Details may be found at The Equality Trust including the background research data, several on-line lectures and a set of PowerPoint slides.

The authors analyse inequality in the top 20 most affluent societies in relation to health and social well-being. A substantial body of data from the USA is included.The extreme position of the USA serves to test and reinforce the trends depicted.

The major differences in health and well-being between rich countries is not a function of absolute wealth. Instead, it is a function of the degree of inequality in each society. In these countries poverty does not explain the overall differences. The well-being of poorer people is worse than the wealthier people but all socio-economic groups benefit in more egalitarian societies.

The causal relationship is discussed. The most important factors appear to be anxiety and stress generated by social comparisons and self-esteem.

The purpose of this book is to fill this gap and to introduce the subject of Health Impact Assessment using plain language, in both general and specific contexts and with reference to both market and less developed economies. As a result, the reader should be able to describe what HIA can and cannot achieve, identify the components of a successful HIA and participate in an assessment as a member of a team. Examples are provided from a number of planning and development sectors, including extractive industry, water resource management, and housing. The reader, whether student or professional, need not be a health specialist, although prior knowledge of some public or environmental health would be an advantage.

Review quotes

Chapter list

1. Introduction

2. Health and its determinants

3. History of HIA

4. HIA Management

5. Methods and tools

6. Baseline

7. Prioritization

8. Recommendations

9. Water resource development

10. Extractive industries

11. Housing and spatial planning

12. Current and future challenges

13. Sources of further information

14. Glossary and acronyms

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Professor Sir Michael Marmot, professor of Epidemiology and Public Health, University College London, Chair Commission on Social Determinants of Health and the Strategic Review of Health Inequalities in England post 2010 (Marmot Review) and current president of the BMA

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‘Martin Birley was a pioneer of health impact assessment, working first in low income countries and more recently also in the UK. This book is the crystallisation of these years of experience…. My own favourite section is on the history of HIA, which challenged my understanding of how different approaches to HIA developed and the assumptions underpinning these. This book will be invaluable to those already working on HIAs as well as those wanting an introduction to the basic steps. ‘

Margaret Douglas, Consultant in Public Heath, Edinburgh, Scotland

Health Impact Assessment
Principles and Practice
by Martin Birley

‘I warmly commend this book. Apart from being by far the most useful work on how to operationalize Health Impact Assessment, the book is brilliantly comprehensive and a profoundly wise distillation of the author’s unparalleled experience worldwide.’

Robert Goodland, former Senior Environmental Advisor to the World Bank Group in Washington, DC, and former president of the International Association for Impact Assessment

‘To many people, Health Impact Assessment is a new concept requiring new skills. A pioneer and global expert in the subject, Dr Birley has been grappling successfully with this challenge for many decades. His book reveals extraordinary experience and insight, providing depth and context to existing HIA guidelines, invaluable to those who are trying to use them.’

Professor Sir Michael Marmot, professor of Epidemiology and Public Health, University College London, Chair Commission on Social Determinants of Health and the Strategic Review of Health Inequalities in England post 2010 (Marmot Review) and current president of the BMA

I wrote this textbook because there wasn’t one and I wanted to record my knowledge and experience, what I knew and didn’t know. I did not intend that it would cover all, or even most, of the vast field of HIA. I do not expect it to satisfy all my peers. If I had set my own expectations so high, then I would not have written it.

I have watched HIA grow from an off-the-wall, cranky kind of idea to a mainstream pursuit. I am reminded of Schopenhauer’s dictum that all truth passes through three stages: first it is ridiculed; then it is violently opposed; finally it is accepted as being self-evident. In the early days I was told that Iwas wasting my time, and later I was told it was an inappropriate academic pursuit. Now I am told it is self-evident.

The material for the book grew from teaching and training material that have been used and tested in many introductory lectures or courses on the subject. The audience for those courses have been drawn from many cultures and have included both postgraduate students and professionals. About half have had some form of health background such as medicine, nursing, occupational safety or community health. I have observed the bewilderment of experts without health backgrounds when presented with the question “what is health?”, as well as the bewilderment of those with health backgrounds when presented with the proposition that health is largely determined by decisions made outside the health sector. Many of the training courses have had an inter-sectoral focus. Experts from widely different disciplines do not always have skills in framing questions or explanations to colleagues in other disciples. I hope I have included enough explanation and examples to make my meaning clear to readers from many different disciplines.

HIA is now conducted in such widely different settings and contexts that they seem to be speaking a different language and have very different aims and objectives. Finding the common thread is getting harder. For example, there are civil servants in the UK who seek to maximise the health gain of local public sector policies. On the other hand, there are managers of transnational corporations who seek to safeguard the reputation of their company while implementing a project in a rural area of a least developed country. There are policy makers in the European Commission who seek to ensure that new social policy conforms to treaty agreements.

There are still vast and unexplored territories in the area of expertise covered by HIA. These await discovery by the next generation of practitioners. I try to map out some of the issues that have yet to be resolved and to put them in the context of examples based on my own, and others, experience.