Introduction

In a country, a policy, programme, or project is planned for the benefit of the people whereas health effects are often overlooked while planning these development projects which may range from new highways to water supply or drainage systems to improve sanitation.

Health Impact Assessment (HIA) is a tool to improve decision-making, to weigh the policy options in different sectors so that possible impacts on health and of the contribution of improved health to development are explicitly taken into consideration.¹

Apart from the significance of HIA with regard to domestic policies of a country, it can also play a part when foreign policy is developed and global decisions are made to treat people as rights holders.²

Review

Though Environmental Impact Assessment (EIA) is already mandatory in India,³ it focuses only on the environmental outcomes whereas HIA focuses on the health outcomes.⁴ Bypassing the issues of health impacts of a project, may also result in widening of equity/ inequality gaps.⁴

Conducting systematic HIA (either as standalone assessment or as part of an integrated Environmental, Social & Health Impact Assessment – ESHIA) for a project or programme can ensure that disruption is kept to a minimum and is tolerated by local communities.⁵

Another question which crops up in mind is at what stage in the project is HIA conducted? HIAs should be initiated when projects are at the early design stage and ideally, HIA should be undertaken in an iterative manner in parallel with project planning, with HIA results timed to inform key decisions.⁵

It would be undoubtedly appreciated by all that HIA for the Common Wealth Games (CWGs) 2014 has already been conducted and the comprehensive HIA report is available online well in advance ⁶ whereas such assessment reports were also desirable as regards, inter alia other projects planned in India like Tehri DAM and Hydro Power Complex Uttaranchal, Jaitapur Nuclear Power Project, etc, the CWGs 2010 New Delhi, India. Similar HIA reports could also be found at International Health Impact Assessment Consortium (IMPACT) at University of Liverpool, United Kingdom web link i.e., http://www.liv.ac.uk/ihia/IMPACT_HIA_Reports.htm.

Recently, National Conference on Health Impacts of Polluted Environment was organized at New Delhi with collaborations from different sectors of Indian Government.⁷ Moreover, the International Association for Impact Assessment, with more than 1,600 members and representing more than 120 countries, considers HIA as an important part of impact assessments.⁸ Importance of HIA as regards South East Asian countries was also addressed in a publication of World Health Organization.⁹

Limited resources and experts for conducting HIA, indifferent attitude, or even the lack of awareness about the importance of HIA might be few of the many possible constraints faced by a Government. Until the within-in country capacity building is accomplished, decision makers have the alternative option of commissioning external HIA experts.⁴ International Health Impact Assessment Consortium (IMPACT) is based in the Division of Public Health, a WHO Collaborating Centre at the University of Liverpool, UK and delivers a 5-day HIA training programme twice a year as well as a Masters module which is part of University's Masters of Public Health programme.¹⁰

Conclusions and Recommendations:

Conclusively, HIA must be regarded as a right of the people and steps must be identified to move ahead the field of HIA in India, being recognized as the largest democracy, and of course other countries as well.

Key points

HIA is important for planning a healthy public policy or project.

EIA will not suffice for HIA.

HIA is still not mandatory even for large projects and policies in India and many other countries.

Steps must be identified to move forward the field of HIA in India and other developing countries.

Steps towards preparedness for future can be - laying emphasis on the topic of HIA in curriculum of Post Graduate courses in Community Medicine and other related streams like Public Health or Preventive and Social Medicine, organizing workshops for refining the skills of existing HIA experts, and, thinking over the legislative planning for making HIA mandatory at least for large projects/ policies and at a later stage for all the projects, as the case may be. The officers who are entrusted with Public Health Management must be encouraged for acquiring the proficiency in HIA by attending HIA training programmes/courses outside their homeland or when available, within the homeland.