Health Impact Assessment: International Best Practice Principles. Findings of each stage of the HIA and a summary of outputs at the end of each stage. 2005; Frank et al. The HIA drew on public testimony, literature review, and accepted mechanisms of health and illness to establish the scope of health concerns that should be considered. Past Projects: Paid Sick Days Legislation. Although a wide variety of excellent resources on community health assessment and CQI currently exist, those materials generally do not link assessment and CQI concepts and techniques in the way that is envisioned for . As noted above, the iterative process is known as adaptive management in the field of environmental management. The various categories of HIAs, although useful for describing distinct themes in the field, do not necessarily represent consistently distinct strains of practice. Cole BL, Shimkhada R, Fielding JE, Kominski G, Morgenstern H. Methodologies for realizing the potential of health impact assessment. World Bank. In this report, HIA practitioner refers to the person (or people) involved in conducting an HIA. Monitoring should provide information that allows one to conduct the evaluations noted above. The committee concludes that the following are the most important factors to consider in determining whether to do an HIA: Ultimately, the HIA report should provide a rational and consistent explanation of how proposals are selected for screening. FOIA That issue is discussed at greater length in Chapter 4. Health and impact assessment: Are we seeing closer integration. Cookies used to make website functionality more relevant to you. A community health improvement plan is critical for developing policies and defining actions to target efforts that promote health. To provide this care as a community health nurse, you need to continually acquire knowledge, refine skills, and assess yourself. Bookshelf Shortened life expectancy associated with air pollution. The final HIA report describes each factor (see below) and presents the results of the scoping. Cancer risk associated with exposure to hazardous chemicals. Another variation, rapid-appraisal HIA, has been described and in some texts includes explicit public engagement through an initial half-day workshop for stakeholders (Parry and Stevens 2001; Mindell et al. As described by Ross (2007, p. 9), the Atlanta BeltLine is a transit, trails, parks, and redevelopment project that uses a 22-mile loop of largely abandoned freight rail line that lies between two and four miles from the city center and affects about 45 neighborhoods. Section 1508.27). The baseline profile characterizes the health status of affected populations and includes trends and factors (social, economic, and environmental) known to affect health. On the basis of its review, the committee synthesized the information from guidance, practice, and literature to propose criteria that define an HIA and draw several conclusions regarding HIA practice. Health impact assessments are needed in decision making about environmental and land-use policy. HIA guidance often points out the need for monitoring and continuing management and verification that mitigation measures are being implemented. The source of public funding for the project was the Tax Allocation District (TAD), and only within the districts boundaries could funding be collected and bond money spent. Personal (income, employment; can include occupational risk), Revenue or expense to local, state, or tribal government (support for or drain on services, infrastructure), Need for new roads and transit, water, or sanitation systems, New services as a direct result of proposal, Drain on existing services resulting from proposed action. It may lack the objectivity and rigor of an external evaluation conducted by an experienced evaluator, but it is important because it contributes to a database that informs other efforts in the field and provides basic information about the applications of HIA, the methods and strategies used by HIA practitioners, and the success of and challenges to its use. It characterizes health effects according to their nature, direction, intensity, magnitude, distribution, timing and duration, and likelihood. Community Health Assessment Toolkit. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services. From Principles to Consider for the Implementation of a Community Health Needs Assessment Process [PDF 457KB] (June 2013), Sara Rosenbaum, JD, The George Washington University School of Public Health and Health Services, Department of Health Policy. Such programs and projects involve many agencies and entities that have authority over some aspect of planning and implementation. If the HIA is based on a thorough analysis, provides complete information so that community members are able to critique the analysis, and is conducted openly, it may provide reassurance to affected communities even if the conclusions do not support the communitys concerns. Neidell M. Information, avoidance behavior, and health: The effect of ozone on asthma hospitalizations. sharing sensitive information, make sure youre on a federal Even when there is substantial uncertainty, an assessment can illuminate potential causal pathways thateven when there appear to be conflicting influences on a specific outcomecan point the way toward a flexible framework for monitoring and managing any impacts that might occur as the proposal is implemented. Public Health: What It Is and How It Works. A lack of access to needed goods and services. Understanding