- Health and health impacts - key definitions
- Health inequalities - key definition
- Planning policy context for health in England
- Planning policy guidance for health in England
- Health Impact Assessment - what is it?
- Health Impact Assessments - what to expect
- Topics that could be covered in Health Impact Assessment
- When to request an HIA from a developer – an approach
- HIA and Nationally Significant Infrastructure Projects (NSIPs)
- HIA and statutory environmental assessment
- Where to find out more about HIA and planning
This guidance statement outlines Surrey County Council (SCC) Public Health Team's stance on Health Impact Assessment (HIA) in planning. It has been produced by the SCC Public Health Team and Spatial Planning Team.
The guidance statement explains the context for HIA in terms of health, health inequalities and the planning system and recommends an approach to the introduction and use of HIA across planning in Surrey.
This should be read in conjunction with the information on Health and Spatial Planning in Surrey.
For further information, please contact the Surrey County Council Public Health Team by email: firstname.lastname@example.org
Date of publication and document review
Publication date: July 2023
Document review date: October 2023
Health and health impacts - key definitions
Defined by The World Health Organization (WHO) as:
A state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity
World Health Organization, 2018b
Defined by the WHO as:
A health impact can be positive or negative. A positive health impact is an effect which contributes to good health or to improving health. For example, having a sense of control over one's life and having choices is known to have a beneficial effect on mental health and wellbeing, making people feel "healthier".
A negative health impact has the opposite effect, causing or contributing to ill health. For example, working in unhygienic or unsafe conditions or spending a lot of time in an area with poor air quality is likely to have an adverse effect on physical health status.
World Health Organization, 2018c
Health inequalities - key definition
Health inequalities can be defined as: "… the unjust and avoidable differences in people's health across the population and between specific population groups… Health inequalities go against the principles of social justice because they are avoidable".
Population groups particularly vulnerable to health inequalities include: children and young people, older adults, people with disabilities, people from lower socio-economic groups and people with long term illnesses. (NHS Health Scotland, 2018).
Health inequalities should be assessed using the social determinants of health (Department of Health, 2010). The adapted version of Whitehead and Dahlgren's social determinants of health model – commonly called the "health map" (see Figure 1) – published by Barton and Grant (2006) – is a useful guide to the wider determinants of health.
Figure 1: The Health Map – the determinants of health and wellbeing in our neighbourhoods (Source: Barton & Grant, 2006).
- Global ecosystem impacts:
- Natural environments; built environments and activities
- These in-turn impact:
- Local economy; community and lifestyle.
- Climate stability impacts:
- Natural habitats; buildings and places; how we work, shop and move
- These in-turn impact:
- Wealth creation; social capital; aiet and physical activity.
- Biodiversity impacts:
- Air, water and land; streets and routes; living, playing and learning
- These in-turn impact:
- Resilient markets; social networks and work-life balance.
- All of the above impacts people's health no matter what age, sex or any hereditary factors.
Collaboration across multiple sectors is required to optimise health using the health map such as public health, urban designers, planners, ecologists, community development organisations and environmental health officers. This was the intention of Barton and Grant (2006) when it was developed.
Planning policy context for health in England
The July 2021 version of the National Planning Policy Framework (paragraphs 92-103) sets out the role of the planning system in promoting healthy and safe communities.
Paragraph 92 (p.27) of the NPPF states: "Planning policies and decisions should aim to achieve healthy, inclusive and safe places which:
(a) promote social interaction, including opportunities for meetings between people who might not otherwise come into contact with each other – e.g., through mixed-use developments, strong neighbourhood centres, street layouts that allow for easy pedestrian and cycle connections within and between neighbourhoods, and active street frontages;
(b) are safe and accessible, so that crime and disorder, and the fear of crime, do not undermine the quality of life or community cohesion – e.g., through use of attractive, well-designed, clear and legible pedestrian and cycle routes, and high-quality public space, which encourage the active and continual use of public areas; and
(c) enable and support healthy lifestyles, especially where this would address identified local health and well-being needs – e.g., through the provision of safe and accessible green infrastructure, sports facilities, local shops, access to healthier food, allotments and layouts that encourage walking and cycling."
Planning policy guidance for health in England
The national guidance on healthy and safe communities defines a healthy place as: "…one which supports and promotes healthy behaviours and environments and a reduction in health inequalities for people of all ages. It will provide the community with opportunities to improve their physical and mental health, and support community engagement and wellbeing.
It is a place which is inclusive and promotes social interaction. The National Design Guide sets out further detail on promoting social interaction through inclusive design including guidance on tenure neutral design and spaces that can be shared by all residents.
It meets the needs of children and young people to grow and develop, as well as being adaptable to the needs of an increasingly elderly population and those with dementia and other sensory or mobility impairments."
Paragraph: 003 Reference ID:53-003-20191101 Revision date: 01 11 2019
Plan-making bodies will need to consider the implications of their emerging Local Plan for health and care infrastructure and wider determinants of health. Planning applications for developments likely to significantly impact on the health and wellbeing of the local population or particular groups within it, will likely benefit from detailed assessment prior to decision. Health impact assessment (HIA) is identified in the guidance on healthy and safe communities as a means of identifying and evaluating the significant impacts of development on health and care infrastructure or wider determinants of health.
Health Impact Assessment - what is it?
Health impact assessment (HIA) is defined by the WHO as: "A combination of procedures, methods and tools by which a policy, programme or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population" (WHO, 2018a).
