Health impact assessment and health equity in sub-Saharan Africa : a scoping review

Background:Naturalresourceextractionprojectscanhavepositivebutalsonegativeeffectsonthehealthofaffectedcommunities, governed by demographic, economic, environmental, physical and social changes. Negative effectsoftenprevailandthesemightwidenexistinghealthinequities.Healthimpactassessment(HIA)isadecision-supporttool that aims at maximizing benefits and minimizing negative impacts on people's health. A core value of HIA isequity; yet, little is known about health equity in the frame of HIA, particularly in sub-Saharan Africa.Methodology:Weconducteda scopingreview todetermine whetherand towhat extent HIAin sub-Saharan Africaaddresses health equity. We included peer-reviewed publications and guidelines pertaining to HIA, environmentalimpact assessment (EIA) and social impact assessment (SIA). Health equity was investigated by identifying (i) howhealth considerations were addressed and (ii) whether health was stratified by subgroups of the community.Results:Out of 1′640 raw hits, we identified 62 articles (16 HIA, 36 EIA, one SIA and nine integrated assess-ments),32ofwhichspecificallyaddressedhealth.While20articlesfocusedonaspecifichealthtopic,12articlesusedamorecomprehensiveapproachtoaddresshealth.In15articlestherewerespecificsubgroupanalyses(e.g.mothers, children or marginalized groups) as a measure of health equity. Another 12 papers referred to thecommunity in a more general way (e.g. affected). Without exception, health was an integral part of the nineincluded guidelines. HIA guidelines addressed health systematically through environmental health areas, riskassessment matrix or key performance indicators.Conclusions:We found evidence that previously conducted HIA in sub-Saharan Africa and current guidelinesaddresshealthequity.However,thereisaneedtostratifycommunitysubgroupsmoresystematicallyinordertodeterminehealthdifferentialsbetter.FutureHIAshouldconsidercommunityheterogeneityinanefforttoreducehealth inequities by "leaving no one behind", as suggested by the Sustainable Development Goals