Besides supporting ethical principles of open, democratic decision-making, community participation in HIA can serve a valuable utilitarian function as well. By bringing in diverse viewpoints from technical experts and a range of stakeholders, community participation can help identify locally important concerns and health issues, and can test the results of the assessment against the local knowledge of community stakeholders.
Following the model of community participation formalized in environmental impact assessment, the greatest role for community participation in HIA is during the scoping and reviewing phases of the assessment, although community stakeholders may also participate in other phases, such as screening and assessment/analysis. Opinions of community stakeholders, however, is not a substitute for careful, balanced analysis based on objective, testable data.
Ensuring that community participation is meaningful and significant, not just a symbolic gesture with no real opportunity for influencing decisions, is always a challenge. Even when meaningful opportunities for true participation exist, community stakeholders may not want to participate or may find it difficult to participate because they may lack time or the means to get to meetings, or feel they lack sufficient technical knowledge, or because they are not comfortable speaking the language in which meetings are conducted. When such barriers limit participation, a few stakeholders with the means to participate may claim to represent the broader community. It may be difficult to ascertain whether these individuals are seen by the community and its different constituencies as legitimate spokespeople. The problem of representation and inclusiveness becomes more problematic as the scale of the affected population increases. True community participation is unlikely at the national, state and perhaps even county level. Participation is still important in HIAs of policies and projects that affect large populations, but participation will necessarily involve different advocacy groups and other representatives speaking for constituencies, not a broad, spectrum of the community. This changes the nature of participation, and may become highly polarized.