Purpose of this technical advice note
The purpose of this technical advice note is to provide guidance on undertaking Health Impact Assessment (HIA) for development proposals within Belfast City Council area, supporting the implementation of Policy HC1: Promoting healthy communities of the Belfast Local Development Plan Strategy 2035, adopted 2nd May 2023.
HIA is a process that ensures the impact of development on health and wellbeing is considered and responded to during the planning process. This leaflet aims to support applicants in the preparation of HIAs in relation to planning applications for Major residential, commercial and industrial development proposals. HIAs may also be required for other developments that could have a significant effect on public health and wellbeing.
What is Health and Wellbeing?
Health is defined as a state of complete physical, mental and social wellbeing. As well as access to good quality healthcare services and lifestyle choices, there are many factors that affect health and wellbeing. These include the physical and social conditions in which people live, neighbourhood amenity, accessibility, culture, education, housing, transport, air quality, noise, access to open space and nature, employment, crime, income, leisure and other services. These all influence health in either a positive or negative way, both directly and indirectly. These factors are commonly known as the wider determinants of health. The ‘health map for the local human habitat’ shows the relationship between health and the physical, social and economic environment as shown below in Figure 1.
Figure 1: The determinants of health and wellbeing in our neighbourhoods [Footnote 1]
What is a Health Impact Assessment (HIA)?
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 [Footnote 2]. 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.
When applied in the planning system, an HIA helps to provide 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.
An HIA helps to ensure that health and wellbeing are properly considered in development proposals. In looking at how a proposal might affect people’s health, an HIA can identify ways to amend the proposal to reduce possible harmful effects and increase possible beneficial effects. HIAs can be done at any stage in the development process but are best done at the earliest stage possible in project design to allow scope for applicants to consider mitigations and other improvements.
An HIA generally should:
- Identify the potential positive and negative health and wellbeing impacts of the proposed development on planned new communities and neighbouring existing communities in vicinity of the development.
- Make recommendations to mitigate against any potential negative health impacts and maximise potential positive health impacts, highlighting where possible the most affected vulnerable groups.
When is an HIA required?
Policy HC1 requires an HIA for all new Major* development including residential, commercial and industrial proposals. The policy may also require HIA for other forms of development with potential to have a significant adverse effect on public health and wellbeing.
* Major planning applications are a special category of development and include:
- housing proposals for 50 units or more, or sites of 2 hectares or greater
- retailing, community, recreation and culture proposals of 1,000 square metres or more outside town centres, or sites of 1 hectare or greater • business, industry (light and general), storage and distribution proposals of 5,000 square metres or more, or sites of 1 hectare of greater
- all other development of 5,000 square metres or more, or sites of 1 hectare or more.
The full list of Major application types can be found at the legislation.gov.uk website
Where a proposed development requires Environmental Impact Assessment (EIA), it is expected that any health and wellbeing impacts will be considered and addressed in the Environmental Statement (ES) and the HIA may be incorporated as a discrete section of the ES. Where an EIA is not required, then an HIA should form part of the submitted planning application documentation.
For developments that seek approval under separate outline and reserved matters applications, an HIA should be undertaken at both stages, with HIA reflecting the content of the applications. For example, an HIA undertaken at outline stage would likely assess the overarching principles and quantum of development; an HIA undertaken at reserved matters stage would assess the remaining matters of the scheme, such as access, design, layout, scale and the overall quality of development proposed.
For relevant developments, HIAs should commence at the start of the planning and design process, at the pre-application stage. This will enable the HIA findings to be incorporated by applicants as changes to the proposed development, where necessary.
What type of HIA should be undertaken?
The type of HIA required will depend on the type, size, and location of the development scheme as well as the likely implications for local public health issues and health infrastructure. Whilst it is common in many jurisdictions to describe three types of HIA, largely based on speed and level of detail (see below), it is important to ensure that the HIA is proportionate to the time available, resources, proposal complexity and compliance requirements.
The three indicative types of HIA commonly referenced are:
- A Desktop HIA: This provides a broad overview of potential health impacts. It draws on existing knowledge and evidence.
