East Sussex Health Impact Assessment manual for planning applications
Overview
This Manual has been produced and agreed by the East Sussex Planning for Health Working Group which includes representatives from all Local Planning Authorities (LPAs) in East Sussex, the Public Health Team, Highway Authority and County Planning Authority within East Sussex County Council.
1.1 Aims and Purpose of the Manual
Aim - to provide a ‘How to Guide’ to undertaking a Health Impact Assessment (HIA) on planning applications within East Sussex
Purpose - to provide a clear step by step guide for all those involved and interested in the HIA process, including details on the supporting tools available and the expectations and requirements at each stage.
1.2 Who the Manual is for
- Developers and those undertaking on their behalf a HIA or HIA screening.
- LPAs who manage, review, assess and consult Public Health on HIAs.
- Public Health who provides overarching guidance, management, reviews and assesses HIAs.
- Stakeholders, investors, and communities wanting to understand the HIA process in East Sussex.
1.3 What the Manual Covers
This Manual provides a ‘How to Guide’ by providing information on:
- What a HIA is (para or section)
- Why a HIA should be undertaken (para or section)
- The East Sussex overall approach to HIA (para or section)
- Where the requirement to undertake a HIA or HIA screening is set out (para or section)
- Roles and responsibilities (para or section)
- East Sussex Tools to support HIA (para or section)
- The various stage’s purposes, timings and requirements (para or section)
- How to complete templates (para or section)
- What needs to be submitted with a planning application (para or section)
- How the HIA will be Quality Assured. (para or section)
1.4 How to Use the Manual
Part 1 – Provides the context to HIA. Refer to this section for general information on HIAs, roles and responsibilities and the overall approach to undertaking HIAs in East Sussex.
Part 2 – Provides the step-by-step guide to completing the various HIA stages with specific details on completing templates and the HIA report structure, what should be considered and when it should be undertaken. Refer to this section for help in understanding and undertaking the various stages and the specific expectations.
1.5 East Sussex HIA Toolkit, Planning for Health, and Healthy Places Tools
This Manual sits within the East Sussex HIA Toolkit which has been produced to support the implementation of HIA requirements for planning applications within East Sussex.
It is also part of the tools which have been produced to support ‘Planning for Health’ and the creation of Healthy and Sustainable Places within East Sussex.
For East Sussex ‘Planning for Health’ by definition is ‘planning for health’ whereby the planning system(s) works with public health to deliver a conscious and cooperative approach to maximise processes that enable, and support population health and wellbeing, with the intention to ‘develop’ healthy and sustainable built and natural environments where communities can enjoy healthy lifestyles, healthy life expectancy and healthy places.
How the tools above diagram support the HIA process:
- HIA Templates (add links) – supports undertaking the various HIA stages by providing clear, consistent and transparent structures.
- Planning for Health, Wellbeing and Sustainability Framework ‘Framework’ (add link) – supports the overall HIA process by outlining evidence, issues and considerations on health and wellbeing, with links to planning and healthy sustainable place making, including potential opportunities and measures to address issues and increase benefits.
- East Sussex Healthy Places Data Profile – supports the overall HIA process by providing up to date local health and wellbeing data to assist in identifying key local health and wellbeing issues and considerations.
Part 1: Context
2.1 What is a HIA
East Sussex is working to the International Association of Impact Assessments (IAIA) definition of HIA which has updated the World Health Organisation (WHO) definition to:
“A combination of procedures, methods and tools that systematically judges the potential, and sometimes unintended, effects of a policy, plan, programme or project on the health of a population and the distribution of those effects within the population. HIA identifies appropriate actions to manage those effects.”
Further to this definition a HIA should consider particularly the impact on vulnerable or disadvantaged groups. Recommendations should be produced for decision-makers and stakeholders with the aim of maximising the proposal’s positive health effects and minimising its negative health effects. (Health impact assessments | WHO | 2024)
Stakeholder and community engagement is a key principle of HIA which promotes participation. Inclusive engagement with communities and stakeholders informs the HIA and supports the identification of appropriate measures.
