Skip to content

Advertisement

You're viewing the new version of our site. Please leave us feedback.

Learn more

BMC Public Health

Open Access
Open Peer Review

This article has Open Peer Review reports available.

How does Open Peer Review work?

Proposing a framework for Health Impact Assessment in Iran

BMC Public Health201515:335

https://doi.org/10.1186/s12889-015-1698-1

Received: 15 January 2014

Accepted: 27 March 2015

Published: 9 April 2015

Abstract

Background

Health impact assessments (HIA) of policies and projects are conducted differently in different contexts although there has been less HIA research to date in non-western countries. Global HIA research has however suggested that the technical conduct of HIAs is tied to broader conditions and influences to do with decision making and policy development.

This study was conducted to develop a conceptual framework for progressing HIA in Iran including all factors influencing HIA planning and practice.

Methods

A comprehensive review of the international HIA literature identified core characteristics and principles. Then key informant interviews (n = 14) identified Iranian perspectives about factors influencing HIAs practice. These two stages resulted in a conceptual framework for HIA planning and practice including influencing factors and HIA content that was confirmed by our participants using e-Delphi technique.

Results

91 HIA characteristics were organized into 20 categories. The interviews showed that four core concepts i.e. context, actors, HIA principles and policies and HIA capacities influence HIA practice in Iran. Comprehensive content of HIA considering all health dimensions and health determinants, assessing health inequalities, appropriate HIA type, quantification and participation is formed under influence of the above mentioned four factors. The study also demonstrated need to redefine the HIA principles and make decision about integration of HIA in Environmental Impact Assessment and also about the level of HIA before implementing HIA. The e-Delphi resulted in expert consensus on the variables, concepts, and their relations in proposed framework.

Conclusions

Progressing HIA practice in Iran is perceived locally as subject to similar contextual conditions to those identified in the international literature. Further we have demonstrated the utility of mixed methods to progress HIA implementation in differing country contexts.

Keywords

Health impact assessmentHealthy public policyHealth policy

Background

Health system authorities not only seek ways to provide the best health care but also improve the health of populations by considering the wider determinants of health [1,2]. One established way of doing this is the use of Health Impact Assessment (HIA) to aid decision makers by predicting positive and negative health impacts of proposed policies, programs and projects. However, the reality of influencing policy [3] and project [4] decisions is that these involve a complex set of factors. Considering this broad range of factors is, therefore, essential for the planning and effective conduct of HIA [5-7].

This placing of HIA within the array of influences on decision-making suggests that HIAs are conducted differently in different contexts. There has been empirical investigation into these factors in Europe [6], the U.S. [8] and globally [7,9,10]. Developing countries have started to implement HIA. For example, Thailand health system has developed HIA by conducting HIA case studies, developing HIA guideline and introducing HIA rules and procedures document [11-13]. Nonetheless, there has been no research to date which has focused on how adaptable HIA is in Iranian context. However each country requires its own policy frameworks and procedures for HIA that are adapted to the structure and legislation of local ministries and to its environment and communities [14].

In Iran, environmental impact assessment started in1990 but health had not been detailed in EIAs with only some projects i.e. industrial estates, wastewater treatment and some impacts i.e. air pollution have been assessed by academics using EHIA guidelines. The ignoring the health in EIAs and also an increased emphasis on the social determinants of health, caused the Fifth Economic, Social and Cultural Development Plan (2010–2015) [15] oblige the Ministry of Health and Medical Education (MoHME) to define national standards for ‘Health Annex of Developmental Plans’ aimed to implement HIA. This means HIA would be a regulatory requirement in Iran. This impetus provided the opportunity to investigate the perspectives of experienced Iranian practitioners and policy makers about the applicability of globally defined factors to progress a comprehensive HIA practice in Iran.

Methods

A comprehensive review of the international HIA literature identified core characteristics of HIA. A qualitative study identified Iranian perspectives about factors influencing HIAs practice. These two stages resulted in a conceptual framework for HIA implementation and practice confirmed using e-Delphi technique. Ethical approval was provided by the Complementary Educations Council of the School of Health Management and Information Sciences, Iran University of Medical Sciences on February 2012.

Data collection

This study was informed by two data sources. We first undertook a literature review to identify globally defined HIA characteristics and wider influences on HIA practice. Stakeholder interviews where then undertaken to understand local contextual issues and factors influencing HIA. We used the findings from both of these stages to propose a conceptual framework.

