While we welcome references to the Health Impact Assessment (HIA) tool, we believe that the following steps could be taken to improve HIA implementation for planners, public health officials and developers:

- An unambiguous trigger for an HIA within policy wording. At present, Policy T27 states that ‘All major development proposals or those that the Council would consider having the potential to have a significant impact on health and wellbeing’ must be accompanied by an HIA. The triggers for the latter are not clearly defined - precise thresholds could include the number of homes, size of floorspace, location and/or type of business. In Medway, we suggest that HIAs could be required for proposals in deprived areas with poor levels of health and/or on certain business types, such as hot food takeaways, betting shops, and off-licence shops.

- Consider setting out the HIA process to clearly state expectations for what an HIA should include.

- Consider the outcomes of HIAs and explain how the results of HIAs will be implemented, for example through planning conditions. This could also include details of implementation, ongoing management of issues and/or monitoring.​

- Include explicit metrics for monitoring HIAs to inform evaluation of the effectiveness in a given location.