practical guide on Environmental
Health Impact Assessment
(EHIA) of development projects
in the Eastern Mediterranean
Raki Zghondi, WHO/CEHA
Impact of development policies
on health status
-Trade off between economic benefits /
development and community health status is un-
acceptable. Any attempt in that direction will
1/reduce social and economic benefits expected
from the development and 2/transfer hidden
costs to the health sector. The price will have to
be paid in the form of increased health sector
budgets. If no budget available then the price is
paid through deterioration in community health.
-Beneficial effects on human beings may include
health effects which can be avoided by careful
planning including EHIA.
What is EHIA?
• EHIA is an HIA done in the framework of an EIA.
Its purpose is to assess potential impacts of
development policies,programes and projects on
health status of human population and mitigate
negative impacts on health over project stages
and use opportunities for health promotion.
• EHIA focuses on the environmental and social
determinants of health
What is EHIA?(continued)
• EHIA is a planning tool to fine-tune selection of
development options, improve project design and
introduce health safeguards and mitigation
measures when necessary over the project stages.
• EHIA tool could be used for retrospective
and prospective assessments of
EIA situation in the EMR & need for
EHIA practical procedures/guide.
• Countries without EIA/EHIA.
• Countries with weak health
component in their EIA procedures.
• Countries with EHIA/strengthened
health component in their EIA
Practical guide on EHIA
of development projects
Chapter 1:Setting the stage for
EHIA: creating enabling policy,
and legal and institutional
Chapter 2:EHIA policies and
institutional frameworks in EMR
Chapter 3: Observational
epidemiology: information as a
basis for screening
Chapter 4:Elements and methods
to carry out EHIA studies.
Chapter 5:Appraisal of EHIA
Practical guide on EHIA
of development projects
The guide promotes EHIA as a planning and development
-To introduce policy, procedural and methodological
requirements for EHIA.
-To propose mechanism for the incorporation of EHIA in the
development planning of member states in EMR.
-To advise on the process of adapting the scope and format of
EHIA guide to the specific needs of individual countries in
N.B: Framework for social impact assessment is not included due to lack
of information on the social determinants of health in the region.
Chapter 1:Creating enabling policy, legal and
• Policy basis for screening (No EHIA, simplified
EHIA, full scale EHIA)
• Policy basis for scoping: Establish boundaries
for the assessment, helps identify knowledge
and data gaps and finalizes the TORs of EHIA
• Legal framework/EHIA legislation.
– stating roles&responsibilities of gov. agencies, criteria
to decide which project is subject to EHIA, project
scoping, terms of reference, mechanisms to ensure
public participation, procedures for appraising EHIA
Chapter 1 (continued)
• Institutional framework:
– In countries where EIA/EHIA is established: Licensing
mechanism is under the auspices of an environmental
authority (e.g. MOE,EPA). Recommended to prepare
TORs at the pre-feasibility stage of project cycle.
– In countries where EIA/EHIA is not an established
practice: Licensing mechanism is under the auspices of
MOEP. Health and environmental issues are considered
in the TORS of the feasibility study at the pre-feasibility
stage of the project cycle.
– Quality control of EIA/EHIA: Independent, multidisciplinary
committee (ministries officials, scientists, etc).
– MOH essential functions -to perform under arrangements
established with MOE/ MOEP- are presented in details in
EHIA at early stages of planning/decision making
Or by MOEP
TORs by MOEP
MOH: Ministry of health -internal funds: MOF
MOE: Environment - external funds: Donors
MOEP: Economic planning
Chapter 2: Policies and institutional
framework in EMR
• Policies of sectoral ministries responsible for
development planning&implementation, environment
and health allow in many cases for EHIA. However, it
has rarely led to effective action and tangible results
–mainly- due to:
– Limited awareness
– Lack of capacity (resources available in terms of staff,
equipment and budget)
– Lack of coordination between concerned sectors.
• Need for a fresh EHIA policy committing ministries
and authorities to EHIA emanating from the highest
political level: Steps towards development of a
sustainable EHIA policy framework are stated in
• Mechanism and arrangements for national coordination and
integration continue to be absent or ineffective.
• Need to establish strategic alliance between the environment
and health sectors which will lead to the establishment of an
environmental health department in MOH that will play an
interface role between MOH and other sectors.
• Knowledge base for further evolution of policies is
inadequate/absent (databases with information linking health&
disease to specific elements of development projects are often
incapable of providing such evidence)
• Situation analysis identified the following priorities in EMR:
– Policy formulation and adjustment
– Promotion of inter-sectoral collaboration : pre-requisite for
successful & sustainable EHIA.
– Human resource development.
– Putting health concerns on the development agenda.
Putting health concerns on the development agenda
• Sector policies adjustments: Health policy is not a matter
pertaining to the health sector (including inter-sectoral
dimensions) other sectors should build health considerations
into their policies in a transparent manner.
• Strengthen the role of the economic planning councils -or
similar bodies- which have a key role in the pre-feasibility
stage of project development by providing them with key
health criteria that can be used in the process of considering
• Sensitize policy makers in all sectors about the need for and
the benefits of EHIA and health risk management in the
development context. As a result, they will perceive the need
to allocate,from the very early stages of project cycle,
adequate resources for health activities in the development
Chapter 2 (continued)
• Prioritizing health issues in development using for instance:
– economic terms (i.e. cost of ill-health that could be a
significant portion of economic benefits of development
activity or even higher)
– summary measurement of the burden of diseases: DALY
(one DALY represents one year lost of healthy life due to
disability and premature mortality).
– Presenting health impacts of dev. Projects and the
benefits of EHIA in solid economic terms.
– considering health issues (by local
governments/municipalities) in land/urban
Chapter 2 (continued)
• From policy to action: Strengthening existing
EIA guidelines to include health
– EIAs in many countries in EMR contain a definition of
the environment that is too narrow. The definition
should include human communities and their health.
– Address human health at each step of the EIA
procedure (chapter 2 provides an example).
– EIA terms of reference to include at least: Hazard
identification, vulnerable communities, community;
environmental and institutional risk factors, health risk
management and cumulative effects.
Chapter 4: Elements and methods to carry out EHIA studies
• EHIA (HIA done within an EIA framework)
procedures aims to 1/ identify potential
hazards of development
policies,programmes and projects 2/relate
them to changes in environmental and
social determinants of health, 3/ interpret
these changes into health risks and 4/
suggest risk management strategies.
Key elements of EHIA (chapter 4)
Decision making criteria that guide the
procedures to achieving an agreed
goal linked to effective institutional
Management of the assessment
process: what will be done (e.g. health
in EIA TORs,responsibility) and quality
control of what has been done (e.g.
mechanism for appraising EHIA study
and appraisal criteria )
assessing changes of health determin.
identify vulnerable groups, health
management plan, etc
hazard& risk analysis, Env&Oc
epidemiology, verification of lessons
learned from past development
experiences, review of existing
knowledge and evidence, etc
Chapter 4 (continued)
Terms of reference of an EHIA study
TORs set the framework for EHIA and for effective quality
control/appraisal of EHIA study. They should:
• Reflect all points in the scoping procedure raised by the
EHIA commissioning authority.
• Allow EHIA consultants to cover any other significant
impacts they identify.
• Include the degree of detail required and the accuracy of
• Include the framework and the contents of the study report
and deadline for submission of the study report.
Chapter 5: Appraisal of EHIA studies
• Independent review committee to
– EHIA method and procedure (what was addressed in the
TORS and what was not)
– Conclusions (accuracy, comprehensiveness, etc)
– Recommendations (technical adequacy/soundness, social
acceptability and economic feasibility)