Insights article

What is a health impact assessment for planning projects? Why should you care?

Sebastian Weise
Published: 16/07/2020

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Health Impact Assessments (HIAs) for planning applications focus on how a development proposal will impact residents' wellbeing and how any negative impacts can be mitigated or even improved upon.

While Environmental Impact Assessments (EIA) have become a statutory requirement for most planning applications in the UK, the Health Impact Assessment has not.

Read on to find out about Health Impact Assessments for planning applications. 


When is a Health impact assessment required?

Health Impact Assessments are not yet very common as a validation requirement when submitting planning applications for major developments in England. According to our information, in England, only 30% of councils in one way or another perform or require health impact assessments for major planning applications.

Here are some examples of requirements at different local planning authorities:

  • Camden (and most borough councils in London): Planning applications for more than ten homes or 1000m2 require a rapid assessment; Planning applications for 99 homes or 9,999m2 floor development area require a comprehensive assessment
  • Essex: Planning applications for more than 50 homes or 1000m2 require a rapid impact assessment.  

However, even if not directly implemented by architects or required for submission, aspects of health appraisals can be a part of a baseline analysis for a design and access statement or, indeed, may be mentioned in Environmental Impact Assessments, which are generally required for major applications.

With the recent attention to our immediate surroundings' role in personal health as part of the Covid 19 pandemic, we expect that HIAs will become a more prominent part of the development approval process for new developments.


What is a Health Impact Assessment good for?

Health Impact Assessments are the primary tool for appraising a new development for potential health impacts on the neighbouring population. In the U.K., Wales Health Impact Assessment Support Unit (WHIASU), funded by the Wales Government, has been a major proponent for the adoption of Health Impact Assessments in development planning.

Health Impacts Assessments bring together insight into the built environment's present conditions and the people in a particular area, engagement with local needs, and references to health impact evidence and studies. 

HIAs provide a framework that captures essential dimensions of urban features thought of being conducive to support health outcomes. The Health Impact Assessment provides an opportunity for a user-focused review of construction projects' impacts based on evidence from other projects and, ideally, evidence from spatial analysis. 

Health Impact Assessments improve the design and make it sensitive to the site context, especially health impacts. 


What are the different types of Health Impact Assessment?

The format of the health impact assessment should be proportionate to the significance of the project, the sensitivity of the site context, and the purpose of the assessment.

There are three primary formats of Health Impact Assessment that can be applied to new development projects:

  • Desktop appraisals can be done quickly by reviewing a few key aspects of the site context and is a general part of any good site analysis. 
  • ‘rapid’ assessment is often referenced by councils, especially in London, and is a signifier of a limited impact review. This kind of assessment usually follows a structured checklist to cross-reference evidence.
  • A ‘full assessment’ is a substantial and detailed assessment that will be a separate work programme. This tends to be a requirement for significant projects, such as national infrastructure and village-scale residential developments.

Type of assessment

Effort

Description

Desktop

Hours to days

  •  
    Limited to no stakeholder engagement
  • Review of readily accessible data
  • Reference to local policies

Rapid

Days to weeks

  • Steering group and more extensive stakeholder engagement
  • Literature review or study to evidence link between built environment and health
  • Approach is a bit more formalised through checklist templates

Comprehensive

Months

  • Extensive stakeholder engagement, e.g. including community needs appraisals (for example with asset based approaches)
  • Dedicated project team and steering group
  • Approach more tailored to the unique requirements surfaced in the early scoping activity 

The timing of the impact assessment can be prospective (before the project start), concurrent (while the design project unfolds), or after (as a retrospective). In general, a prospective assessment is better than a retrospective as it ensures that the design direction has been influenced by awareness of health outcomes in the first place.


Rapid HIA frameworks: HUDU and Essex Livewell

Undoubtedly, many other frameworks support design quality, including accreditation frameworks, each with a respective focus. 

Thus far, there is no agreed standard for health impact assessments on planning applications. There are however a few toolsets that have been developed in recent years and have been well used in their local areas. Those include the London-based HUDU framework and the rapid Health Impact Assessment used in Essex. 

The NHS HUDU’s Rapid Health Impact Assessment, as used in London, is amongst the better-known ones, and borough councils in London consistently require it. It has also been used to inspire adaptations, such as the HIA for Essex, which is also used as part of the Livewell developer accreditation scheme developed by Chelmsford Council.

Rapid assessment tools come in the format of a checklist. An overview of dimensions is provided below with a mapping according to the wording in the criteria of the respective section. In both cases the architect used the framework criteria to comment on the likely health impacts. For each criterion, the impact on health outcomes would be described as positive, neutral or negative. There is also a requirement to describe the likely length of that impact and ideally to which population group it applies. 

Below we list the overlaps and synergies between HIA frameworks used in London and Essex. 


