A health impact assessment (HIA) of a national lung cancer screening programme in Wales

Lung cancer is a major cause of death in Wales, with late diagnosis contributing to poor outcomes. This is exacerbated by inequalities such as accessibility, socioeconomic status and rurality. As Wales developed a national Lung Cancer Screening Programme (LCSP) in 2024, a prospective Health Impact Assessment (HIA) was undertaken to understand potential health, wellbeing and equity impacts to support evidence-based decision making. Public Health Wales conducted the HIA using mixed methods, including national data analysis, Welsh Pilot evidence, published research and a participatory stakeholder workshop. The HIA explored potential positive/negative impacts, affected groups and led to recommendations for action for equitable delivery. The HIA was undertaken over several months to contribute to a Welsh Government decision in 2025. The HIA identified major potential benefits, including earlier detection of lung cancer and other respiratory conditions, improved smoking cessation opportunities and increased access to wider support services. Potential negative impacts included communication challenges, transport and cost barriers, stigma, digital exclusion and accessibility issues. Affected groups included rural communities, socioeconomically disadvantaged people, transient populations and people with disabilities. Recommendations such as multilingual communication, trauma‑informed practice, community engagement and strong links with cessation services were made, to inform evidence which contributed to programme funding approval. The HIA demonstrated the value of early engagement using HIA to support equitable implementation of the LCSP.Key lessons included the importance of accessible communication, flexible delivery models and working with other services. As the first known HIA for a lung cancer screening programme globally, it offers transferable learning for other countries seeking to implement a similar programme maximising benefits and reducing inequalities.

Key messages

• HIA is a beneficial process to support equitable decision making and prevention approaches.

• Lung Cancer Screening programmes have major potential positive impacts for health and wellbeing.