Developing health impact assessment in the European Union.

It is not surprising that the use of impact assessments has been pioneered at local and regional levels, where the potential impacts of a proposal cover a limited geographical area and the projects tend to be specific and tangible, such as infrastructure plans for roads and airports. Evaluating the potential impact of a piece of legislation, or even a whole policy area, is muchmore complex; to do so at the European Union (EU) level adds further layers of complexity. As EU interest in health matters and powers regarding them has increased, so has its interest in intersectoral approaches to health. This is attributable to several factors. First, the European Community’s involvement in health is largely through work outside its narrow public health competence. Secondly, there is already a strong tradition of impact assessments within the Community, in particular environmental impact assessment (EIA). Thirdly, the Community institutions are insisting on coherent approaches to health across policies. An initial starting point to understanding the rationale behind applying health impact assessment (HIA) within the EU is to examine the legal base of its activities. The Treaty of Rome stipulates, in Article 152, ‘‘A high level of human health protection shall be ensured in the definition and implementation of all Community policies and activities’’. This obligation is unique compared with most Member States in introducing a basic requirement to give consideration to possible health implications of measures and actions. The European Commission has put into place procedures to implement the Treaty objective. These include a mandatory consultation of the Commission’s Directorate General in charge of health on proposals for policy or legislation with a potential health dimension. Moreover, the Interservice Group on Health was established to coordinate health-related initiatives across different areas of Community policy. Strengthening health-related work is a central priority of the current Commission; the Community’s health strategy, published in May 2000 (Communication from the Commission to the Council, the European Parliament, the Economic and Social Committee and the Committee of the Regions, COM (2000) 285 final of 16.5.2000), ensures coherence and coordination between health-related policy areas. In order to improve understanding of how different policy areas link to health, the Commission has taken an interest in the assessment of health impacts of policies, legislation and proposals, the scientific background and methodology of the impact assessment, and its application to decision-making processes. As far as the application of HIA is concerned, the Commission has drawn on national experiences across Europe—set out elsewhere—and on experiences with related impact assessments at Community level. The Community’s EIA legislation foresees compulsory impact assessments to be undertaken for projects of a certain size and cost. Effects on human beings, which must include health effects, are an integral part of the EIA regulatory framework. It is not surprising that in some countries HIA has developed as a sub-speciality of EIA. However, health issues tend not to be in the forefront of regular EIAs. Experience in the Community has therefore been to develop independent work on HIA, while at the same time exploring synergies with and connections to other impact assessments. Especially at Community level, a number of key questions arise concerning the application of HIA (summarized in Box 1). These questions need to be answered convincingly before large investments in health impact assessments would be feasible. For example, the amount of research and analysis necessary to assess a particular policy or proposal will differ considerably from case to case. Decisions have to be taken on whether— because of time pressures— a superficial analysis is sufficient or whether in-depth analysis is required. In only a few cases, policy-makers will require full, rigorous scientific evaluations. In addition, the assessment of potential impacts has to take into account the social, economic, cultural and climatic diversity of the Community and its Member States, especially after enlargement. It has to allow for different political traditions and citizens’ customs and behaviours. The Interservice Group on Health was instrumental in developing responses to these considerations. Following a seminar highlighting different experiences inMember States, it developed a practical guide on ensuring a high level of health protection (available from: http://europa.eu.int/comm/ health/ph/key_doc/key07_en.pdf). The purpose of this guide is to serve as a toolkit for Commission services. It includes a checklist for proposal screening, background material for puttingHIA in a broader perspective and references for further reading. The aim is to ensure that health impacts are dealt with and presented in a similar way across services. Based on the Gothenburg consensus paper on health impact assessment (European Centre for Health Policy, WHO-Euro, Brussels, 1999), Developing health impact assessment in Wales (The National Assembly for Wales, Cardiff, 2000) and A short guide to health impact assessment (NHS Executive London, London, 2000), the guide presents five steps for health impact assessments: screening, scoping, appraisal of potential health effects, decision-making, and implementation and monitoring. It recommends either a rapid impact appraisal, an impact analysis or an impact review. Furthermore, the guide highlights the importance of other factors, such as elements deriving from the political process, e.g. political urgency or lack of funding. Thus it provides initial guidance to assessing potential health impacts and increases awareness about the importance of taking health impacts into account when developing proposals and planning activities. In practical terms, the guide has led to a stronger involvement of health services vis-à-vis other services