Development of an Urban Health Impact Assessment methodology: indicating the health equity impacts of urban policies.

Background: An overarching recommendation of the global Commission on Social Determinants of Health was to measure and understand health inequalities and assess the impact of action. In a rapidly urbanising world, now is the time for Urban HIA. This article describes the development of robust and easy-to-use HIA tools to identify and address health inequalities from new urban policies. Rapid reviews and consultation with experts identified existing HIA screening tools and methodologies which were then analyzed against predefined selection criteria. A draft Urban HIA Screening Tool (UrHIST) and Urban HIA methodology (UrHIA) were synthesised. The draft tools were tested and refined using a modified Delphi approach that included input from urban and public health experts, practitioners and policy makers. The outputs were two easy-to-use stand-alone urban HIA tools. The reviews and consultations identified an underpinning conceptual framework. The screening tool is used to determine whether a full HIA is required, or for a brief assessment. Urban health indicators are a readily available and efficient means of identifying variations in the health of populations potentially affected by policies. Indicators are, however, currently underutilised in HIA practice. This may limit the identification of health inequalities by HIA and production of recommendations. The new tools utilise health indicator data more fully. UrHIA also incorporates a hierarchy of evidence for use during impact analysis. The new urban HIA tools have the potential to enhance the rigour of HIAs and improve the identification and amelioration of health inequalities generated by urban policies.

How Health Impact Assessments (HIAs) Help Us to Select the Public Health Policies Most Likely to Maximise Health Gain, on the Basis of Best Public Health Science.

Health Impact Assessment (HIA) is a decision support tool intended to present timely, evidence-based recommendations to decision makers in all sections of society in order to accentuate potential positive health and well-being impacts (and mitigate potential negative impacts) of policies, plans (including local and neighbourhood plans), programmes and projects (including infrastructure and local development proposals), in order to reduce health inequalities/disparities. HIA is a well established and proven means of linking research evidence from public health and the environmental sciences with equitable decision making processes at all levels, from local to global. It may also provide a platform for examination of research proposals to strengthen the impact statement therein, identifying potential for future public benefit. This paper highlights some of the main drivers for a timely re-emphasis on the use of best scientific evidence and systematic HIA to inform decision making for future public benefit, citing the example of air pollution.