HIAs consider how a population will be affected by development assessing both positive and negative health impacts. Health inequalities should be a key consideration to ensure they are not increased further by proposed developments. (U.K. Department of Health, 2010).
Health Impact Assessments - what to expect
- Describe baseline health conditions for the Plan area or development site (and surrounding area).
- Identify the likely beneficial and harmful health effects of the proposed Plan or development, including those groups of people most likely to be affected.
- Identify opportunities to mitigate harmful effects and enhance beneficial effects on health and wellbeing.
- Use primary research (e.g., surveys, focus groups and interviews) and secondary research (e.g., desk research using existing data).
- Cover all stages of the proposed development – i.e., construction phase, operation/ occupation, and decommissioning and restoration (if applicable). (Project level only)
- Provide information to assist decision makers in terms of plan making and the determination of planning applications.
HIA should be proportionate to the scale, type and location of the proposed development or to the scale, type and location of the development covered by the proposed Plan.
HIA does not involve the undertaking of clinical trials.
Topics that could be covered in Health Impact Assessment
The scope of the matters covered in any HIA should be determined on a case-by-case basis. For projects this will involve discussion between the developer, the Local Planning Authority (LPA) and the relevant Public Health Team. For Local Plans, the discussion will be between the LPA and the relevant Public Health Team.
Matters that could appropriately be covered in the scope of an HIA are listed below. The list is not exhaustive and other matters may be relevant to specific localities or development/plan types.
- Safety for women and children
- Community needs, barriers and issues of concern
- Health Inequalities – priority populations and local health needs
- Accessibility and active travel
- Active Design (10 principles) Active Design | Sport England
- Housing design and affordability and its impact on specific groups
- Access to health and social care services and other social infrastructure
- Access to green space and nature, for example allotments
- Neighbourhood amenity
- Crime reduction and community safety
- Access to healthy and affordable food
- Access to work and training for all
- Social cohesion and inclusive design - SCC All Age Autism Strategy
- Impacts of climate change on health – such as extreme heat or cold and extreme weather events.
When to request HIA from a developer - an approach
There are various approaches that could be used to identify those development proposals that require HIA.
A criteria-based approach would involve requesting HIA for development proposals where one or more of a defined set of criteria are met. For example:
The application site is situated in an area (e.g., ward) with known health inequalities relevant to the type of development proposed(1).
The development would create substantial(2) or specialist(3) additional demand for health or social care services.
The development would result in the loss of publicly accessible greenspace.
The development would involve the use of novel / innovative processes or technologies the effects of which are not well understood or regulated.
Such an approach could be adopted in Surrey, subject to discussion and agreement with the LPAs and the County Planning Authority.
- These areas are to be identified with the assistance of the SCC Public Health Team
- The term 'substantial' should be defined by each LPA to reflect their local circumstances
- The term 'specialist' could include inter alia groups such as older persons, people with disabilities, babies and children but should be defined by each LPA to reflect their local circumstances
HIA and Nationally Significant Infrastructure Projects (NSIPs)
The information requirements that apply to developments for which consent is sought under the NSIP regime are specified by the Planning Inspectorate (PINS) (the Examining Authority). Guidance on the requirements for NSIP schemes is published on the National Infrastructure Planning website.
All NSIP schemes will require statutory Environmental Impact Assessment (EIA) – as required under the Infrastructure Planning (Environmental Impact Assessment) Regulations 2017 (as amended). The effects of a NSIP project on population and human health is one of the topics that may need to be addressed as part of the EIA process.
The scope of the EIA for any NSIP project will be defined through the Examining Authority's EIA Scoping Opinion. All relevant planning authorities for the area affected by the proposed NSIP project, and all adjoining planning authorities, are statutory consultees and will be consulted by PINS on the scope of the proposed EIA.
Where a relevant planning authority is of the view that impacts on human health and population should be subject to specific assessment as part of the EIA process that should form part of their response to the EIA Scoping Opinion consultation.
HIA and statutory environmental assessment
Local Plans are subject to statutory requirements for strategic environmental assessment (SEA) and sustainability appraisal (SA).
Certain types of development proposals require statutory environmental impact assessment (EIA) prior to the grant of planning permission.
Those assessments (and appraisals) cover a range of topics and can include the assessment of significant impacts on population and human health. HIA will more likely be required for projects and plans that do not require statutory environmental assessment.
At the Plan level it is likely that impacts on population and human heath should always form part of the scope of the SEA and SA. The planning authority should consult with the SCC Public Health team on the proposed scope of the SEA and SA.
The scope of project-level EIAs can be defined on a case-by-case basis by the relevant planning authority through an EIA Scoping Opinion (note – Scoping Opinions are requested at the developer's discretion). Consultation with the SCC Public Health Team when formulating Scoping Opinions will ensure that where a development would likely have significant effects on human health and population that these are covered in the EIA. Further guidance on scoping for health in EIA is available from the Institute of Environmental Management and Assessment (IEMA).
Where to find out more about HIA and planning
- London Healthy Urban Development Unit has a range of useful information and guidance on Health Impact Assessment
- Where a HIA is submitted the HUDU Toolkit should be used to review the HIA
- Future Oxfordshire Partnership: Oxfordshire Health Impact Assessment toolkit and other resources
- London Borough of Tower Hamlets: Health Impact Assessment webpages
- South Cambridgeshire District Council: Health Impact Assessment Supplementary Planning Document and associated resources
- Wakefield Council: Health Impact Assessment guidance and toolkits
- Wales Health Impact Assessment Support Unit