Literature review; Identifying HIA characteristics

We extracted HIA characteristics from a thesis in Persian [16] previously categorized and published as underlying principles for Health Impact Assessment [17]. According to primary source, the phrase “Health Impact Assessment” was searched for in Pubmed and Scopus databases from 1995 to 2012 resulted in 322 and 660 results respectively while 278 were common. The review was not systematic. Reviewing titles and abstracts in the peer reviewed literature, papers were excluded if they concerned or reported specific cases of HIAs. This review resulted in a total of 201 papers with background knowledge about HIA. Papers were included if they written in English and dealt with generic characteristics of HIA. Aim to data saturation. we started the review with common results by this order; written by authors who have the more papers in the Web of Sciences in this subject; extracted from international workshops and published by World Health Organization. Review was stopped by 63 papers reaching data saturation. For example, some papers referred to HIA characteristics and principles as the terms of characteristics [5,18], principles [19], requirement [20], prerequisites [21], key topics [22], key tasks [23], HIAs main value [24], criteria and parameters [25], broad factors [26] and other papers described one or more characteristic and principle without mentioning a specific term.

Key informants Interviews; Identifying contextual factors

A purposive sample of participants was selected for their experience with HIA or related areas. Unstructured interviews, which took from 30 to 90 minutes, were conducted until data saturation was reached (n = 14). Participants’ characteristics were: four members of Health Annex National Standards Committee responsible for developing National standards for HIA, three from Environmental Protection Organization, three from the Social Determinants of Health Secretariat in MoHME, and four Academic experienced in Environmental Health Impact Assessment and HIA have conducted their HIA projects as an academic activity in different field e.g. industrial estates documented in Persian. Interviewees were informed about interview and they signed a consent form before interview. AF conducted the interviews which focused on identifying HIA characteristics and principles and their influencing factors. Interviews were tape-recorded. The interviews revolved around two broad questions;
  1. 1-

    What are the factors influencing health impact assessment in Iran?

     
  2. 2-

    What are the dimensions of doing a comprehensive health impact assessment which need to be considered?

     

E-Delphi consensus; confirming the framework

Our participants in the interviews were our experts to reach consensus using Delphi method. Proposed framework was e-mailed to participants (n = 14). These data were collected over 1 month from December 2013 to January 2014. Of 14 experts in HIA and related fields from previous stage of the study, 14 completed Round 1 and 13 completed Round 2. Percent agreement was computed to establish consensus.

Data analysis

Using MS word to conduct a conventional content analysis of the included literature, AF and MM coded the identified HIA characteristics and principles until data saturation occurred. Codes were categorized based on their similarities. For example the term of “political environment” was used to cover, “political context”, “political environment” and “political commitment”.

Using thematic content analysis, AF and MM coded transcribed texts until the data were saturated to identify Iranian contextualized perspectives concerning factors influencing HIA and about the dimensions of doing a comprehensive HIA. For example participants emphasized the role of economic conditions influencing HIAs practice, which we therefore developed as a parameter influencing the HIA content.

In the following way we coded these parameters and categorized them for developing the conceptual framework. From the literature we categorized 91 codes and 24 categories (see Table 1). Then, using the interview data, we further reduced these categories into 20 contextualized parameters, five subthemes and two themes (see Table 2). Finally, the conceptual framework was formed considering emerged relations between five concepts from the literature and interview data that was validated by our participants using e-Delphi technique 2 Round to establish consensus (see Figure 1).
Figure 1

HIA conceptual framework.

Results

The HIA characteristic and principles in literature

Considering 171 codes identified from the literature review [16], by deleting identical concepts, 91 codes (HIA characteristics) were developed which were subsequently categorized into 24 categories (Table 1).