Risk: Informing Decisions in a Democratic Society. Accessibility The assessment phase includes two tasks. Scoping considers input from many sources, including preliminary literature searches, public input, and professional or expert opinion in fields relevant to the proposal. An HIA does not have to accept community concern uncritically. The available data, however, may not be sufficient, and the HIA team may make a decision to dedicate resources to collection of new data. Noncommercial use of original content on www.aha.org is granted to AHA Institutional Members, their employees and State, Regional and Metro Hospital Associations unless otherwise indicated. Screening should also consider whether a proposal conforms with applicable standards, policies, or laws relevant to health inasmuch as there is a wide variety of them that bear directly or indirectly on health. Thank you for taking the time to confirm your preferences. Epub 2018 Jun 19. It includes the information that was taken into account and the final output of the screening process, which was a decision on whether to commission and proceed with an HIA. HIA and national policy in the Netherlands. A variety of information was used to inform the process, Scoping: Atlanta BeltLine HIA. As a final note, it is important to remember the context in which HIAs are conducted when considering the recommendations phase. Recommendations form the core of a health-management plan, but the plan also determines authority for and assigns responsibility for implementing each recommendation, establishes a monitoring plan, and creates or suggests mechanisms to verify that assigned responsibilities are being met. Quigley RJ, Taylor LC. Process evaluation can range from a simple self-assessment that is undertaken at the end of an HIA and focuses on a few variables that are relatively simple to describe, track, or measuresuch as the methods used, degree of certainty of predictions, and approach to stakeholder engagementto a more comprehensive case study that seeks to evaluate the HIA process holistically. official website and that any information you provide is encrypted However, where practical, the HIA team should aim to evaluate a variety of alternatives or, minimally, to identify the characteristics of proposed actions that would be health-protective or detrimental to health. It identified which areas and villages were most likely to be affected and when. Thus, the assessment phase is separated from the management phase, as recommended elsewhere (NRC 1983). other key elements that will be important for the work moving forward. The second task is to analyze and characterize effects on health and its determinants for the proposal and for any alternatives under consideration relative to the baseline and to each other. Discuss what entity has the authority or ability to implement each measure and document any commitments to do so. Box 3-2 provides an example of scoping for the HIA of a proposed development in Atlanta. Public concern or controversy regarding health effects of the proposed decision. The committee notes that in any assessment, it would be difficult or impossible to quantify all potential health impacts. Major issues and challenges for HIA development and practice are considered in Chapter 4. Qualitative data can be gathered through, for example, focus groups, one-on-one interviews, surveys, individual meetings with stakeholder organizations, testimony in community meetings, Web-based or other written input, and running a stand or exhibition in a public place. Those pathways and others were evaluated by using public-health data, literature on analogous populations, knowledge about accepted mechanisms of health and disease, witness testimony, and the effects analysis of other resources. . The opportunity to bring health information into a decision-making process that may otherwise not include this information. The committee considers self-evaluation and independent evaluation to be essential for moving the field ahead. There could also be concerns that disclosure of such information would lead to litigation. HIAs are also differentiated according to whether they are integrated into an environmental impact assessment or done independently. This chapter has described HIA categories, defined HIA, discussed current HIA practice, noted variations in practice, and provided the committees conclusions regarding each step of the HIA process. Although completed HIA reports are readily available, peer-reviewed or gray literature that discusses the impacts of specific HIAs is still rare. It is not reasonable to expect decision-makers to adopt HIA widely in the absence of evidence of its effectiveness and value. Another issue that should be addressed in scoping is identifying alternatives to the proposed action. Decision-making is rarely based solely on scientific evidence but instead takes into account an array of political, economic, technical, and practical considerations. National Library of Medicine The associations between expected disturbances and changes in health were then analyzed in more depth to look at the alternatives proposed for the expansion and at the cumulative effects of oil exploration and extraction. Improving community health starts with knowing the factors that impact people's health, both inside and outside of the clinic. Past Projects: Vehicle Miles Traveled Legislation. Collaboration with decision-makers or consultation with experts familiar with the legal or regulatory context may be the most effective way to ensure that recommendations