The Stress Response: How HIAs Can Help Connect the Dots

Seems like every time you turn around stress is in the news. A recent article in the New York Times discussed how Dutch researchers were able to use hair samples to show a link between a major stress homrmone called cortisol and cardiovascular disease and diabetes.  Another article published in Discover Magazine discusses how traumatically stressful events can even influence the genes of future generations.

But what is stress, exactly, and how does it make you sick? And what does all of this have to do with Health Impact Assessments?

Stress is what happens when you perceive that your demands exceed your resources. If you were taking a stress reduction course the teacher might tell you not to over-commit yourself, to learn how to meditate, or to change your way of perceiving things. But what if you’re stressed out from living in an overcrowded apartment because there aren’t enough affordable housing options? Or you’re a U.S. citizen but one of your parents is undocumented and may be deported? Policy and project decisions can affect the stress levels of large groups of people, including those who have the fewest resources to deal with it. And many of those stressors are chronic, which means they may have the worst influence on health.

The body’s stress response is like a light switch. Every time you perceive a situation as stressful your body reacts by flipping the switch and releasing stress hormones. This stress response is an evolutionary holdover, designed to protect you from physical danger, like a tiger charging toward you. The stress response prepares your body to fight off the tiger or flee. Your blood pressure increases to push the blood to the muscles that will help you fight or run away. Fats and sugars are released into the bloodstream for a quick energy supply. Your blood clots more easily, so if the tiger scratches you you can still survive, and your immune system increases to fight off any infection from that potential wound. Your mind becomes more alert so you can notice all of the details of the situation and make the best move.

The problem is, you’re not supposed to have a tiger charging toward you every day. But if you have ongoing stressors that switch might get flipped on a daily basis. And the switch doesn’t work very well that way. Sometimes it gets stuck in the on position. Your blood pressure might stay high all the time. Your blood might try to clot all the time. You might always have high levels of sugars and fats in your bloodstream. Sometimes the light bulb burns out and you can’t turn it on anymore. The neurochemicals that help your mind stay alert might get depleted and you end up with a foggy memory and depression. Your immune system wears out and you end up more prone to everyday infections. Over time, these conditions could contribute to diabetes, high cholesterol, heart disease, stroke, depression, and anxiety.

So when policy and project decisions expose whole populations of people to chronically stressful circumstances, it can affect their health. This is where HIAs have a unique opportunity to connect the dots. HIAs can help decision-makers understand the impacts of those decisions on health outcomes through the stress response. For example, an HIA conducted by the Adler School Institute on Social Exclusion helped connect the dots between hiring practices and mental health outcomes for a community.

Another HIA conducted by Human Impact Partners helped connect the dots between a proposed football stadium in downtown Los Angeles, the gentrification and displacement that could result for the community nearby, and how those potential implications could influence stress and health.

The field of HIA is just beginning to explore these possibilities in more depth. At the March 2013 HIA of the Americas meeting, a mental health workgroup was established. Members of this group committed to work over the next 18 months to create resource sheets that would help define mental health terms that are often relevant to HIAs, describe some of the typical pathways for policy and project decisions to affect health outcomes, and identify data resources to utilize in HIA work.

Helping people understand how some decisions could create more stress for people, and how that could impact their health, is just what HIA was built for.

For more information about the mental health workgroup, contact

Holly Avey

Holly Avey
Program Director


Holly Avey joined Human Impact Partners in February 2013. Prior to joining HIP, Holly worked at the Georgia Health Policy Center at Georgia State University on a variety of HIA and Health in All Policies projects, including serving as an HIA practitioner, trainer, and technical assistance provider. Holly has a PhD from the University of Georgia and a Master's in Public Health from the University of Michigan, both in the health behavior specialty area. She also holds a bachelor's degree in Creative Writing from the University of Arizona. Her work in the public health field ranges from community, university, and hospital settings, and covers a wide variety of topics. Her research interests include structural sources of chronic stress (such as policies that influence resource access and distribution) and their differential impacts on vulnerable populations. She is interested in innovative research methodologies such as participant photography (PhotoVoice), mixed methodology, and addressing equity issues through policy and community engagement initiatives. Holly currently serves on the steering committee of the Society of Practitioners of Health Impact Assessment (SOPHIA).