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HIA and EA are approaches and processes that support better, healthier, and more sustainable policy development and decisionmaking. When undertaken well, and when valued and applied, they can also help to support better, more informed, transparent and democratic policy development and decision- making processes. However, they are not a panacea; rather, they constitute one important piece of the policy development and decision- making puzzle. Public health practitioners need to increase their knowledge and understanding of EA and HIA. They should improve their links with EA and HIA specialists. They also need to proactively and consistently undertake and commission assessments of health either within EA or as stand alone HIAs. Public health practitioners would also do well to oversee and scrutinize the scope of work for, and the findings of, EAs and HIAs that are commissioned and undertaken by others in the localities in which they work. By doing so, public health practitioners can help to advance the agenda of improving health for all by acting on the upstream determinants of health and bringing together key actors across society.

Health impact assessment (HIA) has matured as a form of impact assessment over the past two decades. The use of HIA methods and approaches has expanded rapidly, and it now has applications in both the public and private sectors and in an increasing number of countries around the world. This paper presents an overview of the historical and recent international developments in HIA, before detailing the existing strengths, weaknesses, opportunities and threats to practice. It draws upon the HIA literature, five workshops on ‘Current issues in HIA practice’ held at International Association for Impact Assessment (IAIA) conferences between 2006 and 2011, and the experience of the authors.

An important issue for the geography of health in urban areas concerns how urban change arising from renewal of inner-city areas relates to health of urban populations. In this paper we examine ways in which urban regeneration schemes in Britain are attempting to incorporate consideration of health impact into their planning and development. It concentrates especially on diverse ways that different stakeholders perceive the outcomes of these schemes and the significance for health. The paper is based on two case studies of urban development projects, focusing on housing improvement and training for unemployed people, in a London borough where levels of deprivation are high and various forms of social exclusion affect large numbers of people. The methods used aimed to represent the views of different types of stakeholders, by means of interviews and focus groups with a range of stakeholders in these schemes. Health impact assessment needs to be evidence based. We discuss the evidence for potential health impact of regeneration projects through effects on housing and employment as determinants of health. We focus especially on the ways in which this evidence can be viewed and used by different stakeholders, and how far their perceptions seemed to match with research findings from public health. We consider the potential and the limitations for health improvement associated with urban regeneration in view of the case studies presented here.

Gary Krieger and colleagues (June 19, p 2129) present a polarising narrative, pitting themselves, as private sector consultants, against health impact assessment (HIA) as conceptualised in the Gothenburg Consensus. Krieger and colleagues represent one per spective among HIA practitioners, who all share a commitment to the protection and enhancement of health and wellbeing. The private sector’s use of HIA has not evolved independently of the public sector. Krieger and colleagues omit to note that the International Finance Corporation is a government-owned entity. Demand by govern ments for the accountability of fi nancial institutions has been a driver for the private sector’s use of impact assessment, including HIA. The interplay between public and private sectors has led to guidance for, and commissioning of, HIAs. Krieger and colleagues also do not acknowledge their role in writing the International Finance Corporation guidance for HIA. The environmental health areas frame work and the social determinants of health are not incompatible approaches. Public health is best served by acknowledging the dynamic between environmental and social factors, and refl ecting this in integrated analysis—an approach common to most HIA practice including that articulated by the environmental health areas framework. Krieger and colleagues write that the operationalis ation of HIA is the key. We state that transparency, accountability, and having a wide scope are also crucial to achieving the promise of “tangible results” from large projects. We do not agree with Krieger and colleagues’ Comment, but welcome their contribution. We call on them, and others, to come together to develop a post-Gothenburg inter national HIA consensus that moves the fi eld forward.