HEALTH IMPACT

ASSESSMENT

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 OBJECTIVE :-

► To study about Health Impact Assessment (HIA)

► To appraise the types and process of conducting HIA

► To understand the tools used to conduct HIA

The above objectives will be explained along with 2

HIA Case Studies

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 WHAT IS HIA ?

Health Impact Assessment is 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 distribution of
those effects within the population

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 EVOLUTION OF HIA…
HIA was initially developed by WHO in 1980s in response to
the need to control vector-borne diseases resulting from
water projects without using chemicals
WHO established the guidelines and tools to carry out HIA
In India, however, there are very few examples where HIA
has been carried out as a standalone process
» Sardar Sarovar Water Resources Development Project
(Gujarat)
» Konkan Railway Project
» Bargi Dam Project (Madhya Pradesh)
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 SIGNIFICANCE OF HIA
All projects will have a direct or indirect impact on health
Agriculture, transport, and housing sectors have a major
impact on health
HIA identifies the most critical environment and social
determinants of health that may be affected by a project
HIA provides information in order to prioritize prevention
and control strategies
Enhances the potential positive effects while mitigating the
negative effects to the extent possible

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 TYPES OF HIA
Based on the “ Time of Conduction ”

Prospective HIA : Aims to consider the effects on health

that may be expected as a result of implementation
Concurrent HIA : Concurrent HIA assesses the impact of
health in parallel with implementation of a policy
Retrospective HIA : This type of HIA considers the
consequences for health as a result of project already
implemented

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 TYPES OF HIA
Desk based Rapid Comprehensive
2-6 weeks for one 6-12 weeks for one 6-12 months for one
person full time person full time person full time
Provides broad Provides more detailed Provides
overview of health overview comprehensive
impact assessment of impacts
Analysis of existing Involves collecting Involves collecting
and accessible data and analyzing existing and analyzing existing
data data from multiple
sources
Used where time and Used where time and Requires significant
resources are limited resources are limited time and resources
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 PRINCIPLES OF HIA
Democracy : The rights of the people to participate in a
transparent process of decision making
Equity : Examines the impact within the population in terms of
gender, age, ethnic background and socioeconomic status and
identifies vulnerable groups
Sustainable Development : The short-term, long-term, direct
and indirect impacts are taken into consideration, and
development effectiveness is not undermined by unintended ill
health effects for its beneficiaries
Ethical Use of Evidence : Emphasizing a rigorous use of
quantitative and qualitative evidence, based on various
scientific disciplines to ensure as comprehensive an assessment
as possible
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HEALTH IMPACT ASSESSMENT 8
 HIA PROCESS

SCREENING

SCOPING

APPRAISAL

REPORTING

MONITORING
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 HIA PROCESS
• Quickly establishes health relevance of the project or policy; is HIA
required?
SCREENING

Policy and
program
• Indentifies key health issues and public concerns; establishes ToR, sets
development boundaries
phase for SCOPING

prospective
Assessments
• Rapid or in depth assessment of health impacts using available evidance
– who will be affected, baseline prediction, significance, mitigation
APPRAISAL

• Conclusions and recommendations to remove / mitigate negative impacts

on health or to enhance positive
Policy REPORTING

implementation
phase
• Action where appropriate, to monitor actual impacts on health to
enhance existing evidence base
MONITORING

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 HIA TOOLS
Checklists
» Used particularly during the preliminary phases of HIA
» To determine potential areas of significant impacts
» Outlining impact areas, available data and methods of analysis
during the scoping phase
Community Participation
» Serve a valuable utilitarian function
» By bringing in diverse viewpoints from technical experts and a
range of stakeholders and can give local knowledge
Census Data
Establishing a baseline understanding of who might be affected by a
given project or policy and their current health risks and assets
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 HIA TOOLS
Logic Frameworks
Illustrates the putative causal pathways and likely positive and
negative health effects for the proposed program or policy. Logic
frameworks serve three primary purposes:
» Organize Existing Knowledge
» Guide Analysis
» Communicate Information
Systematic Reviews
The new data generated in health impact assessments is through only
by qualitative data collection. This includes focus groups, key
informant interviews, participatory observation, etc
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 HIA EXAMPLE :
A PAINT FACTORY IN DENNINGTON
Proposal : A new paint factory to be built on an existing industrial
site in Dennington
Background :
» Dennington is a small town in the South Midlands. A national paint
manufacturer is proposing to build a production factory on the
industrial estate. The factory would employ 160 people
» The estate is surrounded on two sides by owner-occupied
residential areas and by a junior school on the third side with the
road access at fourth side
» The Environmental Agency has granted an Integrated Pollution and
Prevention Control permit to the paint manufacturers for the setting
of the factory in Dennington
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HEALTH
IMPACT
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ASSESS
MENT
HEALTH
IMPACT
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ASSESS
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 Intermediate Affected Health Impact Comment
Factor Group
Employment All The factory will create 160 Potential
jobs thus increase beneficial effects
employment in the area. on the health of
community

Mental health Residents in Proposal will generate Open Process so

housing considerable anxiety and that residents do
next to impact on mental not feel things are
industrial wellbeing. Residents are being hidden
estate concerned about pollution from them
and fire /explosion hazard.