Table 1

The HIA characteristics extracted from literature review and their categorizations

The characteristics of HIA in the papers

Categories

Range of impacts considered

- Health impacts (Health dimensions and health determinants)

Focus of HIA

Multidisciplinary

Comprehensive

Potential impacts

Health determinants

Type of HIA (rapid, intermediate, comprehensive)

- Type of HIA (rapid, intermediate, comprehensive)

Effective stakeholder participation

- Participation

Cross-sectoral approach

Multidisciplinary

Intersectoral engagement

Health advocacy

Quantification

- Quantification

Consideration of health inequalities

- Inequality assessment

Supportive institutional context

- Economic conditions

Politicised context

- Political environment

Political commitment

- Social context

Clear bureaucratic mandate

 

Politico-administrative environment

 

Policy process

 

Community context

 

Context for HIA use

 

Governance

 

Social acceptance

 

Socio-political environment

 

Policy framework and procedures

 

Socio-political context

 

Developed or developing economy

 

Population attitude and belief

- Community

Stakeholder position

- Key informants

Engaging a diverse set of stakeholders

- Project proponents

Engagement with impacted communities

- Decision makers

Community and stakeholder involvement

- Assessors

Policy makers involvement

 

Community participation

 

Participation in HIA

 

Shared ownership

 

Base

- HIA principles

General stream

- HIA values

Principles and values

- Relation to other IAs

Timing (retrospective, concurrent, prospective)

- Level of HIA

Influence decision making

 

Predictive

 

Sector of intervention

 

Steering group

 

Who conduct HIA

 

Conceptual framework

 

Robust and broad theoretical foundation

 

Model of health

 

Using of structured framework

 

Systematic approach

 

Structured and stepwise process

 

Level of HIA

 

Administrative level of conducting HIA

 

Relation to other forms of IA

 

Integration with economic appraisal

 

Institutionalization

- Statutory requirements

Statutory requirements

 

Clearness of responsibility and Accountability

 

Voluntary vs. Regulator

 

Funding

- HIA resources

Resource needs and limitations

 

Economic feasibility

 

Cost-effectiveness of HIA

 

Skilled facilitation

- Human capacities

Competent practitioners

- Organisational capacities

Capacity for professional development

 

Capacity and workforce needs

 

Capacity-building mechanisms

 

Expertism

 

HIA capacity building

 

Administrative frameworks

 

Institutional infrastructure

 

Technical appropriateness

- HIA methods & tools

End-user–friendly implementation

 

Guidance for health analysis

 

Tools and methods

 

How to Identify health impacts

 

Methods and techniques

 

Uncertainty

 

Availability of data

- Appropriate data

Value of evidence

- Appropriate evidence

International HIA experience

 

Published literature consideration

 

Appropriate data sets

 

Evidence base HIA

 

Explicit source of evidence

 

Type of data

 

Examples and case study

 

Use of appropriate evidence

 

Robust evidence

 

Interview findings

In the qualitative interviews (translated here from Persian to English) participants mostly referred to the broad conditions influencing HIA practice. Participants referred to the different parameters influencing HIA’s role in decision making. Interviewees believed that because Iran is now focused on economic growth this necessitates considering the environment and health more than before. One participant explained;

“….in countries with rapid economic growth, something is sacrificed for other things, for instance the environment and health are sacrificed for economic development…” (p1)

Participants were concerned about challenges in HIAs development being perceived to prolong developmental planning which could be out of step with political imperatives and the economic motivations of development proponents. For example one participant engaged in Policy Making Council of MoHME said:

“…Election promises means they [elected politicians] are under pressure and don’t acquiesce for projects to be slowed or stopped. Authorities’ attitude is a major challenge…” (p7)

However, participants also felt that HIAs focusing on broad concerns to society as opposed to the interests of individuals was an enabler for HIA success in Iran. One participant explained;

“…Social development which emphasizes the subordination of individual interests to general interests causes the social acceptance of HIAs recommendations …” (p4)

Additionally, participants believed that although principles and standards for HIA practice have been developed internationally (i.e. the Gothenburg consensus), there is a need to define HIA principles which consider Iran’s cultural and socio-political context.

All participants identified that supportive legislation, financing, skilled human resources and organizational capacity, appropriate data and tools are prerequisites for effective and successful HIA. They felt that all these are prerequisites, or ‘HIA capacities’, that must be built before HIA implementation.

“…we have good capacity in specialist human resources [for HIA] but they also should be trained and skilled…” (p6)

Some believed that HIA practice must be integrated with Environmental Impact Assessments of projects. There was however some consensus that these issues of integration vs. stand alone HIA be resolved prior to the development of an HIA system in Iran. Similarly participants also felt that decisions about conducting HIAs at a policy level in addition to projects should be made before the development of an HIA system.