are pragmatic and can be practically incorporated into the decision-making process. It is also useful to assess the political context of the proposal to be assessed and consider, for example, the major political drivers of the proposal, the arguments made by political supporters and those opposed to the proposal, and any economic or technical constraints that limit the alternatives that can be considered. The fact, however, that the team conducting the HIA is aware of the decision context allows the assessment to be decision-relevant. Action plans have mutually reinforcing activities. Source: ICMM 2010. Improving relationships and collaboration between stakeholders. For example, the chair of the California Assembly Labor Committee referred to the HIA and asked the opposition to the bill if they condoned the spread of disease through restaurant workers.. The committee concludes that when alternatives to the proposal being assessed are under consideration, the HIA team should assess the impacts of each alternative. For example, rather than providing an estimate of lung-cancer rates in a small community, an HIA might identify smoking rates and important sources of airborne pollutants in the communitys airshed. Health impact assessment: A tool for healthy public policy. For example, in Oregon, an independent health-oriented nonprofit organization conducted an HIA of a series of proposals to reduce vehicle miles traveled in a bill intended to reduce greenhouse- gas emissions (UPH 2009). The HIA conclusions and recommendations should be presented in a manner that is clear and easily understood. Harris P, Harris-Roxas B, Harris E, Kemp L. Harris-Roxas B, Harris E. Differing forms, differing purposes: A typology of health impact assessment. HIAs conducted as part of a formal government process are generally subject to disclosure and freedom-of-information requirements. Fifth, transparent reporting of possible environmental and health impacts has proved in many studies to lead to risk reduction because it motivates changes, such as improved pollution controls, on the part of industry and governments (Wolf 1996; Bennear and Olmstead 2008; Vaccaro and Madsen 2009). However, decision-makers are often overwhelmed by today's proliferation of fragmented indicator sets. Integrates stakeholder input into the analysis of effects. Health-supportive measures that would generally support health but are not tied directly to a specific impact (for example, building a clinic in an underserved neighborhood that would be adversely affected by emissions from a new freeway). In practice, therefore, the HIA team will be asking a decision-maker to consider the findings and recommendations. Describes data sources and analytic methods and methods used to engage stakeholders. Instead, the committee focused its review on the characterization of effects and the use of evidence, although several recommendations to improve the quality of analysis are discussed in Chapter 4. PMC Industrial proponents, government decision-making agencies, local health departments, and independent organizations (such as universities and nongovernment organizations) may all be in a position to implement measures recommended in the HIA. The core issues that are commonly addressed are as follows: Some HIA guides recommend using a matrix, such as those shown in Tables 3-2 and 3-3, to characterize effects (Harris et al. 2005 and Bhatia and Seto 2011. These 7 components are oftentimes divided into three stages: (1) information, research, and data collection stage, (2) a prioritization and strategy design stage, and (3) an implementation and action stage. For that reason, it is important for the field to define the circumstances under which outcome evaluation may be practicable. Before discussing the various elements of HIA, it is important to understand the context in which HIA is undertaken in the United States. Alerting decision-makers to the more general need to focus on health in future decisions. Bhatia R. A Guide for Health Impact Assessment. As part of the assessment phase, a set of specific indicators that can be used to describe the baseline and potential changes in health status or health determinants should be developed. For that reason, it is important that scoping begin with a systematic consideration of all potential effects rather than limiting consideration to a subset of issues predetermined by the teams research interests or regulatory requirements. In each case, it is important to determine how the standards, policies, programs, and laws bear on how health is factored into a proposal. Northeast National Petroleum Reserve-Alaska, Supplemental Integrated Activity Plan, Record of Decision. A large and growing body of quantitative evidence is available; where specific additional information is needed and resources are available, HIA teams may collect new quantitative data in the course of conducting an assessment. It would then fall to the decision-makers to determine routes that met those criteria. Most vulnerable populations: Less information was provided about this step. The variability also reflects a lack of clear criteria that define HIA as a distinct field. Furthermore, impact assessments, including HIAs, may rely on proprietary business information whose disclosure is legally barred or could damage a proponents business edge or competitiveness. IPIECA/OGP (International Petroleum Industry Environmental Conservation Association and International Association of Oil and Gas Producers). A smaller set of related indicators was endorsed for use in monitoring key elements of community health status (CDC, 1991). 