Open Access Research article

The effectiveness of health appraisal processes currently in addressing health and wellbeing during spatial plan appraisal: a systematic review

Selena Gray1*, Laurence Carmichael2, Hugh Barton2, Julie Mytton1, Helen Lease2 and Jennifer Joynt2

Author Affiliations

1 Department of Health and Applied Social Studies, Faculty of Health and Life Sciences, University of the West of England, Room 2B06, Glenside Campus, Blackberry Hill, Stapleton, BS16 1DD Bristol, UK

2 WHO Collaborating Centre for Healthy Cities and Urban Policy, Faculty of Environment and Technology, University of the West of England, Bristol, UK

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BMC Public Health 2011, 11:889  doi:10.1186/1471-2458-11-889

Published: 24 November 2011



Spatial planning affects the built environment, which in turn has the potential to have a significant impact on health, for good or ill. One way of ensuring that spatial plans take due account of health is through the inclusion of health considerations in the statutory and non statutory appraisal processes linked to plan-making processes.


A systematic review to identify evaluation studies of appraisals or assessments of plans where health issues were considered from 1987 to 2010.


A total of 6161 citations were identified: 6069 from electronic databases, 57 fromwebsite searches, with a further 35 citations from grey literature, of which 20 met the inclusion criteria. These 20 citations reported on a total of 135 different case studies: 11 UK HIA; 11 non UK high income countries HIA, 5 UK SEA or other integrated appraisal; 108 non UK high income SEA or other integrated appraisal. All studies were in English. No relevant studies were identified reporting on low or middle income countries.

The studies were limited by potential bias (no independent evaluation, with those undertaking the appraisal also responsible for reporting outcomes), lack of detail and a lack of triangulation of results. Health impact assessments generally covered the four specified health domains (physical activity, mental health and wellbeing, environmental health issues such as pollution and noise, injury) more comprehensively than SEA or other integrated appraisals, although mental health and wellbeing was an underdeveloped area. There was no evidence available on the incorporation of health in Sustainability Appraisal, limited evidence that the recommendations from any type of appraisal were implemented, and almost no evidence that the recommendations had led to the anticipated outcomes or improvements in health postulated.


Research is needed to assess (i) the degree to which statutory plan appraisal processes (SA in the UK) incorporate health; (ii) whether recommendations arising from health appraisal translate into the development process and (iii) whether outcomes are as anticipated.