results

You will want to learn from other people’s experience and other people want to learn from yours.
That is one reason why it is important to produce a written report. The West Midlands Health
Impact Assessment Research Unit (HIARU) keeps a register of health impact assessments
projects completed or in progress. Please make sure they know about any health impact
assessments you do so that others contemplating a similar effort can look at the report of what
you did, copy the things you did well and improve on the things you did less well.

14. The West Midlands Health Impact Assessment Research Unit

The West Midlands Health Impact Assessment Research Unit (HIARU) was established in
January 2000 funded in part by monies from the English Department of Health. The HIARU is
located in the Department of Public Health & Epidemiology at the University of Birmingham.

The HIARU has two streams of separate albeit inter-related work. One stream focuses on the
development of robust tools and techniques to analyze changes in community health and well-
being, and to explore mechanisms by which the cause-effect relationship between health and
public policy might be elicited. The other area of work is directed at getting ‘health’ onto the
agenda of non-NHS agencies throughout the West Midlands.

To achieve its aims, the HIARU works closely with academic colleagues both from the University
of Birmingham and other institutions elsewhere in the U.K. and Europe, and also with key
organisations in the West Midlands. With regard to the latter, these have included health
authorities, local authorities, the voluntary sector, the Government Office of the West Midlands,
the Regional Development Agency (Advantage West Midlands), the Local Government
Association, the Health Development Agency, and the NHS Executive Regional Office for the
West Midlands.

The HIARU is a regional resource for all organisations and agencies within the West Midlands
who wish to undertake health impact assessments. The HIARU has collaborated on the
production of this guide and can also:

ƒ provide advice on specific projects and access to learning materials and tool-kits,
ƒ maintain an inventory listing all HIA projects undertaken in the region (not just by the
HIARU but by all organisations)
ƒ run workshops for organisations which include participants undertaking a hands-on
‘desk-top’ HIA of a project relevant to the organisation
ƒ organise educational sessions at specific professional events.

By May 2001, access to the HIARU web-site will be available for all individuals with access to the
Internet. The web-site will include documents relevant to HIA in downloadable PDF and WORD
formats, links to other HIA and related sites, up-dates on on-going projects, and lists of contacts
and other related links. In the meantime, for any further information on the HIARU please
contact:
Dr Jayne Parry
Health Impact Assessment Research Unit
Department of Public Health & Epidemiology
University of Birmingham
Edgbaston
Birmingham B15 2TT
0121 414 3191
J.M.Parry.1@bham.ac.uk

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15. Selected Published Materials on Health Impact Assessment
15.1. Easily available short introductions / How to do it guides
ƒ Lock K. (2000) Health Impact Assessment BMJ 320, 1395-1398.
ƒ London’s Health (2000) A short guide to health impact assessment. NHS Executive London, London.
ƒ Scott-Samuel A, Birley M, Arden K (1998) The Merseyside guidelines for health impact assessment. Merseyside
Health Impact Assessment Steering Group. University of Liverpool, Liverpool.

15.2. Other short introductions / How to do it guides

ƒ Douglas M (1998) Health Impact Assessment: a practical approach. Office for Public Health in Scotland.
ƒ Landstings Forbundet and Svenska Kommunforbundet (1998) Focussing on health. Landstings Forbundet,
Stockholm (Sweden) www.lf.se.hkb/engelskversion/enghkb.htm
ƒ Department of Health (1995) Policy Appraisal and Health. The Health of the Nation, London.
ƒ Milner S, Marples G. (1997) Policy appraisal and health project Phase 1 – a literature review, University of
Northumbria, Newcastle.
ƒ National Assembly for Wales. (1999) Developing health impact assessment in Wales. National Assembly for Wales,
Cardiff
ƒ Public Health Commission (1995) A guide to health impact assessment. Public Health Commission, Wellington (New
Zealand)
ƒ Scottish Needs Assessment Programme (2000) HIA; Piloting the process in Scotland. Scottish Needs Assessment
Programme, Glasgow. http://info.gla.ac.uk/inter/OPHIS/pdf/hia.pdf
ƒ Scott-Samuel A. (1996) Health Impact Assessment: an idea whose time has come. BMJ 313, 183-184.
ƒ Transport and Health Study Group (2000) Carrying out a health impact assessment of transport policy. Faculty of
Public Health Medicine, London. www.fphm.org/INTERNETPAGES/Policy_frame.htm

