HIA can be divided into five sequential phases: 1. Scanning or screening
to determine whether an HIA should be conducted; 2. Scoping to outline
the specific focus of the HIA and methodologies to be used; 3. Profiling;
4. Impact assessment to analyze relevant evidence in order to make
qualitative and quantitative assessments of potential health impacts;
5. Report preparation to synthesize the results and communicate
them to target audiences (e.g. policy-makers and stakeholders).
To assess the suitability of HIA for a given policy proposal in
order to decide whether or not to proceed with the HIA. The purpose
of scanning is to identify current or emerging policy proposals
for which an HIA might produce useful information. A useful metaphor
is 'winnowing'-sifting through the chaff of countless policy proposals
to identify those that might have significant health impacts and
for which HIA might contribute valuable information to the policy-making
process. Screening, on the other hand, starts with just one policy
proposal, not many, and aims to determine the suitability of HIA
for that proposal, and culminating in a decision on whether or not
to proceed with the HIA.
1. Define the policy, program or project to be analyzed.
2. Review criteria for selection (including general HIA screening
criteria and additional criteria relevant to a particular program,
3. Complete and discuss screening tools (checklists, etc.)
4. Make a preliminary assessment on whether to proceed with HIA.
5. Review decision with stakeholders.
A brief preliminary assessment on the feasibility and value of an
To outline the impacts, an explicit model describing how the proposed
policy may impact health determinants and health-related outcomes,
methodological approach, expected challenges and resources needs
for impact analysis.
1. Consult policy-makers, stakeholders, experts and research literature
to assess and describe the:
- proposed policy;
- population affected;
- immediate, intended effects;
- health-related secondary and side effects;
- pathways through which the proposed policy or program is expected
to affect health outcomes and intermediate outcomes (i.e. determinants
2. Determine methodologies to be used and set boundaries for the
proposed HIA to maximize the efficient use of resources for producing
the most salient and valuable information.
An outline for the impact analysis, including data on the relevant
baseline characteristics of the target population
To describe key aspects of the health status and demographics of
the population that can act as a baseline against which possible
health impacts can be assessed.
1. Compile a profile of the areas and communities likely to be affected
by the project using available socio-demographic and health data
and information from key informants (Scott-Samuel et al, 2001).
2. Describe key aspects of the health status and general make-up
of the population, particularly in relation to factors that are
believed to be susceptible to change or that may act a as indicators
of anticipated health impact(s) (Commonwealth Department of Health
and Aged Care, 2001).
3. Assess the nature and characteristics of groups whose health
could be enhanced or placed at risk by the project efforts. Vulnerable
and disadvantaged groups require special consideration (Scott-Samuel
et al, 2001).
A comprehensive description of the socio-demographic and health
profile of a community or population.
To identify the positive and negative health impacts of the proposal.
1. Assess qualitative evidence pertaining to each of the links in
the causal chain(s) linking the policy with putative health outcomes.
2. If possible, use evidence from the literature to construct quantitative
models and estimate potential health effects and their likelihood.
3. Conduct cost analyses when feasible and appropriate.
1. A brief summary and assessment of literature, expert opinion,
2. Impact estimates, including probable direction, magnitude, distribution
To produce a coherent, usable synthesis of findings from the analysis.
1. Document the quantitative and qualitative findings from the preceding
steps of the HIA
2. Prepare a summary of the findings for policy-makers.
The end product
A comprehensive HIA report for target audiences (e.g. policy-makers).
The report(s) should include a brief summary as well as a more complete
report that provides detailed information about the findings, methodologies,
and underlying assumptions.