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Health Impact Assessment Guidance Statement July 2026

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Introduction

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: public.health@surreycc.gov.uk

What health is

The World Health Organisation (WHO) defines health as:

‘A state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity’ (WHO, 1948).

‘Health is a positive concept emphasizing social and personal resources, as well as physical capacities’ (WHO 1986).

Health is a resource for everyday life. Good health and wellbeing are central to living an active, independent and engaged life. They enable people to be resilient to stress and to adapt to changes in the environment.

What determines health

Health is not determined by genetics, biology, individual behaviours and access to healthcare services alone; environmental, social and economic factors have an impact on physical and mental health and wellbeing. These wider determinants of health (also called ‘the building blocks of health’) intersect with individual and biological factors to determine health and wellbeing.

For spatial planners and public health, Barton and Grant’s ‘health map’ for the planning of human settlements provides a useful framework for considering the impact of development on the wider determinants of health.

Health map diagram showing the impact of the environment on health and well-being in our neighbourhoods. This is explained in more detail on the page

The health impacts of development can be positive, negative or neutral.

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 Organisation, 2018

Well-designed homes, streets and neighbourhoods that have good access to transport, employment, education, leisure and green space can have a positive impact on health and wellbeing by creating the social, economic and environmental conditions that build good health and wellbeing and address health inequalities.

Health inequalities

Health inequalities are ‘avoidable, unfair and systematic differences in health between different groups of people’ (The King’s Fund, 2020). Health inequality refers not only to differences in the status of people’s health and differences in the care people receive, but also to the opportunities people have to lead healthy lives. Inequalities in the wider determinants of health are a fundamental cause of health inequalities. Addressing these social, economic and environmental inequalities through the built environment is a crucial part of reducing health inequalities.

Cross-sector collaboration between public health, urban designers, planners, environmental health officers, developers, ecologists, and communities is necessary to create the healthy eco-system for human habitation as described by Barton and Grant.

Health in planning policy in England

The December 2024 version of the National Planning Policy Framework (paragraphs 96 to 108) sets out the role of the planning system in promoting healthy and safe communities.

Paragraph 96 of the National Planning Policy Framework (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 – for example, 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 – for example, 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 lives, through both promoting good health and preventing ill-health, especially where this would address identified local health and wellbeing needs and reduce health inequalities between the most and least deprived communities – for example, 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.’

A revised National Planning and Policy Framework is expected in the summer 2026.

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.’

The guidance recommends that local planners consult with Public Health:

‘It is helpful if the Director of Public Health is consulted on any planning applications (including at the pre-application stage) that are likely to have a significant impact on the health and wellbeing of the local population or particular groups within it. This would allow them to work together on any necessary mitigation measures. A health impact assessment is a useful tool to use where there are expected to be significant impacts.

Information gathered from this engagement will assist local planning authorities in considering whether the identified impact(s) could be addressed through planning conditions or obligations.

Alternatively, local planning authorities may decide the identified need could be funded through the Community Infrastructure Levy.’

What a Health Impact Assessment is

Health impact assessment (HIA) is 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).

HIA is a tool used to identify the health impacts of a plan or project and to develop recommendations to maximise the positive impacts and minimise the negative impacts, while maintaining a focus on addressing health inequalities. By bringing such health considerations to the fore, HIAs add value to the planning process. HIAs puts people and their health at the heart of the planning process. An HIA supports the planning system to address local health and wellbeing needs and tackle inequalities though influencing the wider determinants of health (Health Impact Assessment in Spatial Planning, 2020).

HIAs may be used by local planning authorities (LPA) responsible for developing local plans and making decisions on planning applications to assess the health impact of their Local Plan. LPAs may adopt a policy within their Local Plan requiring the proportionate use of HIAs by planning applicants.

HIAs may be used by planning applicants and consultants to identify, mitigate and enhance the health and wellbeing impacts of proposed developments on future residents and surrounding communities.

What a Health Impact Assessment does

HIAs can:

  • Describe baseline health conditions for the Plan area or development site (and surrounding area).
  • Identify the likely positive and negative health effects of the proposed Plan or development, and the population groups most likely to be affected.
  • Identify opportunities to mitigate negative impacts and enhance positive impacts on health and wellbeing.
  • Use primary research (for example, surveys, focus groups and interviews) and secondary research (for example, desk research using existing qualitative and quantitative data) to understand local health and wellbeing needs and health inequalities.
  • Cover all stages of the proposed development; that is: 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.

HIAs 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.

The scope of a Health Impact Assessment

The scope of any HIA should be determined on a case-by-case basis. For developments this will normally involve discussion between the developer and the Local Planning Authority (LPA), with input from Surrey County Council Public Health where appropriate. For local plans, discussion will normally take place between the LPA and Public Health.

Matters that could be covered within the scope of a HIA are listed below. The list is not exhaustive, and other matters may be relevant to specific localities or to different types of development or plan.

Health inequalities:

  • Local demographics and health data
  • Health & Wellbeing Strategy priority populations, including Key Neighbourhoods
  • Socio-economic disadvantage

Environmental determinants:

  • Air quality, water quality and noise pollution
  • Access to green space (including allotments) and natural infrastructure
  • Biodiversity and access to nature
  • Health effects of climate change (including extreme heat/cold, flooding and extreme weather events)
  • Housing, street and neighbourhood design
  • Opportunities for active travel (walking, wheeling, cycling)
  • Access to local amenities
  • Access to healthy and affordable food
  • Access to inclusive and safe play and recreational facilities

Social determinants:

  • Social cohesion and inclusivity
  • Community strengths and needs
  • Crime reduction and community safety (especially for women and girls)
  • Access to health and social care services and to other social infrastructure

Economic determinants:

  • Access to employment and skills (especially for disadvantaged groups)
  • Access to education and training (especially for disadvantaged groups)
  • Housing affordability
  • Transport affordability and accessibility

Surrey-specific resources to support the scoping and production of HIAs are listed at the end of this page.