15.3. Commentaries and more extended treatments

ƒ Birley M H (1995) The health impact assessment of development projects. HMSO London
ƒ BMA Board of Science and Education (1998) Health and Environmental Impact Assessment . Earthscan Publications
; London
ƒ Department of Health (1999) Health Impact Assessment. Report of a methodological seminar. Department of
Health, London www.doh.gov.uk/research/documents/rd2/healthimpact.pdf
ƒ Ewan C, Young A, Bryant E, Calvert D. (1994) Framework for Environmental and Health Impact Assessment.
National Health and Medical Research Council, Canberra (Australia)
ƒ HM Treasury (1997) Appraisal and evaluation in central government (The Green Book) HMSO, London
ƒ Kemm JR (2000) Can health impact assessment fulfil the expectations it raises? Public Health 114, 431-434.
ƒ Putters K (1997) Health Impact Screening. Ministry of Health, Welfare and Sport, Rijswijk (Netherlands)
ƒ Winter L. (1997) Health Impact Assessment: A literature review. Observatory report series No 36 Liverpool Public
Health Observatory, University of Liverpool, Liverpool.
ƒ WHO Regional Office for Europe. (1999) Gothenburg consensus paper: Health Impact Assessment: Main concepts
and a suggested approach. European Centre for Health Policy; Brussels
www.who.dk/hs/ECHP/attach/gothenburg.doc

15.4 Selected HIA reports

ƒ Housing
ƒ Scottish Needs Assessment Programme (2000) HIA of North Edinburgh Area Renewal (NEAR) Housing Strategy.
Scottish Needs Assessment Programme, Glasgow.

ƒ Transport
ƒ Will S, Arden K, Spencely M, Watkins S (1994) Proof of evidence of Stockport Health Commission to Town and
Country Planning Act Inquiry on Application by Manchester Airport PLC for the development of a second main
runway (part) and associated facilities.
ƒ Abdel Aziz, Radford J, McCabe J (2000). Health impact assessment of Finningley Airport.
www.donhlth.demon.co.uk/documents/finningley/finningley-report.html
ƒ Fleeman N. (1999) A prospective Health Impact Assessment of the Merseyside Integrated transport Strategy
(MERITS) Observatory report series No 45 Liverpool Public Health Observatory, University of Liverpool, Liverpool.
ƒ Scottish Needs Assessment Programme (2000) HIA of the City of Edinburgh Council’s Urban Transport Strategy.
Scottish Needs Assessment Programme, Glasgow.

ƒ Miscellaneous
ƒ Winter L. (1998) Health Impact Assessment of the International Astronomy and Space Centre, Twelve Quays, Wirral.
Observatory report series No 43 Liverpool Public Health Observatory, University of Liverpool, Liverpool.

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 APPENDIX 1
Worked Examples of Health Impact Assessments

In this section, three examples, using fictitious proposals, attempts to show the sort of issues,
which need to be thought of when carrying out a Health Impact Assessment and what a summary
of impacts might look like.

Example 1: The Stonewell By-pass

1. The proposal
To build a by-pass round Stonewell town.

2. Background
Stonewell is a market town in a predominantly rural county in England. Currently all traffic passes
through Stonewell high street and throughout the year those who live in the high street
experience very heavy levels of traffic which creates noise, fumes and inconvenience. The only
route for the by-pass is through the Grovedale valley between Stonewell and the hamlet of Six
Crosses. A colony of crested newts (endangered species) lives in this valley. The by-pass will
pass within 200 metres of Six Crosses, and crosses the land of six farms.