A HIA supports the planning system to address local health and wellbeing needs and to reduce health inequalities. It enables delivery of the National Planning Policy Framework, Dec 2024 (NPPF) and the National Planning Practice Guidance (NPPG) on promoting healthy and safe communities. NPPG identifies HIA as a useful tool to use where there are expected to be significant impacts. HIA also supports the delivery of wider national policy and aims to create healthy places and reduce health inequalities such as the National Design Guide | MHCLG | 2021, Healthy Homes, a foundation for healthier and resilient communities | UK Gov | 2025 and Health matters: physical activity - prevention and management of long-term conditions | Public Health England | 2020
Health and wellbeing are impacted not only by an individual’s behaviour, but by the ‘wider determinants of health’ which are a range of social, economic and environmental factors. HIA is based on the consideration of the ‘wider determinants of health’ within the built and natural environment, such as housing, transport and green space. These determine the health of an individual or population and affect health, wellbeing, and health inequalities. For more information see Wider Determinants of Health | Department of Health and Social Care
2.2 Benefits of undertaking a HIA on proposed developments
A HIA undertaken on a proposed development has many benefits beyond a more strategic HIA that may have been undertaken for the Local Plan either as a standalone assessment or as part of a Sustainability Appraisal or Integrated Impact Assessment.
The HIA process provides an opportunity to consider how policies collectively within the Local Plan are interpretated and implemented in the specific local context, to benefit health and wellbeing.
A HIA is an essential systematic process, methodology, and tool:
- For developers/applicants to systematically and comprehensively consider, work through and evidence considerations for health and wellbeing.
- For developers/applicants to demonstrate the health and wellbeing benefits and opportunities of the proposal and how it has been positively and beneficially planned so that it will mitigate against negative health impacts for the health and wellbeing of both the existing communities in the area as well as future residents of the new development.
- Which will help shape the proposal so that it meets the health related policies within Local Plans, there by smoothing the proposal’s passage through the planning process.
- Which provides transparency and shows how the development meets the prevention and doing no harm principle.
- That provides a democratic process which engages and involves communities affected by the proposal and incorporates where appropriate local community needs.
- That provides a useful mechanism and evidence to inform decision making showing the potential health and wellbeing impacts.
- Which increases awareness and coordinates action across sectors, stakeholders and communities on health and wellbeing issues and decisions.
- Which can potentially reduce additional demand and burden on the NHS and social care budgets through the promotion of good health and prevention of ill-health.
2.3 Requirement for HIA
The requirement for certain developments to undertake HIA screening or to automatically undertake a HIA is set out in Local Plan policies and/or within the Planning Application Validation Checklist for the specific LPA which the development falls within. Each LPA may set different requirements for HIA which will be dependent on the specific characteristics of their area.
Prospective applicants will need to check the precise HIA requirements e.g. if screening or an automatic HIA is required for their development within the area’s adopted Local Plan and the Planning Application Validation Checklist which sets out the information required for the submission of a valid planning application. Both are produced by the LPA for the area the proposed development is in and can be found on their respective websites.
2.4 Who should undertake a HIA and Roles and Responsibilities and competencies
The Developer - is responsible for undertaking a HIA screening and HIA if required. The HIA should be completed by those with an appropriate understanding of the project, its context and public health knowledge.
LPAs - will manage the overall HIA process providing support, guidance and decisions to the developer. They will liaise and consult with Public Health officers as necessary and as agreed in the Engagement and Process Protocols between Public Health and individual LPAs.
Public Health - will be responsible for leading and providing overarching advice on HIA across the county and will review, assist and support LPAs and developers in undertaking HIA screening and HIAs. They will engage and provide information to LPAs as agreed in the Engagement and Process Protocols between Public Health and individual LPAs.
2.5 Overall East Sussex HIA process and methodology
Public Health and LPAs in East Sussex have signed a Memorandum of Understanding (add link) to work together to improve the health and wellbeing of residents through the planning system. A coordinated and consistent strategic approach to planning for health has been developed across East Sussex through a Planning for Health Working Group which includes the co-development of HIA guidance to support the establishment of HIA requirements for planning proposals being adopted.
Table 1: Key East Sussex HIA Principles, Aims and Approaches:
- Principle
- User friendly
- Aim
- Developers and officers have clear understanding of what is expected and required.
- Approach aspect
- Toolkit is prescriptive and structured with clear step by step instructions and explanations. Thorough guidance with signposting and provision of support tools make it easy to complete stages and HIA.
- Principle
- Focused
- Aim
- Local health and wellbeing issues and priorities are considered and delivered.
- Approach aspect
- Integrated robust screening and scoping stage. Requirement to provide local data and intelligence on populations and health and wellbeing issues early in the process Link to Healthy Places Profile which provides local data and intelligence.
- Principle
- Consistent Approach
- Aim
- There is a consistent approach across the county to creating healthy places.
- Approach aspect
- Toolkit supports requirement for HIA across the county. Public Health supports and builds capacity and consistency.
