Health Impact Assessments are still relatively new in the planning domain. So if you arrived here wondering what is a health impact assessment for a major planning application, you are in the right place!

Health Impact Assessments (HIAs) for planning applications focus on how a development proposal will impact residents' well-being and how any negative impacts can be mitigated or 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.  
• Durham County Council: Major planning applications for more than 100 homes or employment sites with more than 10+ ha.

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 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 significant proponent of adopting 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 conducive to supporting support health outcomes. The Health Impact Assessment offers 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 project's significance, the site context's sensitivity, and the evaluation's purpose.

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

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, no standard for health impact assessments on planning applications has been agreed upon. However, a few toolsets have been developed and well-used in planning applications. Those include the London-based HUDU framework and the rapid Health Impact Assessment used in Essex.

As used in London, the NHS HUDU’s Rapid Health Impact Assessment is amongst the better-known ones, and borough councils in London consistently require it. It has also inspired adaptations, such as the HIA for Essex, which is 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. The architect used the framework criteria in both cases to comment on the likely health impacts. Each criterion's impact on health outcomes would be described as positive, neutral or negative. There is also a requirement to describe the possible 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. 

Barriers to using health impact assessments

The impact assessment requires cross-referencing substantive evidence about the population and the development; completing an HIA can therefore appear daunting, especially for any architect who might not have finished it before. A ‘rapid’ assessment can take several days or 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. Consequently, understanding in practice remains low; 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.

Find out more. Read more on common factors for health impacts here: Health impacts of housing projects – and how you can improve 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.

Easy to access evidence and location analytics in a powerful tool like PlaceChangers Site Insights help you complete Health Impact Assessments faster.