Acorn Notes

Issue No. 7, May 2008

"Top 10" Lessons Learned About HIA

In an interest to better understand and manage business sustainability, international industries and investors have begun to integrate environmental, social and health risks into their management procedures and project planning. While most companies are adept at managing environmental risks, industry standards for Health Impact Assessment (HIA) are still emerging. Further, our network of international partners have warned that although HIA is gaining acceptance, its application is not widespread in developing nations.

Top 10
To share our thinking and initiate dialogue around effective use of HIA by international industry, we offer the "top 10" lessons learned. The list is based on our experience as leading practitioners in the integrated environmental, health and social impact and risk assessment fields for international oil and gas companies, and from our ongoing research on best practices in HIA.

10. Community Health: The New Safety
Industry has long understood the safety risks its operations pose to the surrounding population, and has strictly managed these risks accordingly. However, full inclusion of community health impacts has been avoided because these can be difficult to evaluate and are generally perceived to fall under the jurisdiction of local public sector authorities. HIA helps to systematically identify and evaluate possible health impacts early in the decision making process and facilitates the integration of these concerns into project planning and alternatives analysis.

9. Health: Beyond Sickness
In order to evaluate health impacts, it is important to understand that health is not just the absence of disease or sickness. Many individual, social and environmental, and institutional factors contribute to the health of individuals and the community, examples outlined in Table 1. HIA looks at these determinants of health and the potential for a project to impact them.

Table 1: Examples of the Determinants of Health

Categories of determinants
of health

Examples of specific health determinants

Individual factors: genetic, biological, lifestyle/behavioral and/or circumstantial

Gender, age, dietary intake, level of physical activity, tobacco use, alcohol intake, personal safety, employment status, education, self-esteem, life skills, stress levels, etc.

Social and environmental factors: physical, community and/or economic/financial conditions

Access to services and community (health, shopping, support, etc.); social support or isolation; quality of air, water and soil; housing; income; distribution of wealth; disease vector breeding places; sexual customs and tolerance; racism; attitudes to disability; trust; land use; urban design; sites of cultural and spiritual significance; etc.

Institutional factors: the capacity, capabilities and jurisdiction of public sector services

Availability of services, including health, transport and communication networks; education and employment; environmental and public health legislation; environmental and health monitoring systems; laboratory facilities; etc. (Quigley et al. 2006)

8. Know When to Apply Rapid Appraisal vs. Comprehensive HIA
HIA can be used at any stage of the industry lifecycle, whether this is new country entry, exploration and development, modification of an existing activity or closure of existing projects. Larger development projects may require a comprehensive HIA, whereas a rapid appraisal may be sufficient for small projects and modifications (WHO 1999). Many impacts commonly found in HIAs overlap those identified in environmental and social impact assessments. However, it is important that practitioners give community health adequate attention in these situations to ensure the integrity of the study.

7. Define the Area of Influence
Impacts can occur at many levels of the community so it is important to evaluate impacts at the individual and household scale as well as at the community/village, population, organizational, and institution scale (Krieger & Balge 2005). Scoping can be especially difficult in HIA because the area of influence is difficult to assign. For example, the spread of HIV/AIDS among temporary workers in regions where the disease is rampant is a concern and within the normal scope of an HIA, but what happens when those workers return home to areas where HIV/AIDS is less prevalent? Careful scoping is a precursor to effective mitigation.

6. Earn the "License to Operate"
HIA can serve as an important tool to support a "license to operate" in host countries, especially in areas where other extractive industry projects have been conducted poorly. By collaborating with the surrounding community and the government, it can help build a trust between parties. This transparent process allows all stakeholders to build consensus regarding real issues and work together to solve challenges that arise over the lifetime of the project.

5. Devote Adequate Resources - Show the Money and Get the Experts
"Many impact assessment reports give the impression that less than 5% of the total resources were devoted to the health component, an unacceptable imbalance," (Birley 2007). Common areas of concern for large oil and gas projects include: respiratory infections, vector borne diseases, sexually transmitted infections, soil and water borne diseases, food and nutrition-related issues, accidents and injuries, exposure to potentially hazardous materials, accidents and injuries, psychosocial, cultural health practices, and health systems infrastructure and capacity (Krieger & Balge 2005). To manage these concerns effectively, a greater percentage of impact assessment funds needs to be allocated to the health component of impact assessments. Additionally, HIA requires professionals that are familiar with the process and have the adequate knowledge and background to be able to identify and plan for project related health issues (Parry 2006).

