3 Policy and Guidance

3.1 Government Policy

The Scottish Government’s Action Plan, Better Health Better Care (2007) sets out the Government's programme to deliver a healthier Scotland. Section 2, Helping People to Sustain and Improve their Health, Particularly in Disadvantaged Communities, sets out four key actions to:

increase healthy life expectancy in Scotland;
break the link between early life adversity and adult disease;
reduce health inequalities, particularly in the most deprived communities; and
reduce smoking, excessive alcohol consumption and other risk factors to a healthier life.

Section 2.4 of the Action Plan, Tackling Health Inequalities states that ‘poor mental and physical health is both a cause and consequence of social, economic and environmental inequalities. Risk factors include … aspects of the wider social, economic and physical environments including educational achievement, income / relative poverty, the work environment and unemployment’.

A Ministerial Task Force on Health Inequalities led by the Minister for Public Health has been established to identify and prioritise practical actions to reduce the most significant and widening health inequalities. The Task Force has adopted some key principles including:

improving the whole range of circumstances and environments that offer opportunities to improve people's life circumstances and hence their health; and
reducing people's exposure to factors in the physical and social environment that cause stress, that are damaging to health and wellbeing, and that lead to health inequalities.

In December 2008, the Task Force published its report ‘Equally Well’ (Scottish Government, 2008), which aims to take the emerging understanding of the deep-seated causes of health inequalities and turn it into practical action. Actions and recommendations are arranged under five headings:

Smarter Scotland: Early Years and Young People.
Wealthier and Fairer Scotland: Tackling Poverty and Increasing Employment.
Greener Scotland: Physical Environments and Transport.
Safer and Stronger Scotland: Harms to Health and Wellbeing: Alcohol, Drugs and Violence.
Healthier Scotland: Health and Wellbeing.

Of relevance to this HIA Report are the recommendations identified in the Task Force’s report under the heading of ‘Greener Scotland’ which include:

"28. The Government and local agencies and partnerships should apply the "precautionary principle" across policy development affecting green space in environment, education and health. It should increase the priority given to the creation, retention and promotion of green spaces as essential for health improvement, especially in communities at risk of poor health.

34. The Government should take forward action targeting children from disadvantaged areas who are at greater risk of injury in road accidents and to encourage local authorities to follow existing good practice in this area.

35. New Government whole-community initiatives should be measured on their impact on health and health inequalities, these include for example, sustainable transport demonstration projects, designed to engage the whole community."

3.2 Local Policy

3.2.1 Fife

Fife’s Joint Health Improvement Plan, ‘A Healthier Future for Fife, 2007-2010’ was developed by the Fife Health and Wellbeing Alliance (FHWA). The Plan aims to provide a strategic framework which would enable community planning partner organisations to work with the communities they serve to continue to improve health and wellbeing and reduce health inequalities in Fife. The key themes of the plan are:

reducing health inequalities (including reducing discrimination and promoting equality);
creating healthier environments; and
supporting healthier lifestyles.

3.2.2 West Lothian

The West Lothian Health Improvement Team has been set up to integrate health improvement and well-being, and address inequalities through the development and implementation of relevant policies and strategies across West Lothian.

The Health Improvement Team is involved in the development of the ‘Life Stage Outcome Planning Programme’ which integrates health improvement into a Community Planning Partnership approach to tackling health and social inequalities. This process replaces the previous Joint Health Improvement Plan.

3.2.3 Edinburgh

The 2003 – 2006 Joint Health Improvement Plan for Edinburgh was developed by an interagency Health Action Team set up by the Edinburgh Partnership. The purpose of the joint plan is to bring together the interconnecting factors which contribute to a healthier city and establish a common commitment to achieving good health in the City of Edinburgh.

The overall vision of the plan is ‘maintained and improved health and wellbeing for Edinburgh’s residents, together with sustained action to reduce health inequalities’. The plan states that ‘the objectives of improved community health and wellbeing and reduced health inequalities can only be achieved when health impacts are prioritised … by the main community planning partners, by organisations in all sectors, and by individuals themselves – to work towards a healthier Edinburgh’.

In 2008, the Edinburgh Community Health Partnership published a consultation paper on the revised Edinburgh Joint Health Improvement Plan. The vision set out in this paper is ‘for Edinburgh (city) to show steady improvement in the health and wellbeing of its people and a reduction in the health inequalities experienced by its disadvantaged communities’.

Key actions include:

to improve the physical environment and infrastructure of the city to ensure physical activity is the easy option for people (e.g. by identifying mechanisms to ensure physical activity is included in spatial planning); and
to increase physical activity of adults of working age (e.g. by encouraging active commuting to work).

3.3 HIA Guidance

3.3.1 Health Scotland Guidance

Health Scotland advocates the use of HIA and has produced Guidance on Health Impact Assessment of Transport Projects (Health Scotland, 2007). The guidance highlights the importance of transport to health and wellbeing, and refers to data linking poor transport with health and social exclusion issues.

The Guidance states that ‘Health impact assessment is a way of applying the evidence in this document, and other relevant evidence, to a transport proposal in order to inform decision making. This should be done at a stage of planning when the proposal is clear enough to be assessed but there is still the opportunity to make changes that would improve the health impacts that would arise from that proposal. The evidence must be applied to the specific proposal and local context.’

3.3.2 West Lothian Supplementary Planning Guidance

West Lothian has produced Supplementary Planning Guidance (SPG) on ‘Health Impact Assessment’. The SPG provides guidance on the preparation of HIAs for major new developments in West Lothian. The aim is to assist decision making by taking into account key determinants to protect human health.

3.3.3 The Merseyside Guidelines for Health Impact Assessment

The Merseyside Guidelines for Health Impact Assessment (2001) prepared by Liverpool Public Health Observatory, set out a staged process for undertaking HIA and include criteria to describe the significance of potential health effects (see Section 4.6). This is the only guidance which provides criteria to describe the nature of health effects, and is widely used in HIA.

The HIA scope and approach described in Section 4 below incorporates elements from each of the above guidance documents.