An Evaluation of Health Impact Assessments in the United States, 2011 - 2014

Logic model of a typical health impact assessment (HIA). The evaluators developed the logic model to depict the intermediate and long-term outcomes that HIAs are designed to achieve and guide development of data collection instruments. The activities are aligned with the recommended 6-step HIA framework (footnote 1). The logic model is divided into 5 vertical sections labeled Inputs, Activities, Outputs, Intermediate Outcomes, and Long-Term Outcomes. The sections flow in a stepwise fashion from left to the right, starting with the first section, which lists the resources needed to conduct an HIA; an arrow to the next section lists the specific activities the HIA team will carry out with an arrow to the outputs that would occur as a result of the activities. Finally, arrows to the last 2 sections describe the changes one might see as a result — the outcomes. Each section has a box below each of the 5 headers as follows:

Inputs:

Boxes beneath the header are labeled public health resources; other public and private sector resources (eg, transportation, energy, housing, agriculture, education); community resources (footnote 1); legislative and regulatory resources; information systems; scientific expertise; foundation funding and technical assistance.

Activities:

Boxes beneath the header are labeled 1. Screening, 2. Scoping, 3. Assessment, 4. Recommendations, 5. Reporting, 6. Monitoring and Evaluation.

Outputs:

Under the Outputs header, boxes of text define each of the 6 boxes under Activities as follows:

1. Screening: Opinions gathered regarding timeliness and opportunity for an HIA to inform decisions; resource requirements identified; decision made to proceed with an HIA.
2. Scoping: Scope and objectives of the HIA defined; data sources and analysis methods identified; HIA team established; partnerships identified; cross-sector communication links developed; stakeholder engagement plan in place; mechanism for engaging experts in place.
3. Assessment: Literature and evidence review completed; related HIAs identified and reviewed; baseline population and environmental profiles established; vulnerable populations’ perspectives included; information from experts gathered and synthesized; potential impacts assessed and analyzed.
4. Recommendations and 5. Reporting: Actionable recommendations and plan for implementation established; recommendations made publicly available and reached appropriate audiences.
5. Monitoring and evaluation: Monitoring system set up; process evaluated and short-term impact assessed,

Intermediate outcomes:

Under the Intermediate Outcomes header, boxes of text are as follows:

• Decisions made to modify policy or project as recommended in the HIA.
• Enduring cross-sector coalitions and partnerships established; community capacity built (footnote 2).
• Attitudes changed.
• Common language and new ways of framing health issues developed.
• Health objectives included in nonhealth sectors’ plans, policies, and programs.
• HIA results and tools widely disseminated.
• Surveillance systems with data resources established.

Long-Term Outcomes:

Two boxes under the Long-Term Outcomes heading are connected with a vertical arrow.

Box 1:

• Policy or project implemented or enforced as recommended.
• Organizational policies and procedures changed.
• Improved physical and/or economic environment.
• Policy or project spread beyond geographic area of original HIA.

Box 2:

• Reduced health disparities and improved health equity.
• Increased participatory democracy and equitable decision making.
• Improved population health (footnote 3).

Two 2-way vertical arrows running from top to bottom of the model are labeled “Engagement with policy and project proponents and decision makers” and “Engagement with key stakeholders, including those affected by policy or project.”

A 2-way horizontal arrow running across the bottom of the model from the Activities column to the Long-Term Outcomes column is labeled “Political, social, economic, and environmental factors that can facilitate or hinder HIAs.”

1. Includes financial resources, staffing, technical assistance, local knowledge, and advocacy.
2. Improved capacity to conduct HIAs, enhanced decision-making ability.
3. Outcomes that are not within the scope of this evaluation.

Figure 1. Logic model of a typical health impact assessment (HIA). The evaluators developed the logic model to depict the intermediate and long-term outcomes HIAs are intended to achieve and to guide development of the data collection instruments. The activities are aligned with the recommended six-step HIA framework (1). ¹ Includes financial resources, staffing, technical assistance, local knowledge, and advocacy. ² Improved capacity to conduct HIAs, enhanced decision-making ability. ³ Outcomes that are not within the scope of this evaluation.

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