3. Summary Table of Impacts – Comparing the building of the by-pass with a ‘no change’
option.

Intermediate Affected Health Impact Comment

Factor Group
Construction of All Inconvenience of construction traffic, dust Construction nuisance
by-pass and noise for at least 12 months. would be limited by
Temporary increase in respiratory conditions attached to
disease and reduced mental well-being. planning permission.
Noise Residents of Increase in sound levels all year around.
Six Crosses Slight harm to mental health.
Residents of Decrease in daytime sound levels. Slight
Stonewell improvement to mental health.
Levels of PM10 Residents of Small increase – background levels low –
and other vehicle Six Crosses traffic will generally be fast moving. No
pollutants change in risk of asthma.
Residents of Big decrease – queues of slow moving
Stonewell traffic currently cause very high levels.
Slight reduction in risk of asthma.
Risk of injury Residents of Fast moving traffic creates hazard. Risk Problem more likely to
Six Crosses of injury to those trying to cross the road. be fear of injury and
community severance
rather than actual injury.
Investigate possibility of
bridge / underpass /
crossing if much
pedestrian traffic across
road.
Residents of Although current traffic levels are high, it
Stonewell is slow moving. Therefore background
risk of accidents already very low.

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 Intermediate Affected Health Impact Comment
Factor Group
Economic well- Residents of Several farms offer bed & breakfast and
being Six Crosses farm holidays. Fear that holiday-makers
will be put off by proximity of traffic.
Residents of Difficult to predict – On the one hand
Stonewell current unpleasant traffic conditions may
deter trade, thus trade from local people
could increase after the by-pass.
Alternatively there may be a loss of
passing trade if the by-pass is built.
People in the At present, poor transport links add to To what extent are the
rural areas in costs of local businesses. New by-pass interests of people living
the rest of the should marginally improve the viability of outside the Stonewell
county. the area. and Six Crosses
communities being
considered.
Farms crossed Difficulty in moving stock. Decreased
by the by-pass. income through loss of land, although
compensation should be received.
Social networks Residents of Little direct effect. Heavy traffic can
Six Crosses produce major
community severance.
Effect on community
easily underestimated.
Residents of Traffic on high street currently prevents
Stonewell social interchange between residents. By-
pass should therefore improve social
activity.
Visual amenity All Natural beauty of the Grovedale valley Very difficult to assess
reduced. this impact. Some
people will be very
distressed by the new
road. Others may not
notice it. Take
measures to protect the
colony of crested newts.

In addition, there are a number of issues that might be further addressed in more detail by a
standard HIA.

Factor Issues
Construction When will noise and dust occur? What measures are being taken to control
them?
Noise When will noise occur? How many decibels will it be above background? Could
there be mitigation measures?
Air pollution What are the background levels of different pollutants? How will they be changed
in different locations? Are there any particular atmospheric conditions that would
cause high levels (for example, inversions)?
Economic well-being Estimate how much by-pass will affect the incomes of different sectors of the
population.
Social network What is the current level of social networking? What are existing barriers and
promoters? How would the by-pass affect these?

4. Conclusion
The main negative impact is loss of visual amenity. It is very difficult to balance this against other
impacts. The net impact of the proposal is probably positive.

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 Example 2 - Craddon Leisure Centre

1. The proposal
A new leisure centre to be built in Craddon

2. Background
Craddon is a large town in the Midlands (population 150,000). In the north of the town is a large
housing estate (Hillsvale - population 13000). Hillsvale is one of the most deprived housing
estates in the Midlands, and is home to a large Bangladeshi community (45% of Hillsvale’s
population)

The rest of Craddon lies to the south of the estate and is separated from it by a dual carriageway
running east-to-west. This road links Craddon to the West Midlands motorway network. To the
north of the estate is 15 acres of waste and derelict lands that separate Craddon from its
neighbouring town, Inkelbury.