Essex HIA

London HIA

Major themes

10 dimensions

11 dimensions

Criteria

79 criteria

51 criteria

 
 
 
 
 
 
 
 
 
 
 


Essex HIA

London HIA

1

 Design of homes and neighbourhoods

 Housing design and affordability

2

 Active environments and active design principle application

 Accessibility and active travel

3

Access to open, green and blue space


Access to open space and nature

4

Access to healthcare infrastructure


Access to health and social care services and other social infrastructure

5

Supporting communities and lifetime neighbourhoods


Air quality, noise and neighbourhood

6

(picked up in ‘Design of homes and neighbourhoods’)


Crime reduction and community safety

7

Access to healthier food environments


Access to healthy food

8

Education, employment and skills

Access to work and training

9

(picked up in ‘Design of homes and neighbourhoods’)


Social cohesion and inclusive design

10

(picked up in ‘environmental sustainability’)


Minimising the use of resources

11

Environmental sustainability


Climate change

Barriers to using health impact assessments

The impact assessment requires the cross-referencing of substantive evidence both about the population and also the development; the task of completing an HIA can therefore appear daunting, especially for any architect who might not have completed it before. A ‘rapid’ assessment can take several days or a couple of weeks. Perhaps most problematic are the funding sources, as project owners typically are averse to spending substantial funds on baseline assessments if the local authority does not require it.

Practitioners doing the assessment may face further challenges that can make an impact assessment less meaningful for considering health outcomes.

Firstly, health outcome considerations may be critiqued as “wishy-washy”, especially if the link between the health outcomes and specific built environment features is not clearly backed by evidence that demonstrates the link. Despite the abundance of evidence and data on public health (the best source for data in England is the PHE’s fingertips data tool — Link), it remains notoriously hard to link health outcomes and building design proposals, especially in complex urban environments, where many relationships are at play.

And then, there are simple, pragmatic issues, for instance, the lack of time for analysis and understanding of all the details in the context of the locality. Performing a baseline analysis often relies on conversations with local experts, but direct involvement of residents is often unfeasible, given the time involved. Health practitioners may not be seen easily to access. Therefore, gathering in-depth insight on a locale’s community assets can be tricky -- “you need to be pointed in the right direction”, which is often by the client.

Clear guidance by local authorities on health outcomes remains rare. There is a lack of a commonly agreed position regarding the requirements for Health Impact Assessments across the UK; a consistent nationally agreed standard for health impact assessments is lacking. In consequence, understanding in practice remains low; and there is a clear case for data overload, especially when trying to find meaningful evidence that demonstrates specific health deficits in a locality and how to address them.

Removing barriers to using health impact assessments

Addressing health and wellbeing in planning projects systematically and up-front has substantial long-term benefits. For instance, the King's Fund estimated that every pound spent on features that promote walking and cycling has a long-term return of £50 and £168, for example, through reductions in the burden on health services.

Given the wider availability of data on how urban spaces are used, the links between health and wellbeing and planning will become more evident.

PlaceChangers, for instance, is a leader in location insights for health and wellbeing. The Site Insights tool on PlaceChangers addresses the above challenges and helps architects and developers make wider use of health impact assessments in their work. 

The Site Insights tool creates a health/wellbeing baseline with the click of a button. Lack of time and money presently is a critical barrier which this addresses. Our actions tap into general suggestions for improvement in practice, including the following tips.

  •  
     
     
    Data and evidence for developers. The data that drives evidence on health outcomes needs to be more contextual, and ideally meaningful. Over time, we need to link evidence of outcomes seen to the changes we make in the built environment. This is a long process and can not be evidenced rapidly. We are working on mapping the evidence for the outcomes those interventions have on different population groups and their health outcomes. 
  •  
     
     
     
     
    Work towards complementary frameworks. PHE leads this work to mainstream health impact assessments and to push for a few well-recognised frameworks to avoid an abundance of checklists or insular approaches where everybody creates their own, as consistency is key.
  •  
     
     
     
     
     
    Suitable digital tools to support health outcomes. Give local councils, architects, and developers easy to use tools to pro-actively appraise development proposals for health outcomes and consider the needs of the local community given the existing neighbourhood features and public health characteristics. We are working to link built environment and health outcome data to create better baseline analysis and, ultimately higher-quality designs. 
  •  
     
     
     
    Aiding training and readiness in local councils. This will also help local authorities, who’ll start to look more closely at what outcomes are needed and wanted and how they could be described with greater clarity. For instance, few local authorities presently consider health outcomes in their planning processes. Without clear targets, many councils will find it impossible to measure progress.

Easy to access evidence and location analytics in a powerful tool like Site Insights help more developers to shape site layouts at earlier design stages for the long-term benefit of residents. 

Explore the PlaceChangers planning toolkit

PC Site Insights - Unique location insights tool for health and wellbeing outcomes

Start to make use of location data and enrich your community engagement planning with insights on local people. Add in your own data sources and gather analytics in one place. 

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