Health Impact Assessment in spatial

planning

A guide for local authority public health

and planning teams
October 2020
Health Impact Assessment in spatial planning

Organisations who have contributed to and

support this guide

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Health Impact Assessment in spatial planning

About Public Health England

Public Health England exists to protect and improve the nation’s health and wellbeing,
and reduce health inequalities. We do this through world-leading science, research,
knowledge and intelligence, advocacy, partnerships and the delivery of specialist public
health services. We are an executive agency of the Department of Health and Social
Care, and a distinct delivery organisation with operational autonomy. We provide
government, local government, the NHS, Parliament, industry and the public with
evidence-based professional, scientific and delivery expertise and support.

Public Health England

Wellington House
133-155 Waterloo Road
London SE1 8UG
Tel: 020 7654 8000
www.gov.uk/phe
Twitter: @PHE_uk
Facebook: www.facebook.com/PublicHealthEngland

Prepared by: Michael Chang, Carolyn Sharpe, Aimee Stimpson, Carl Petrokofsky and
Andy Netherton (Public Health England) with contributions from Professor Thomas
Fischer and Dr Tara Muthoora (University of Liverpool), and Laura Taylor-Green (Essex
County Council). See Annex 1 for acknowledgements and full list of contributors.

For queries relating to this document, please contact: HealthyPlaces@phe.gov.uk

© Crown copyright 2020

You may re-use this information (excluding logos) free of charge in any format or
medium, under the terms of the Open Government Licence v3.0. To view this licence,
visit OGL. Where we have identified any third-party copyright information you will need
to obtain permission from the copyright holders concerned.

Published October 2020

PHE publications PHE supports the UN
gateway number: GW-1620 Sustainable Development Goals

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Health Impact Assessment in spatial planning

Contents
Organisations who have contributed to and support this guide 1
About Public Health England 3
Foreword 5
Executive Summary 6
Glossary 7

1. About the guide 8

2. HIA in planning policy and practice 12
3. Developing HIA policy and guidance 21
4. Is an HIA required 26
5. Establishing the scope of an HIA 29
6. Integrating an HIA with other assessments 31
7. Summary 34

References 35
Annex 1. Acknowledgements 37
Annex 2. Health and wellbeing outcomes in planning 38
Annex 3. Strategic and local HIA policies and triggers 42
Annex 4. Local HIA guidance and SPDs 43
Annex 5. Local HIA guidance template 44
Annex 6. HIA scoping framework for plan or development project 45
Annex 7. HIA integration in SA/SEA process 47
Annex 8. HIA integration in EIA process 48

Table of tables and figures

Table 1. The guide in the context of existing HIA guidance in England and the UK ................. 10
Table 2. Wider determinants of health and wellbeing outcomes .............................................. 14
Table 3. Public Health Outcomes Framework indicators relevant to planning.......................... 18
Table 4. Some examples of national and local tools and data sources .................................... 22
Table 5. Significance - magnitude of impact............................................................................. 23
Table 6. Likelihood of impact.................................................................................................... 24

Figure 1. Policy basis for considering health in the National Planning Policy Framework ........ 14
Figure 2. Indicative type of HIA appropriate for plans and development projects..................... 16
Figure 3. Health outcomes in planning pathway example: healthy housing ............................. 19
Figure 4. Process of determining the need for an HIA ............................................................. 25
Figure 5. Process of screening for planning applications ......................................................... 28

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Health Impact Assessment in spatial planning

Foreword
The COVID-19 global pandemic has changed the way individuals, families and society
value our relationship with the spaces and places in which we live, work and play.

Public Health England’s disparities in the risk and outcomes of COVID-19 report has
confirmed those who live in more deprived urban and rural areas are more susceptible to
the effects of COVID-19. The pandemic has replicated existing underlying health
inequalities and, in some cases, has widened them.

As we look past the initial peak of the pandemic, evidence indicates that many want to
embrace the positive changes seen in our environments during the social lockdown such
as increased opportunities for walking and cycling, more spaces for social interaction, and
a greater value placed on our green and blue spaces. As the nation shifts towards
economic renewal, for example, by building more and better homes, strengthening the
use of health impact assessments (HIA) in spatial planning offers local authorities a
powerful lever to improve public health and wellbeing, and ultimately reduce inequalities.

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.

When used in the planning system, HIAs can also identify opportunities to deliver co-
benefits across a range of policy areas: better quality housing, particularly in areas where
they are most needed, will in the long term improve health outcomes; more and better
active travel infrastructure in areas of poor air quality will lead to improved cardiovascular
health; safer and more inclusive spaces for older people as well as those with a mental or
physical health problem will deliver benefits to individual quality of life. Each of the above
opportunities will also contribute to reductions in health inequalities.

This guide was created in collaboration with national, regional and local experts in
planning, public and environmental health, and impact assessment. This collaboration
demonstrates a strong commitment from many who believe HIAs to be an essential tool
to ‘health-proof’ spatial plans and project designs for future generations. The guide aims
to provide local authority teams with the practical information they need to embed HIA in
the local planning system and, in doing so, create safer and healthier places.

Professor John Newton

Public Health England

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Health Impact Assessment in spatial planning

Executive summary
This guide focuses on the use of Health Impact Assessment (HIA) in the planning
system. An HIA is a process that identifies the health and wellbeing impacts (benefits
and harms) of any plan or development project. A properly conducted HIA recommends
measures to maximise positive impacts; minimise negative impacts; and reduce health
inequalities.

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.

As health inequalities continue to widen in England (1), there is a need to better identify
and address the health impact of planning decisions. To help achieve this, Public Health
England (PHE) has developed this guide on HIAs for planning in England.

This guide describes the health and wellbeing outcomes that are influenced through
planning and how these outcomes can be optimised through the process of plan-making
(when developing policies in local plans) and planning applications (designing proposals
for development projects). It also describes how these health outcomes can be
considered in other impact assessments (such as strategic and environmental impact
assessments).

The guide is targeted towards local authority public health and planning teams, planning
applicants, impact assessment practitioners, and others involved in the planning process.

It provides information to support:

• the National Planning Policy Framework (NPPF) and the Planning Practice
Guidance (PPG) on promoting healthy and safe communities
• local adoption of planning policies and guidance on the use of HIAs
• consideration of how the planning process impacts population health, wellbeing and
inequalities through the wider determinants of health
• consideration of whether an HIA is required; what the trigger points should be; the
type of HIA needed; and alignment with other planning assessments
• consideration of the range of health and wellbeing issues to be included in an
assessment
• engagement of relevant practitioners when considering health in impact
assessments, including environmental health officers and impact assessment
practitioners operating in the private sector

This guide is applicable to the English policy context.

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Health Impact Assessment in spatial planning

Glossary
These definitions describe various terms used in this publication.

Authority Monitoring A statutory annual performance update on the Local Planning

Report (AMR) Authority such as on local plan policy implementation.
A statement submitted with a planning application that explains the
Design and Access
design thinking behind the proposal and shows how everyone will
Statement (DAS)
be able to use the places they want to build.
A statutory assessment to evaluate the likely significant impacts of
Environmental Impact
a proposed project as defined in Regulation 4 of the Town and
Assessment (EIA)
Country Planning (EIA) Regulations 2017.
Avoidable and unfair differences in health status between groups of
Health inequalities
people or communities.
An integrated assessment to appraise the environmental, social
Integrated Impact
and economic sustainability impacts, and the equalities, health,
Assessment (IIA)
crime and disorder effects of the policies.
A strategy to inform commissioning decisions across local services
Joint health and
to ensure they are focused on the health needs of service users
wellbeing strategy
and communities based on the JSNA.
A statutory assessment of the current and future needs and assets
Joint Strategic Needs
of an area to improve health and wellbeing outcomes and impact
Assessment (JSNA)
on the wider determinants of health.
Local information A list of the information a local area requires to be submitted in
requirements list support of a planning application.
Local Planning Authority A public authority whose duty it is to carry out specific planning
(LPA) functions for a particular geographic area.
The government’s planning policies for England and how these
National Planning Policy
should be applied in plan-making and making planning decisions. It
Framework (NPPF)
was last updated in February 2019.
Refers to the process of creating local plans and policies, and other
Plan-making
development plan documents by the LPA.
Planning Practice Web-based resource which brings together planning guidance on
Guidance (PPG) various topics to support the National Planning Policy Framework.
A high-level overview of public health outcomes, supported by a
Public Health Outcomes
broad set of indicators, that allows local authorities to assess
Framework (PHOF)
progress in comparison to national averages and other local areas.
Planning obligations that are legal agreements to mitigate the
Section 106
impacts of a development proposal.
Population groups or areas which are more susceptible to the
Sensitive receptors
adverse effects of impacts from a proposed policy or project.
A statutory assessment which allows local authorities to assess,
Strategic Environmental
consult on, and monitor the likely impacts their plans, programmes
Assessment (SEA)
and strategies will have on the environment.
Produced by Local Planning Authorities to build upon and
Supplementary planning
document (SPD)
provide more detailed advice on the policies contained in a
local plan.
A statutory planning assessment which requires a LPA to carry out
Sustainability Appraisal
a SA during plan preparation to achieve relevant environmental,
(SA)
economic and social objectives.
Wider determinants of A diverse range of social, economic and environmental factors
health which impact on people’s health.
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Health Impact Assessment in spatial planning

1. About the guide

Introduction

1.1 The factors that influence our health are multiple and complex. Most of these factors
lie outside the health and social care system. It has been estimated that socio-economic
and physical environments determine 60% of health outcomes (2). Focusing on these
determinants of health is essential for improving population health and wellbeing and
reducing inequalities.

