It’s understandable why, universally, HIA is seen as a tool because if we didn’t call HIA , or any kind of impact assessment, a tool, what would we call them? Its also nice to say to national and local politicians and government officers - policy and decision-makers - its a tool to help inform your decisions, as if it is some objective, fact-finding and impact predicting piece of objective and neutral equipment or computer model. Don’t worry about the assumptions made, the quality or lack of evidence, the uncertainty in predicting future health effects and the social, economic and political aspects of the wider decision-making process which HIA informs, and which in turn, HIA is influenced by.
It is comparing HIA to a screwdriver, anyone can use it and there is no need to understand what it is and how it was made, because it’s ‘obvious’ how to use it. Yet while using a screwdriver to unscrew a kitchen appliance is one thing, using a saw, chisel, or plane requires much more skill, and to create a bookshelf or chest of drawers using these tools is not just about skill but about aesthetics. Aesthetics because there are myriad of ways that a bookshelf or chest of drawers can be designed and made. We don’t see much handmade furniture but if you look at famous furniture makers like Chippendale, Sheraton and Hepplewhite you can see making furniture, and art in general, is about aesthetics and having an artistic philosophy and vision.
So, HIA is an aesthetic, methodology, an approach, an orientation, a way of seeing the world, where we are active agents. Where we can identify, prioritise and do something about minimising harmful effects and inequalities while maximising beneficial effects and equity.
By calling HIA a tool we diminish its capacity to bring communities, businesses, politicians and government officers together in social process, at one point in time and place, and forget that HIA is ultimately about the choices we choose to make. By calling HIA a tool we can, inadvertently or advertently, make it into a technical objectivist ‘scientistic’ tool.
By calling HIA a tool we run away from the implicit and explicit philosophical foundations and resulting methodologies and methods that underlies all HIAs that have been, and will be, carried out.
Hence HIA, like public health, is a craft and a practice, as well as a science. It is not a tool. It involves skills, knowledge and experience coming together. It has a specific way of seeing and engaging with the world and others.
So HIA has an aesthetic, a philosophy a worldview. It is based on an ontology and an epistemology. Ontology is how we think about the world outside of ourselves and of ourselves. Epistemology is about the nature of knowledge, at its simplest, do we discover knowledge, like we discover star in the sky, or is it generated and constructed as we think and discuss it with ourselves and others, or is it both.
At its core the philosophical debates in impact assessment, particularly health impact assessment, are around the nature of evidence and what should be called evidence or evidence that should be used for policy- and decision-making.
Are we positivists, who say “Reality is there. Look! You can see, hear, touch and measure it.”
Are we post-positivists, who say “Reality is there, but we can only see, hear, touch and measure a bit of it.”
Are we criticalists, who say “Reality is a product of our time and place in history.”
Or, are we constructivists, who say “Everyone sees the world differently. We share overlapping realities.”
Each of these philosophical orientations for seeing the world and knowledge requires a different approach to impact assessment.
There has always been a tension, in HIA, between those with a positivists or post-positivists and those with a constructivists view of the world and of HIA. What’s interesting is that there are few with a criticalists perspective that HIA, an impact assessment, and our concerns about health, are a product of our time an dplace in history.
Often there is a mix of positivist, post-positivist and constructivist thinking and analysis within a HIA. Health impact evidence is often written up and discussed using a positivists/post-positivist mindset and the stakeholder feedback is written and discussed using a constructivist mindset.
The question though is what is the implicit and explicit foundational orientation of the HIA, this often comes out when communities see their feedback being ‘disregarded’ i.e. outweighed by what is seen as the ‘scientific’ research evidence. This is because the underlying philosophical orientation in a development consent or policy-making process, and the proponent and impact assessment practitioners, is positivist or post-positivist, while communities often see the impact assessment process as constructivist.
Hence as practitioners we need to be aware of the worldview, ‘philosophical orientations’, ontologies and epistemologies, of the various stakeholders involved in a HIA process: proponent, communities, business, different groups within communities, politicians, government officers and departments, and of course ourselves, as HIA practitioners.
This is why scoping becomes such an important step because it is often at the scoping step that these discussion emerge directly or indirectly bout what kinds of information, knowledge, evidence and analysis will be included and what excluded and why.
Further reading
Pigliucci, M. (2018) The problem with scientisim. Available at: https://blog.apaonline.org/2018/01/25/the-problem-with-scientism (Accessed: 21 June 2021).
Burnett (2021) What is scientism? Available at: https://www.aaas.org/programs/dialogue-science-ethics-and-religion/what-scientism (Accessed: 21 June 2021).
Vohra, S. (2005) Health impact assessment: a training reader. Available at: https://www.hiagateway.io/guides (Accessed: 21 June 2021).