Social cohesion and local democracy as determinants of health: Testing the liveability framework for health impact assessment of a major infrastructure

Social cohesion and local democracy (SCLD) are determinants of health. They contribute to health via complex pathways that include the free exchange of ideas and values, mutual trust and benefit, the sharing of resources and a sense of agency and efficacy in one's community. Like other determinants, SCLD can be affected by major infrastructures in subtle yet pervasive ways, both positively and negatively. Health impact assessment (HIA) is an established method of assessing major infrastructure projects and is capable of detecting and proposing responses to such impacts. Despite this, HIA is not undertaken as frequently as could be beneficial. Given governments' interest in the concept of liveability, we conducted an independent study to apply one domain of a previously introduced, eleven-domain liveability conceptual framework for HIA to assess a level crossing removal (LXR) project in Australia. Social cohesion and local democracy was assessed using a survey, interviews and data obtained via freedom of information (FOI). Local democracy was significantly negatively affected, primarily due to shallow and non-genuine consultation, with impacts on the mental health of a small but important segment of the community. Paradoxically, social cohesion was positively affected as a result of the new community groups and networks that evolved in opposition to the project. We conclude that the government's broadly granted social licence, established using popular but unproven claims that the LXR would increase safety and decrease congestion, allowed tokenistic local consultation. We comment on our experience with FOI processes, and on the potential of using 'liveability' to raise the profile of HIA, to yield better results for community health from major projects.