Step 6: Monitoring Impacts

Note: This step is for projects that commissioned steps 3-5 of a HIA. Where any identified impacts were captured by other impact assessments (e.g. EqIA) the project team should ensure that the monitoring process in place for those impact assessments adequately monitors any health and equity impacts dealt with through that process.

The final step of HIA is monitoring of impacts that arise after the proposal has been implemented. Monitoring will usually take place after the HIA has been completed but the HIA report should consider arrangements for monitoring and include these in the recommendations where appropriate. This may allow changes to be made to address unanticipated impacts and adds to the evidence base for future HIAs.

It is important to clarify the aims of monitoring and define in advance the determinants and/or population(s) and outcomes to be monitored.

Monitoring of an HIA can mean different things: i) monitoring whether the HIA recommendations have been implemented or ii) monitoring impacts on health determinants that the HIA identified could be impacted.

Monitoring HIA Recommendations

Monitoring of HIA recommendations should be incorporated into any existing monitoring plan, to track whether recommendations are implemented and also their impact on the proposal. Monitoring implementation of recommendations will help teams to identify if recommendations were both feasible and beneficial to the project. This type of monitoring will also inform future HIAs providing evidence of what has and hasn't been successful in completed HIAs.

 Monitoring Impacts on Health Determinants

In most cases it is better to monitor changes in the relevant health determinants as well as - or instead of - monitoring changes in health outcomes, as health outcomes may take years (or decades) to emerge. It is also often very difficult to determine if changes in health outcomes are attributable to a specific proposal. This is particularly the case if the expected changes are small, or the outcomes are affected by other factors, especially if these are also changing over the period when the proposal is being implemented.

Also, if only health outcomes are monitored it means there is no opportunity to intervene and address the issue before it becomes a manifest health issue. Health determinants to measure could include air quality, noise or community complaints, access to services and education, available housing quality, employment, or availability of greenspace, depending on the impacts identified in the HIA.

It is important to monitor the distribution of these impacts across the population, particularly in populations at highest risk of poor health. It may be helpful to involve affected populations and stakeholders in monitoring processes.

Monitoring may use routine data where appropriate or require prospective collection of new data. It should ideally be part of standard monitoring processes. Routine data may not be available at the level needed to attribute changes in a determinant to a specific development or project.

If there is a Community Action Plan or equivalent it is useful to include monitoring within this. This will define who is responsible for monitoring, the specific measures, and who results are reported to. It should define the levels at which action would be needed to prevent adverse health impacts.

A HIA monitoring and impact management plan template which can help to set out the indicators to monitor, actions to be taken for adverse impacts and who is responsible for these actions is provided in Table 1.

Table 1.