2003; ICMM 2010). 2009; Bhatia et al. A statement of why the proposal was selected for screening. ACTION STEP 1: Assemble the Community Team Representation from diverse sectors is key ACTION STEP 2: Develop Team Strategy Decide whether to complete CHANGE as a whole team or divide into subgroups Benefits include An HIA, however, might not provide any recommendations; this could occur if the HIA failed to reveal any important health effects. 1. Reporting is the communication of the findings and recommendations of an HIA to decision-makers, the public, and other stakeholders. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. [online] Available: ICMM (International Council on Mining and Metals). A plan for continuous monitoring, adaptation of mitigation measures, and verification of performancealthough not currently a uniform aspect of HIA practice helps to ensure that measures are carried out and achieving their objectives. Although deviation from the criteria may occur, a valid and clearly articulated rationale for such deviation should be described when the HIA is reported. HIAs are also done by private consultants who are hired by a project proponent or decision-maker or by private-industry stakeholders. HIA recommendations take various forms, and some examples are provided below. Although less common to date, HIAs are also sometimes conducted by a decision-making agency, such as a metropolitan planning organization or a federal agency complying with NEPA. Stakeholders, however, may have insights into local conditions and potential solutions for addressing concerns raised by the proposal under consideration. The ideal community health status assessment consists of three components: a household survey, community discussion groups, and an examination of existing data (secondary data) from a variety of other . Screening should result in a simple statement that includes the following: Screening is essential for high-quality HIA. A variety of planning and zoning, funding, and environmental regulatory decisions were required for the BeltLines various components to be developed. For example, U.S. priorities for improving public health are expressed in the Healthy People 2020 Program of the U.S. Department of Health and Human Services (DHHS 2010). The HIA team identified the following critical issues that could affect the health of the study area population: access and social equity, physical activity, safety, social capital, and environment (including air quality, noise, and water management). An official website of the United States government. Box 3-4 provides several examples of topics that have been addressed in HIA by using quantitative methods. For example, the San Francisco Department of Public Health routinely screens major projects and plans to ensure adequate analysis and mitigation of environmental health impacts. The impacts of right-to-know: Information disclosure and the violation of drinking water standards. Identifying high-priority issues has been addressed in numerous contexts outside HIA, including human-health and ecologic risk assessment (see, for example, EPA 1989, 1992; NRC 1996, 2009). 2007; Bhatia 2010). Describes the baseline health status of the affected population with appropriate indicators, including prevalent health problems, health disparities, and social, economic, and environmental factors that affect health. Although little has been written on the reasons for keeping HIA information confidential, the committee recognizes that there may be reasons for organizations conducting HIAs to decide not to disclose the results. Assessing and addressing community health needs. Developing new cross-disciplinary and interagency collaborations. The World Bank Policy on Access to Information. Open communication is necessary to build trust and ensure mutual objectives. Practice implications include better understanding of different models and requirements by health departments, hospitals, and others involved in assessment and planning to improve cross-sector collaboration, collective impact, and community health. Morgan RK. The National Partnership for Women and Families commissioned Human Impact Partners and researchers at the San Francisco Department of Public Health to conduct an HIA of the federal Health Families Act of 2009, (more). An initial brief summary of the pathways through which health could be affected and the health effects to be addressed, including a rationale for how the effects were chosen and an account of any potential health effects that were considered but were not selected and why. Recommendations identify specific actions that could be taken to avoid, minimize, or mitigate harmful effects identified during the course of the HIA or to take maximal advantage of opportunities for a proposal to improve health. The information generated by the HIA process needs to be organized and presented in such a way that it can be readily understood by the intended audiences and present a compelling case for recommended actions. On the basis of its review of current guidance and practice, the committee recommends that scoping should result in a framework for the HIA and a written project plan that includes the following: The credibility and relevance of HIA to the decision-making process rest on a balanced and complete examination of the health risks, benefits, and tradeoffs presented by the project, policy, program, or plan being assessed.

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