Ethical aspects in Health Impact Assessment

Health Impact Assessment, HIA is intended to contribute to public health by allowing those who make decisions on behalf of the public to anticipate how those decisions will affect people's health. It is a combination of procedures, methods and tools to be adapted in different contexts to evaluate projects, plans, and policies. The premise of HIA is thus the possibility to foresee impacts; the same is true for Environmental Impact Assessment, as well as Strategic Environmental Assessment. The difference is the inclusion of humans as subjects: local communities often require HIA where high impacts are present or suspected, because HIA produces numbers relating to people that could impact their lives. Here we find the first ethical implication of HIA. It is a decision support tool, based on the inclusion of communities in HIA design and process development; the inclusion of nonexpert knowledge is foreseen by HIA methods through both quantitative and qualitative data collection and evaluation. The roles of actors have to be considered, and their ethical duties linked to their responsibility. In addition, the power vested of assessors and decision-makers also needs to be considered. The ethical duty of assessors is to provide decision-makers with the information needed in order to make ethical decisions, describing existing inequalities, identifying positive and negative impacts under each option, and describing on whom these will fall. HIA involves multiple competencies, among which environmental epidemiology plays a central role. Ethical issues relate specifically to the hypothesis to be tested, which health impacts have to be considered, the scientific strength of evidence produced, the validity of results obtained, as well as the equity and equality considerations along the health-disease continuum. The ethical duty of decision-makers is linked to the responsibility to act and decide, supported by legislation, where the right of the public to information and participation is recognised, and by the practice of openness and transparency required by democracy.