A development company has acquired the rights to build on 12 acres of this land. They are
proposing to build a multi-purpose leisure centre including an aqua-centre, artificial ski-slope and
three artificial playing pitches (for football, hockey e.t.c). There are no other leisure centres or
purpose-built recreation centres within a 15-mile radius from the centre of the proposed
development.

3. Summary Table of Impacts – Comparing the building of the leisure centre with a ‘no
change’ option.

Intermediate Affected Health Impact Comment

Factor Group
Construction of Hillsville Inconvenience of construction traffic, dust Construction nuisance
leisure centre residents and noise for at least 12 months. would be limited by
Temporary increase in respiratory conditions attached to
disease and reduced mental well-being. planning permission.
Residents of Nil
the rest of
Craddon
Employment All Leisure centre will provide employment Residents from more
for up to 50 full-time staff, with part-time affluent areas may be
jobs also available. better qualified to
compete for jobs. Could
request development
company to consider
mechanisms to build
employment links with
local Hillsville residents
Traffic and Hillsville Access to the centre requires motorists to Need to consider
transport residents leave the dual carriageway and drive measures to mitigate
through Hillsville. Traffic through estate potential adverse effects
will increase, and result in increased on mental and
likelihood of noise and air pollution, and respiratory health, and
of road traffic accidents. on accidents.
Residents of Traffic on dual carriageway could
the rest of increase, but likely to be fast-moving and Enhance use of public
Craddon thus minimal pollution effects. Change in transport to and from
background noise levels minimal. centre.

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 Intermediate Affected Health Impact Comment
Factor Group
Lifestyle Hillsville Increased participation in exercise and Centre café should
residents leisure classes due to access to centre. promote healthy eating.
However, entrance costs may be Licensed bar available.
prohibitive to economically-deprived
communities. Admission fees could
include reduced rates for
the elderly, unemployed,
students etc. Reduced
rates at off-peak times
could be considered.
Residents of Access to multi-purpose centre should
the rest of increase participation in exercise and
Craddon leisure pursuits.
Bangladeshi Could feel excluded from leisure centre if Ensure facilities and
population facilities and classes not ethnically classes offered are
sensitive. The leisure needs of the culturally sensitive, for
Bangladeshi community should be example availability of
considered –e.g. mechanisms to enhance female class instructors.
participation in exercise by older adults
and women.
Residents Effects could be beneficial if they use the
elsewhere in exercise and other facilities. Thus, may
the West need to consider other populations in the
Midlands HIA
Family and social All Centre may provide a focal point for Admission fees could
cohesion social interaction and family outings. include a reduced cost
However, as noted previously, admission for families.
fees could be prohibitive Hillsville
residents Teenagers could start
hanging around the
building in groups,
especially at night.

Amenity and All Land is currently derelict and laid to Need to consult with
natural waste. Leisure centre and playing fields residents of Inkelbury as
environment may provide visual improvement. part of the HIA.
However loss of ‘land barrier’ between
the two towns (Craddon and Inkelbury)
Economy Hillsville Leisure centre may draw in other
businesses and increase trade at local
shops. Potential opportunity to develop
retail amenities in Hillsville.

4. Conclusion
The leisure centre is likely to have an overall positive effect on the residents of Craddon.
However there is the potential for residents of Hillsville to be differentially and adversely affected
by the development if remedial measures (e.g. pricing policy for admissions) are not put in place.
Particular consideration needs to be given to measures to mitigate the adverse effects of a
potentially large increase in traffic through the Hillsville estate.

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 Example 3: A Paint Factory in Dennington.

1. The proposal
A new paint factory to be built on an existing industrial site in Dennington.

2. Background
Dennington is a small town in the South Midlands. Within the town is an industrial estate that at
present comprises mainly software development industries and customer service centres. A
national paint manufacturer is proposing to build a production factory on the industrial estate.
The factory would employ 160 people.