- A Rapid HIA: This type of HIA involves a more detailed assessment of potential health impacts and mitigation measures. It includes a broader range of knowledge and evidence and may involve stakeholder consultation.
- A Full HIA: This is the most detailed form of HIA and is undertaken when the potential scale and severity of health issues warrant in-depth investigation. It typically involves quantitative and qualitative information, data from healthy needs assessments and community engagement.
- Methodology - How to Undertake an HIA
The Process involves a number of stages, beginning with a screening phase to determine if a full HIA is required or would be beneficial. After initial screening, the process may require scoping, analysis, reporting/recommendation, implementation, monitoring and evaluation.
The screening stage involves considering whether to perform a full HIA. Whilst the policy is triggered by all applications for Major residential, commercial or industrial development, a screening exercise will help applicants determine if non-major applications may require HIA. This case-by-case approach can use the following screening consideration:
- whether there is the potential for change in ‘risks to human health’ in a way ‘likely’ to ‘significantly’ affect population health. Appendix 1 sets out some of the key issues and questions for HIA of planning proposals. These issues and questions may be used to assist applicants in the screening of sub-threshold (non-major) developments and are likely also to assist the HIA scoping stage (see below).
The scoping stage is about planning how the HIA is to be undertaken and the level of detail and type of HIA required. The type/extent of the HIA will depend on the type and size of the project. Most planning projects in Belfast are likely to require desktop or rapid assessment, with only nationally significant proposals expected to undertake a 'Full' HIA.
For example, a simple desk-top approach may often be suitable for most residential developments and in some cases could be addressed as part of any Design and Access Statement or similar planning report. This can be informed through an exercise that considers the attributes of the proposal and its location – in order to identify the main potential impacts and possible mitigations.
The key issues and questions set out at Appendix 1 should assist applicants in the HIA scoping stage. In many cases, these may be adequate as a basis for an HIA submission to accompany a planning application. However, the scoping exercise may also determine that a more detailed HIA is required. These are matters that can be considered during any Pre-Application Discussion (PAD) stage with the Planning Service.
The assessment stage of a HIA includes analysing information and prioritising potential health impacts. This can take the following stepped approach:
- Consider the effects of the proposal on different population groups for each health impact category (in the demographic, socio-economic and geographic contexts).
- Assess the type and level of impact of the proposal.
- Identify whether the proposal will have a positive, negative or no impact on the particular population group.
The level of detail in any assessment will be proportionate to the type of HIA being undertaken. Whilst the issues in Appendix 1 will be of assistance as prompts, applicants must consider how the proposed development could affect health, both positively and negatively. The assessments should be used in an iterative way by applicants to consider possible amendments to the proposed development if potential health issues or potential improvements are identified.
The HIA report/recommendation stage should conclude whether there are any potential negative or positive impacts for health and include proposals to remove or mitigate adverse health impacts and to enhance positive effects of the proposal. Where applicable, these will normally be reflected in amended proposals or other mitigation measures. The Council will consider the submitted HIA, including how the proposals have taken account of the HIA findings.
Any planning permission for proposals that require HIA may be subject to planning conditions or s76 legal agreements to ensure that any mitigation measures or proposed improvement are delivered through the implementation of the project.
The Council will monitor the effectiveness of this policy as part of the ongoing review of the LDP Plan Strategy. The Council may also publish additional guidance to assist in the implementation of the policy requirements.
This HIA Technical Advice Note draws on existing guidance and best practice in HIA from across the island of Ireland and Britain. Further guidance resources include the following:
- Institute of Public Health Ireland: https://publichealth.ie/hia-guidance/
- Public Health England: https://www.gov.uk/government/publications/health-impact-assessment-in-spatial-planning
1 Barton, H. and Grant, M. (2006) “A health map for the local human habitat”, The Journal for the Royal Society for the Promotion of Health, 126 (6). pp.252-253.
2 World Health Organization, https://www.who.int/health-topics/health-impactassessment# tab=tab_1