About Health Impact Assessment

To stem the rising tide of chronic disease and create safe, thriving communities, health needs to be regularly factored into policy and program decisions in sectors that do not traditionally focus on health outcomes. 

Health impact assessments (HIAs) bring together relevant public input, available data and a range of qualitative and quantitative methods to anticipate the potential health consequences of a proposed policy, program or project. They use a structured yet flexible process for developing practical recommendations that decision makers can use to advance well-informed public policies, programs and projects that avoid unintended health consequences and unexpected costs.

Health Impact Assessments:

  • Acknowledge the trade-offs and potential costs and benefits of various choices, and outline opportunities to maximize health gains, minimize adverse effects and improve health for everyone in the affected community;
  • View health from a broad perspective, taking into account a wide range of environmental factors, such as housing conditions, roadway safety, and social and economic variables;
  • Consider whether there are subgroups within an affected population that may be more vulnerable to a given impact;
  • Promote civic engagement by engaging community members and other stakeholder groups who will be affected by a decision; and
  • Present an impartial, science-based appraisal of the risks, benefits, trade-offs and alternatives involved in the decision.

HIAs can vary in complexity and depth of analysis. Not every proposal requires a full HIA, and the level of analysis should be tailored to the decision process at hand. A “rapid” HIA can be accomplished within a few weeks, whereas a more thorough HIA that includes the collection of significant new data might take several months. The timing of the HIA also affects its value - if the assessment is done earlier in the process, it may be easier for a planner or decision maker to integrate the information.

The field of HIA has developed largely outside the United States through efforts by the World Health Organization, the European Union and Canada, among others. HIA in the United States, while at an early stage, has already proven a valuable approach to promote decisions attuned to health.

 

With some variation, HIA follows a well-defined series of stages:

  1. Screening - Determines whether the HIA is likely to succeed and add value. Questions include: How important to health is the decision? Will the HIA provide new and important information or insight on previously unrecognized health issues? Is it feasible in terms of available resources (data, time, money, stakeholder interest)?

  2. Scoping - Creates an outline for the HIA by asking questions such as: What health effects should the HIA address? What concerns have stakeholders expressed about the pending decision? Who will be affected by the policy or project, and how?

  3. Assessment - Involves two steps: (1) describes the baseline health of people and groups affected by the decision; and (2) performs an impact assessment that predicts the potential health effects of the decision.

    • The first step attempts to explain not only the important causes of illness but also the conditions that influence health – such as the local economy, air quality, availability of parks and recreation facilities or access to healthy food choices.
    • The second step (the impact assessment) can involve literature review and qualitative/descriptive analysis or quantitative modeling to identify the important health risks and benefits of a given project, as well as the distribution of risks and benefits among vulnerable subgroups within the population (such as children, the elderly, people with chronic illnesses, racial and ethnic groups or low-income populatoins).

    The impact assessment should be conducted in an impartial, scientific way that identifies both the risks and the benefits associated with a decision. Assessment of economic costs and benefits, when possible, may help decision makers weigh the relative importance of identified health issues against other considerations.

  4. Recommendations, Implementation and Advocacy - The HIA should point the way to a decision that protects and promotes health. The strategies and actions required to facilitate the adoption of an HIA’s recommendations into the final decision will vary. In some cases, simply highlighting the potential risks, benefits and costs of alternatives can allow decision makers to make an informed choice that supports health. In many cases, the practitioner will need to develop specific recommendations or a health management plan offering concrete steps that decision makers can take to promote health benefits and avoid, minimize or mitigate adverse consequences.

    Simply providing recommendations, however, may not be enough to compel decision makers to adopt or implement them. The HIA should be conducted with an eye toward what methods—policy levers, legal and/or regulatory avenues, communications and advocacy, etc.—will most likely succeed. In some cases, for example, it may be possible to implement the recommendations of an HIA through new or existing laws, policies or regulations, without extensive advocacy efforts. In other cases, media outreach and efforts to engage and educate decision makers, build consensus among stakeholders and involve the community may contribute to an effective plan for advocacy and implementation.

  5. Reporting - The HIA practitioner disseminates the findings to decision makers, affected communities and other stakeholders, and solicits their feedback. This stage may result in a revised report that addresses public responses to the draft.

  6. Monitoring and Evaluation - The HIA should identify indicators to track the outcomes of any implemented recommendations. This monitoring information serves as the basis of evaluating the impact of the HIA and also helps shape future policy and management decisions. Evaluation should focus both on the process (In what ways did the HIA affect decision making?) and on intermediate outcomes (For example, what health-oriented changes resulted? Did the HIA affect any specific groups differently than it did the broader population?) While some cases may appear to warrant a longer-term evaluation of downstream health outcomes, these evaluations are rare and often present practical and methodological challenges.

Have additional resources suggestions for this site? Send us an email.