Visual Residents in Factory will have two Difficult to

amenity and housing emission chimneys that quantify the
natural next to will protrude above the effect on visual
environment industrial existing roofline. Local impacts and on
estate residents may be upset by property prices
visual impact. Other
concerns may include a fall
in property prices.
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HEALTH IMPACT ASSESSMENT
 HIA EXAMPLE :
Conclusion :
The major beneficial effect of the factory is the employment
opportunities it offers
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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 CASE STUDY
SARDAR SAROVAR WATER RESOURCES
DEVELOPMENT PROJECT (GUJARAT) - MOSQUITO-
BORNE DISEASE
The Sardar Sarovar is a multipurpose water resources
development project created on river Narmada in the Gujarat
state
It provides electricity, irrigation facilities and drinking water to
nearly 110 cities and towns in the semi-arid states in western
India
Construction of dam started in 1979 and picked up momentum in
1986
Several residential colonies for engineers, workers, labourers and
other supporting communities came up in the close vicinity of
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HEALTH IMPACT ASSESSMENT
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 CASE STUDYNARMADA BASIN

(Source : Narmada Control Authority)

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 CASE STUDY
Sardar Sarovar Water Resources Development Project
(Gujarat) - Mosquito-Borne Disease
An unusual increase in malaria was recorded at the project site
following commencement of the construction of the dam
Although the dam has been built in the valley area, creation of
dyke ponds and interruption of downstream flow of water caused
potential breeding habitats of vector species
The incidence and prevalence rates of malaria were far higher in
the population at the project site as compared to those in the
surrounding villages

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 CASE STUDY
Sardar Sarovar Water Resources Development Project
(Gujarat) - Mosquito-Borne Disease

Assessment of the impact of the project on vector-borne diseases

was undertaken by NIMR during 1994–98 and later in July 2002
also.
The main aims were to assess the following changes:
» Environmental receptivity of the project area
» Community vulnerability to various diseases
» Preparedness of health services to mitigate any adverse effect

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 CASE STUDY
The activities includes :
Geographical reconnaissance (GR) of borrow pits and other
mosquito breeding habitats created by construction of the canal
network
Studying abundance of mosquito vector population, bionomics
of vectors of malaria, filariasis and dengue
Evaluating insecticide susceptibility of mosquito vectors
Measuring overall vectorial potential
Determining parasite prevalence by mass blood/rapid fever
surveys
Asses malaria risk by application of GIS, and training needs
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 CASE STUDY

The Geographical reconnaissance of outdoor breeding habitats

revealed that Anophele Culicifacies was predominant species
and preferred irrigation related structures, viz. dyke ponds,
canals, siphons, seepage channels and seepage water pools, for
breeding

GIS based mapping of malaria incidence showed low incidence

of malaria although malaria showed variations from year to year

Cross sectional mass blood surveys (MBS) were carried out and
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a low
HEALTH parasite
IMPACT rate tally the GIS based mapping results
ASSESSMENT
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 CASE STUDY
To know whether intermediate hosts of Guinea worm disease are
present in the project area, a survey of Cyclops and snails was
also done
As anti-malaria programme, pyrethroid insecticides were
sprayed indoors in all high risk villages together with
strengthening of malaria surveillance and treatment services
The water is used for irrigation and so far the study covered the
pre-irrigation baseline phase, the health impact study of rest is
still not considered

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 IWRM PERSPECTIVE.....?
The principle and approach of HIA tally with that of IWRM
principle
Public Participation, Sustainable Development, Equity etc. are
dealt in both
HIA is implementing IWRM approach if it is conducted before
commencement of a project
In water resources development project HIA ensures the water
quality standards, minimum pollution, enhanced health condition
etc.

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 HIA IN INDIA......
Many of the developmental projects carried out in India are
beyond the ambit of health ministry
A strong inter sectoral coordination between other ministries such
as agriculture, transport, and other non-health ministries is
essential
A well-planned strategy is required for introducing and integrating
HIA into basic management system
Making HIA mandatory by law by integrating it with
Environmental Impact Assessment Policies
Including HIA in curriculum of medical studies

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 CONCLUSION
By understanding the significance of environment and social
impacts, the multi lateral funding agencies like the World Bank,
ADB and others has given more importance to the EIA and SIA
studies in almost all their funding project
Similar kind of lime light should also be required for HIA studies
Though the impact of HIA may be minimal in the beginning but
in due course of time the monotonous effect will have more
impact on human resources
So for all the major projects, the importance of HIA might be
part of policy mandate check list

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 REFERENCE
Binny Dua, Anita S Acharya, Health Impact Assessment: Need
and Future Scope in India, Indian Journal of Community
Medicine, Vol 39, Issue 2, April, 2014, p 76-81,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4067933,
accessed on 08-November-2016.
WHO Regional Office for Europe, Health Impact Assessment:
main concepts and suggested approach, Gothenburg consensus
paper, December 1999.
A Profile of National Institute of Malaria Research, Health
Impact Assessment (HIA) of Development Projects with
Reference to Mosquito-borne Diseases.
West Midlands Directors of Public Health Group, Using Health
Impact Assessment to make Better Decisions - A simple guide.
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 THANK YOU
FOR YOUR ATTENTION

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