Health impact assessment and health promotion.

Introduction The Bangkok Charter on Health Promotion in a Globalized World, adopted at the Sixth Global Conference on Health Promotion in August 2005 (http://www. who.int/healthpromotion/conferences/ 6gchp/bangkok_charter/en/), highlights the role of health impact assessment (HIA) as a key decision-making tool in development planning. HIA is a combination of procedures, methods and tools by which a policy, programme or project may be judged with regard to its potential effects on the health of a population and the distribution of those effects within the population.1–3 The formulation of a public health management plan, consisting of safeguards, mitigation and promotional measures, is an integral part of HIA. HIA has the potential to optimize the role of health promotion in development, as it cuts across health issues, presumes specific settings and aims to address the needs of groups whose vulnerability is increased by development. Over the past 30 years, environmental impact assessment (EIA) has evolved into a standard tool to predict adverse effects of development on the environment, as a basis for selection between different options and for mitigation of such effects as far as possible. Dealing with health in the context of EIA has been less than satisfactory. Within EIA health is invariably conceptualized narrowly rather than comprehensively, there is a bias towards environmental determinants of health at the expense of social determinants and the ensuing recommendations tend to focus on action required by the health sector, usually overlooking options to integrate health into development policies and into programme/project design and operation. By adopting a distinct profile, HIA can overcome these constraints. HIA should run in parallel with EIA and