The industrial estate lies in the east of Dennington. The estate is linked directly to the nearby
motorway system by a road built as part of the overall industrial estate plans. The estate is
surrounded on two sides by owner-occupied residential areas and by a junior school on the third
side.

The Environmental Agency has granted an Integrated Pollution and Prevention Control permit to
the paint manufacturers for the siting of the factory in Dennington.

3. Summary Table of Impacts – Comparing the building of the leisure centre with a ‘no
change’ option.

Intermediate Affected Health Impact Comment

Factor Group
Construction of Residents in Inconvenience of construction traffic, Construction nuisance
factory housing next dust and noise for at least 12 months. would be limited by
to industrial Temporary increase in respiratory conditions attached to
estate disease and reduced mental well- planning permission.
being.
Residents of Nil
the rest of
Dennington
Pollution All The factory has been subject to an Health effects due to
IPPC. This has concluded that the pollution are predicted
factory’s processes and emissions to be minimal.
present no significant adverse threat
to the public health. The IPPC permit
has been granted.
Employment All The factory will create 160 jobs – Potential beneficial
based on the manufacturing floor, effects on the health
and in clerical and administration of the local
posts. These jobs should be open to community.
local people and thus increase
employment in the area. Other jobs
may be created indirectly, for
example through increased demand
on suppliers.

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Intermediate Affected Health Impact Comment
Factor Group
Traffic and Residents in Although factory is linked to the More detailed
transport housing next motorway system, some increase in assessment of
to industrial traffic on other roads is possible. transport implications
estate This is likely to be in the form of are required.
tankers carrying chemicals. In Factory could be
addition, employees at the factory required to limit heavy
may drive to and from work transport movement
increasing local traffic. Risk of noise at certain times of the
pollution and air pollution may be day.
increased as traffic will be slow-
moving, as may risk of pedestrian Likelihood of a
accidents (note presence of school). chemical spill
Chemical hazard incident may arise if occurring is low.
a tanker is involved in an accident or However local
‘leaks’ its contents. residents may still
Residents of Adverse effects predominantly due to perceive it as a
the rest of threat of chemical spill. Tankers substantial risk.
Dennington routes should be discussed and
planned to avoid residential areas Procedures for
where possible. dealing with chemical
incidents should be in
place and discussed
with local residents.
Mental health Residents in Proposal will generate considerable Open process so
housing next anxiety and impact on mental well- residents do not feel
to industrial being. Residents are concerned things are being
estate about pollution and fire /explosion hidden from them.
hazard
Visual amenity Residents in Factory will have two emission Difficult to quantify the
and natural housing next chimneys that will protrude above the effect on visual
environment to industrial existing roofline. Local residents may impacts and on
estate be upset by visual impact. Other property prices.
concerns may include a fall in
property prices.

3. Conclusion

The major beneficial effect of the factory is the employment opportunities it offers local residents.
The risk of pollution from the factory affecting health is small, but some problems may be
encountered among local residents as a consequence of an increase in through traffic. The
potentially adverse effect of the visual impacts is difficult to quantify. Overall, the factory is likely
to produce a positive health gain for the community.

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 APPENDIX 2
‘Check-lists’ for intermediate factors and population groups to be considered in
Health Impact Assessments

1. Checklist for Health Impact Assessment

This checklist may be used as a quick screening tool to identify proposals that merit further HIAs

(i) Proposed policy decision - Is there a short but complete description of policy option
proposed available?

(ii) Groups affected by the policy decision - Will any of these groups be particularly
affected by the decision?

YES NO
2.1. Whole population
2.2. Social and economically deprived communities, for example
priority neighbourhoods
2.3. Black and Minority Ethnic groups
2.4. Older people
2.5 Children
2.6 Pregnant women
2.7 Women
2.8 People with specific diseases
2.9. Any other group with particular susceptibility

(iii) Intermediate variables - Will the decision affect any of these factors? If so, how are they
likely to effect health and which groups of the population might they affect in particular?