In terms of the content of HIAs, interestingly the importance of incorporating indirect health dimensions when assessing impacts was regarded by one participant;

“…calculating mortality isn’t enough. We must take into account stress of workers and their families in primary stages of a developmental project that is built in another province…” (p4)

Also in terms of HIAs content some participants believed that direct community participation is not possible, with others suggesting that because of potential dissension in communities HIAs should avoid involving them and instead look to involving community representatives.

‘….If we do not involve the community, HIA purpose will not be achieved but we cannot involve the community directly. We have to involve the formal representatives of the population…’ (p3)

Different beliefs were also detected about the use of data in HIA. Conducting rapid HIAs, which involve less data, was seen as acceptable at the policy level but not in the assessment of projects:

‘…rapid assessment is a way to avoid of data deficit… It is acceptable for health impact assessment of policies and laws that time is restricted but it is not enough for assessing of projects…’ (p1)

Although where possible data quantification was seen as needed;

‘…decision makers like numbers and statistics. I think quantification is needed although I agree a few prerequisites are necessary for this…’ (p7)

Finally data was discussed in relation to health inequalities,

‘…I think if we conduct HIA, we will able to decrease health inequalities… We have to gather the data about all subgroups if the money permits…’ (p11)

The developed conceptual framework

Five core factors emerged from the literature and interviews; four as influencing factors and one as how to do HIA. The term of “HIA Context” was used to cover all contextual parameters. “HIA Actors” was selected to cover the all stakeholder’s attitude. “HIA Principles and Policies” covered the accepted core principles and adopted policies concerning HIA. “HIA Capacities” referred to any prerequisites for conducting HIA. Finally “HIA Content” referred to HIA characteristics that detail the ‘doing’ of comprehensive HIAs during defined process. These factors considering their role in HIA as influencing factor or HIA content based on the literature and participants’ viewpoints formed the basis of the conceptual framework (Table 2). Figure 1 shows the proposed conceptual framework diagram. The framework was confirmed by our participants during two Rounds by e-Delphi method coming to 80% agreement on parameters, concepts and their relations [27].

Table 2

Contextualized parameters and supposed causal influencing factors identified from the interviews and literature

Contextualized parameters

Supposed causal influencing factors

Contextualized parameters

Different HIA practices

Economic growth

Context

Health impacts

HIA content

Socio-political development

HIA type

Social development

Health inequalities assessment

Policy and decision makers

Actors

Quantification

Key informants

Participation

Community

  

Proposal proponents

HIA principles

Redefined principles and policies

HIA level

Integration to EIA

Supportive regulations

Capacities

Resources

Organizational structure

Methods and tools

Data and evidence

Discussion

This study has proposed a framework for including HIA in policy making, planning and project development in Iran. By considering the range of factors involved in progressing HIA, the developed framework incorporates the broad parameters which influence HIA’s content and practice.

The results show that globally defined HIA characteristics and principles are largely supported in the Iranian context. At the same time this is the first study to develop a framework of how these various factors are perceived to play out in the application of HIA, in this instance in Iran. This provides local, non-western, contextual support for global research showing that HIA practice requires paying attention both to the external tactical or broader institutional factors as well as the technical issues related to HIAs conduct and practice [7]. For example, in Iran the results emphasize the broad influence of economic conditions, where the focus on economic growth and development influence the perceived socio-political usefulness of HIA and whether sufficient funds can be allocated to the practice of HIAs [6,28]. In the public policy arena the broad context in which HIAs are undertaken have been shown to be institutional, structures (the entities and rules within organizations or systems which influence policy making), actors (the stakeholders involved in policy making) and ideas (the content of policy making) as factors which work to create policy change [29]. We have similarly demonstrated that in Iran the ‘context’, which is largely structural, ‘actors’, which concern the people involved in progressing HIA, and ‘principles’, which largely concern the ideas which HIA has to offer, are each significant in progressing HIA as a technical process to influence decision-making. Our results support the need, in Iran, for legal commitments, financial and human resources and the development of supportive institutions [6,10] as well as technical requirements also in terms of methods, appropriate data and evidence [30,31] to influence decision making. We have also provided empirical support that these enablers have been also recognized as required to progress HIA in non-western countries [14].

