The 6/94 gap in health impact assessment

Health impact assessment (HIA), a methodology that aims to facilitate the mitigation of negative and enhancement of positive health effects due to projects, programmes and policies, has been developed over the past 20-30 years. There is an underlying assumption that HIA has become a full fledged critical piece of the impact assessment process with a stature equal to both environmental and social impact assessments. This assumption needs to be supported by evidence however. Within the context of projects in developing country settings, HIA is simply a slogan without a clearly articulated and relevant methodology, offered by academia and having little or no salience in the decision-making process regarding impacts. This harsh assertion is supported by posing a simple question: Where in the world have HIAs been carried out? To answer this question, we systematically searched the peer-reviewed literature and online HIA-specific databases. We identified 237 HIA-related publications, but only 6% of these publications had a focus on the developing world. What emerges is, therefore, a huge disparity, which we coin the 6/94 gap in HIA, even worse than the widely known 10/90 gap in health research (10% of health research funding is utilized for diseases causing 90% of the global burden of disease). Implications of this 6/94 gap in HIA are discussed with pointed emphasis on extractive industries (oil/gas and mining) and water resources development. We conclude that there is a pressing need to institutionalize HIA in the developing world, as a consequence of current predictions of major extractive industry and water resources development, with China's investments in these sectors across Africa being particularly salient. (c) 2007 Elsevier Inc. All rights reserved.