Influencing the wider determinants of health: Conducting Health Impact Assessments for environmental change and understanding the scope of stakeholder influence

Despite associations between environmental features and physical and mental health outcomes urban development projects may not result in healthy places. This can increase risks of ill-health and health inequalities. Health Impact Assessments (HIAs) are increasingly used as a tool to evaluate potential health impacts of environmental changes, such as for large-scale house building and transport infrastructure projects. HIAs may help to influence designs to support healthier environments, however they have been criticised for taking a retrospective approach and being ineffective.

This research seeks to improve HIA practice and understand the opportunities and limitations of influencing the wider determinants of health during environmental change projects. It presents learning from practice in local government in England by an embedded researcher who worked part-time within a regeneration team (Oct 2020 – present). It describes the iterative and collaborative process of conducting HIAs to inform development of a regeneration framework for a deprived urban area where over 1000 new homes will be built in the coming years.

The HIA framework involved 11 wider determinants of health topics: Housing design and affordability; Access to health and social care services and other social infrastructure; Access to open space and nature; Air quality, noise and neighbourhood amenity; Accessibility and active travel; Crime reduction and community safety; Access to healthy food; Access to work and training; Social cohesion and inclusive design; Minimising the use of resources; and Climate change. The links to health were highlighted for each topic, alongside relevant local contextual issues. Recommendations were given for various non-health stakeholders to support healthy urban development, particularly property developers and local government services.

Using action research methods the research also analyses the scope of influence of key stakeholders for each of the 11 wider determinates of health topics. This focuses on property developers, local government (predominantly non-health services), and the public. This understanding is important to inform prevention research and practice and support public health interventions for healthier environments.

The research identifies that HIAs, if conducted early and iteratively, can be helpful to focus attention on health and wellbeing considerations for environmental change projects, however it also highlights the potentially limited influence of local government and members of the public. This is due to their limited power as a result of national policies and legislation, land ownership, and resource availability.

Public health researchers and practitioners need to understand the complex system of urban development decision-making to be able to influence the wider determinants of health.