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Health Impact Assessment

	people walking and bikingHealth impact assessment (HIA) is a tool that can help communities, decision makers, and practitioners make choices that improve public health through community design.

CDC’s Healthy Community Design Initiative is the only source of federal expertise to help states and communities integrate health considerations into transportation and community planning decisions. Learn more about the Healthy Community Design Initiative's funded HIA programs and HIA accomplishments.

In the United States, HIA is a rapidly emerging practice among local, state, and federal jurisdictions. A list of completed and in progress HIAs in the United States is available at

What Is HIA?

HIA is a process that helps evaluate the potential health effects of a plan, project, or policy before it is built or implemented. HIA brings potential positive and negative public health impacts and considerations to the decision-making process for plans, projects, and policies that fall outside traditional public health arenas, such as transportation and land use. An HIA provides practical recommendations to increase positive health effects and minimize negative health effects.

The major steps in conducting an HIA include

  • Screening (identifying plan, project, or policy decisions for which an HIA would be useful).
  • Scoping (planning the HIA and identifying what health risks and benefits to consider).
  • Assessment (identifying affected populations and quantifying health impacts of the decision).
  • Recommendations (suggesting practical actions to promote positive health effects and minimize negative health effects).
  • Reporting (presenting results to decision makers, affected communities, and other stakeholders).
  • Monitoring and evaluation (determining the HIA’s impact on the decision and health status).

HIA is usually voluntary, though several local and state laws support the examination of health impacts in decision making and a few explicitly require the use of HIA. HIA is different from a public health assessment, a health risk assessment, and an environmental impact assessment. Learn more about the different types of health assessments.

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 An Important Assessment Tool

HIA is a useful tool to assess how a proposed decision will affect the health of a population and whether vulnerable populations are more likely to be impacted [or whether the health impacts are distributed evenly within the population]. The goal of HIA is to provide recommendations during the decision-making process that will protect health and reduce health inequities. Below are examples of how HIA has been recommended as an important assessment tool.

CDC cosponsored the 2011 National Research Council report Improving Health in the United States: The Role of Health Impact Assessment, which found that the HIA holds promise for incorporating aspects of health into decision making because of its

  • Applicability to a broad array of policies, programs, plans, and projects.
  • Consideration of adverse and beneficial health effects.
  • Ability to consider and incorporate various types of evidence.
  • Engagement of communities and stakeholders in a deliberative process.

The U.S. Department of Health and Human Services recommends HIA as a planning resource for implementing Healthy People 2020.

Step it Up! The Surgeon General’s Call to Action to Promote Walking and Walkable Communities recommends the use of HIA to enhance planning and evaluation processes for community interventions.

HIA supports two key directions of the Office of the Surgeon General’s National Prevention Strategy: Building Healthy and Safe Community Environments and Empowering People to Make Healthy Choices[PDF - 4.67 MB].

The CDC transportation recommendations state that HIA may be a useful tool for identifying the impact of a new policy, program, or major transportation project on community and individual health.

HIA can be a valuable tool for use in a Health in All Policies approach to decision making. Examples include the following:

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