Validating Health Impact Assessment: Prediction is difficult (especially about the future)

Health Impact Assessment (HIA) has been recommended as a means of estimating how policies, programmes and projects may impact on public health, and on health inequalities. This paper considers the difference between predicting health impacts, and measuring those impacts. It draws upon a case study of the building of a new hypermarket in a deprived area of Glasgow, which offered an opportunity to reflect on the issue of the predictive validity of HIA, and to consider the difference between potential and actual impacts. We found that the actual impacts of the new hypermarket on diet differed from that which would have been predicted based on previous studies. Furthermore they challenge current received wisdom about the impact of food retail outlets in poorer areas. These results are relevant to the validity of HIA as a process and emphasise the importance of further research on the predictive validity of HIA, which should help improve its value to decision-makers.