- Principle
- Proportionate
- Aim
- HIA is proportionate and reflects the scale of and potential health and wellbeing impacts and opportunities of the specific development.
- Approach aspect
- Integrated robust screening and scoping stage. Identify early key focus areas to address and opportunities. Identify early areas of no impact which can be scoped out. Identify early population groups and health and wellbeing issues within area and potential issues and opportunities.
- Principle
- Adds benefit
- Aim
- Incorporation of measures which will contribute and lead to improved health and wellbeing outcomes as well as opportunities for the developer.
- Approach aspect
- Focused and clear HIA expectations. Front loading considerations enables opportunities not to be missed. Link to issues and considerations tool ‘Framework’ raises awareness of opportunities and measures which can be incorporated. Holistic consideration of health and wellbeing throughout the development of the proposal will lead to a healthy development making the development more attractive and lucrative.
2.6 Types of HIA
The East Sussex approach does not include different types of HIA or refers to terms such as ‘desktop, ‘rapid’ and ‘comprehensive’.
Terms such as ‘desktop, ‘rapid’ and ‘comprehensive’ are sometimes used to describe different types of HIA. However, there is no consistency in their interpretation and how they are practically applied, leading often to confusion about which type of HIA should be used. The terms are often not representative, reflect assessments required and can be unhelpful. For example, using the term ‘rapid’ can undermine the credibility of the HIA. Development proposal timescales and details can change, a HIA needs to be undertaken alongside the proposal and therefore will reflect its timescales and particular circumstances.
The East Sussex approach ensures that HIAs are proportionate by including robust screening and scoping stages which will identify the specific site opportunities, requirements, and expectations. The conclusions of these stages will influence the scale and focus of the HIA.
2.7 Timing and Integrating the HIA process
HIA is a process which should influence and support the proposal throughout its development to ensure health and wellbeing is considered and built into the scheme at the earliest opportunity.
It is most effective when the HIA process is started early and undertaken concurrently to inform and shape the proposal as it is progressed. The East Sussex approach front loads comprehensive consideration and incorporation of health and wellbeing early into the development process. This will ensure that measures can be incorporated early so that key opportunities for mitigating and maximising health and wellbeing benefits are not missed, rather than it be done retrospectively when there is little opportunity to develop the proposal.
A thorough consideration and incorporation of the HIA process will lead to a better quality HIA, than an isolated assessment. It will reduce gaps which would need to be picked up later and will lead to a development which maximises health and wellbeing benefits. This will reduce delays and having to repeat stages or fill in missed information once the application and HIA have been submitted.
The timing of stages will be different depending on the scale and nature of the development, the following is a rough guide:
Screening and Scoping Stages
- These should be undertaken with the Integrated Template completed and submitted when the overall nature of the proposal is known but before details of the scheme design have been decided so that health and wellbeing can be factored in and optimised at the very start. (Undertake during RIBA Design Stage 2)
Appraisal Stage
- Information for the Local Profile: baseline, context and evidence, which supports the appraisal should be collated as the scheme is developed.
- The appraisal of health and wellbeing impacts should be undertaken once options for the overall design and layout of the scheme are known or at least the nature and purpose of the proposal is known so that potential impacts can be assessed, but it should be done early enough so that findings can influence the scheme and changes for example to the layout can be made.
- Appraisal recommendations which require changes to the scheme should be considered and actioned before the planning application is submitted.
- (Undertake during RIBA Design Stage 2 and 3)
Outline and Reserved Matters Applications
For developments which require a HIA and are seeking planning approval through separate Outline and Reserved Matters applications a HIA will need to be undertaken at both stages. The level of detail in the HIA will reflect the content of the applications.
The HIA for the Outline application will need to consider the overall principles of the development proposal and its impact on health and wellbeing considering its location and proposed uses. This will include impacts on the wider area, access to services and facilities and transport impacts. The HIA can identify and recommend specific aspects and site details, as appropriate, which will be considered and undertaken as part of the Reserved Matters application. The Reserved Matters application HIA will then build on the HIA undertaken at the Outline stage by considering the detail around the matters being considered at that stage.
2.8 Determining Significance
When considering health and wellbeing impacts through the HIA process it is necessary to make professional judgements, using the evidence available, on their potential significance. The significance of an impact can only be identified in relation to the scale and type of the project and its location.
As shown in the tables below (from Health Impact Assessment in spatial planning | PHE | 2020 ) significance can be determined by:
- The expected magnitude of the health and wellbeing impact on specific population characteristics.
- The likelihood of the impact occurring within specific population groups.
- The sensitivity of the receptors such as vulnerable population groups, or environmental conditions.