However, our results also suggest that more work is required to understand the role of actors in the Iranian context. Contrary to expectation, viewpoints of some participants from Iran in this study concerning the role of actors i.e. policy and decision makers and proposal proponents were not positive. However, they suggested that actors do play an essential role. More detailed research is required to confirm the role of actors in progressing HIA in Iran.

The main purpose of this study was to qualitatively identify the various factors required to progress HIA in Iran. We suggest however that the results here are seen as initial and time limited. HIA has not progressed in Iran at the same level as in other countries, for example in Europe [6], the U.S. [32] or Australia [33]. In future more detailed quantitative work can confirm and refine our proposed framework both in Iran and in other contexts and countries response to call to develop an international HIA consensus that moves the field forward [34].

Conclusions

This is a study which has developed categories to navigate the practice of HIA as a decision making tool. The present approach to HIA in Iran is an environmental health approach concerning environmental determinants of projects. Our framework suggests HIA could be modified to become a healthy public policy approach that considers all social determinants of health at multiple levels: project, programs, plans and policies. So in Iran it is necessary to make decisions about conducting of HIA for programs and policies and redefining of HIA principles before the implementation of an HIA system. It is also needed to make the decision about integrating of the HIA to Environmental Impact Assessment before implementation rather during the assessment. We have shown that experienced practitioners and policy makers in Iran feel that the most important aspects about HIA are context, redefined principles and HIA capacities. There are complex inter-relations between factors influencing HIA role on decision making. We have proposed an important conceptual framework for planning, progressing and conducting HIA in different contexts.

Declarations

Acknowledgement

This study data was part of a PhD dissertation supported by the School of Health Management and Information Sciences, Iran University of Medical Sciences.

Authors’ Affiliations

(1)
Social Determinants of Health (SDH) Research Center, Kashan University of Medical Sciences
(2)
Menzies Centre for Health Policy, School of Public Health, Sydney Medical School, the University of Sydney
(3)
Department of Health Service Management, School of Health Management and Information Sciences, Iran University of Medical Sciences