1.2 HIA is a valuable process that enables local action on the wider determinants of
health. It can help maximise the health benefits of a plan or development and minimise
the potential harms, while maintaining a focus on reducing inequalities. There is an
economic as well as a moral case for tackling health inequalities. Poor health and health
inequalities in England are estimated to cost the NHS an extra £4.8 billion a year from
the greater use of hospitals by people in deprived areas (3) and cost the UK £31-33
billion a year in lost productivity (4).

1.3 The NPPF sets out the government’s planning policies and how they should be
applied. It requires planning policies and decisions to “enable and support healthy
lifestyles, especially where this would address identified local health and wellbeing
needs” (5). It also emphasises that the level of detailed supporting information provided
to local planning authorities (LPAs) should be relevant, necessary and material, and that
having the right information is crucial to good decision-making. The supporting PPG,
healthy and safe communities, suggests the use of HIA can be beneficial “where there
are expected to be significant impacts” (6).

1.4 The development of this guide has been informed by research from the Universities
of the West of England (7) and Liverpool (8), and the York Health Economics
Consortium (9). Their recommendations called for better integration of local health and
wellbeing needs and priorities into the local plan and decision-making process. To
achieve this, they recommended further guidance on how and when to undertake an
HIA and on the screening and scoping stages, improved integration and alignment of
HIAs with other assessments, and strengthened local HIA capacity and skills. This
guide responds to these recommendations.

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Health Impact Assessment in spatial planning

Purpose of the guide for England

1.5 This guide aims to increase the coverage of HIAs in the planning process1. It forms
part of PHE’s strategic commitment to local systems to support preventative action on
the wider determinants of health (10), and helps clarify the process of establishing HIA
policies and requirements to users of the planning system.

1.6 It has been developed with input from stakeholders and expert practitioners. See
Annex 1 for acknowledgements.

1.7 Target audience groups are:

• local authority public health teams and wider health and social care partners
(including: primary care, Clinical Commissioning Groups (CCGs), Sustainability and
Transformation Partnership (STP) / Integrated Care Systems (ICS), local NHS
Trusts) to
• make the case for the positive and proactive role of HIAs to help local
authorities and health organisations deliver their duty to improve population
health and reduce health inequalities under the Health and Social Care Act
2012
• support planning teams to create planning policy and development
management guidance such as supplementary planning documents (SPDs)
input into the development of strategic, local or neighbourhood plans, inform
pre-application discussion on health impacts, and inform recommendations on
preventative and mitigation measures to address these impacts
• local authority planning teams and those responsible for plan-making and decision-
making on planning applications to
• meet the requirements set out in the NPPF and PPG on healthy and safe
communities
• adopt planning policy and guidance requiring the proportionate use of HIAs
• help consider how best to employ HIAs in relation to other statutory
assessments
• develop proportionate and justified HIA requirements in strategic and local plans
• inform whether an HIA is required and the scope of the assessment
• create development management guidance such as SPDs on the use of HIA
• planning applicants, consultants and others involved in the planning process to
• consider a wide range of health and wellbeing impacts within the design
processes for development projects prior to submission of planning applications
to the local authority

1 Town and Country Planning Association found 30% of LPAs have an HIA requirement in local plans (11)

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Health Impact Assessment in spatial planning

• inform the content and structure of commissioned HIAs either as a standalone

assessment or as part of other assessments, promoting the use of existing tools
and resources in Table 1

Alignment with existing HIA guidance

1.8 This guide supplements existing HIA guidance for the UK. It focuses on the earlier
stages of the planning process to help support the local policy case for the use of HIAs.
Technical guidance for carrying out HIAs already exists as well as guidance on quality
assurance and the consideration of health in other impact assessments such as EIA
(Table 1).

Table 1. Existing HIA guidance in the UK

General HIA • Health impact assessment of government policy by the Department
of Health (12)
Carrying out of • Health Impact Assessments – a practical guide by the Wales
an HIA Health Impact Assessment Support Unit (WHIASU) (13)
• Rapid Health Impact Assessment Tool by NHS London Healthy
Urban Development Unit and other HIA guidance (14)
• Health Impact Assessment (HIA) and Local Development Plans
(LDPs): A toolkit for practice by WHIASU (15)
• Local authorities have developed local HIA guidance (See Annex 4)
Quality • Quality Assurance Review Framework for Health Impact
assurance Assessment by WHIASU (16)
methods • Review Package for Health Impact Assessment Reports of
Development Projects by Ben Cave Associates (17)
Health in other • Health in Environmental Impact Assessment. A briefing for public
impact health teams in England by PHE (18)
assessments • Health in Environmental Impact Assessment. A Primer for a
Proportionate Approach by Institute for Environmental Management
and Assessment (IEMA) (19)
• Addressing human health in Environmental Impact Assessment by
International Association for Impact Assessment (IAIA) and
European Public Health Association (EPHA) (20)
• Health Equity Assessment Tool by PHE (21)

1.9 A separate PHE guide helps planning applicants understand the health issues that
PHE expects to see addressed by applicants when preparing an Environmental
Statement for Nationally-Significant Infrastructure Projects (NSIPs) under the Planning
Act 2008. PHE, NHS England and CCGs are statutory consultees for such NSIP
applications. For further information, see Advice on the content of Environmental
Statements accompanying an application under the Nationally Significant Infrastructure
Planning Regime (22).

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Health Impact Assessment in spatial planning

1.10 An HIA is one mechanism to integrate health throughout the planning process.
There are other methods local authorities may wish to consider as part of a health in all
policies approach described in PHE’s other resources and supporting information on
good planning for health (23).

1.11 Please note at the time of publication of this Guide, the government published the
Planning for the Future White Paper for England (24). The White Paper sets out reforms
to the planning system that aim to make it simpler, faster and more predictable in
creating local plans and making decisions on development projects. Its’ proposals will
have implications for how and whether the use of HIAs can be justified, and this Guide
may be updated as these proposals are implemented.

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Health Impact Assessment in spatial planning

2. HIA in planning policy and practice

What is an HIA?

2.1 The World Health Organization defines an HIA as a combination of process and
methods used by those planning, deciding and shaping changes to the environment to
evaluate the significance of health effects of a plan or project (25). An HIA helps
decision-makers in local authorities and other stakeholders make choices about actions
to best prevent ill-health, promote good health and reduce health inequalities.

2.2 When applied in the planning system, an HIA puts people at the heart of the
process. It is an objective assessment tool for addressing the barriers and enablers for
creating healthy places. An HIA can help identify a set of evidence-based practical
recommendations to promote and protect the health of local communities.

HIA process

2.3 An HIA process follows 5 stages (13):

1. Screening: Determine whether an HIA is needed and justified subject to

anticipation of health impacts on population groups.
2. Scoping: Identify the potential health impacts and target population groups to
assess.
3. Assessing: Assess the significance of health impacts, qualify and quantify
potential costs and benefits, how health varies in different circumstances, across
different populations and any alternatives.
4. Reporting: Engage all relevant stakeholders and recommend preventative and
mitigation actions to deliver the greatest possible health gain.
5. Monitoring and evaluating: Include indicators and mechanisms, and set out
processes and resources for the local authority and/or with the planning applicant
to undertake and act on results of regular monitoring.

2.4 The HIA process can also include a stage for quality assurance. This is a
recommended additional stage whereby those responsible for agreeing the
recommendations of an HIA (the local planning and/or public health team), review the
quality of the final HIA submitted as part of the planning application. The quality
assurance stage ensures HIAs are carried out objectively, address local health and
planning priorities, and are based on quality evidence base. The quality assurance
findings can then be used to inform how recommendations are taken forward in plans or
development projects.

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Health Impact Assessment in spatial planning

Practice example: Hertfordshire County Council Public Health review of HIAs

Hertfordshire County Council requires developers to undertake HIAs in line with its HIA Position
Statement. Public health seeks engagement during early masterplanning of strategic sites to
ensure HIAs are undertaken and scoped effectively; submitted HIAs are reviewed using the
WHIASU Quality Assurance Framework (16).

Types of HIA

2.5 There are 3 types of HIA (13) which are:

• comprehensive HIAs are more in-depth and so are the most resource intensive,
requiring extensive literature searches and data collection, and stakeholder and
public engagement - this type of HIA is most suited to more complex proposals
• rapid HIAs involve a brief assessment of health impacts, including a literature review
of quantitative and qualitative evidence, and the gathering of knowledge and further
evidence from local stakeholders - rapid HIAs usually include the establishment of a
small steering group and carrying out a stakeholder workshop
• desktop HIAs can encompass engaging a small number of participants using
existing knowledge and evidence to undertake the assessment of health impacts

2.6 In practice adopting the appropriate type of HIA depends on the focus, scale and
scope of the plan or development project, the stage at which the HIA will seek to
influence, and the time and resources available to commission, undertake or review the
HIA. When setting out requirements during earlier stages in the decision-making
process, it is best to specify the type of HIA expected to be undertaken. Refer to
Figure 2.

