What is Health Impact Assessment?
What is the purpose of HIA?
What are the benefits of conducting HIA?
What are the steps conducted in a HIA?
Is HIA one standard tool?
When is a HIA carried out?
What are the typical triggers for a HIA?
How much does conducting a HIA cost?
What are the roles for stakeholders in HIA?
What are the underlying values of HIA?
What does a completed HIA produce?
What is the relationship of HIA to Environmental Impact Assessment?
What is the difference between HIA, community health assessment, and health risk assessment?
Is HIA required by law?
What types of issues does HIA consider?
Why have most HIAs focused on the built environment?
How have HIA programs/projects been funded sustainably?
Where a person lives has a dramatic affect on health. For example, in New Orleans, L.A., a few miles can mean a 25-year difference in how long a baby will live. (See the Robert Wood Johnson Foundation’s website for more on this.)
These differences in how long we live, as well as the quality of our lives, are rooted in the characteristics and policies of the places where we are born, grow, live, learn, work, and age. Many of dominant health problems facing our nation – such as obesity, asthma, diabetes, and heart disease – stem from the characteristics of these places. Health Impact Assessment (HIA) is a process to weigh in on decisions that shape these places and affect health.
Health Impact Assessment is formally defined by the National Research Council as, “A combination of procedures, methods and tools that systematically judges the potential, and sometimes unintended, effects of a policy, plan, or project on the health of a population and the distribution of those effects within the population. HIA identifies appropriate actions to manage those effects.”
There are many purposes to HIA reports and the processes used to create them.
Through reports and communications, HIA seeks to:
- Make a judgment about how a proposed project, plan, or policy will affect health
- Highlight disparities (or differences) in health between groups of people
- Provide recommendations to improve decisions
- Raise awareness among decision makers and the public
- Clearly state health effects.
Through its process, HIA aims to:
- Promote engaged and empowered communities
- Recognize lived experiences in decision-making
- Build relationships and collaborations
- Improve evidence
- Improve transparency in decision making.
Health Impact Assessment is a practical approach to help create healthier communities by addressing the root causes of prominent health problems. It can benefit the field of public health, communities, and decision makers.
Benefits to the field of public health include that HIA:
- Provides a comprehensive lens on issues
- Offers a structured process to determine how a policy, plan, or project will affect health
- Considers historical, cumulative, and disparate impacts
Benefits to communities include that HIA:
- Supports community participation in decision-making processes and legitimizes “unheard” voices
- Works in communities that experience significant consequences from decisions
Benefits to decision-makers include that HIA:
- Provides input early in decision-making and helps build support for better outcomes
- Helps identify trade-offs in decision-making, so policy and project dollars are used efficiently
- Provides decision makers with the information necessary to carry out a main role of government – protecting and improving health and well-being
A typical HIA has six steps, including:
- Screening – Determine the value and need for HIA
- Scoping – Clarify and prioritize issues to focus on in the HIA, methods for analysis, and a work plan
- Assessment – Two parts that include: a) Conducting research on existing conditions; b) Identifying the effects of the project, plan, or policy on health;
- Recommendations – Identify actions to address any harms identified
- Reporting – Write a report and communicate its findings and recommendations
- Monitoring – Track how the HIA affected decision-making processes, the actual decision, and effects of the project on health
We provide a detailed guide through the HIA Summary Guides. However, this is a general framework. Approaches to HIA vary greatly. For more on the variation within HIAs, see the next section.
No, HIA is not one single tool. It is a systematic process that may use diverse tools and methods.
Health Impact Assessments are tailored to work with the specific needs, timeline, and resources of each particular project. This flexibility has led to a range of practices, both in the United States and internationally.
If you pick up two HIA reports, they likely analyze a different set of issues and use different set of research methods. A report can use existing data, published research, include the collection and analysis of new data, use multiple quantitative and qualitative methods, or – as is often the case – do a mix of these approaches. Some are done as part of other impact assessments that are required by regulations, while others are done apart from them. Who leads the process may be an expert, public institution, community organization, or other entity, depending on the specific project. The roles that policy-makers, stakeholders, and the public have in the work vary too, as do the ways HIAs are used to influence policy.
To be most effective, HIA is often done before a decision is made or a policy is implemented. The decision can be about a project, policy, or plan on a local, regional, state, or national scale. Our case stories show how HIAs have been carried out for projects at various levels across the country.
