Open Access Highly Accessed Research article

Evaluating the impact of equity focused health impact assessment on health service planning: three case studies

Ben Harris-Roxas1*, Fiona Haigh1, Joanne Travaglia2 and Lynn Kemp1

Author Affiliations

1 Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW 2052, Australia

2 School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia

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BMC Health Services Research 2014, 14:371  doi:10.1186/1472-6963-14-371

Published: 5 September 2014



Health impact assessment has been identified internationally as a mechanism to ensure potential health impacts and health equity impacts of proposals are considered before implementation. This paper looks at the impact of three equity focused health impact assessments (EFHIAs) of health service plans on subsequent decision-making and implementation, and then utilises these findings to test and refine an existing conceptual framework for evaluating the impact and effectiveness of health impact assessments for use in relation to EFHIAs.


Case study analysis of three EFHIAs conducted on health sector plans in New South Wales, Australia. Data was drawn from 14 semi-structured interviews and the analysis of seven related documents (draft plans and EFHIA reports).


The case studies showed that the EFHIAs all had some impact on the decision-making about the plans and their implementation, most clearly in relation to participants’ understandings of equity and in the development of options for modifying service plans to ensure this was addressed. The timing of the EFHIA and individual responses to the EFHIA process and its recommendations were identified as critical factors influencing the impact of the EFHIAs. Several modifications to the conceptual framework are identified, principally adding factors to recognise the role individuals play in influencing the impact and effectiveness of EFHIAs.


EFHIA has the potential to improve the consideration of health equity in health service planning processes, though a number of contextual and individual factors affect this. Current approaches can be strengthened by taking into account personal and organisational responses to the EFHIA process.

Health impact assessment; Health equity; Health service planning; Impact evaluation; Evaluation framework; Conceptual framework