erations are factored into projects, programs, plans, and policies in non-health-related sectors, such as transportation, housing, agriculture, and education (Kemm and Parry 2004; Cole and Fielding 2007).

Given the studies of the determinants of public health, a new field, HIA, arose in the 1980s and 1990s. The most commonly cited definition of HIA was provided in what is known as the Gothenburg consensus paper:

A combination of procedures, methods and tools by which a policy, programme or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population (WHO 1999, p. 4).

Other definitions have arisen over the decades, and several examples are provided in Table 1-1. As shown, HIA has been defined in various ways and described by such terms as method, process, approach, tool, and framework. Diverse practices have been associated with HIA, and that diversity has been attributed somewhat to how health has been defined (or not defined) by the various governments and organizations that use HIA. Parry and Kemm (2004), however, asserted that the essential features of HIA are predicting the consequences of various options and educating and assisting decision-makers.

The International Experience

HIA has been used throughout the world to evaluate the potential health consequences of various projects, programs, plans, and policies (see Appendix A for discussion of the international experience in implementing HIA). Europe and such countries as Canada, Australia, and Thailand—and states, provinces, and territories in these countries—have used various approaches to introducing and promoting HIA. Some have integrated it into existing environmental-assessment frameworks or practices, and others have established it as a standalone or distinct process. Some have tried to legislate its use, and others have relied on voluntary processes in which various degrees of government support and resources are provided. Each country’s experience offers different perspectives and lessons to be learned. For example, although the experience in a few countries has suggested that legislation is needed to provide an impetus for conducting HIA, the experience in many other countries has emphasized that legislative requirements alone are not sufficient to ensure its consistent implementation. Education, training, and resources appear to be critical to the success of its use, and engaging traditionally non-health-related sectors and agencies and heightening awareness of HIA also appear to be key.

International organizations have contributed to the development and evolution of HIA. Over the last few decades, the World Health Organization has supported the development and use of HIA through declarations, initiatives,

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