Health and wellbeing outcomes

2.7 Table 2 summarises a list of factors that an HIA can seek to address; ranging from
health improvement to health protection issues. It reflects how health outcomes relate to
the wider determinants of health and wellbeing such as access to services and
amenities, traffic and transport, social and economic factors, and land use factors.
There may be further health determinants and outcomes that are relevant to local areas
and their consideration within an HIA should be based on local health needs and
priorities. See Annex 2 for more details on health outcomes.

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Health Impact Assessment in spatial planning

Table 2. Wider determinants of health and wellbeing outcomes

HIA health Wider determinants of health and wellbeing
considerations Access Traffic and Socio-economic Land Use
(Annex 2) Transport
Reduce Health inequalities • Local public key • Accessibility • Employment,
services and • Access to public including skills
Improve mental health facilities transport development and • Sustainable and
and wellbeing • Good quality • Opportunities for training efficient land use
Improve diets and weight affordable housing active travel opportunities in urban and/or
• Healthy and (cycling and • Local business /rural settings
Improve musculoskeletal affordable food walking) activity • Quality of Urban
health • Natural • Links between • Regeneration and natural
Improve respiratory health environment communities • Tourism and environments,
• Green spaces • Community leisure industries such as air and
Improve cardiovascular and public realm severance • Community/ noise pollution
health • Leisure, sport, • Connections to social cohesions • Climate change
Protect environmental recreation, play jobs and access to impacts
health and physical • Connections to social networks
Provide access to health activities within the services, facilities • Community
and care infrastructure environments and leisure engagement

Planning policy context for HIAs

2.8 The PPG on promoting healthy and safe communities is explicit about when the use
of HIAs can be justified in planning applications for development projects through the
Director of Public Health (DPH). It states that “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. A health impact assessment is a useful tool to use where
there are expected to be significant impacts.” (6)

Figure 1. Policy basis for considering health in the National Planning Policy Framework

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Health Impact Assessment in spatial planning

2.9 The PPG guidance on HIAs is set in the context of meeting NPPF requirements for
the consideration of health and wellbeing (Figure 1). HIAs can support local authorities
to discharge their legal duty to take appropriate actions to improve the health of local
people under the Health and Social Care Act 2012.

2.10 When developing policies either as part of joint plans or spatial development
strategies, local authorities are required to consider requirements set out in relevant
regulations. These policies relate to issues of a strategic nature and relevant cross-
boundary issues, including enhancing the natural environment, healthcare facilities and
housing as set out in the NPPF (5).

Practice example: Liverpool City Region Spatial Development Strategy and health
The Liverpool City Region Combined Authority is creating a strategic Spatial Development
Strategy covering the 6 constituent local authorities in the north west of England. The Spatial
Development Strategy will have policies to ensure developments have regard to their effect on
the health and health inequalities of and between people living in the Liverpool City Region.

When to use HIAs

2.11 An HIA is most effective when it is undertaken prospectively and concurrently to

inform and shape a plan, policy or development project during options appraisal and
design (that is before decisions are made and submitted as part of a planning
application) (8). The intention to use an HIA should be determined early in the planning
process. Depending on the scale of the plan or project, it may be appropriate to
integrate or align an HIA with a sustainability appraisal (SA) / strategic environmental
assessment (SEA) for plan-making or EIA and other assessments required as part of
local information requirements for planning applications.

2.12 Figure 2 indicates the type of HIA that may be appropriate for different
applications. The type and purpose of an HIA and responsibilities should be agreed
from the outset. When agreeing the type of HIA, factors including the anticipated scale
of impact, significance, proportionality to the plan or development project and local
health needs and priorities should be considered. Sections 4 to 6 of this guide provide
information on this process.

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Figure 2. Indicative type of HIA appropriate for plans and development projects
Purpose Type of HIA Responsibility Implementer

2.13 To improve the quality of an HIA and help secure consensus on meeting local
needs and priorities, stakeholder or community engagement can be scoped into the
process. Stakeholder and community engagement will be proportionate and dependent
on the type of HIA. Those implementing and carrying out the HIA should make sufficient
time and resources available for this stage of the process.

Practice example: Barton Park Healthy New Town HIA 2017

The HIA qualitatively assessed the potential health impacts of the proposed Barton Park
development and the Underhill Circus redevelopment. While the Barton Park HIA was carried
out retrospectively, it fed back recommendations into the design process of the Underhill Circus
redevelopment to help support physical and mental health and wellbeing.

Improving the use and implementation of HIA requirements

2.14 Local authority public health and planning teams need to agree how HIAs will be
enforced, funded and resourced. Considerations such as the existence of policy
requirements, proportionality, and role and capacity of public health involvement may be
useful. Local arrangements should have agreement from the DPH, head of planning
and elected members, and in consultation with relevant stakeholders and developers.
There are different options available for implementing HIAs in the plan-making and the
planning process.
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Health Impact Assessment in spatial planning

2.15 When preparing plans and policies, the available options to include an HIA are:

• resourced as part of existing assessment procedures for SEA/SA or IIA, to be

undertaken by commissioned HIA practitioners or done in-house between the
planning and public health teams
• implemented as a standalone assessment, to be undertaken by commissioned HIA
practitioners or done in-house by the planning and public health teams
• undertaken for those planning documents that do not require a SEA/ SA such as
neighbourhood plans and SPDs, by commissioning HIA practitioners or done in-
house between the planning and public health teams

Practice example: London Borough of Croydon local plan HIA 2015-16

The HIA on the draft local plan was undertaken by spatial planning and public health
departments. It involved a scoping report, policy screening and an HIA workshop, and the
assessment was based on the NHS London Healthy Urban Development Unit (HUDU) rapid
HIA tool. Other stakeholders will include housing, transport, environmental health and pollution
departments, and NHS partners including the CCG and Croydon Health Services NHS Trust.

2.16 For planning applications, the available options to improve the use of an HIA are:

• adopt an HIA policy with triggers in the strategic or local plan

• where appropriate, inclusion in the local information requirements list for
applying for planning permission or a prior approval application for change of
use
• provide detailed guidance on how to carry out an HIA, for example as a SPD
• discuss with planning applicants during the pre-application stage
• use of planning conditions to implement HIA recommendations
• use of Section 106 planning obligations to implement HIA recommendations,
including requiring developers to cover monitoring costs for some years after
construction
• allocate local authority resource to advise on and review HIAs. This can be
funded as part of planning performance agreements 2 for major projects

2.17 To make HIAs more effective and meaningful, those involved throughout the HIA
process can be supported by undertaking continuing professional development (CPD)
training in order to build capacity for this activity. Training can clarify the local process
and can enhance the understanding of health and wellbeing, the impact and effects on
the population, and the identification of recommendations.

2 A project management tool for the LPA and applicants to agree actions and resources for handling applications.

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Health Impact Assessment in spatial planning

Practice example: London Borough of Tower Hamlets HIA capacity building programme
Tower Hamlets has formalised the partnership between public health and planning and has
appointed an HIA Officer to lead on the delivery of its HIA policy, including an HIA capacity
building programme. This includes developing guidance for developers and planners, a best
practice community engagement guide, briefings for HIA stakeholders and workshops/webinars
for planners focusing on HIA in development management and the process of HIA itself.

Monitoring of HIA use and health impacts

2.18 Where possible, local authorities should evaluate the effectiveness of HIAs/HIA
policies against a range of health outcomes outlined in Annex 2. The indicators in the
Public Health Outcomes Framework (PHOF) (at local authority level) and the Local
Health Fingertips tool (at ward level) (26) can support local authorities to benchmark
and monitor health and wellbeing metrics. The indicators are grouped into 4 domains
(see Table 3 for relevant indicators), many of which are directly or indirectly influenced
by the planning system.

2.19 Changes to the number of HIAs undertaken and the way in which HIAs are
undertaken, as well as progress towards improving public health outcomes can also be
monitored through the statutory monitoring requirements of the LPA Authority
Monitoring Report (AMR) and the Director of Public Health Annual Report. These
should be aligned, as required by the NPPF, to local health and wellbeing needs and
priorities.

Table 3. Public Health Outcomes Framework indicators relevant to planning

Domain Indicators relevant to planning
B05 - 16-17 year olds not in education, employment or training (NEET) or whose
activity is not known
Wider B14c - The percentage of the population exposed to road, rail and air transport
determinants of noise of 55 dB(A) or more during the night-time
health B16 - Utilisation of outdoor space for exercise/health reasons
B17 - Fuel poverty
B18 - Social isolation
C09a - Reception: Prevalence of overweight (including obesity)
C10 - Percentage of physically active children and young people
C16 - Percentage of adults (aged 18+) classified as overweight or obese
Health
C17a - Percentage of physically active adults
improvement
C27 - Percentage reporting a long term Musculoskeletal (MSK) problem
C28a - Self-reported wellbeing - people with a low satisfaction score
C29 - Emergency hospital admissions due to falls in people aged 65 and over
Health protection D01 - Fraction of mortality attributable to particulate air pollution
Healthcare public E03 - Mortality rate from causes considered preventable
health and Under 75 mortality rate from respiratory disease considered preventable
premature E14 - Excess winter deaths index
mortality E15 - Estimated dementia diagnosis rate (aged 65 and over)

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2.20 PHE’s Spatial Planning and Health evidence resource (27) describes how health
outcomes are shaped by actions taken across the wider determinants of health such as
neighbourhood design, housing, transport, food environment and the natural
environment. For example, Figure 3 highlights housing and health outcomes.

