Publications

20 years of the Wales Health Impact Assessment Support Unit (WHIASU) and the evolution of Health Impact Assessment (HIA) in Wales

The 20th anniversary of WHIASU marks two decades of advancing HIA as a vital tool for healthier decision-making and reducing health inequalities in Wales. Established in 2004, WHIASU has led the way in enabling the integration of HIA into policy at local, regional and national levels.

The timeline highlights key milestones, documents, and publications in WHIASU’s history and the practice of HIA in Wales. Looking ahead, WHIASU will continue to champion HIA and Health in All Policies (HiAP), supporting public bodies in implementing upcoming HIA regulations under the Public Health Act (Wales) Act 2017.

Putting the Spotlight on Health, Well-being and Equity Using Health Impact Assessment: Case Studies from Public Bodies in Wales

This publication focuses on the use of Health Impact Assessment (HIA) by public bodies in Wales as a process that can support policymakers and those involved in decision taking to maximise well-being benefits, minimise harm to health, and avoid widening health inequalities. It also supports public bodies in meeting duties under the Public Health (Wales) Act (2017).

Analysing the value, benefits and barriers to stakeholder and community participation in health impact assessments (HIAs) in Wales from 2005 to 2020

Health Impact Assessments (HIA) are undertaken to inform decision-making processes by assessing the potential health and health equity impacts of a programme, policy, or project and developing appropriate responses to mitigate harms and maximize benefits. Stakeholder and community participation is central to the impact assessment process. This research explores the experiences of stakeholders and community members who participated in HIA workshops in Wales between 2005 and 2020. Data were gathered through a questionnaire at the end of each HIA workshop session with stakeholder and community participants from diverse backgrounds reporting on the experience of their participation. The analysis reveals a range of perceived benefits of participation in the HIA process. The identified benefits included the opportunity to be heard, networking, and a view of participation as a community service. These findings reinforce the importance of stakeholder and community participation in HIA, through the perspective of participants themselves. This study contributes to the understanding of community and stakeholder participation in impact assessment processes and offers recommendations for improving the practice and impact of HIA in policy development. These findings have the potential to be transferable to other types of impact assessments, and other forms of community and stakeholder participation.

Self-administered sexual health testing in an open prison setting: a pilot health impact assessment and social return on investment analysis

The sexual health of the male prison population is often among the poorest in a country. This paper aims to identify the wider health impacts and social value of a sexual health self-sampling programme offered to male prisoners in an open prison setting in Wales.

This study applied a unique pilot approach of using Health Impact Assessment and Social Return on Investment Frameworks in tandem. Key stakeholder groups affected by the intervention were identified, and engaged with through workshops, interviews and questionnaires to identify and quantify the health impacts and wider outcomes. Outcomes were then valued using proxy financial values to present the overall estimated social value of the self-sampling service.

Based on a small sample, results indicate that for every £1 spent on the self-sampling service in the prison, a potential value of £4.14 was created. This resulted in a ratio of £4.14:£1. Approximately one-third of the value created (£1,517.95) was categorised as monetarily returnable, whereas the remaining value (£3,260.40) was purely illustrative social value, for example improved mental well-being.

This unique pilot study demonstrates the health impacts and wider social value of providing a self-sampling sexual health service to prisoners within an open prison setting. By innovatively testing the feasibility of using a Health Impact Assessment process alongside Social Return on Investment analyses, this paper has outlined how the frameworks can be used in synergy to illustrate not just direct return on investment but also the social value of providing such a service.

Successfully creating the conditions for Health Impact Assessment in Wales: a case study. In: Impact Assessment Outlook Journal Volume 21: July 2024. Impact Assessment Frontiers Part 2: People, Health and Equality. Thought pieces from UK and International practice

Reflections from the Wales Health Impact Assessment Support Unit (WHIASU), Policy and International Health, World Health Organization (WHO) Collaborating Centre on Investment for Health and Well-being, Public Health Wales.

Assessing public health implications of free trade agreements: The Comprehensive and Progressive Trans-Pacific Partnership Agreement

In 2016, the United Kingdom voted to exit the European Union, which was surrounded by political and social uncertainty. The United Kingdom now negotiates its own trade agreements, and in March 2023, it agreed to join the Comprehensive and Progressive Trans-Pacific Partnership Agreement (CPTPP). A health impact assessment (HIA) was undertaken in 2022–23 to predict the potential impact of the CPTPP on the health and well-being of the Welsh Population. This paper explores the HIA findings and highlights the value of the approach in engaging with stakeholders and informing policymakers. This HIA followed a standard five-step approach which involved a literature review to identify potential health impacts, qualitative interviews with cross-sectoral stakeholders and the development of a community health profile. The HIA identified potential impacts across the wider determinants of health and specific vulnerable population groups. Investor state dispute settlement mechanisms, economic uncertainty and loss of regulatory policy space were identified as key pathways for health impacts. The findings have been beneficial in informing decision-makers to prepare for the CPTPP in Wales using an evidence-informed approach. This work has demonstrated the value of a HIA approach that uses a transparent process to mobilise a wide range of evidence, resulting in transferrable learning.

