Properzi Sara, Coa Angela Andrea, Fiorilla Claudio, Pasetto Roberto
Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
Unit of Environmental and Social Epidemiology, Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy.
Front Public Health. 2025 Mar 19;13:1546394. doi: 10.3389/fpubh.2025.1546394. eCollection 2025.
Health Impact Assessment (HIA) procedures can include the assessment of inequalities and inequities associated with the distribution of environmental health risks and benefits, aimed at attenuating the exacerbation of environmental health disparities. This systematic review, conducted as part of the Joint Action Prevent Non-Communicable Diseases initiative, explores methods for assessing health inequalities and equity within HIA frameworks, particularly in local projects affecting the distribution of environmental risks and benefits.
Adhering to the PRISMA guidelines, a systematic review of the scientific literature was conducted using the MEDLINE/PubMed, Scopus, and Embase databases, searching until March 8, 2024. Furthermore, a grey literature analysis encompassed the Institutional Repository for Information Sharing (IRIS) of the World Health Organization, to identify guidelines and recommendations addressing equity considerations in HIAs. Studies were included based on predefined eligibility criteria if they explored issues related to inequalities, inequities, and vulnerabilities within the context of HIAs. Data extraction focused on methodologies that incorporated equity considerations within the HIA framework, particularly concerning local urban planning initiatives, transport infrastructure, and industrial settings.
A total of 33 studies met the inclusion criteria. Among these, eight documents from the grey literature, identified as guidelines and guidance, underscored the importance of prioritizing equity to ensure that health impacts are addressed fairly across diverse population groups. The remaining 25 peer-reviewed studies employed a combination of quantitative and qualitative methodologies. Quantitative approaches, including exposure-response modeling and Geographic Information System (GIS) mapping, were utilized to evaluate spatial and demographic health disparities. Qualitative methods, such as focus groups, interviews, and participatory tools, provided insights into the lived experiences of vulnerable populations affected by local interventions. Studies addressing urban and transportation planning predominantly emphasized socioeconomic stratification, whereas those focused on industrial settings highlighted occupational hazards and community vulnerabilities.
This review highlights the diverse and fragmented approaches used to address health inequalities and equity in HIA. It underscores the need for interdisciplinary and systematic methodologies that integrate quantitative and qualitative perspectives, ensuring equity remains a central consideration in policymaking and project implementation. Finally, it proposes a practical framework for integrating equity into HIA.
健康影响评估（HIA）程序可包括对与环境健康风险和益处分配相关的不平等和不公平现象进行评估，旨在减轻环境健康差距的加剧。作为“预防非传染性疾病联合行动”倡议的一部分进行的这项系统评价，探索了在HIA框架内评估健康不平等和公平性的方法，特别是在影响环境风险和益处分配的地方项目中。
遵循PRISMA指南，使用MEDLINE/PubMed、Scopus和Embase数据库对科学文献进行系统评价，检索截至2024年3月8日的文献。此外，灰色文献分析涵盖了世界卫生组织的信息共享机构知识库（IRIS），以确定涉及HIA中公平性考虑的指南和建议。如果研究探讨了HIA背景下与不平等、不公平和脆弱性相关的问题，则根据预先定义的纳入标准将其纳入。数据提取侧重于在HIA框架内纳入公平性考虑的方法，特别是关于地方城市规划倡议、交通基础设施和工业环境的方法。
共有33项研究符合纳入标准。其中，灰色文献中的8份文件被确定为指南和指导意见，强调了优先考虑公平性以确保在不同人群中公平解决健康影响问题的重要性。其余25项同行评审研究采用了定量和定性方法相结合的方式。定量方法，包括暴露-反应模型和地理信息系统（GIS）绘图，用于评估空间和人口健康差异。定性方法，如焦点小组、访谈和参与式工具，提供了受地方干预影响的弱势群体生活经历的见解。涉及城市和交通规划的研究主要强调社会经济分层，而关注工业环境的研究则突出职业危害和社区脆弱性。
本综述强调了在HIA中用于解决健康不平等和公平问题的多样且分散的方法。它强调了跨学科和系统方法的必要性，这些方法整合了定量和定性观点，确保公平性在政策制定和项目实施中仍然是核心考虑因素。最后，它提出了一个将公平性纳入HIA的实用框架。