Figure 3. Health outcomes in planning pathway example: healthy housing

See full pathways and diagrams in PHE (2017), Spatial planning and health: evidence review (27)

How health organisations can contribute to the HIA process

2.21 The PPG on promoting healthy and safe communities provides details regarding
the health organisations that need to be involved in planning for health (6). Local
authority DPHs; at the unitary authority or county council (for 2-tier areas) level; should
be the first point of contact when seeking input on public health and inequalities. The
DPH and the public health team can support the HIA process by:

• helping to determine the type of HIA needed

• supporting the scoping stages to identify the likely significance of impacts and
effects on population health, and health inequalities of implementing the plan or
project
• signposting to public health data and supporting with their interpretation
• supporting with the collection of health information to monitor the progress of the
plan or project implementation

2.22 CCGs and NHS England are statutory consultees on local plans and have a duty
to cooperate with LPAs. CCGs and NHS England, through STPs and ICSs, can also be
consultees for development projects and can help identify potential health impacts and
mitigating actions in relation to the demands on local health infrastructure and services.
CCGs and STPs/ICSs can work in partnership with public health teams to produce a
collective health response.

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Practice Example: Essex approach to HIAs with NHS Estates Partners

The Essex County Council Public Health Team and NHS estates forums work closely with local
authority partners to ensure that the impacts of new development and upstream prevention
through primary, GP and community, acute and specialist services can be considered. NHS
estates teams, County and local public health teams promote the use of HIAs and health in
EIAs to highlight potential impacts from proposals.

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Health Impact Assessment in spatial planning

3. Developing HIA policy and guidance

3.1 Local authorities are encouraged to adopt policies that require an HIA to be carried
out for certain types of developments in their local plan or spatial development
processes. Such a requirement may support local health and wellbeing priorities
(Annex 2) as well as the local health and wellbeing policy. An HIA policy requirement
may also support other health-promoting policies such as those relating to sustainable
transport, sport and play, housing, access to healthy and affordable food and green
infrastructure.

3.2 To ensure a robust policy (within strategic or local plans) the policy must meet the
soundness tests as defined in the NPPF (5) which are:

• positively prepared – providing a strategy which, as a minimum, seeks to meet the

area’s objectively assessed needs
• justified – an appropriate strategy, taking into account the reasonable alternatives,
and based on proportionate evidence
• effective – deliverable over the plan period
• consistent with national policy – enabling the delivery of sustainable development in
accordance with NPPF policies

Annex 3 provides examples of adopted strategic and local planning policies on HIAs.

3.3 The local authority can adopt necessary guidance, such as an SPD, which provides
more details regarding when and how to carry out HIAs and the range of health and
wellbeing considerations to include in the HIA scope. The SPD should be developed
collaboratively by planning and public health teams and involve stakeholder and public
consultation in line with planning regulations.

Annex 4 provides local HIA guidance examples. Annex 5 provides a SPD template
structure.

3.4 Planning policies and SPDs can introduce triggers that require an HIA to be
submitted as part of a planning application where evidence demonstrates the
development impacts can be expected to be significant on sensitive receptors. The
process of determining local triggers should be evidence-based and follow the steps
below (and summarised in Figure 4).

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Health Impact Assessment in spatial planning

Identify local health needs and priorities

3.5 Local health needs and priorities can be identified from:

• local health strategic documents, such as the Health and Wellbeing Strategy
• the local Joint and Strategic Needs Assessment (JSNA) which informs the Health
and Wellbeing Strategy and is approved by the Health and Wellbeing Board
• local data sets and intelligence sources, including indicators published in the PHOF
and local health profiles
• engagement with wider health and social care partners including: primary care,
CCGs, STPs/ICSs and NHS trusts

3.6 A number of tools and databases are available at a national and local level to
support the identification of local health and wellbeing needs and priorities, including for
health impact monitoring and review purposes. Examples are set out in Table 4. Local
authorities can make greater use of data and digital technology to make it easier to
access and use this information to inform the HIA process.

Table 4. Examples of national and local tools and data sources

Tools and data Source
Measures of National Wellbeing Dashboard (28) Office for National Statistics
PHOF and health profiles (25) PHE
Strategic Health Assets Planning and Evaluation (SHAPE) (29) PHE
Indices of deprivation (30) MHCLG
Active Lives, Active People, Active Places data (31) Sport England
People and Nature survey (32) Natural England
Cambridge Centre for Diet
Food Environmental Accessibility Tool (FEAT) (33)
and Activity Research
UK Implementation of Sustainable Development Goals (34) UK Government

Identify population characteristics

3.7 Preventing the negative impacts and maximising positive impacts of a plan, policy or
planning application on population groups is key to an HIA. It is important to identify how
sensitive and susceptible population groups or areas are to the impacts of a
development project, whether positive or negative, for example on Black, Asian and
Minority Ethnic (BAME) groups (35).

3.8 From the PHE Health Equity Assessment Tool, different characteristics to consider
are (21):

• protected characteristics as defined by the Equality Act 2010: age, sex, race, religion
or belief, disability, sexual orientation, gender reassignment, marriage and civil
partnership, and pregnancy and maternity (36)

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Health Impact Assessment in spatial planning

• individual’s socio-economic position, as defined by their education, employment

status, income, household composition
• area variations by factors such as deprivation level, service provision, urban/rural
• vulnerable and inclusion health groups for example homeless people, people in
prison, or young people leaving care

3.9 The sensitivity of population groups to the impacts of a development project will
depend on:

• location and context of the development project

• population needs set out in health needs assessments or other evidence sources
• their importance as identified in local health strategies
• influence and impact from external factors (for example major incidents)

Practice example: Wakefield Council HIA guidance priority themes by wards

Wakefield Council created guidance and tools to assist planning applicants with the process of
carrying out a comprehensive or rapid HIA for planning applications. Its guidance identifies key
themes in each of the 21 wards on which HIAs should initially focus.

Identify health impacts and their potential significance

3.10 Significance is not absolute and can only be identified in relation to the project and
its location. Through the identification of major adverse impacts, local authorities can
justify the adoption of an HIA policy or guidance. Significance can be determined by the
expected magnitude of the health and wellbeing impact on specific population
characteristics (Table 5). These may be positive (beneficial), neutral (no discernible
change), or negative (adverse), direct or indirect, cumulative, permanent or temporary
(short, medium or long term).

Table 5. Significant impact

Significant based on: high exposure or scale; long-term duration; continuous
Major Major frequency; severity predominantly related to mortality; majority of population
adverse affected; permanent change; and substantial service quality implications.
benefit
Prevention measures will be required.
Potentially significant based on: low exposure or medium scale; medium-
term duration; frequent events; severity predominantly related to moderate
Moderate Moderate
changes in morbidity; large minority of population affected; gradual reversal;
adverse benefit and small service quality implications. Prevention or mitigation measures will
be required.
Not significant based on: very low exposure or small scale; short-term
Slight Slight duration; occasional events; severity predominantly related to minor change
adverse benefit in morbidity; small minority of population affected; rapid reversal; and slight
service quality implications. Mitigation measures will be required.
Not significant based on: negligible exposure or scale; very short-term
duration; one-off frequency; severity predominantly relates to a minor change
Neutral in quality-of-life; very few people affected; immediate reversal once activity
complete; and no service quality implication.

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Health Impact Assessment in spatial planning

Identify likelihood of impacts

3.10 Identify the likelihood of the impact occurring within specific population groups and
its significance (Table 6).

Table 6. Likelihood of impact

Strong direct evidence (for example from a range of qualitative and quantitative
Definite sources) or direct evidence from official statistics.
Good direct evidence (for example from a range of qualitative and quantitative
Probable sources) to support the impact.
Direct evidence to support the impact but drawn from limited source(s) (for
Possible example grey literature, news articles, blogs or commentaries).
Unlikely No direct evidence but issue highlighted as a potential impact.

Determine local HIA triggers

3.11 Understanding the significance of health impacts on population groups or sensitive

receptors will allow each local authority to determine whether an HIA will be needed.
This allows a range of local triggers or thresholds to be set. These triggers or thresholds
provide clarity to planning applicants as to what development projects require an HIA,
including suggestions of potential mitigation measures such planning conditions or
planning obligations.