EFFECT ON HEALTH
GOOD NONE BAD
3.1. Employment
3.2. Income
3.3. Workplace
3.4. Housing
3.5. Transport
3.6. Built Environment
3.7. Air Pollutants
3.8. Water pollutants
3.9. Noise
3.10. Amenity
3.11. Lifestyle
3.12. Social Cohesion
3.13. Family cohesion
3.14. Parenting
3.15. Education
3.16. Use of health services
3.17 Other cause of public concern

(iv) Impact on equity

Will groups in the community be differentially affected?

More net benefit to Equal net benefit to advantaged More net benefit to advantaged
disadvantaged groups and disadvantaged groups groups

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2. Mersey (U.K.) Guidelines.

The Mersey guidelines have identified the following key areas influencing health.

Categories of influences on Examples

health
Biological factors age, sex, genetic factors

Personal, Family Circumstances
and Lifestyle factors
Social Environment
family structure, education, occupation, income, risk taking
behaviour (including diet, smoking, alcohol use, substance
use, exercise), recreation and transport.
culture, peer pressure, discrimination, social support,
participation in community, cultural or spiritual activities.

Physical Environment air, water, housing, working conditions, noise, smell, view,
public safety, civic design, shops, communications, land use,
waste disposal, energy, local environment.

Public Services access to and the quality of healthcare, childcare, social

services, housing leisure, employment, public transport,
policing, other public / non-statutory services.

Public Policy Economic, social, environmental and health trends, local and
national priorities, programmes and projects.

Source: Scott-Samuel, Birley, Arden (1998)

3. Office for Public Health in Scotland

A document on Health Impact Assessment was produced by the Scottish Office for Public Health
in 1998. The following health impacts were identified to assist during brainstorming meetings or
individual interviews.

Diet Psychosocial environment

Housing and living conditions Pollution

Lifestyle Tobacco, alcohol and drug use

Accidental injury Employment & occupational health

Geophysical factors Access to essential services

Equity implications

Source: Douglas (1998)

With regard to equity implications, the differential impacts on the following groups should be
considered: whole population, elderly, children, women, ethnic minorities, deprived communities,
and other relevant groups.

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4. English Department of Health.
In 1995, the English Department of Health published a document entitled “Policy Appraisal and
Health” which contained a list of factors designed to assist consultation exercise and
brainstorming sessions when assessing the health impacts of proposed policy actions.

ƒ Diet; e.g. choice and availability

ƒ Psycho-social environment; e.g. exposure to stress, crime risk

ƒ Housing and living conditions; e.g. cold, damp, noise, sanitation, food storage and
preparation, lightening space, domestic waste, indoor air quality, capacity for self care

ƒ Pollution

ƒ Lifestyle; e.g. exercise, reproductive and sexual behaviour

ƒ Accidental injury; e.g. in the home, at work, on the roads or from faulty products

ƒ Tobacco and alcohol consumption;

ƒ Occupation; e.g. exposure to industrial processes

ƒ Geophysical factors; e.g. exposure to ultra-violet light, radon.

Source: Department of Health (1995)

5. Swedish Federation of County Councils

The Swedish Federation of County Councils has developed an HIA tool-kit to help local decision-
makers identify the impacts of their policies.

Three general questions are asked:

ƒ Will the proposal promote health development for various groups / the population in relation
to the social environment (e.g. opportunity to exert influence, mutual work and support)?

ƒ Will the proposal promote health development for various groups / the population with regard
to certain risk factors (e.g. the physical environment, lifestyle)?

ƒ Is the proposal consistent with overall municipality / county health targets and objectives?

A list of health determinants is also provided to assist in discussions about the health impact

Democracy and the opportunity to exert influence, and equality

Financial security
Employment, meaningful pursuits and education
Social network
Access to healthcare and welfare
Service
Belief in the future, life goals and meaning
Physical environment
Living habits

Source: Landtingsforbudet and Svenska Kommunforbundet (1998)

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