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Different Types of Health Assessments

This page explains different types of health assessments and how they relate to health impact assessment (HIA).

Health Impact Assessment

Health impact assessment (HIA) is used to evaluate the public health consequences of proposed decisions in non-health sectors. HIA is a systematic process that uses an array of data sources and analytic methods and considers input from stakeholders to determine the potential effects of a proposed policy, plan, program, or project on the health of a population and whether the health effects are distributed evenly within the population. HIAs provide practical recommendations for how to minimize negative health effects and maximize beneficial health effects. [Source: National Academies Press]
HIA should be distinguished from other health assessment methodologies, described below, that can be used during or after an HIA.

Community Health Assessment

A community health assessment, or community health needs assessment, is a systematic examination of the health status indicators for a given population that is used to identify key problems and assets in a community. The ultimate goal of a community health assessment is to develop strategies to address the community’s health needs and identified issues. Community health assessment is a prerequisite for tribal, state, local, or territorial public health departments seeking voluntary accreditation. A variety of tools and processes may be used to conduct a community health assessment; the essential ingredients are community engagement and collaborative participation. [Source: Public Health Accreditation Board]

Data obtained on health status and community health needs and assets during a community health assessment can be used in an HIA to describe the existing health status of the affected population.

Cost-Benefit Analysis

Cost-benefit analysis is a type of economic evaluation that measures both costs and benefits (i.e., negative and positive consequences) associated with an intervention in dollar terms.
Because HIA typically does not examine the costs associated with its recommended strategies to promote health and mitigate adverse health impacts, a cost-benefit analysis could be conducted to help decide which HIA recommendations are the most feasible. For more information, see CDC’s Introduction to Prevention Effectiveness.

Environmental Impact Assessment

Environmental impact assessment (EIA) is the process of identifying, predicting, evaluating and mitigating the biophysical, social, and other relevant effects of proposed developments prior to major decisions being made. EIAs are currently a requirement in most countries. [Source: International Association of Impact Assessment]

In the United States, the National Environmental Policy Act (NEPA) requires federal agencies to integrate environmental values into their decision-making processes by considering the environmental impacts of their proposed actions and reasonable alternatives to those actions. To meet NEPA requirements, federal agencies first prepare an environmental assessment (EA) to determine whether a more thorough environmental impact statement (EIS) is needed. For more information on NEPA, visit the U.S. Environmental Protection Agency website.

NEPA requires consideration and analysis of health effects of specified federal agency actions within the EIA process. Although NEPA does not refer to HIA as a separate requirement, HIA can be an appropriate way to meet statutory requirements for health effects analysis when conducted within the context of an interdisciplinary EIA.

Bhatia and Wernham (2008) reviewed the purpose and procedures of EIA, existing regulatory requirements for health effects analysis, and potential barriers to and opportunities for improving integration of human health concerns within the EIA process. The authors suggested that EIA might be an unrealized opportunity for improving environmental health and justice.

Human Health Risk Assessment

A human health risk assessment is a quantitative, analytic process to estimate the nature and risk of adverse human health effects associated with exposure to specific chemical contaminants or other hazards in the environment, now or in the future. For more information, see the U.S. Environmental Protection Agency website.

Human health risk assessments are not comprehensive and tend to focus on biophysical risks from exposure to hazardous substances. Results from a human health risk assessment can be used within an HIA to predict human health effects of specific exposures.

Public Health Assessment

The Agency for Toxic Substances and Disease Registry (ATSDR) developed the public health assessment process for evaluating the public health implications of exposures to environmental contamination. A public health assessment is formally defined as “The evaluation of data and information on the release of hazardous substances into the environment in order to assess any past, current, or future impact on public health, develop health advisories or other recommendations, and identify studies or actions needed to evaluate and mitigate or prevent human health effects” [Source: 42 Code of Federal Regulations, Part 90]. See the ATSDR Public Health Assessment Guidance Manual for more information.

Findings from a public health assessment can be used within an HIA to predict human health effects of specific exposures.