3.12 When developing strategic and local planning policies and guidance, LPAs can
have regard to:

• specific locations with poor physical and mental health outcomes

• opportunities to maximise health impact on the wider determinants such as, but not
limited to, socio-economic indicators, physical activity, housing, access to healthy
food, access to green spaces, access to health and care services and social
infrastructure
• proximity to locations where there is a higher risk of impact on the physical and
mental wellbeing of vulnerable population groups such as children and young
people, disabled people and older people
• proximity to locations where there is and will be potential to increase people’s
exposure to hazards such as air and noise pollution, land and water contamination
• being aware of triggers set in other assessments such as for EIA developments (37)
or major developments for design and access statements (38)
• further information requirements to support decision-making as part of a prior
approval application, such as office to residential development, where there may be
impacts on matters identified in regulations for example transport and traffic impact,
noise, access to natural daylight and other amenity issues (39)

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Health Impact Assessment in spatial planning

3.13 Many local authorities have already defined local triggers as part of an HIA policy
in their local plan (see examples highlighted in Annex 3). Example triggers are:

• size – ‘major’ developments defined as 10+ dwellings / area over 0.5 hectares
or a floorspace of over 1,000sqm / area of 1 hectare, and major infrastructure
• use – developments which include uses for education, health and social care,
leisure or community, A5 hot-food-takeaways or other food retail, and betting
shops
• location – sites in areas of high deprivation, fuel poverty, poor health, elderly or
vulnerable groups, levels of childhood obesity using the PHE Wider
Determinants tool

Figure 4. Process of determining the need for an HIA

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Health Impact Assessment in spatial planning

4. Is an HIA required?
4.1 This section describes how to carry out an initial screening stage to determine
whether an HIA is required, within the parameters of the PPG and any adopted HIA
policy. This section will be useful for those without an HIA policy in strategic or local
plans, or for those who are in the process of developing their local triggers or
thresholds. For local authorities with established HIA policy and triggers, this stage may
not be required. If an application triggers the need for an HIA then those local
authorities can move onto the scoping stage in Section 5.

4.2 The objectives of this process are firstly to identify the expected health impacts and
effects on population groups and their significance, and secondly to conclude whether a
standalone HIA is justified in planning terms (see Figure 5).

4.3 The screening stage can also be carried out to determine whether a development
project requires an EIA in accordance with the EIA Regulations (37). The EIA
Regulations require consideration of significant impacts on, amongst others, population
and human health. Most development projects will not be subject to an EIA.

Identify policy requirement for HIA

4.4 This step establishes whether a development project triggers the requirement for an
HIA to be carried out, based on a policy and trigger in strategic or local plan or a SPD. If
an HIA is required, then proceed to scoping (Section 5). If there is no policy requirement
for an HIA currently in place, it may still be justified to progress screening to determine if
an HIA should be required based on significant impacts. An alternative option would be
to seek to align an HIA with existing assessment requirements, such as design and
access statements.

Identify health considerations and population characteristics

4.5 Determine the potential health impacts and effects of the proposed development
using the information provided in the health and wellbeing outcomes table (Annex 2). A
range of population groups should be considered (as outlined in paragraph 3.8). Local
authority planning, and/or public health teams are best placed to carry out this step.

Identify significance and likelihood of these impacts

4.6 Once the range of anticipated health impacts and effects, and their relevance to
different population groups, have been identified, it is necessary to determine their
potential significance. Significance is not absolute and can only be identified in relation
to individual development projects and their unique location and context. The potential

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Health Impact Assessment in spatial planning

significance of impacts will allow each local authority to determine, subject to their own
needs, whether an HIA is justified.

4.7 Local JSNAs and other supporting intelligence sources, such as the wider
determinants and health inequalities PHE Fingertips tools, can inform this stage. Using
Table 5 and Table 6 can help local authority public health and/ or planning teams
establish whether a potential impact would be considered significant for each health and
wellbeing consideration individually or collectively, and their likelihood of occurring.

Determine whether an HIA is justified

4.8 Discussions between the local authority public health team, planning policy team,
and the development management team, during pre-application, can then take place to
determine whether an HIA is justified. Discussions can be framed according to:

• policy compliance – consider whether an HIA can help meet local policy
requirements such as on green spaces, transport or housing
• proportionality – consider whether undertaking an HIA would be fair and reasonable
to the local threshold set in the previous task, and that it is feasible to conduct an
HIA prior to submission with a planning application and for LPAs to review it for
decision-making
• alternatives – consider whether it may be appropriate to integrate an HIA into, or
draw on relevant health and wellbeing elements from, existing and alternative
assessments such as EIA or design and access statements, following the scoping
advice
• the role of the public health teams – such as providing HIA guidance to planning
applicants or quality assurance of the submitted HIA

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Health Impact Assessment in spatial planning

Figure 5. Process of screening for planning applications

Establish whether the project is subject to EIA

Follow Health in
EIA Process. Refer
to Section 6

Identify policy requirements for an HIA

Identify health needs and priorities and population characteristics

Identify the significance and likelihood of impact on identified population

groups. Refer to Table 5 for significance and Table 6 for likelihood

An HIA or Health Assessment as part Align health considerations into DAS or other relevant
of an EIA is required assessments (Scoping may be useful)

This figure is a process diagram setting out steps to screen health impacts.

First, establish whether the project is subject to EIA. If yes, follow health in EIA process.
If no and unclear, secondly identify HIA policy requirements. If no, align health into
existing relevant assessments. If yes, go to undertake an HIA, or unclear go to thirdly,
identify health needs and priorities and population characteristics. If no, go to align
health into existing assessments. If yes or unclear, go to fourthly identify impact
significance and likelihood.

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Health Impact Assessment in spatial planning

5. Establishing the scope of an HIA

5.1 Local authority public health and planning teams can assist planning applicants to
outline an HIA approach in detail, in terms of its objectives, scope of health and
wellbeing considerations and timescales for completion. Planning applicants may
undertake engagement activities, such as meetings or workshops with other wider
health and social care partners, or with other experts and the public to better
understand their needs in relation to the plan or development project.

5.2 Local authority public health and planning teams will not usually carry out an HIA
assessment. However, they can provide advice, for example during pre-application, to
planning applicants on the best ways to consider the health impacts of the plan or
development project.

Determine the scope of health and wellbeing considerations

5.3 Identify health and wellbeing considerations to be included in the HIA. Refer to the
evidence set out in national and local data sources (see Table 4 and Annex 2 to inform
this process):

• for plan-making, this task informs the issues and options, and preferred option, and
helps to identify the focus of health monitoring in the Authority Monitoring Report
(AMR)
• for planning applications for developments, if impacts have already been identified in
the screening process or as part of an HIA trigger policy (and as part of screening of
an EIA project), this task finalises the scope of issues to act upon

Determine type of HIA needed

5.4 The Screening stage has already established that an HIA is needed. The
appropriate type of HIA (comprehensive, rapid or desktop) is determined during the
Scoping stage.

Identify planning interventions

5.5 The following resources provide evidence on how the built and natural environment
influences health, as well as identify the planning interventions (relevant both to
planning policy and development projects) that support action on the wider determinants
of health and wellbeing: PHE’s Spatial Planning for health evidence review (26),
Building for a Healthy Life development benchmark (40), NHS London HUDU Rapid HIA
Tool (14), Sport England Active Design guidance (41) and the Livewell Development

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Health Impact Assessment in spatial planning

Accreditation (42). The interventions cited in these resources can be required as

prevention and mitigation measures when recommended by an HIA.

Use the HIA Scoping Framework in Annex 6

5.6 The framework in Annex 6 serves as a roadmap for HIA preparation and can be
locally-adapted to plan-making or planning applications according to local needs and
priorities. This scoping framework may be made available for public and wider
stakeholder review during consultation and engagement.

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Health Impact Assessment in spatial planning

6. Integrating an HIA with other assessments

6.1 In certain circumstances, local authorities may prefer to integrate an HIA with other
assessments. This integrated approach can be an alternative option (to a standalone
HIA) for considering the health and wellbeing impacts of a plan or planning application.
The health scoping framework in Annex 6 is intended to support local public health and
planning teams to explore how health and wellbeing considerations can be integrated
into the processes of other assessment requirements.

6.2 There are a range of statutory and policy requirements for assessments to be
carried out when a new plan or planning application is proposed. These provide an
opportunity to consider health, without the need for a separate and standalone HIA. In
seeking to integrate an HIA with other assessments, certain considerations (in addition
to the information set out earlier in this guide) may be useful to ensure the quality of the
health component of the assessment. These are:

• understanding the local population’s physical and mental health needs

• promotion of health equity by identifying and protecting population groups at risk of
the negative impacts of development
• meeting local health and wellbeing priorities
• proportionate assessment of the anticipated impacts (positive and negative)
• engagement with wider health and social care partners (for example; primary care,
CCGs, STP/ICS, local NHS Trust)
• development of SMART (Specific, Measurable, Achievable, Relevant, Time bound)
recommendations for impact prevention, reduction, mitigation and enhancement
• identification of measures to assist the monitoring and evaluation of impacts

Opportunities to integrate health in a SA/SEA for plan-making

6.3 Local authorities are required to undertake a SEA to assess the effects of the plan
on population and human health (43). A SA is also required for local plans and spatial
development strategies to ensure they contribute towards sustainable development and
incorporate SEA requirements. In practice, local authorities usually adopt an approach
of integrated SA and SEA in line with legislative and NPPF requirements.

