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Health Impact Assessment

    Health impact assessment (HIA) is commonly defined as “a combination of procedures, methods, and tools by which a policy, program, or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population” (1999 Gothenburg consensus statement, http://www.euro.who.int/document/PAE/Gothenburgpaper.pdf). HIA can be used to evaluate objectively the potential health effects of a project or policy before it is built or implemented. It can provide recommendations to increase positive health outcomes and minimize adverse health outcomes. A major benefit of the HIA process is that it brings public health issues to the attention of persons who make decisions about areas that fall outside of traditional public health arenas, such as transportation or land use.

    The major steps in conducting an HIA include

    • screening (identify projects or policies for which an HIA would be useful),
    • scoping (identify which health effects to consider),
    • assessing risks and benefits (identify which people may be affected and how they may be affected),
    • developing recommendations (suggest changes to proposal to promote positive or mitigate adverse health effects),
    • reporting (present the results to decision-makers), and
    • evaluating (determine the affect of the HIA on the decision process).

    HIAs are similar in some ways to environmental impact assessments (EIAs), which are mandated processes that focus on environmental outcomes such as air and water quality. However, unlike EIAs, HIAs can be voluntary or regulatory processes that focus on health outcomes such as obesity, physical inactivity, asthma, injuries, and social equity. An HIA encompasses a heterogeneous array of qualitative and quantitative methods and tools. Rapid HIAs can be completed in a few days or weeks; full HIAs may require months to complete. The decision to conduct a rapid or a full HIA is often determined by the available time and resources.

    Numerous HIAs have been performed in Europe, Canada, and elsewhere, as documented in the book Health Impact Assessment by John Kemm et al. (Oxford University Press, 2004). Some countries have mandated HIA as part of a regulatory process; others have used it in on a voluntary basis. In the United States, interest in the topic is growing, with HIA work being performed by the University of California, Los Angeles [www.ph.ucla.edu/hs/health-impact/], the San Francisco Department of Public Health [www.sfphes.org], and CDC. In October 2004, the Robert Wood Johnson Foundation and CDC hosted a workshop of domestic and international HIA experts in Princeton to identify the steps needed to move the field of HIA forward in the United States. A workshop summary is being prepared for publication.

    For more information about health impact assessment, refer to the following resources:

    • Planning for Healthy Places with Health Impact Assessments [external link]
      (http://professional.captus.com/Planning/hia/default.aspx)
      This online course explains the value of conducting an HIA and the steps involved in conducting an HIA. The course, developed by the American Planning Association and the National Association of County & City Health Officials, was funded by the Centers for Disease Control and Prevention.
    • Bhatia, R and Wernham, A. Integrating Human Health into Environmental Impact Assessment: An Unrealized Opportunity for Environmental Health and Justice. Environmental Health Perspectives. 2008;116(8): 991-1000.
      http://www.ehponline.org/docs/2008/11132/abstract.html [external link]
    • Dannenberg AL, Bhatia R, Cole BL, et al. Growing the field of health impact assessment in the United States: an agenda for research and practice. Am J Public Health. 2006;96(2):262-70.

      Abstract: Health impact assessment (HIA) methods are used to evaluate the impact on health of policies and projects in community design, transportation planning, and other areas outside traditional public health concerns. At an October 2004 workshop, domestic and international experts explored issues associated with advancing the use of HIA methods by local health departments, planning commissions, and other decision makers in the United States. Workshop participants recommended conducting pilot tests of existing HIA tools, developing a database of health impacts of common projects and policies, developing resources for HIA use, building workforce capacity to conduct HIAs, and evaluating HIAs. HIA methods can influence decision makers to adjust policies and projects to maximize benefits and minimize harm to the public’s health.
    • Healthy Development Measurement Tool [external link]
      (http://www.thehdmt.org/)
      This tool, created by San Francisco Department of Public Health, Program on Health, Equity and Sustainability, is a comprehensive evaluation metric to consider health needs in urban development plans and projects.
    • Health Impact Assessment Gateway [external link]
      (http://www.hiagateway.org.uk)
      This extensive site, created by the Health Development Agency in England, includes general information on HIA, networking, upcoming training and conferences, resources available to complete HIAs, and completed HIAs.
    • Health Impact Assessment Information & Insight for Policy Decisions [external link]
      (http://www.ph.ucla.edu/hs/health-impact/)
      This joint endeavor of the Partnership for Prevention and researchers at the UCLA School of Public Health aims to assess the feasibility of HIA and to develop prototype HIAs that demonstrate methodologies, eventually enabling HIA to contribute to more informed decision-making about public policies impacting health in the U.S.
    • Human Impact Partners [external link]
      (http://www.humanimpact.org/)
      A nonprofit project of the Tides Center, the purpose of this site is to raise awareness of and collaboratively use innovative data, processes and tools that evaluate health impacts and inequities in order to transform the policies, institutions and places people need to live healthy lives.
    • World Health Organization Health Impact Assessment [external link]
      (http://www.who.int/hia/en/)
      This site provides general information about HIA, tools and methods to complete HIAs, examples of completed HIAs, discussion of the role of HIA in decision making, and information about the evidence base that can be used for HIAs.
    • International Health Impact Assessment Consortium [external link]
      (http://www.ihia.org.uk/)
      This consortium is composed of HIA experts at the Department of Health at the University of Liverpool and individuals from various institutions. Its Web site provides general information on HIA, a link to the Merseyside HIA guidelines, and other publications and reports (completed HIAs, journal articles, conference proceedings, books, and theses).
    • National Association of County and City Health Officials [external link]
      (http://www.naccho.org/topics/hpdp/land_use_planning/LUP_HealthImpactAssessment.cfm)
      This site contains links to numerous resources and examples related to HIA.
    • Use of Health Impact Assessment in the U.S. 27 Case Studies, 1999–2007
      [PDF, 390KB]
      CDC scientists examined 27 Health Impact Assessments (HIAs) that were completed in the U.S. From 1999 –2007. HIAs help planners and others consider the health consequences of their decisions.