Main steps of HIA

In the structured approach of drawing up evidence-based action plans to address socioeconomic health inequalities as adopted in the Health Equity 2020 project, the goal of the HIA is to estimate the potential health effects of actions before the actual implementation of these actions. The outcome of the impact assessment informs the decision making process, for example through the provision of quantitative, measurable estimates of the effects of an action.

An HIA in which the potential effects of the action are estimated before the action is actually implemented, is called a prospective HIA. In some cases, an HIA is carried out retrospectively but then the aim is to evaluate an action after its implementation.

An HIA consists of five main steps, which are depicted in Figure 32, and includes (1) screening, (2) scoping, (3) impact assessment, (4) decision making (reporting and recommendations), and (5) monitoring and evaluating. In the screening phase it is determined whether an HIA is suitable and feasible. In the scoping phase, the scope of the HIA is determined and the methods and work plan are set out. The third step, ‘impact assessment’ is the core step in which the actual estimation of impact on health is determined. This step can be further divided into several sub-activities. In the fourth step, the results of the HIA are reported and recommendations are formulated in order to enable the decision-making process. The final step contains of monitoring and evaluating the HIA recommendations and process.

There may be some small differences in the number or the names of the steps, depending on the specific HIA framework used. However, the core process is essentially similar.

In the next session, all steps will be briefly explained. The guidelines of all different available frameworks provide more extensive information on how to perform each of these steps. An overview of available guides and frameworks is provided here.


Figure 32

Next: Equity focus within HIA