6.4 When developing local plans and policies (plan-making), local authorities determine
the health impacts to be considered. It is a judgement call as to whether a standalone
HIA is needed and would add value to the SA/SEA assessments, or an integrated
assessment would be a more appropriate approach. Plan documents such as the joint
spatial plan between local authorities and the local plan for individual local authorities,
are required by law to carry out a SA/SEA during their development.

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Health Impact Assessment in spatial planning

6.5 Annex 7 describes where and how an HIA can be integrated into the SA/SEA
process as well as the specific opportunities that exist for public health input. This
integrated assessment can offer a proportionate and sometimes favourable approach to
consider the social, economic, environmental and health factors of a plan or policy.

Practice example: Health in a sustainability appraisal in East Yorkshire

A sustainability appraisal (SA) of a city council’s local plan in East Yorkshire was carried out
with an integrated HIA as it was considered more efficient. The human health chapter
considered the likely significant health effects arising from impacts on human health during
construction and from the completed development.

Opportunities to integrate heath in an EIA for planning applications

6.6 In May 2017, changes in the UK regulations on EIA clarify that ‘population and
human health’ factors should be considered by EIA. EIAs apply to some development
projects, such as housing and commercial developments, but not all developments will
meet the threshold of EIA regulations (37). If a development does not require an EIA,
previous sections of this guide can help determine if a standalone HIA is required. For
projects that require an EIA, there is an opportunity for local authority public health
teams to shape the way population and human health are assessed in an EIA through
integration with an HIA.

6.7 Annex 8 describes where and how an HIA can be integrated into the EIA process.
Further guidance on how health should be meaningfully addressed in an EIA is provided
in PHE’s briefing on health in EIA (18), IEMA’s health in EIA (19) and addressing health
in EIA by IAIA and EPHA (20).

Practice example: Human health as part of an Environmental Statement in Yorkshire

An Environmental Statement accompanied a detailed planning application for a major
commercial development. The human health chapter considered the likely significant effects
with reference to human health during construction and from the completed development. It set
out relevant health outcomes and population groups as part of the assessment.

Integration opportunities in other assessments or requirements for planning

applications

6.8 When submitting a planning application, applicants need to undertake and submit a
range of assessments. These are set out in local information requirements by the local
authority and include; design and access statements, transport, air quality, noise and
flood risk assessments. Many of these assessments will need to comply with NPPF and
PPG requirements in which the material consideration of health needs and priorities are
already explicitly set out.

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Health Impact Assessment in spatial planning

6.9 Although these assessments may or may not place health and wellbeing as central
to their objectives, they can help deliver health and wellbeing benefits. It may be useful
to adopt the HIA advice in this guide so that health and wellbeing factors can be
adequately assessed.

Practice example: Essex Livewell Development Accreditation for Developers

The Livewell Scheme, developed by Chelmsford City Council with Active Essex LDP, Sport
England and Essex County Council Public Health, is available to developers for contribution to
health and wellbeing. Initially submitted at pre-app as part of an HIA, the awards are a 2-stage
design and implementation wellbeing assessment against specially developed criteria.

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Health Impact Assessment in spatial planning

7. Summary
7.1 It is now widely accepted that the health and wellbeing of a population is largely
determined by the environments in which people are born, grow, live, work and age.
Embedding health within the planning system provides an important opportunity to
address the wider determinants of health and improve population health outcomes.

7.2 HIA has been recognised by national planning policy and guidance as an
appropriate tool to identify the health impacts of spatial plans and development projects
and to develop recommendations to maximise the benefits and minimise harm. When
based on evidence of local health needs and with the involvement of local public health
teams, an HIA can help address health inequalities by protecting those who are
vulnerable to the negative effects of development.

7.3 This guide provides a framework for embedding HIA in the planning process; both in
terms of the development of local plans and policies (plan-making), and for informing
development projects for housing or other non-residential activities (planning
applications). It promotes an approach which is consistent with the rigorous soundness
tests applied by planners throughout the planning process. In summary an HIA should:

• maximise positive health impact, minimise negative health impact and enable an
overall reduction in health inequalities
• be based on evidence and align with local health and wellbeing needs and priorities
• be delivered within the existing parameters and mechanisms of the planning process
• be proportionate to the significance of impact of the local plan or project proposal on
population groups and based of locally determined triggers
• be shaped by opportunities for early and ongoing engagement and involvement by
public health teams and wider health and social care partners

7.4 This guide provides local authority public health teams with the necessary information
to start formalising the consideration of health and wellbeing outcomes through HIA. It
provides local authority planning teams with options to support health and wellbeing,
either through a standalone HIA or through an HIA which is aligned and integrated with
other statutory assessments. It also supports HIA practitioners to consider a wide range
of health and wellbeing impacts within the scope of a standalone or integrated HIA.

7.5 The actions set out need to be considered locally. It will take time and many
conversations to establish what works best according to local circumstances. There is
already wide recognition and commitment that supporting strong, vibrant and healthy
communities is central to the purpose of planning. HIA provides a mechanism to
achieve these aims and can support local areas to meet the health and wellbeing needs
of current and future generations and promote health equity.

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Health Impact Assessment in spatial planning

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Health Impact Assessment in spatial planning

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(40) Birkbeck, D., Kruczkowski, S. with Jones, P., McGlynn, S. and Singleton, D., (2020), Building for
a Healthy Life. A Design Code for neighbourhoods, streets, homes and public spaces
(41) Sport England, (2015), Active Design. Planning for health and wellbeing through sport and
physical activity
(42) Chelmsford City Council, (2019), Livewell Development Accreditation Guidance for Developers,
Planners and Designers, www.essexdesignguide.co.uk/supplementary-guidance/livewell-
development-accreditation [Accessed 9 July 2020]
(43) MHCLG, (2019), Strategic environmental assessment and sustainability appraisal,
www.gov.uk/guidance/strategic-environmental-assessment-and-sustainability-appraisal [Accessed
27 February 2020]
(44) PHE, (2019), Health matters: Prevention - a life course approach,
www.gov.uk/government/publications/health-matters-life-course-approach-to-prevention/health-
matters-prevention-a-life-course-approach [Accessed 9 July 2019]
(45) National MWIA Collaborative (England), (2011), Mental Well-being Impact Assessment: a toolkit
for wellbeing
(46) PHE, (2019), Wellbeing and mental health: Applying All Our Health
(47) PHE, (2018), Dementia: Applying All Our Health
(48) Royal Town Planning Institute (RTPI), (2020), Dementia and Town Planning
(49) American Planning Association (APA), (2018), Autism Planning and Design Guidelines 1.0
(50) PHE, (2020), using planning to promote healthy weight environments
(51) PHE, (2019), Musculoskeletal Health: A 5 year strategic framework for prevention across the
lifecourse
(52) PHE, (2020), Review of interventions to improve outdoor air quality and public health
(53) PHE, (2019), Respiratory disease: applying All Our Health
(54) PHE, (2019), Cardiovascular disease prevention: applying All Our Health
(55) PHE, (2019), Environmental public health strategy. A PHE environmental public health service fit
for the challenges of 2020 and beyond
(56) CIEH, (2017), ProPG: Planning & Noise Professional Practice Guidance on Planning & Noise
New Residential Development
(57) NHS England, (2019), Putting Health into Place: Principles 9 – 10 Develop and Provide Health
Care Services
(58) NHSI, (2018), Securing section 106 and community infrastructure levy funds

36
Health Impact Assessment in spatial planning

Annex 1. Acknowledgements
In the development of this document, PHE acknowledges the contribution of:

• Andrew Turner, Emma Dyson and Mark Dickens, Liverpool City Region Combined
Authority
• Aude Bicquelet, Royal Town Planning Institute
• Ben Cave and Ryngan Pyper, BCA Insight
• Bethan Clemence and Fiona Deans, Hertfordshire County Council
• Chimeme Egbutah, London Borough of Harrow
• Chris Woodward, Swindon Borough Council
• Eilish Smeaton, Lorna O’Carroll and Yordanka Yordanova, Iceni Projects
• Greg Hodgson (Environmental Hazards & Emergencies Department), Emma Regan
(Healthy Places), Terry Blair-Stevens (South East Centre), Lina Toleikyte (Health
Equity), Ginder Narle (MSK), Public Health England (PHE)
• Dominique LeTouze, Portsmouth Council
• Dr Filipe Silva, Public Health by Design
• Helen Horrocks, Thurrock Council
• Joanne Wort and Nick Laws, Solihull Metropolitan Borough Council
• John Wilcox, Wakefield Council
• Julia Thrift and Tim Emery, Town and Country Planning Association
• Jenny Dunwoody and Polly Turton, Arup
• Laurence Carmichael and Matthew Quin, London Borough of Tower Hamlets
• Liz Green, Wales Health Impact Assessment Support Unit, Public Health Wales
• Malcolm Souch, NHS London Healthy Urban Development Unit
• Melanie Hughes, John Feetam, Dave McGuire and Rob Holt, Sport England
• Nicola Sworowski Planning Advisory Service
• Dr Rufus Howard, Joanna Bagley, Clare Richmond and Peter George, IEMA
• Paul Southon, Spatial Planning and Health Special Interest Group, Faculty of Public
Health
• Planning, Ministry of Housing, Communities and Local Government
• Dr Salim Vohra, University of West London
• Dr Sebastian Weise, PlaceChangers
• Scott Elliott, Medway Council
• Shona Lucitt and Charlotte Morphet, London Borough of Waltham Forest
• Tamara Sandoul, CIEH