In the past, different groups have initiated HIAs – including public health agencies, community groups, advocacy organizations, affected stakeholders, other public agencies, or policy-makers – but what they held in common was concern that health be considered in a decision. HIA can also be required by project-specific legislation or to comply with environmental impact assessment regulations.
Because HIA can be described as a spectrum of practice, there is no standard cost for conducting one. Health Impact Assessments are highly tailored to work with individual budgets: rapid HIAs can cost as little as $10,000, while comprehensive HIAs can cost upwards of $150,000. Scale and approaches of HIA vary widely based on:
- The depth and breadth of issues analyzed
- The types of research methods used
- The extent to which stakeholders are involved in developing the HIA
- The way that HIA findings are used
- The relationship to regulatory requirements.
Each step in the HIA process has opportunities and needs for stakeholder participation. Stakeholders include individuals or groups with an interest in the outcomes of a decision focused on by the HIA. They may include sponsors of development projects, public health officials, government agencies responsible for implementing or enforcing policy, as well as residents, employees, or employers. Inclusive and meaningful participation of stakeholders helps the HIA process to identify relevant research questions, sources of data and information, and proposals for alternatives and mitigations.
Click here for a table of potential roles for stakeholders in the HIA process.
In 2006, the International Association of Impact Assessment outlined a set of values and principles for the practice of HIA (Quigley 2006):
- Democracy – Involve and engage the public, and inform and influence decision-makers
- Equity – Consider the distribution of health impacts, pay attention to vulnerable groups, and recommend ways to improve proposed decisions for affected groups
- Sustainable development – Judge short- and long-term impacts of a proposal
- Ethical use of evidence – Use evidence to judge impacts and inform recommendations, not to support or refute a proposal; be rigorous and transparent
- Comprehensive approach to health – Be guided by the wider determinants of health
When policymakers, project planners, community organizations, and advocacy groups participate in and have data from a Health Impact Assessment, decisions are better informed. Decisions have the opportunity to provide the best outcome for communities, especially those facing health inequities.
Generally, a completed HIA process produces a report. How and who communicates the findings and recommendations in the report will likely be shaped by the decision that the HIA wants to inform. For example, it may influence key messages (e.g., positive and negative impacts on health), messengers (e.g., public health expert, community members), audiences (e.g., stakeholders, decision-makers) use of media (e.g., letters, reports, press releases), and supplementary materials that are made available to the public (e.g., shorter summary).
HIA complements and has a similar procedure to Environmental Impact Assessment (EIA), which is legally required in some states and at the federal level. EIA is called for in some states through statutes such as the California Environmental Quality Act. At the federal level, the National Environmental Policy Act (NEPA) requires the document resulting from the EIA process, called an Environmental Impact Statement, to consider and analyze health effects of specified federal agency actions.
NEPA does not refer by name to “HIA” as a separate requirement per se, and the current practice of health analysis in Environmental Impact Assessments is limited. Given the legal mandate to consider health in the context of an inter-disciplinary Environmental Impact Assessment, HIA can be an appropriate way to meet statutory requirements for health effects analysis.
Read the FAQs about Integrating HIA into EIA.
HIA is different from other forms of stand-alone assessment or forecasting methods. However, these other forms may be used within a HIA.
- Community health assessment is the ongoing process of regular and systematic collection, assembly, analysis, and distribution of information on the health needs of the community. Generally, community health assessments gather statistics on health status as well as data on community health needs/gaps/problems and assets. Within HIA, community health assessments both support policy analysis and development and existing conditions analysis.
- Health risk assessment, as practiced, is a quantitative analytic method used to characterize the nature and magnitude of health risks associated with exposures to chemical contaminants and other environmental substances and processes. Health risk assessments are not comprehensive, but health risk assessment conclusions can be used within HIA to forecast effects of specific exposures.
This is an evolving topic. As of 2013, few places legally require HIA. Examples for select states are below. However, there is growing legal support for HIAs through laws that open the door for their use. See a review of this topic by the Health Impact Project & Arizona State University.
California – No specific legal or regulatory requirements for HIA exist in California.
