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:
- Health Impact Assessment fact sheet
[PDF, 80KB]
This CDC fact sheet describes the Health Impact Assessment process and its value in
objectively evaluating a project or policy before it is built or implemented.
- UC Berkeley Health Impact Group
[external link]
The UC Berkeley Health Impact Group (UCBHIG) is a non-partisan, independent collective whose mission
is to promote the field of Health Impact Assessment through advocacy, education, research, and community
outreach. UCBHIG’s work focuses largely on the development of qualitative and quantitative tools.
-
The UCLA Health Impact Assessment Clearinghouse Learning and Information Center
[external link]
This Web site is designed to collect and disseminate information on health impact assessment
(HIA) in the United States. the Web site has summaries of HIAs conducted in the U.S.,
reviews of common pathways examined by HIAs, HIA-related news, and information about HIA
methods and tools. The goal of this website is to support more informed policy-making that
contributes to improved public health and to promote insight into the many ways that public
policies in all sectors influence the public’s health.
- Cole BL, Shimkhada R, Fielding J, et al.
Methodologies for Realizing the Potential of Health Impact Assessment.
Am J Prev Med 2005;28(4):382–389.
Abstract: Health impact assessment (HIA), a systematic assessment of potential health impacts of
proposed public polices, programs, and projects, offers a means to advance population
health by bringing public health research to bear on questions of public policy. The United
States has been slow to adopt HIA, but considerable strides have been made in many other
countries, and under the auspices of the World Health Organization and World Bank.
Varied applications in these diverse milieu have given rise to diverse approaches to
HIA—quantitative/analytic, participatory, and procedural—each with distinct disciplinary
foundations, goals, and methodologies. Suitability of these approaches for different
applications and their challenges are highlighted, along with areas in which methodologic work is
most needed and most likely to advance the field from theory and infrequent
application to more routine practice in the United States.
-
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.