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Health Impact Assessment in spatial planning

Annex 2. Health and wellbeing outcomes in planning

HIA health Description Examples of planning principles and policy
consideration areas to assess relevant to local context *
Health inequalities exist across a range of dimensions or
characteristics, including but not exclusive to the Equality Act protected
characteristics, socio-economic position, life course stages and 1. Housing design and affordability
geography. These can be affected by different experiences of wider 2. Access to health and social care services and
determinants of health, such as housing, environments, and access to other social infrastructure
3. Access to open space and nature
health and other services. There are further wellbeing indicators in the 4. Air quality, noise and neighbourhood amenity
national wellbeing dashboard for the different areas of life that describe 5. Accessibility and active travel
6. Crime reduction and community safety
“how we are doing” as individuals and as communities.
Reduce health 7. Access to healthy food
inequalities Addressing impact on this outcome (that is each of the affected 8. Access to work and training
population characteristics) is useful to understand the effect on 9. Social cohesion and inclusive design
11. Climate change
population and spatial inequalities to target where actions can be
beneficial and help monitor effects on people’s general health and
wellbeing over time.
References:
• PHE, (2020), Health Equity Assessment Tool (HEAT) (21)
• PHE, (2019), Health matters: Prevention - a life course approach (44)
• ONS, (2019), National Well-being Dashboard (28)
1. Housing design and
The mental health of individuals is influenced by social and affordability
environmental factors, such as having the ability to earn enough 3. Access to open space and
Improve
mental health money, feeling part of a community, access to local services, housing nature
and wellbeing and quality of places. Considerations for those with mental disabilities, 4. Air quality, noise and
such as dementia and autism also require changes in the way places neighbourhood amenity
and spaces are designed. 6. Crime reduction and
community safety
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Health Impact Assessment in spatial planning

Addressing impact on this outcome through, for example the Mental 9. Social cohesion and inclusive
Wellbeing Impact Assessment, can ensure design and management of design
spaces give parity to mental and physical health needs.
References:
• National MWIA Collaborative, (2011), Mental Well-being Impact Assessment: a toolkit for wellbeing
(45)
• PHE, (2019), Wellbeing and mental health: Applying All Our Health (46)
• PHE, (2018), Dementia: Applying All Our Health (47)
• RTPI, (2020), Dementia and Town Planning (48)
• APA, (2018), Autism Planning and Design Guidelines 1.0 (49)
Obesity affects people across the lifecourse. Children and young
people living with excess weight are more at risk of being overweight 1. Housing design and affordability
2. Access to health and social care services and
or obese as adults. Obesity and overweight also affects those in the other social infrastructure
Improve diet over 75 age group. Issues should be considered within a whole 3. Access to open space and nature
and weight 5. Accessibility and active travel
systems approach tackling both food and active environments. 7. Access to healthy food
Supporting this outcome can help encourage people to have healthier 8. Access to work and training
diets, increase active travel and physical activity in community settings.
References: PHE, (2020), Using planning to promote healthy weight environments (50)
Musculoskeletal (MSK) conditions describe conditions affecting the
bones, joints, and muscles, as well as rarer autoimmune conditions
such as lupus. Common symptoms include pain, stiffness and a loss of 1. Housing design and affordability
mobility and dexterity, often interfering with people’s ability to carry out 2. Access to health and social care services and
other social infrastructure
Improve their normal daily activities and are the greatest cause of disability in
3. Access to open space and nature
musculoskeletal England Global Burden of Disease 2017. With an ageing population, 5. Accessibility and active travel
health more people will be living with MSK conditions, increasing the burden 9. Social cohesion and inclusive design
on the health and social care sector and an impact on the economy.
Supporting this outcome in the environment means promoting physical
activity in everyday life while minimising causes of physical disabilities.
References: PHE, (2019), Musculoskeletal Health: A 5 year strategic framework for prevention across the lifecourse (51)

39
Health Impact Assessment in spatial planning

Respiratory disease (those affecting the airways and lungs) is a major

contributor to the overall life expectancy gap is the third leading cause
of death in the UK. They are also a major driver of health inequalities,
1. Housing design and affordability
and much of this disease is largely preventable. This inequality is 2. Access to health and social care services and
related to a multitude of factors, such as greater exposure to risk other social infrastructure
factors (air pollution, poor housing) and variation in healthcare quality 3. Access to open space and nature
Improve
4. Air quality, noise and neighbourhood amenity
respiratory and access. 5. Accessibility and active travel
health Supporting this outcome means understanding factors that increase
risk of respiratory illness, and influencing wider policies that affect
respiratory health, such as air pollution, housing, and transport.
References:
• PHE, (2020), Review of interventions to improve outdoor air quality and public health (52)
• PHE, (2019), Respiratory disease: applying All Our Health (53)
Cardiovascular disease (CVD) remains a significant cause of disability,
death and health inequalities. Heart attacks and strokes are highly
preventable through population level measures, and support for 2. Access to health and social care services and
other social infrastructure
Improve individual behaviour change. Environmental and social factors include
3. Access to open space and nature
cardiovascular employment, housing and air pollution. 4. Air quality, noise and neighbourhood amenity
health Supporting this outcome can help you harness the benefits of 5. Accessibility and active travel
behaviour change in reducing CVD risk - this includes lifestyle factors
such as physical activity and obesity.
References: PHE, (2019), Cardiovascular disease prevention: applying All Our Health (54)
Protection of the public’s health through the environment on issues such as
road accidents, air, noise and light pollution, land and water heavy metal and 1. Housing design and affordability
Protect 4. Air quality, noise and neighbourhood amenity
environmental chemical poisoning from areas such as contaminated brownfield sites,
6. Crime reduction and community safety
health extreme hot and cold weather, and community safety, are determinants that
10. Minimising the use of resources
require consideration.
11. Climate change

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Health Impact Assessment in spatial planning

Addressing impacts on this outcome can help identify, assess and

control factors in the environment that protects the public’s health from
radiation, chemicals, and other natural and human-made hazards.
References:
• PHE, (2019), Environmental public health strategy. A PHE environmental public health service fit for
the challenges of 2020 and beyond (55)
• CIEH, (2017), Planning & Noise Professional Practice Guidance. Planning & Noise New Residential
Development (56)
Considering the future demands on capital and revenue requirements
for the full range of health and care services (from GPs to other 2. Access to health and social care services and
specialist services), particularly large-scale housing growth is critical to other social infrastructure
Provide access 5. Accessibility and active travel
supporting current activities by local healthcare commissioners and
to health and 8. Access to work and training
care providers. Supporting this outcome can also help them set out
infrastructure strategic overview of NHS services that may change in the future.
and services References:
• NHS England, (2019), Putting Health into Place: Principles 9 – 10 Develop and Provide Health Care
Services (57)
• NHSI, (2018), Securing section 106 and community infrastructure levy funds (58)
* Based on NHS London HUDU Rapid HIA Tool (14) as it provides a useful starting point for more details and guidance

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Health Impact Assessment in spatial planning

Annex 3. Strategic and local HIA policies and triggers

Some local authorities have adopted HIA local plan policies on the use of HIAs. See examples below.

Local Plan Policy HW1: Health Impact Assessments

 The use of land for mineral-working deposits
 Waste development
 All forms of residential development where: Coventry City Council Local Plan (2017), with
Coventry (i) Number of homes to be provided is 150 or more further detail included in the Health Impact
(ii) Site area is 5 ha or more Assessment SPD
 All forms of urban development (not involving housing) where:
(iii) The area of development exceeds one hectare
(iv) In the case of industrial estate development exceeds 5 ha
Joint Core Strategy Policy 7: Supporting Communities Local Plan: Joint Core Strategy for Broadland,
Greater  In areas providing over 500 dwellings Norwich and South Norfolk (2014) with more
Norwich  In areas of complexity that will be masterplanned detail available in the Health Impact Assessment
 Over 100 dwellings in areas not identified in the Joint Core Strategy Advice Note (2012)
GG3 Creating a healthy city (D)
Assess the potential impacts of development proposals and Development Plans on The London Plan. Intend to Publish
London the mental and physical health and wellbeing of communities, to mitigate any Spatial Development Strategy for Greater London
potential negative impacts, maximise potential positive impacts, and help reduce (December 2019)
health inequalities, for example using HIAs
Policy DEV1 Protecting health and amenity
Plymouth and
Requiring a Health Impact Assessment to be submitted as part of any Plymouth and South West Devon Joint Local Plan
South West Environmental Statement submitted in relation to planning applications with (March 2019)
Devon a likely significant health impact.
Local Plan Policy SC2: Health Impact Assessment
South Cambridgeshire Local Plan (2018) with
 Development of 20 or more dwellings
more detail available in the South Cambridgeshire
South  Applications for 1,000 sqm or more floorspace
District Council, Local Development Framework
Cambridgeshire *For developments over 100 dwellings or 5,000 sqm a full HIA is required. For
HIA SPD (2011)
developments between 20 and 100 dwellings or 1,000 to 5,000 sqm of floorspace an
extended screening or rapid HIA can be undertaken
Local Plan Policy D.SG3. Health impact assessments
Developments required to complete and submit a rapid health impact assessment:
Tower Tower Hamlets Local Plan 2031: Managing
a. Major development within an area of sub-standard air quality
Hamlets Growth and Sharing Benefits (January 2020)
b. Developments which contain any of the following uses:
c. Developments of a scale referable to the Greater London Authority
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Health Impact Assessment in spatial planning

Annex 4. Local HIA guidance and SPDs

Some local authorities with HIA triggers in place provide guidance as to how an HIA should be carried out. See examples below.

