July 31, 2020

Sebastian Weise

Community engagement in health impact assessments

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Desk studies tell part of the story

The involvement of local residents and stakeholders is a core part of any Health Impact Assessment.

The architects’ desk study may quickly establish that there is a large woodland nearby or a body of open surface water. Woodlands have been associated with improvements of physical health, whereas water features are conducive to mental health. So on paper, that sounds good. However, knowing these features exist near a development site is not useful in itself if those features are inaccessible or in any way unsafe.

Direct public engagement can help to put real life stories to the concerns identified through desk study. Community engagement can indentify if features relevant to the health outcomes are usable; and identify options to improve them. This is not only useful for considering what is provided on site, but can also be addressed through contributions, such as the Community Infrastructure Levy or negotiated developer contributions. 

Public engagement adds the following to the HIA process. 

  • Understand health concerns of local people directly from those potentially affected
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    Understand local circumstances by understanding which built features locally are appreciated for health and which ones are detrimental
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    Cross check needs based on local council guidance 
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    Ranking and prioritising potential impacts desired or avoided

What public engagement is done?

There are three types of Health Impact Assessments of increasing scope. Those are ‘desktop’ reviews, ‘rapid’ more extensive reviews, and lastly comprehensive appraisals that come with an in-depth work programme that sits alongside the development of design proposals (see Hudu Rapid HIA guidance p5). 

For public engagement activities, our review found face-to-face or in-depth focus groups where amongst the most used methods. This is often combined with establishing structure for how participants are involved for example through steering groups. Some of the particular methods mentioned included: 

  • Interviews: Good for getting a detailed view of key stakeholders understanding of local health outcomes  
  • Surveys: Can be distributed widely and can create a detailed picture if used well. 
  • Workshops: Can be powerful to discuss local health outcomes and potential impacts of new developer. They will require good facilitation and structure to enable a link between the conversation, secondary data, and the site context.  
  • Walking tours: Can be a powerful, and often fun activity to co-explore the local area and key issues with local stakeholders.

For rapid and comprehensive health impact assessments, a steering group of experts and some interested local individuals is standard practice in order to incorporate local concers. Steering groups provide the oportunity to include local stakeholders and bring key parties together regularly. In some cases, steering groups can provide a 'wrapper' around organising more targeted or broad based community involvement for a HIA. 

Area appraisals with local residents

What level of engagement is done naturally depends on the scope of the HIA. Often the issue is time and money constraints to do any sort of engagement for a HIA, which in itself is resource-constraint. 

Targeted interviews are generally helpful to prioritise and understand the area better. Fuller community-driven area appraisals are another opportunity to introduce substane and insight. For comprehensive HIAs and in most cases also even rapid HIAs, a low-cost high-impact engagement activity that can reach a wide audience would certainly be perferred to see how the wider area is used and any deficits.

Approaches such as walking tours can look for links between individuals' health and wellbeing and particular built features that have perceived positive or negative implications for participants. Using digital tools, walking tours can be scaled up to reach a large part of the local population and ask questions on particular points of interest. 

A community area appraisal can focus on specific built environment features of interest to Health Impact Assessemtn. Some built environment features relevant to HIAs are listed below. These features come from a review of the rapid Health Impact Assessment frameworks for London and Essex: 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Feature

Suggested placement

Open spaces

Throughout, easily accessible

Natural spaces

Throughout, easily accessible

Healthcare facilities

Within active travel distance

Community facilities / centres

Within active travel distance

Employment

Ideally within active travel distance (mitigrations if not)

Active travel routes (walking & cycling)

Throughout

Food outlets (excluding fast food)

Within active travel distance

Key retail / groceries

Within active travel distance

Child care & education

Within active travel distance

As part of involving a broader audience in a health impact assessment, it is important to prepare the format in which responses are obtained. In particular, the following can be done to help structure the response, both in terms of personal background of respondents, but also the feedback on built environment features relevant to local health outcomes:

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    Ask questions on demographics and other population-relevant aspects matching to the Census, so that individual responses could be compared to the overall population
  •  
    Ask participants for feedback on their current health or general wellbeing using, for instance, the Census’ questions on wellbeing.
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    Have meaningful feedback categories for relevant built environment features, such as rating of service quality. 
  •  
    Feedback on the quality of local services and establish underprovision in access to relevant built environment features and how these features are locally used.

What’s the issue with community engagement in Health Impact Assessments?

Especially for rapid HIAs, but more generally for any project really, the balance of cost and time to meaningful results is often a challenge. Also for smaller project teams or organisations, there are often capacity limitations to undertake broad based engagement. 

For participation in health impact assessments, therefore, representativeness of the people participating could be limited, especially if only steering groups are used. If a larger survey is undertaken, responses need to be interpreted carefully. So for example, what does it mean if somebody indicates poor wellbeing? Or what if participants feedback on local features. What do you do to interpret the response and understand it in context?  

To each of the questions the answer lies in a number of factors.

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    Use priorities identified from scoping work and desk study to inform the priorities in public engagement activities
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    Prepare the engagement activity in such a way that feedback can be related to relevant secondary data material
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    Providing sufficient guidance and structure to each of the responses in order to reference them in respect to meaningful things, such as a theme or a location.
  •  
    Use methods that allow to prioritise local concerns with the public, ideally by sharing responses back publicly for others to review
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