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Health Impact Assessment

    children riding bikes Health impact assessment (HIA) is commonly defined as “a combination of procedures, methods, and tools by which a policy, program, or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population” (1999 Gothenburg consensus statement, http://www.euro.who.int/document/PAE/Gothenburgpaper.pdf [PDF, 138KB] [external link]).

    HIA is used to evaluate objectively the potential health effects of a project or policy before it is built or implemented. HIA can provide recommendations to increase positive health outcomes and minimize adverse health outcomes. The HIA framework is used to bring potential public health impacts and considerations to the decision-making process for plans, projects, and policies that fall outside of traditional public health arenas, such as transportation and land use.

    The major steps in conducting an HIA include

    • Screening (identify projects or policies for which an HIA would be useful),
    • Scoping (identify which health effects to consider),
    • Assessing risks and benefits (identify which people may be affected and how they may be affected),
    • Developing recommendations (suggest changes to proposals to promote positive or mitigate adverse health effects),
    • Reporting (present the results to decision-makers), and
    • Evaluating (determine the affect of the HIA on the decision).

    HIA is similar in some ways to environmental impact assessment (EIA). The EIA process is mandated by the National Environmental Policy Act (NEPA) which requires federal agencies to consider the environmental impact of their proposed actions on social, cultural, economic, and natural resources prior to implementation. HIA, unlike EIA can be a voluntary or a regulatory process that focuses on health outcomes such as obesity, physical inactivity, asthma, injuries, and social equity. HIA has been used within EIA processes to assess potential impacts to 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 [external link].

    HIA consists of a diverse array of qualitative and quantitative methods and tools. Desktop and rapid HIAs can be completed in a few days or weeks while comprehensive HIAs may require months. The decision to conduct a rapid or a full HIA is often determined by available time and resources.

    In the United States, HIA is a rapidly emerging practice. HIA in the United States is being conducted and advanced through efforts at the San Francisco Department of Public Health, Alaska Inter-Tribal Council, the University of California Los Angeles, King County in Washington state, Multnomah County in Oregon, the Robert Wood Johnson Foundation, Pew Charitable Trusts, CDC, and other federal, state, tribal, and local partners.

    HIA is also regularly performed in Europe, Canada, and elsewhere. Some countries have mandated HIA as part of a regulatory process; others use it on a voluntary basis.

    For more information about health impact assessment, refer to the following resources:

    Fact Sheet

    • Health Impact Assessment fact sheet [PDF, 80KB]
      This CDC fact sheet describes the Health Impact Assessment process and its value in objectively evaluating a project or policy before it is built or implemented.

    HIA General Information and Clearinghouses

    On-line Courses and University Education

    • Planning for Healthy Places with Health Impact Assessments [external link]
      This online course explains the value of conducting an HIA and the steps involved in conducting an HIA. The course, developed by the American Planning Association and the National Association of County & City Health Officials, was funded by the Centers for Disease Control and Prevention.
    • UC Berkeley Health Impact Group [external link]
      The UC Berkeley Health Impact Group (UCBHIG) is a non-partisan, independent collective whose mission is to promote the field of Health Impact Assessment through advocacy, education, research, and community outreach. UCBHIG’s work focuses largely on the development of qualitative and quantitative tools.
    • Botchwey N, Hobson S, Dannenberg AL, Mumford KG, Contant CK, McMillan TE, Jackson RJ, Lopez R, Winkle C. A Model Built Environment and Public Health Course Curriculum: Training for an Interdisciplinary Workforce [PDF, 104 KB] [external link]. American Journal of Preventive Medicine. 2009;36(2S):S63–S71.
    • Built Environment + Public Health : Course Curriculum [external link]
      This CDC-funded Web site an interdisciplinary undergraduate, graduate, or continuing education curriculum in public health and built environment. This curriculum is flexible enough to be offered as a full semester course, individual units or single class modules or individual assignments. This Web site also provides opportunity for faculty and other users to share comments, amendments and develop collaborations at the intersection of the built environment and health.

    Methodology, Tools, and Evidence for Practice

    • Human Impact Partners [external link]
      A nonprofit project of the Tides Center, the purpose of this site is to raise awareness of and collaboratively use innovative data, processes and tools that evaluate health impacts and inequities in order to transform the policies, institutions and places people need to live healthy lives.
    • Healthy Development Measurement Tool [external link]
      This tool, created by San Francisco Department of Public Health, Program on Health, Equity and Sustainability, is a comprehensive evaluation metric to consider health needs in urban development plans and projects.
    • Design for Health [external link]
      A collaborative project between the University of Minnesota [external link], Cornell University [external link], and the University of Colorado [external link] that serves to bridge the gap between the emerging research base on community design and healthy living and the everyday realities of local government planning.
    • Cole BL, Shimkhada R, Fielding J, et al. Methodologies for Realizing the Potential of Health Impact Assessment. Am J Prev Med 2005;28(4):382–389.

      Abstract: Health impact assessment (HIA), a systematic assessment of potential health impacts of proposed public polices, programs, and projects, offers a means to advance population health by bringing public health research to bear on questions of public policy. The United States has been slow to adopt HIA, but considerable strides have been made in many other countries, and under the auspices of the World Health Organization and World Bank. Varied applications in these diverse milieu have given rise to diverse approaches to HIA—quantitative/analytic, participatory, and procedural—each with distinct disciplinary foundations, goals, and methodologies. Suitability of these approaches for different applications and their challenges are highlighted, along with areas in which methodologic work is most needed and most likely to advance the field from theory and infrequent application to more routine practice in the United States.

    HIA & Environmental Impact Assessment

    • Bhatia, R and Wernham, A. Integrating Human Health into Environmental Impact Assessment: An Unrealized Opportunity for Environmental Health and Justice. Environmental Health Perspectives. 2008;116(8): 991-1000. http://www.ehponline.org/docs/2008/11132/abstract.html [external link]

    HIA & Public Policy Development

    • Health Impact Assessment Information & Insight for Policy Decisions [external link]
      This joint endeavor of the Partnership for Prevention and researchers at the UCLA School of Public Health aims to assess the feasibility of HIA and to develop prototype HIAs that demonstrate methodologies, eventually enabling HIA to contribute to more informed decision-making about public policies impacting health in the U.S.

    HIA Research for Practitioners

    • Dannenberg AL, Bhatia R, Cole BL, et al. Growing the field of health impact assessment in the United States: an agenda for research and practice. Am J Public Health. 2006;96(2):262-70.

      Abstract: Health impact assessment (HIA) methods are used to evaluate the impact on health of policies and projects in community design, transportation planning, and other areas outside traditional public health concerns. At an October 2004 workshop, domestic and international experts explored issues associated with advancing the use of HIA methods by local health departments, planning commissions, and other decision makers in the United States. Workshop participants recommended conducting pilot tests of existing HIA tools, developing a database of health impacts of common projects and policies, developing resources for HIA use, building workforce capacity to conduct HIAs, and evaluating HIAs. HIA methods can influence decision makers to adjust policies and projects to maximize benefits and minimize harm to the public’s health.
    • Dannenberg, et al. Use of Health Impact Assessment in the U.S.: 27 Case Studies, 1999-2007. Am J Prev Med 2008;34(3):241–256. Use of Health Impact Assessment in the U.S. 27 Case Studies, 1999–2007 [PDF, 390KB]

      CDC scientists examined 27 Health Impact Assessments (HIAs) that were completed in the U.S. between 1999 –2007. HIAs help planners and others consider the health consequences of their decisions

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