A Visualization is Worth a Thousand Pages

Health Impact Assessment (HIA) is “a practical approach used to judge the potential health effects of a policy, programme or project on a population, particularly on vulnerable or disadvantaged groups” (WHO, 2013). The product of an HIA is a set of recommendations for decision-makers and stakeholders, which aim to enhance the proposal’s positive health effects and mitigate possible negative ones (WHO, 2013). A key underlying value of HIA, and also one of it’s strengths, is the engagement and involvement of stakeholders, including impacted communities, in the assessment and decision making process. Current developments in extractive sector HIA research provide a good reminder that HIA is meant to be a support tool for making shared-decisions among diverse stakeholders, and as such, could benefit from an update aimed at helping community members become more empowered and better informed. Promising research is underway.

Decision support tools (DST) exist in abundance. They target all sorts of decision makers, claiming to support the making of all sorts of decisions. DSTs can help decision makers: gather and organize information and knowledge; better understand (“get a handle on”) the situation or context; formulate answers to “what if?” questions; analyze or narrow the field of choice; and/or visualize the data or problem space (University of Cambridge). In the health care realm, Patient Decision Aids are used to involve patients in decisions related to their own care (Ottawa Hospital Research Institute). Other DSTs target clinicians, such as Cochrane reviews, clinical practice guidelines, and condition-specific order sets. The Lives Saved Tool (LiST) is meant for health policy makers to aid in priority setting for service delivery models (Campbell, 2012). If there is a decision to be made, there seems to be a DST to help.

Health Impact Assessment (HIA) is a DST that has been highly promoted by the World Health Organization in recent years as a tool for health promotion and a way of improving health across sectors (WHO, 2013). It is a process used to systematically consider and predict the health consequences of various implementation options for policies, programs and projects (Kemm, 2008). As a DST, HIA is ideally carried out alongside a decision making process during the policy or program development stage instead of after a decision has already been made (Kemm, 2008). A number of HIA toolkits and methodologies exist, but the general procedure for HIA is described in this flowchart:

HIA process

(Source: WHO HIA. http://www.who.int/hia/about/en/)

HIA is used to inform many kinds of shared decisions at local, national and global levels. The implementation of resource extraction developments is but one example. Mining projects can affect the health of impacted communities both directly and indirectly by causing rapid change in the local social-ecological contexts (Winkler et al, 2012). Along with mining companies and local/national governments, impacted communities are obviously important stakeholders in project related decisions. HIA is an important method for including them in the planning process and supporting their informed-decision-making, in theory. Often however, there are barriers preventing this from happening in practice, especially in low- and middle-income countries. These include “high levels of illiteracy, language barriers, cultural, demographic, gender and social differences between stakeholders” (Winkler et al, 2012). These barriers put into question how ‘shared’ the decision making process actually is in these situations, and undermine the utility and success of HIA.

In response to this shortcoming, ‘HIA visualization’ techniques are being developed as a tool to communicate complex information about large development projects to various stakeholders including communities in rural and remote areas, health authorities, and project staff (Winkler, 2012). The approach is to visually display quantitative information “so that the maximum information is conveyed in the simplest and most visual manner” (Krieger et al, 2012). This is meant to address the problem of HIA inaccessibility. Typical impact assessment reports are lengthy, technically complicated, and difficult for most stakeholders to understand (Krieger et al, 2012). Adaptable spacial-temporal HIA visualizations in the form of short videos and ‘supergraphics’ for mining, oil and gas, and water resources projects have been created. The researchers behind this work suggest that their experience shows that these ‘aids’ have facilitated communication and understanding of HIA findings among various concerned groups. They call for other researchers to build upon their work (Krieger et al, 2012; Winkler et al, 2012).


Campbell S. (2012). Knowledge Translation Curriculum. Canadian Coalition for Global Health Research: Ottawa. http://www.sandy-campbell.com/sc/Publications.html

Kemm J. (2008). HIA: An aid to political decision-making? Scandinavian Journal of Public Health, 36:785-788.

Krieger GR, et al. (2012). Enhancing Impact: Visualization of an intergrated impact assessment strategy. Geospacial Health, 6(2):303-306.

Ottawa Hospital Research Institute. Patient Decision Aids. http://decisionaid.ohri.ca/index.html

University of Cambridge. Institute for Manufacturing. Research: Decision Support Tools. http://www.ifm.eng.cam.ac.uk/research/dstools/

Winkler MS, et al. (2012). Health impact assessment of industrial development projects: a spacial-temporal visualization. Geospacial Health, 6(2):299-301.

World Health Organization. (2013). Health Impact Assessment. http://www.who.int/hia/about/en/


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