Impacts can be positive (beneficial), neutral (no discernible change) or negative (adverse), direct or indirect, cumulative, permanent, or temporary (short, medium or long term).
Part 2: How to Guide to Completing HIA Stages and Templates
PART 2: How to Guide to Completing HIA Stages and Templates
3. Screening stage
3.1 Who needs to do it and when
- Screening is required for any proposed development which is above the threshold for screening but below the threshold for an automatic HIA to be undertaken.
- HIA thresholds and triggers are set out within the Local Plan policies and the validation checklist for the specific area of the development.
- Screening needs to be undertaken as early in the development design process as possible, once the overall nature of the proposal is known but before details of the scheme have been decided. (RIBA Stage 2)
3.2 Overall purpose
- Screening is a systematic way to decide if a HIA needs to be undertaken.
- It identifies if a proposed development is likely or there is potential for it to have significant health and wellbeing impacts.
3.3 Overall process
The potential for a development to have significant health and wellbeing impacts depends on:
- The site and location characteristics and opportunities – e.g. green space potential within the site or green space nearby, urban area with good links to services or barriers within the area to key services, potential to create active travel links to key destinations within the local area.
- The local population characteristics and area health and wellbeing issues[1] and priorities[2]- e.g. physical activity rates, obesity levels, proportion of older people, level of health conditions due to poor air quality.
The process involves:
- Answering criteria questions related to health and wellbeing determinants which are distinct and can be objectively identified or measured. This will reflect the site’s features and provisions which are either already existing or which could be provided.
- Determining if the likelihood or potential for health and wellbeing impacts would be significant or limited. Impacts could either be positive or negative. Significant impacts will be scored ‘2’, limited ‘1’ and no impact ‘0’.
- Thresholds are provided on Limited impacts however these are only provided where….
The screening conclusions section will:
- Provide an overall score for the likelihood/potential for health and wellbeing impacts.
- Summarise the potential areas for significant or limited health and wellbeing impacts.
- Identify and provide evidence that a HIA would not add benefit due to either:
- measures already being proposed which would maximise benefits or mitigate negative impacts identified; or
- impacts and opportunities will be addressed in another assessment
- Provide recommended actions.
- Be completed initially by the applicant, information will then be checked, comments and a final decision will be provided by either a Public Health or a Planning Officer.
3.4 Scoring and decision-making process
The decision on whether a HIA is undertaken or not will be dependent on whether there is potential for significant health and wellbeing impacts across the range of determinants, either positive or negative. Then whether the potential impacts or opportunities are already being adequately covered or will be covered by existing measures and/or other assessments.
Firstly Consider: The Overall score for the likelihood/potential for health and wellbeing impacts - add together the scores from all the health and wellbeing determinants, maximum score is 30.
If the overall score is:
- 6 or above – a HIA maybe required because there is potential for significant impacts across several determinants - go to second consideration
- Between 2 and 6 – a HIA is not required because there is limited potential for significant impacts or potential is focused on one or two areas. Specific actions and advice maybe required for the few areas where there are opportunities to maximise positive health and wellbeing impacts.
- Below 2 – a HIA is not required, and no further action is needed because there is minimal potential for significant impacts.
Secondly Consider (only if scored 6 or above): If the HIA would duplicate work already done or could be incorporated into another assessment, such as an environmental assessment or a design and access statement.
- If evidence can be provided which shows that all potential impacts, including all aspects of health and wellbeing and all opportunities for benefits has or will be fully considered and maximised as part of work done or another assessment then a HIA will not be required.
- If no or inadequate evidence can be provided, then a HIA will be required.
3.5 Types of decisions
The screening process will result in the following types of decisions:
- HIA required - there is potential for significant health and wellbeing impacts, and these have not already or are not being fully covered by other assessments or measures.
- HIA not required but other suggested actions – there are limited impacts so consider certain aspects to maximise health and wellbeing benefits or undertake community engagement on a particular issue.
- HIA not required no further action needed – no potential impacts or would be negligible or impacts are already being fully covered by other assessments or measures.
Completing the Template
3.6 Guidance for applicant
The Screening and Scoping Template is an integrated template which supports both the screening and scoping stages. This removes the duplication between the stages and streamlines the two processes.
All applicants that are required to undertake HIA screening need to complete parts A, B and C of the Screening and Scoping Template, and submit this to either the LPA or Public Health, Healthy Places Team. (Check specific LPA Planning Application Validation List for who to submit to)
Part A – Proposal and overarching details
This section provides an initial overview of the existing health and wellbeing context for the development, highlighting key issues and population groups which the development may impact on either positively or negatively or unintentionally.