References

  1. Commision of Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva: World Health Organization; 2008.Google Scholar
  2. WHO. Political Declaration on Social Determinants of Health. Rio de Janeiro: World Health Organization; 2011.Google Scholar
  3. Howlett M, Ramesh M, Perl A. Studying Public Policy: Policy Cycles and Policy Sub-Systems. 3rd ed. Canada: Oxford University Press; 2009.Google Scholar
  4. Cashmore M, Bond A, Cobb D. The role and functioning of environmental assessment: Theoretical reflections upon an empirical investigation of causation. J Environ Manage. 2008;88(4):1233–48.View ArticlePubMedGoogle Scholar
  5. Davenport C, Mathers J, Parry J. Use of health impact assessment in incorporating health considerations in decision making. J Epidemiol Community Health. 2006;60(3):196–201.View ArticlePubMedPubMed CentralGoogle Scholar
  6. Wismar M, Blau J, Ernst K, Figueras J. The effectiveness of health impact assessment, scope and limitations of supporting decision- making in Europe. Brussels: Europian Observatory on Health systems and policies; 2007.Google Scholar
  7. Harris PJ, Kemp LA, Sainsbury P. The essential elements of health impact assessment and healthy public policy: a qualitative study of practitioner perspectives. BMJ Open. 2012;2:e001245.View ArticlePubMedPubMed CentralGoogle Scholar
  8. National Research Council, Committee on Health Impact Assessment. Improving Health in the United States: The Role of Health Impact Assessment. Washington DC: The National Academies Press; 2011.Google Scholar
  9. Mindell JS, Boltong A, Fordea I. A review of health impact assessment frameworks. Public Health. 2008;122:1177–87.View ArticlePubMedGoogle Scholar
  10. Lee J, Röbbel N, Dora C. Cross-country analysis of the institutionalization of Health Impact Assessment. Geneva: World Health Organization; 2013.Google Scholar
  11. Hengpraprom S. Developing Tools for Health Impact Assessment in Environmental Impact Assessment in Thailand. Acta Med Okayama. 2005;65(2):123–8.Google Scholar
  12. Phoolcharoen W, Sukkumnoed D, Kessomboon P. Development of health impact assessment in Thailand: recent experiences and challenges. Bull World Health Organ. 2003;81(6):465–7.PubMedPubMed CentralGoogle Scholar
  13. Office NHC. Thailand’s Rules and Procedures for the Health Impact Assessment of Public Policies. Chiangmai, Thailand: Health Impact Assessment Coordinating Unit; 2010.Google Scholar
  14. Winkler MS, Krieger GR, Divall MJ, Cissé G, Wielga M, Singer BH, et al. Untapped potential of health impact assessment. Bull World Health Organ. 2013;91:298–305.View ArticlePubMedPubMed CentralGoogle Scholar
  15. Islamic Council Assembly of Iran IR. Fifth Economic, Social and Cultural Development Plan. Tehran: Islamic Council Assembly; 2011.Google Scholar
  16. Fakhri A. Developing a framework for health impact assessment of developmental plans in Iran. PhD thesis, Iran University of Medical Sciences; 2014. [In persian].Google Scholar
  17. Fakhri A, Maleki M, Gohari M, Harris P. Investigating underlying principles to guide Health Impact Assessment. Int J Health Policy Manag. 2014;3(1):17-22.Google Scholar
  18. Krieger N, Northridge M, Gruskin S, Quinn M, Kriebel D, Davey Smith G, et al. Assessing health impact assessment: multidisciplinary and international perspectives. J Epidemiol Community Health. 2003;57:659–62.View ArticlePubMedPubMed CentralGoogle Scholar
  19. Douglas MJ, Conway L, Gorman D, Gavin S, Hanlon P. Developing principles for health impact assessment. Public Health Med. 2001;23(2):148–54.View ArticleGoogle Scholar
  20. Fielding JE, Briss PA. Promoting Evidence-Based Public Health Policy: Can We Have Better Evidence And More Action? Health Aff. 2006;25(4):969–78.View ArticleGoogle Scholar
  21. Kemm J. Health Impact Assessment: a tool for Healthy Public Policy. Health Promot Int. 2001;16(1):79–85.View ArticlePubMedGoogle Scholar
  22. Parry J, Stevens A. Prospective health impact assessment: pitfalls, problems, and possible ways forward. BMJ. 2001;323:1177–82.View ArticlePubMedPubMed CentralGoogle Scholar
  23. Kemm J. Perspectives on health impact assessment. Bull World Health Organ. 2003;81(6):387.PubMedPubMed CentralGoogle Scholar
  24. Mindell J, Ison E, Joffe M. A glossary for health impact assessment. J Epidemiol Community Health. 2003;57(9):647–51.View ArticlePubMedPubMed CentralGoogle Scholar
  25. Kemm J. can health impact assessment fulfil the expectation that it raises. Public Health. 2000;114:431–3.View ArticlePubMedGoogle Scholar
  26. Mannheimer LN, Gulis G, Lehto J, Ostlin P. Introducing Health Impact Assessment: an analysis of political and administrative intersectoral working methods. Eur J Public Health. 2007;17(5):526–31.View ArticlePubMedGoogle Scholar
  27. Green J, Thorogood N. Qualitative Methods for Health Research. London: SAGE Publication; 2004.Google Scholar
  28. Ison E. The introduction of health impact assessment in the WHO European Healthy Cities Network. Health Promot Int. 2009;24(1):64–71.View ArticleGoogle Scholar
  29. Harris P. The Relationship Between Health Impact Assessment and Healthy Public Policy: A Critical Realist Investigation. PhD thesis, University of New South Wales; 2013.Google Scholar
  30. Joffe M, Mindell J. Health Impact Assessment. Occup Environ Med. 2005;62:907–12.View ArticlePubMedPubMed CentralGoogle Scholar
  31. Dannenberg AL, Bhatia R, Cole BL, Dora C, Fielding JE, Kraft K, et al. Growing the field of health impact assessment in the United States: An agenda for research and practice. Am J Public Health. 2006;96(2):262–70.View ArticlePubMedPubMed CentralGoogle Scholar
  32. Health Impact Project: HIA in the United States. [http://pewtrusts.org/en/projects/health-impact-project/]
  33. Harris P, Spickett J. Health Impact Assessment in Australia: A review and directions for progress. Environ Impact Assess Rev. 2011;31(4):425–32.View ArticleGoogle Scholar
  34. Vohra S, Cave B, Viliani F, Harris-Roxas BF, Bhatia R. New international consensus on health impact assessment. Lancet. 2010;376:1464.View ArticlePubMedGoogle Scholar

Copyright

© Fakhri et al.; licensee BioMed Central. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Advertisement