Scoping Population Health in Impact Assessment (ScopHIA) Realist Review: Identifying Best Practices for Equity in Scoping of Major Natural Resource and Large-Scale Infrastructure Projects

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About the project

Canada is an international leader in natural resource and large-scale infrastructure projects, which contribute substantially to the domestic economy. However, major projects in rural and remote regions can pose significant challenges for population health equity, defined as the absence of avoidable differences in health determinants, status and outcomes between geographic, socio-economic or demographic communities and subpopulations. In these regions, a more equitable sharing of risks and benefits with Indigenous peoples and affected communities could help address the legacy of colonialism, environmental injustice and systemic oppression tied to major project development.

Population health inequities can manifest themselves in many ways. These include:

• elevated risk perception and distress caused by environmental change
• exposure to pollution and loss of ecosystem services
• stress on community infrastructure and food and water security
• increased socio-economic and political disparity within communities
• increased incidence and prevalence of infectious and chronic diseases, mental illnesses, substance misuse and addiction
• increases in crime and domestic, sexual, interpersonal and structural violence

Consequently, public deliberations and decision-making about the impacts of projects should consider population health equity throughout the exploration, construction, operation and closure phases.

Impact assessment is a legislated process in more than half of the world’s countries. Through public deliberation and decision-making about proposed major projects, impact assessments are generally carried out to identify and mitigate potential negative impacts on the biophysical environment. In Canada, the recent development of a new federal system for impact assessments has extended this mandate to incorporate positive and negative impacts of projects on health, social and economic conditions.

To develop a more tailored impact assessment structure for each project, the new system has introduced a 180-day planning phase to engage with Indigenous peoples and affected communities on the issues that concern them. By providing increased early opportunities for consultation, engagement and input, the planning phase can identify ways of promoting population health equity, helping to ensure that projects contribute to public interest and sustainability.

Our project aimed to prioritize population health equity within federal impact assessment in Canada. We sought to identify key points of leverage in the planning phase for achieving this goal by implementing evidence-based best practice and principles from the peer-reviewed and grey literature.

Key findings and policy implications

A systematic review of 185 peer-reviewed and grey literature documents revealed strategies for implementation and innovation in five key planning phase processes.

Preparing for impact assessments: Supporting self-determination as a population health equity aid for Indigenous peoples and affected communities requires integration with strategic and regional assessments, pre-planning capacity building, and transparency in processes of engagement. Early involvement of federal and local public health authorities was further seen to support technical training and social learning across participants in impact assessments.

Collaborating with federal authorities in public health: Guidance was identified as a key mechanism for promoting scientific standards and encouraging the combined use of publicly available and community-driven data sources. Federal authorities like Health Canada, the Public Health Agency of Canada and the Canadian Institutes of Health Research were shown to play important roles in developing advisory capacity, conducting knowledge translation and funding research on population health equity in impact assessments. 

Providing funding to Indigenous peoples for participatory processes: Funding to community-driven research and development processes could generate meaningful indicators, models and thresholds for population health equity. It could also facilitate community stewardship of data and information. Improved two-way communication about development projects, adequate resourcing of Indigenous governments and boundary organizations, and early consideration of mitigations and compensation are also needed to help Indigenous peoples and affected communities participate meaningfully in decision-making in impact assessments.

Engaging to identify broad issues and concerns: Facilitating social learning across multiple forums is a key strategy for examining biases, reframing issues, building trust, sharing values and fostering legitimacy in the impact assessment process. Notably, comprehensive public health and community-led frameworks categorizing population health equity impacts can foster engagement with Indigenous peoples and affected communities, helping to generate discussion and organize responses in the planning phase.

Developing guidance for the impact assessment: Population health equity promotion at the end of the planning phase would involve ensuring sufficient expertise and community-based coordination on proponent teams setting expectations for accountability, enforcement and grievance mechanisms, and facilitating co-development, co-management and Indigenous-led assessments anticipating post-approval management, monitoring and follow-up programs in impact assessment.

Further information

Read the full report

Contact the researcher

Candace I. J. Nykiforuk, professor, School of Public Health, University of Alberta; candace.nykiforuk@ualberta.ca

Date modified:

2020-11-27