The Different Types of Health Assessments

Health Impact Assessment: A systematic process that uses an array of data sources and analytic methods and that considers input from stakeholders to determine the potential effects of a proposed policy, plan, program, or project on the health of a population and the distribution of those effects within the population. Health Impact Assessments (HIA) provide recommendations on monitoring and managing those effects. [Source: National Research Council, http://www.nap.edu/catalog.php?record_id=13229]. HIAs differ from other commonly used tools for health assessment, such as health risk assessments and public health assessments, in that HIAs

• Are intended to inform deliberations on a specific proposal—legislation, proposed rulemaking, and project permitting, for example.
• Systematically assess the multiple influences on health that can occur as a result of social, economic, and environmental changes.
• Use a broad definition of health that includes physical and psychological health and general well-being.

Public Health Assessment: The evaluation of data and information on the release of hazardous substances into the environment in order to assess any past, current, or future impact on public health, develop health advisories or other recommendations, and identify studies or actions needed to evaluate and mitigate or prevent human health effects (42 Code of Federal Regulations, Part 90, published in 55 Federal Register 5136, February 13, 1990). A public health assessment is conducted to determine whether and to what extent people have been, are being, or may be exposed to hazardous substances associated with a hazardous waste site and, if so, whether that exposure is harmful and should be stopped or reduced. For more information, go to the Agency for Toxic Substances and Disease Registry Web site at http://www.atsdr.cdc.gov/hac/PHAManual/ch2.html#2.1.

The term public health assessment includes other studies or methodologies that evaluate potential impacts on human health, including the Health Risk Assessment.

Health Risk Assessment: An assessment to determine the risk of adverse health effects that would be caused by exposure to specific chemicals or other hazards. Calculations in health risk assessments (HRAs) typically rely on guidance from the U.S. Environmental Protection Agency or other authorities (see http://epa.gov/riskassessment/health-risk.htm). Health risk assessments are distinct from HIAs in that HRAs tend to focus on biophysical risks from exposure to hazardous substances, whereas HIAs evaluate a broader range of health impacts and are generally used to inform policy, project, or programmatic decisions.

Cost-Benefit Analysis: A type of economic evaluation that measures both costs and benefits (i.e., negative and positive consequences) associated with an intervention in dollar terms [Source: http://www.thecommunityguide.org/about/glossary.html ]. Since the HIA typically does not examine the costs associated with its recommendations to promote health and mitigate adverse health impacts, a cost-benefit analysis could be conducted on the recommendations of an HIA to help decide which recommendations are the most feasible. For more information, see An Introduction to Cost-Benefit Analysis.

Environmental Impact Assessment: Both a decision-making process and a document that provides a systematic, reproducible, and interdisciplinary evaluation of the potential physical, biological, cultural, and socioeconomic effects of a proposed action and its practical alternatives. Proposed actions may include projects, programs, policies, or plans. In the United States, an EIA is called an Environmental Impact Statement or EIS. [Source: http://ceq.hss.doe.gov/nepa/Citizens_Guide_Dec07.pdf [PDF - 931 KB]] The National Environmental Policy Act (NEPA) requires federal agencies to integrate environmental values into their decision-making processes by considering the environmental impacts of their proposed actions and reasonable alternatives to those actions. To meet NEPA requirements, federal agencies prepare an EIS. [Source: http://www.epa.gov/compliance/nepa/] EIA is a regulatory process, while HIA is a voluntary or a regulatory process that focuses on such health outcomes as obesity, physical inactivity, asthma, injuries, and social equity. HIA has been used within EIA processes to assess potential impacts on the human environment. For more information on NEPA, visit the U.S. Environmental Protection Agency Web site at http://www.epa.gov/oecaerth/basics/nepa.html.

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