When developments trigger a rapid HIA, applicants are advised to use the NHS London
Healthy Urban Development Unit Rapid HIA Tool. For larger scale developments that trigger
Camden Health impact assessments in planning
Camden a comprehensive HIA, developers should contact Camden and Islington Public Health
applications webpages (accessed June 2020)
through their Development Management team for guidance and advice on the HIA and
impacts on which to focus.
Coventry City Council’s HIA SPD provides information and guidance on completing the
health toolkit and HIA. It also identifies sources of data for applicants to consider and Coventry City Council HIA - Technical Guidance
Coventry provides examples of health impacts of the built environment to be considered as well as SPD (accessed June 2020)
examples of recommendations for mitigating negative impacts and enhancing positive ones.
EDDC Health Impact Assessment Webpages
East Devon District Council’s (EDDC) Environmental Health Officers have tailored a local (last updated March 2020)
HIA tool and guidance document which they request developers use for completing an HIA.
East Devon • Health Impact Assessment Tool (2017)
All submitted HIAs will be evaluated by EDDC staff against local priorities and health issues,
• Guidance for applicants (2017)
as identified in the local JSNA.
• Summary of local health considerations (2017)

The 2008 Essex Planning Officers’ Association Health Impact Assessment guide has been The Essex Design Guide. Health impact
Essex up-dated and now includes the wider Essex Healthier Places guidance. assessments (2020)

Two options for applicants who need to submit an HIA. The preferred option is to contact Halton Borough Council, Local guidance for
Halton local public health staff who are trained in conducting desktop or rapid HIAs, alternatively an developers and their agents wanting to conduct a
independent HIA can be commissioned. HIA (2014).

Sunderland City Council has produced HIA developer guidance (2020) to provide applicants Sunderland City Council Health Impact
Sunderland with the detail that is expected to be included with an HIA that is submitted to the council in Assessment Developer Guidance (2020) an HIA
support of a planning application. The guidance includes an HIA Assessment Matrix. Assessment Matrix

Wakefield Council’s Health Impact Assessment

Wakefield’s Public Health Team have created an HIA for planning toolkit to assist planning
and Spatial Planning Webpages
applicants in the process of carrying out an HIA for a development project. The toolkit
Wakefield • Rapid HIA tool and tool guidance, (no date)
contains a tool and guidance for undertaking a rapid or a comprehensive HIA. Additional
advice can be sought from Wakefield’s Health Improvement Team. • Comprehensive HIA tool and tool guidance,
(2019)
Worcestershire County Council Public Health Team has developed a HIA in planning toolkit
Worcestershire County Council Health Impact
Worcestershire for planning professionals, developers and neighbourhood groups which includes a guide to Assessment Planning Toolkit (2016)
the HIA process, useful data sources, practice examples and an HIA matrix for planning.

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Health Impact Assessment in spatial planning

Annex 5. Local HIA guidance template

The structure below is intended as a brief guide for local teams to develop their own HIA
guidance and toolkits.

Indicative
What should be included? Useful resources
sections

• NPPF and PPG

• What is an HIA and why is it an important tool? • Joint Health and Wellbeing
• Describe the national, strategic and local policy Strategy
Introduction context for healthy planning and use of HIAs • PHE Spatial planning for health
• Make the case for HIA as a key lever for action
on the wider determinants of health • Resources from the TCPA, the
Institute of Health Equity;
including “the Marmot Reviews”
Describe when an HIA will be required locally,
determined by:
Local HIA
• Local HIA triggers • See examples provided in Annex
requirements
• HIA screening stage (state whose responsibility 3 and Annex 4
it is to complete the screening stage)

• Describe the types of HIA & when these are

required • Use Annex 6
HIA process and
• Describe the 5 stages of an HIA and include • NHS London HUDU Rapid HIA
assessment
who is responsible for each stage
guidance Tool
• Include / reference an assessment guide /
toolkit to support its completion • WHIASU practical guide

• Use Annex 2
• Local Plan / Spatial Plan; other
• Include a list of planning and health priorities
strategic documents relating to
Local population that the HIA should address
health context • It may be possible to consider different priorities air quality, transport, food
for different wards (see Wakefield example) environment, green
infrastructure.
• Relevant local JSNA chapters
Ideally an additional quality assurance stage should
Quality
be included between the ‘Assessment’ and • WHIASU quality assurance
assurance
‘Reporting’ stages framework

Include how HIA recommendations will be

Implementation implemented and any monitoring & evaluation -
expectations of the developer / planning applicant

Sources of Include useful sources of health evidence to • See Table 4

health evidence support the assessment
• Relevant JSNA chapters
Further • Provide examples of quality HIAs • HIA gateway (currently archived)
information • Indicate how further support can be accessed
• WHIASU

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Health Impact Assessment in spatial planning

Annex 6. HIA scoping framework for plan or development project

This framework can be adapted to meet local policy requirements, the type of HIA to be used and the type of plan/ development
project. This will help to identify and prioritise those impacts on health and wellbeing outcomes to focus on during the assessment
and reporting stages of an HIA or integrated assessment.

Scoping questions (Adapt the scope and scale of the questions to the plan or project) Assessment response
1. Describe the baseline of the plan or development project
• How does the JHWS informed by the JSNA or any other plans and policies that
are/may be relevant and influence / determine what health issues should be
considered?
• Are there any health issues that are addressed in another assessment and do not
Descriptions
need to be covered again but integrated or aligned during the Assessment stage?
• Is data on the state of physical & mental health & wellbeing available to inform the
process?
• What different development options or alternatives have been/ should be
considered?
2. Identify national, regional and local planning and health policy compliance
• Are there issues relating to policy compliance with the national policy, strategic/ List
local plan and health strategies?
3. Identify HIA health outcomes (refer Annex 2)
• How relevant are each of the health and wellbeing outcomes set out in Annex 2? Description and outcomes
• Are there other issues that should be identified and considered?
4. Identify impact on people or places
• How significant are the population groups to the impacts arising from the plan or
development project? Significance Likelihood
• What is the likelihood? of impact of impact Duration
• What is the extent of impact and duration (short, medium and long-term (Table 5) (Table 6)
permanent and temporary) etc?

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Health Impact Assessment in spatial planning

5. Identify wider determinants of health to be considered in planning policy or projects

• What are the relevant planning issues, policy areas and design elements to
Description and outcomes
assess?
• If impacts can be not avoided, what mitigation measures may be required?
6. Undertake stakeholder and public participation
• How will the HIA process align with consultation requirements proportionate to the
type of HIA? Description and outcomes
• How should the report be made available to other agencies and the public likely to
be affected?
7. Recommend preferred option and identify monitoring
• How has the Assessment informed decisions on the plan or project proposal, its
options and preferred option? List and description
• Will the reasons be provided for selecting the proposal options and the preferred option
dealt with?
8. Identify monitoring and implementation
• Will the assessment provide recommendations that are S.M.A.R.T., and linked to the
impacts identified?
List and action plan
• How monitoring and follow-up will be done, resourced, and specify what will be
monitored, how, and by whom?
• What are the proposed mechanism for quality assurance of the assessment results?

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Health Impact Assessment in spatial planning

Annex 7. HIA integration in SA/SEA process

This figure illustrates where and how an HIA can be integrated into the SA/SEA
process, as well as being undertaken as a standalone assessment as part of the
statutory plan-making stages. For example, during stage 1 of plan-making which
involves gathering evidence and preparing issues and options of the local plan, HIA and
public health input can help screen the possible health impact of the options.

Plan-Making Stages SA/SEA Process HIA and public health input

Develop, refine
alternatives, assess
impacts and effects

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Health Impact Assessment in spatial planning

Annex 8. HIA integration in EIA process

This figure illustrates where and how an HIA can be integrated into the EIA process, as
well as being undertaken as a standalone assessment if it meets a certain local trigger
and not subject to an EIA. If an HIA is integrated into an EIA, it should be undertaken to
the same quality, scope and scale as a standalone HIA. For example, when preparing
development briefs and designs (the first planning application stage), the HIA process
and public health input can help screen significance and likelihood of impact.

Planning application stages HIA process and input (With

EIA process
or without EIA)

Updated from PHE (2017) Health in EIA briefing (18)

48