When a Health Impact Assessment should be requested from a developer

There are various approaches that could be used to identify 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 (for example, 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.

Notes:

  1. These areas are to be identified with the assistance of the SCC Public Health team and with reference to the Health & Wellbeing Strategy (2026 refresh).
  2. The term 'substantial' should be defined by each LPA to reflect their local circumstances.
  3. 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.

A Health Impact Assessment policy in local plans

Local Plans should provide links to Surrey Country Council guidance on Health and Spatial Planning in Surrey and to this guidance on HIAs, which includes approaches local planning authorities could use to decide when a HIA should be requested from a developer.

The Local Plan should propose that the Joint Strategic Needs Assessment, Surrey's Health & Wellbeing Strategy and the Health & Wellbeing Strategy Index (which measures the impact of the strategy on reducing health inequalities in Surrey) are used to identify relevant health and wellbeing needs and to inform relevant policy documents.

Example Health Impact Assessment policies in local plans

1. Surrey Heath draft local plan - HIA policy

Section 1 (Introduction and context):

Page 13: ‘Policies in this Plan will collectively contribute to improving health and wellbeing. This includes the requirement for a Health Impact Assessment for certain developments; ensuring there is an appropriate supply of employment land and premises to meet future employment needs; ensuring a continuing supply of housing to meet future local needs; protection and enhancement of green infrastructure; encouraging the use of sustainable travel modes as well as minimising pollution. Policies also ensure the delivery of appropriate infrastructure (including health) alongside new development and the Plan has a specific Policy supporting Frimley Park Hospital.’

Section 2 (Spatial strategy):

  • Page 40: Climate Change adaption: ‘Measures that will help contribute to healthier communities and reduce health inequalities must be incorporated into new development where appropriate. Proposals for major development schemes should incorporate a Health Impact Assessment (HIA).’
  • Page 44: ‘For major development proposals it is a requirement to prepare a Health Impact Assessment (HIA). The HIA should identify the likely health impacts of the development and include measures to improve health outcomes and address negative effects and inequalities. The scope of a HIA will vary depending on the size of the development and its location.’

Appendix:

Page 278: Abbreviation glossary: ‘Health Impact Assessment (HIA): 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.’

2.Epsom and Ewell draft local Plan - HIA Policy

In the Epsom and Ewell draft Local Plan there are also several references to HIAs:

Policy DM12 – Health Impact Assessments:

  • 7.19. The built and natural environment is a key determinant of our health and wellbeing. Healthy built environments encourage and support good physical and mental health, and also help to reduce health inequalities.
  • 7.20. A Health Impact Assessment (HIA) helps ensure that health and wellbeing are being properly considered in planning policies and proposals. Where relevant individual applications for new development will be expected to provide a proportionate Health Impact Assessment.
  • 7.21. As a minimum, the assessment should include the following: a) a description of the physical characteristics of the proposed development site and surrounding area, including the current use; and b) identification of relevant population groups that could be affected by the development and associated health issues, inequalities and priorities in the area, which should be supported with appropriate evidence/data; and c) an assessment of the impacts of the proposal on the identified population groups and local health issues, inequalities and priorities, including any potential positive and negative impacts, along with any mitigation measures incorporated into the design to reduce identified negative outcomes; and d) details of monitoring which will be undertaken in relation to the proposed mitigation to be implemented.
  • 7.22. The analysis presented within the HIA should be of a sufficient level of detail to allow the Council to make a clear determination as to impacts the development will have on the health environment.

Pre-application advice - action for local planning authorities

Surrey County Council Public Health request that paragraphs 1-4 be included in pre application advice where a local plan does not include a HIA policy:

  1. Planning significantly influences health. Housing quality, sustainable and accessible transport, accessible green space, employment, education and leisure are ‘wider determinants of health’, all of which the planning system can affect. To be proactive about creating the conditions for good health and wellbeing, developers should incorporate Health Impact Assessments (HIAs) into proposals. HIAs evaluate how developments may affect the existing and the proposed community’s health, and the health inequalities experienced, and offer evidence-based recommendations to enhance positive health outcomes and reduce negative ones.
  2. HIA helps ensure the early assessment of health impacts in projects, provides a focus on understanding local populations, including health inequalities and areas of socio-economic deprivation, ensures health considerations are central to decision-making and promotes health equity and wellbeing as decision-making criteria.
  3. Surrey County Council Public Health would expect to see a Health Impact Assessment for new developments consisting of: (a) residential schemes (Use Class C3) of 50 homes or more; (b) developments providing 50 or more C2 bedspaces; and (c) employment sites of 5 hectares (gross) or more. The HIA should be appropriate for and proportionate to the level and types of development anticipated.
  4. The importance of health in planning is reflected in Surrey's Health & Wellbeing Strategy
  5. (2026). Surrey’s Health and Wellbeing Strategy highlights 24 Key Neighbourhoods that experience the poorest health outcomes in the county. These neighbourhoods were identified using the English Indices of Deprivation 2025 and focus on Surrey wards containing the 20% and 30% most deprived Lower Super Output Areas (LSOAs) nationally. Developments within or near to these Key Neighbourhoods should be especially mindful of health impacts because these communities face the greatest health inequalities and require targeted and evidence-based action to improve long-term outcomes.’

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 health 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 and population health 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).

Further information on Health Impact Assessments and planning

Surrey resources to support the scoping and production of HIAs

Health inequalities

Wider determinants of health

Priority populations

Files available to download

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