Table X. Explanatory notes for completing certain parts of the template:
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Template section |
Guidance |
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2. Pre-application reference number
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This could either have been provided by the LPA or could be a specific Public Health reference depending on who is managing the screening process. If unknown leave blank. |
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4. Local Health and Wellbeing data, issues and inequalities |
As a minimum provide local data, down to ward level unless overwise stated, for the following health and wellbeing indicators, including population characteristics and compare with district, county and national averages:
Highlight and describe the key local population and health trends. E.g. High percentage of the ward population are aged above 65 which is higher than district, county or England averages. Data unless otherwise stated can be obtained from the East Sussex Healthy Places Data Profile |
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5. Key population groups who may be affected.
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Using and the data identified in Point 4 and the list of vulnerable and disadvantaged groups see ‘Framework’, identify which groups amongst the general population will potentially be affected by the proposal, either positively or negatively. |
Part B –Potential for health and wellbeing impacts
Part B provides a framework for identifying potential health and wellbeing impacts for both the screening and scoping stages.
The structure is based around the 5 ‘Aspects’ of the built and natural environment which have been identified as the main characteristics that can be influenced by planning[1] :
- Neighbourhood Design
- Housing
- Natural and Sustainable Environments
- Healthy Food
- Transport
Health and Wellbeing ‘Determinants’ are grouped under each of these 5 ‘Aspects’. It focuses on the wider determinants of health that are most relevant to the built and natural environment, and which can be influenced by development proposals.
This structure of ‘Aspects’ and ‘Determinants’ is a consistent structure in the:
- Integrated Scoping and Screening Template
- HIA Appraisal Template
- East Sussex Planning for Health, Wellbeing and Sustainability Framework.
[1] Public Health England. Spatial planning for health: An evidence resource for planning and designing healthier places review. PHE publications, 2017.
3.7 Submission
Once the template has been completed it needs to be submitted to either the LPA or to Public Health, Healthy Places Team - healthyplaces@eastsussex.gov.uk Refer to the individual authority, which the site is located in, Planning Application Validation Checklist for who to send it to.
3.8 Guidance for Public Health and Local Planning Authority Officers
Review information submitted in Parts A and B
Ensure all areas have been adequately considered. Refer to evidence provided on proposal details, local plan policies and other guidance documents. If necessary, liaise with specific subject expert officers to make a judgement such as transport officers regarding potential opportunities for a new walking and wheeling route.
Complete column three of Part C: Screening conclusions
Either agree with the applicant’s comments or note where information has not been provided, or areas have been missed. Provide reasons for why there is likely to be potential for significant health and wellbeing impacts. It may be necessary to request further information from the applicant if information is not provided or unclear.
Review evidence provided under sections 5 and 6
Consider if it shows that all potential impacts, including all aspects of health and wellbeing and all opportunities for benefits has or will be fully addressed and maximised as part of work done or another assessment. Decide if the evidence is adequate to conclude that no HIA is required as it would duplicate work done or will be undertaken. Ensure that the full scope of health and wellbeing mitigation and benefits will be considered and that where necessary Public Health will be consulted on the measures or assessments.
Decide if a HIA should be undertaken
Based on the information provided and a desk top review of the site location, opportunities, local plan policies decide whether a HIA should be undertaken. If information is incomplete or uncertain a HIA should be undertaken to ensure health and wellbeing impacts are considered.
If an applicant disagrees with the conclusion that a HIA is required, it the responsibility of the applicant to provide evidence to show how there would not be likely or potential for significant impacts or how any potential impacts would be mitigated, or benefits maximised.
If it is concluded that a HIA is not required
Consider if there are any opportunities to increase health and wellbeing benefits related to either one specific area or where there are limited opportunities. This could include:
- Providing further details or signpost to guidance on maximising health and wellbeing impacts. Such as specific design measures.
- Suggest undertaking community engagement around certain issues or with certain population groups.
Inform the applicant
Provide the completed template to the applicant informing them of whether a HIA is required.
4. Scoping stage
5. Appraisal stage
6. Recommendations stage
7. Reporting stage
8. Quality assurance stage
9. Amendments to HIA report, proposal (if required)
10. Further quality assurance stage (if required)
11. Decision stage
Templates
To be done by web authors
- 3 template forms which can be filled in
- 2 examples of filled out forms
The forms are too complex to be done as Umbraco Forms. Ellen to ask Tech Advocates for advice on how to set them up as an accessible Word form instead, then add it to website page as a download.