Major update of the International Best Practice Principles for health impact assessment

Cover of the International Best Practice Principles: Health Impact Assessment document

The International Association for Impact Assessment has published revised International Bets Practice Principles: Health Impact Assessment.

This influential guide has been updated for the first time in fifteen years to reflect the evolution of health impact assessment practice. Mirko Winkler led the revision and the team included Francesca Viliani, Astrid Knoblauch, Ben Cave, Mark Divall, Geetha Ramesh, Peter Furu and I .

Key Citations

The Principles are accompanied by an updated IAIA Key Citations document. This sets out important health impact assessment milestone publications, guidance documents and journal articles .

The new guide complements the findings of the international survey on Current Global Health Impact Assessment Practice that was published last year .


Winkler, M., Viliani, F., Knoblauch, A., Cave, B., Divall, M., Ramesh, G., Harris-Roxas, B., & Furu, P. (2021). International Best Practice Principles: Health Impact Assessment (2nd edition) (Special Publication Series). International Association for Impact Assessment.
Winkler, M., Viliani, F., Cave, B., Divall, M., Knoblauch, A., Harris-Roxas, B., Ramesh, G., & Furu, P. (2021). Key Citations: Health Impact Assessment (Key Citations Series). International Association for Impact Assessment.
Winkler, M. S., Furu, P., Viliani, F., Cave, B., Divall, M., Ramesh, G., Harris-Roxas, B., & Knoblauch, A. M. (2020). Current Global Health Impact Assessment Practice. International Journal of Environmental Research and Public Health, 17(9), 2988.

Current Global Health Impact Assessment Practice

Mirko Winkler led a team that undertook a survey of 122 HIA practitioners across 29 countries . The findings highlight that:

  • HIA is being used worldwide
  • Capacity is concentrated at the beginner and intermediate levels, though a higher proportion of respondents from Europe reported having more than ten years of HIA experience
  • there is a need for more advanced capacity building and training offerings internationally
  • strengthening the policies and legal frameworks under which HIAs are undertaken remains relevant.
Origin countries of respondents; and the number of respondents per region with corresponding years of HIA practice experience
Regions where HIA assignments were conducted; and fields of HIA application
Types of health assessments conducted; and decision-maker on type of health assessment to conduct

Twenty-four percent of respondents were from the Asia Pacific, and practices across our region are reflected in the overall results.

Health Impact Assessment: A practical guide that I wrote with Patrick Harris, Elizabeth Harris, and Lynn Kemp was identified as the fifth most-used HIA guidance internationally, after WHO guides, Martin Birley’s book on HIA , and the IAIA Best Practice Principles .

In general respondents were split on whether HIA’s use is continuing to increase or has stagnated, a debate that has relevance across the Asia Pacific region. Of particular important to our region, the paper emphasises that:

Finally, there is an increasing recognition of the role that biodiversity and ecosystem services play in the relationship “healthy planet, healthy people”, and the role that impact assessments play. In an outlook for the future, and additionally to providing a framework for safeguarding health in sustainable development, HIA has the potential to be contributory to the operationalisation of “planetary health”.



Martin Birley. Health Impact Assessment: Principles and Practice. London: Routledge, 2011.
Quigley, R., L. den Broeder, P Furu, A Bond, B Cave, and R Bos. “Health Impact Assessment International Best Practice Principles.” Fargo, North Dakota: International Association for Impact Assessment, 2006.
Winkler, Mirko S., Peter Furu, Francesca Viliani, Ben Cave, Mark Divall, Geetha Ramesh, Ben Harris-Roxas, and Astrid M. Knoblauch. “Current Global Health Impact Assessment Practice.” International Journal of Environmental Research and Public Health 17, no. 9 (April 25, 2020): 2988.

Lessons about health impact assessment: Learning by Doing

VicHealth Walk to School HIA
VicHealth team presenting on their equity focused health impact assessment

Last week I attended the final day of a Learning by Doing health impact assessment (HIA) training program. Learning by Doing is a structured six-day training program run by the Centre for Health Equity Training, Research and Evaluation (CHETRE), where I work. The training is broken up into distinct stages. People learn about HIA, go away and do the steps they’ve learned about, then come back to reflect and learn about the remaining steps.

The final day is always great because the different groups who have been doing HIAs present their work and their findings. There were five HIAs conducted in this round of Learning by Doing, which involved the South Western Sydney Local Health District, the NSW Department of Family and Community Services, VicHealth, Liverpool City Council, the Think+Do Tank and community representatives.


Some of the stand-out lessons from the Learning by Doing sites were:

  • A lot of the value of HIA lies in highlighting and clarifying assumptions made during planning.
  • A planned engagement approach is useful as part of all HIAs.
  • Conceptual learning remains an important outcome of HIAs, in particular learning about health equity.
  • Involving consumers in HIAs has multiple practical benefits, such as identifying alternatives and providing an understanding of  context and history.
  • Scoping remains as critical as always – being rigorous but not biting off more than you can chew (it also reminded me of this paper about scoping in EIA).
  • Not all barriers can be overcome; you need to be realistic about what you can achieve within the limits of an HIA.

More on Learning by Doing

For more on CHETRE’s work on health impact assessment go to HIA Connect. The Learning by Doing approach is described in greater detail in the chapter below:

Harris E, Harris-Roxas B, Harris P, Kemp L. “Learning by Doing”: Building Workforce Capacity to undertake HIA – An Australian case study, in O’Mullane M (ed) Integrating Health Impact Assessment into the Policy Process: Lessons and Experiences from around the World, Oxford University Press: Oxford, 2013, p 99-108. ISBN 9 7801 9963 9960 Google Books link