Some environmental laws for planning and development require analysis of select health impacts. For example, the California Environmental Quality Act requires that all potential environmental changes that can result in significant adverse impact on humans or public health must be addressed in an environmental impact report. (Section 15126.2 (a); Section 15065)
HIA may also help fulfill the implementation of rules for social or community impact assessment. For example, where project areas contain low- or moderate-income housing, California Redevelopment Law requires a neighborhood impact report which describes in detail the impact of the redevelopment plan “…upon the residents of the project area and the surrounding areas, in terms of relocation, traffic circulation, environmental quality, availability of community facilities and services, effect on school population and quality of education, property assessments and taxes, and other matters affecting the physical and social quality of the neighborhood.”
Massachusetts – HIA is required in Massachusetts for specific transportation projects through the Massachusetts’ Healthy Transportation Compact, established by statute in 2009.
Washington – HIA is required for applicants in the state of Washington who seek approval to build new or modify existing units that emit toxic air pollution and cannot show they will comply with the state’s air impact requirements. Also, a bill passed in 2007 required an HIA as part of the planning process for replacing the State Route 520 bridge in Seattle.
HIA considers a broad set of social and environmental factors that affect the health of community members. A big picture view is critical because many policy and land use decisions affect health; even ones that don’t seem specifically about health—like the effect new roadways have on the safety of pedestrians and bicyclists or how the spread of disease in a community can change depending on if local workers have paid time off.
Most public decisions affect health – either directly or indirectly through their influence on social, economic, or environmental conditions. To account for these consequences a HIA can include physical and mental health issues like mortality and disability, but also behavioral, family, neighborhood, public, environmental, economic, and political factors. HIA may analyze a broad array of issues, but must contribute to understanding explicit connections between the decision at hand and health outcomes on communities.
HIA is an emerging practice in the United States. Thus far, HIAs have mostly been applied to the built environment, meaning the spaces created by humans, such as buildings, parks, roads, and the infrastructure that supports them. There is abundant evidence that land use, transportation, and community design have significant and wide-ranging impacts on the environment and health. Despite similar and complementary objectives, land use planning, environmental protection, and public health agencies typically have little communication on many public and environmental health issues. While it seems commonsense that major decisions about the built environment should be judged against their potential health benefits and burdens, this does not always happen and city and regional planning agencies do not necessarily have the resources or expertise to assess the health impacts of planning. As such, public health practitioners have begun using HIA as a tool to fill this gap.
However, another role for HIA is to provide a health perspective to policy decisions. To that end, Human Impact Partners has completed policy HIAs. While some policies target health directly, many affect public health indirectly by shaping social, economic, and environmental conditions. By defining and quantifying a policy’s expected effects on public health, a HIA can have healthy and far-reaching influences on society. Learn more about how HIA can lead to smarter and more effective policies by reading our case stories.
they often ask how to fund an ongoing HIA program. Below are ideas based on our experiences at HIP and from a few partners. We invite you to contact us with additional ideas.
1. Public and Private Foundations
Examples of foundations that have supported HIAs include:
- Blue Cross/Blue Shield of Minnesota Foundation. Blue Cross/Blue Shield Foundations in many other states could be cultivated as well
- The California Endowment
- The Annie E. Casey Foundation
- Health Impact Project (Robert Wood Johnson Foundation & Pew Charitable Trusts)
- The Kresge Foundation
- The Jacob & Valeria Langeloth Foundation
- Liberty Hill Foundation
- Marin Community Foundation
- Northwest Health Foundation
- Robert Wood Johnson Foundation
- The W.K. Kellogg Foundation
2. Government Grants
Increasingly, funding available through grants from federal and state agencies may be used for HIA. Federal programs such as Communities Putting Prevention to Work and grants made by the HUD/DOT/EPA Sustainable Communities effort specifically call out HIA as an approved activity. The Federal Transportation Authority has funded an HIA effort. The CDC has also funded and is continuing to fund HIA efforts. Through a grant from the CDC, the Association of State and Territorial Health Officials (ASTHO) has been able to support some HIA work around the country as well.
Some proposed legislation at the state level (e.g., in Minnesota) would allocate tobacco settlement funds for an HIA grant program.
Organizations interested in HIA must make an effort to ensure that more state and federal funding opportunities include HIA as an approved activity.
3. Fee for service funding
Local planning agencies collect fees and have other sources of revenue to support their analyses of proposed land use plans and projects. These funds can be used for HIAs on these proposals, especially when requests for proposals (RFPs) for the development of such plans include a call for analysis of health impacts. Oakland is an example of a city that has provided such opportunities (see for example: Oakland Estuary)