4. Listen to the Locals
Effective HIA is dependent on rigorous stakeholder engagement that involves health experts, project proponents, key players such as the Ministry of Health, NGOs, and the community affected by the proposal. HIA should involve and engage the public, and inform and influence decision-makers (Quigley et al. 2006).

3. Opportunity to Take Advantage of Local Expertise
HIA is an aspect of capital development planning in which local experts could play a large role. Local experts are well suited to work with surrounding communities and government officials because they are more trusted and they know local customs, language, and cultures. The oil and gas industry and their consultants need to commit to developing the capacity of local experts to help merge the use of best global practices and technology with the benefits of local know-how and trust.

2. Add Value Through Early Identification of Potential Impacts
One of the primary benefits of HIA is the identification of mitigation measures. By addressing health concerns early in the project lifecycle, it is much easier to minimize the negative impacts and to take advantage of the available opportunities to improve health. Developing and following Health Action Plans (HAP) helps ensure effective implementation and monitoring of the mitigation measures.

1. Know that "It All Starts at the Top"
As with business performance, world-class health performance starts with the commitment of management. Management needs to set health related goals, objectives, policies and procedures in order to include health in management systems. It is promising to see that industry leaders have been working diligently on this in the past few years.

We look forward to participating in and seeing the benefits of advances in the application of best practices in HIA. As always, we appreciate your thoughts and feedback on this topic. Please send feedback to

Birley, M. (2007). A Fault Analysis for Health Impact Assessment: Procurement, Competence, Expectations, and Jurisdictions. Impact Assessment and Project Appraisal, 25 (4), December 2007, pp 281-289.

Krieger, G., & Balge, M. (2005, November). Guide to Health Impact Assessments. Retrieved April 7, 2008, from IPIECA Web site:

Parry, K. (2006). Health Risk Assessment (HRA): A Case Study - Implementing HRA Into the Shell Petroleum Development Company Ltd., Nigeria. SPE International Conference on Health, Safety, and Environment in Oil and Gas Exploration and Production, Abu Dhabi: Society of Petroleum Engineers.

Quigley, R., den Broeder, L., Furu, P., Bond, A., Cave, B., & Bos, R. (2006). 2006 Health Impact Assessment International Best Practice Principles. Special Publication Series No. 5. Fargo: International Association for Impact Assessment.

World Health Organization. (2008). Definitions of HIA. Retrieved April 7, 2008, from World Health Organization:

World Health Organization. (1999, December). Health Impact Assessment: Main Concepts and Suggested Approach. (Gothenburg Consensus Paper). Retrieved April 9, 2008, from World Health Organization Web Site:

Acorn International Notes

Acorn Notes is a series of periodic papers to share ideas regarding EHSS and sustainability management for international industry.

Issue 21 - March 2014: Above-ground Facilities and Stakeholder Engagement: Deploying the 'CAC'
Issue 20 - March 2014: A Starting Point for Shared Equity
Issue 19 - March 2014: What It Takes to Run a Great Consulting Firm
Issue 18 - February 2014: Considering Human Rights - Trends and Lessons in Oil and Gas Impact Assessments
Issue 17 - June 2013: Managing Environmental Health in International Development Projects
Issue 16 - January 2013: Integrating Environmental and Social Performance throughout the Project Lifecycle
Issue 15 - January 2013: The State of Shale Play in 2013
Issue 14 - August 2012: Building Environmental and Social Governance in Host Countries
Issue 13 - May 2012: Human Rights and Business: A New Era
Issue 12 - February 2012: Extractive Industries Confront Pressure for Greater Transparency
Issue 11 - January 2012: Key Updates to the IFC Sustainability Policy and Performance Standards
Issue 10 - June 2011: Oil & Gas and NGOs: New Rules of Engagement?
Issue 9 - February 2010: Annual Study of Sustainable Development Priorities
Issue 8 - January 2009: Annual Study of Sustainable Development Priorities
Issue 7 - May 2008: Top Ten Lessons Learned About Health Impact Assessment
Issue 6 - January 2008: Annual Study of Sustainable Development Priorities
Issue 5 - September 2007: Results of web forum with our International Partners
Issue 4 - January 2007: Annual Study of Sustainable Development Priorities
Issue 3 - May 2006: Suggestions and tips for safe international travel
Issue 2 - January 2006: Annual Study of Sustainable Development Priorities
Issue 1 - November 2005: The Top 10 "unspoken" criteria for determining the success of EIAs


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