Determining the Public Health Impact of Climate Change: A National Study Using a Health Impact Assessment Approach in Wales

Climate change is recognised as the biggest threat to global health of the 21st century and impacts on health and wellbeing through a range of factors. Due to this, the need to take action in order to protect population health and wellbeing is becoming ever more urgent.

In 2019, Public Health Wales carried out a comprehensive mixed-method Health Impact Assessment (HIA) of climate change. Unlike other risk assessments, it appraised the potential impact of climate change on health and inequalities in Wales through participatory workshops, stakeholder consultations, systematic literature reviews and case studies.

The HIA findings indicate potential impacts across the wider determinants of health and wellbeing. For example, air quality, excess heat/cold, flooding, economic productivity, infrastructure, and community resilience. A range of impacts were identified across population groups, settings, and geographical areas.

These findings can inform decision-makers to prepare for climate change plans and policies using an evidence-informed approach. The work has demonstrated the value of a HIA approach by mobilising a range of evidence through a transparent process, resulting in transferrable learning for others.

Health Impact Assessment (HIA): Frequently Asked Questions

WHIASU have created this document which looks to answer your Health Impact Assessment (HIA) questions, including looking at the benefits, what it involves and when to carry out a HIA, alongside other questions. Alongside our other resources, it can help to further your understanding of HIA.

The Impact of the COVID-19 Pandemic on Women, Employment and Health Inequalities

The infographic summarises the findings, looking at the Population Groups and Determinants of Health impacted, along with the key statistics, mitigating actions and potential areas of future research. The Explanatory Note goes into further detail on the above, giving a breakdown of the evidence that informed our positive and negative findings on women, employment and health inequalities. It also offers readers the chance to see the HIA methodology that was used by the team.

Health Impact Assessment for Climate Adaptation: Examples from Practice

This briefing focusses on adaptation to address climate change and the application of Health Impact Assessment (HIA) as a process that can support policy makers to maximise wellbeing benefits, minimise harm to health, and avoid widening health inequalities when designing adaptation policies. It contains five case studies – two international and three from Wales, and provides action oriented examples of putting HIA into practice.

Climate Change in Wales: Health Impact Assessment

This health impact assessment (HIA) is a strategic and comprehensive appraisal of the potential implications of climate change on population health in Wales. It provides robust evidence to inform public bodies, agencies and organisations in their preparations for, and responses to, climate change and climate change events. It aims to support adoption of policies and plans that can promote and protect health and wellbeing for all in Wales and in those population groups and geographical areas particularly at risk of negative impacts.

The outputs of the HIA available to download here are:

• An evidence based HIA Summary report
• Individual chapters on the evidence of impact of climate change on the wider determinants of health and population groups in Wales
• A set of 4 infographics
• A PowerPoint slide deck
• A Technical Report

The health, well-being and equity impact of the Comprehensive and Progressive Trans-Pacific Partnership (CPTPP) Agreement on Wales

This report provides a short summary of the findings of a Health Impact Assessment (HIA) of the Comprehensive and Progressive Trans-Pacific Partnership (CPTPP) Agreement on Wales. This report is a high-level, evidence-based strategic overview. It summarises the main health, well-being and equity impacts that could potentially occur in the short and longer-term following the UK’s accession to the CPTPP.

Predicted and observed impacts of COVID-19 lockdowns: two Health Impact Assessments in Scotland and Wales

Health Impact Assessment is a key approach used internationally to identify positive or negative impacts of policies, plans and proposals on health and well-being. In 2020, HIAs were undertaken in Scotland and Wales to identify the potential health and well-being impacts of the ‘stay at home’ and physical distancing measures implemented at the start of the coronavirus disease (COVID-19) pandemic. There is sparse evidence evaluating whether the impacts predicted in HIAs occur following policy implementation. This paper evaluates the impacts anticipated in the COVID-19 HIAs against actual observed trends.

Facilitators, Barriers and Views on the Role of Public Health Institutes in Promoting and Using Health Impact Assessment—An International Virtual Scoping Survey and Expert Interviews

Public health institutes have an important role in promoting and protecting the health and well-being of populations. A key focus of such institutes are the wider determinants of health, embracing the need to advocate for ‘Health in All Policies’ (HiAP). A valuable tool to support this is the health impact assessment. This scoping study aims to support public health institutes to advocate more successfully for the use of health impact assessments and HiAP in order to promote and protect health, well-being and equity. It highlights the enablers and barriers to the use of HIA in the contexts of the participants and suggests some actions which PHIs can take and Units they can learn from. The results from this study can serve as a platform to help build knowledge, networks and expertise, to help support a ‘Health in All Policies’ approach and address inequalities which exist in all societies.

Protecting the mental wellbeing of our future generations: learning from COVID-19 for the long term

This comprehensive Mental Wellbeing Impact Assessment (MWIA) has been carried out by the Wales Health Impact Assessment Support Unit to identify the impacts of the COVID-19 pandemic, and associated policy responses, on the mental wellbeing of young people aged 10-24 in Wales.

The MWIA was carried out with the engagement of young people, teachers and lecturers and the support of a Strategic Advisory Group with representatives from a range of organisations in Wales.

The report aims to provide evidence and learning to inform cross-sector policy and practice directed at pandemic recovery, future emergencies and improving population mental wellbeing for the long term.