3.4. Community-led HIAs
One of the emerging areas of practice internationally are those
HIAs conducted by communities to help define or understand issues
and contribute to decision-making that impacts directly on their
health. The purpose of community-led HIAs is to ensure the
community's health-related concerns are recognised and addressed.
It is seen as an evidence-informed and practical by way in which
communities can contribute to decisions — moving beyond a simple
reliance on consultation to seek community views.
Community-led HIA is a democratic and political process, rather
than a technocratic or rational process. Depending on the issue it is
important to recognise that this type of HIA may not be formally
recognised and have no control over, or input into, decision-making,
beyond a community's rights as citizens. Community values will play
a strong role in the assessment of evidence. The process of making
these values transparent may lead to significant social learning for thecommunity, allowing them to develop a deeper understanding of the
issues from a variety of stakeholder views and allow the community
to move from an adversarial role to a dialogue with decision-makers
about alternative solutions. The role of HIA practitioners in community-
led HIAs is often quite different to other HIAs, as it is usually to
provide technical assistance and facilitation rather than direction.
Community-led HIAs are unlikely to be bound by disciplinary
traditions of practice or treatment of evidence, which may allow
greater assessment of underlying social, economic and political forces
that may be shaping the development and implementation of the
proposal. While most community-led HIAs are in reaction to a specific
proposal, there are increasingly requests for HIA capacity building
coming directly from community groups who are interested in more
proactive involvement in informing planning and implementation
processes (Sukkumnoed et al., 2005).