Thinking about HIA effectiveness

Washington MonumentI’m in Washington D.C. for a meeting on evaluating health impact assessment, which has been organised by the Health Impact Project at the Pew Charitable Trusts.

As part of my preparation for the meeting I’ve pulled together some of my ideas into a document, based mainly on my involvement in the Effectiveness of Health Impact Assessments in Australia and New Zealand ARC-funded project.

I’d be interested in any feedback. In particular I’d appreciate any responses to what I think remains unknown/future directions for HIA evaluation research:

  • How does HIA change perceptions at individual and organisational levels and how can we better account for this through research design?
  • How can we better evaluate learning that can occur through HIAs, at individual and organisational levels?
    • Technical
    • Conceptual
    • Social (Glasbergen, 1999)
  • How can we account for different forms of bias in evaluations of HIA?
    • Framing bias
    • Confirmation bias
    • Hindsight bias
    • Creeping determinism
    • Narrative fallacy (Harris-Roxas et al 2014)
  • How can we develop a more nuanced approach to scoping HIAs to consider the determinants of health inequities, as distinct from the determinants of health?

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Source: Harris and Harris-Roxas 2010

“What is clear here is that impact assessment is beginning to be seen not just as a tool for informing and influencing decision-makers, but as a process which changes the views and attitudes of stakeholders who engage with the process such that their own attitudes and practices change outside of the immediate decision making context. That is, the influence of impact assessment processes may extend well beyond the narrow decision window in which they operate. There is also recognition that such learning operates on an institutional and social level as well as on an individual level.” Bond & Pope (2012:4)


Bond A, Pope J (2012) The State of the Art of Impact Assessment in 2012,  Impact Assessment and Project Appraisal, 30(1): 1-4. Download PDF

Glasbergen P (1999) Learning to Manage the Environment in Democracy and the Environment: Problems and Prospects (Eds Lafferty W and Meadowcroft J), Edward Elgar: Cheltenham, 175-193.

Harris E, Harris-Roxas B (2010) Health in All Policies: A pathway for thinking about our broader societal goals, Public Health Bulletin South Australia, 7(2): 43-46.

Harris-Roxas B, Haigh F, Travaglia J, Kemp L (2014) Evaluating the impact of equity focused health impact assessment on health service planning: Three case studies, BMC Health Services Research, 14(371), doi:10.1186/1472-6963-14-371.