Improving Health in the United States The Role of Health Impact Assessment (2011) / Chapter Skim
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2 Why We Need Health-Informed Policies and Decision-Making
2 Why We Need Health-Informed Policies and Decision-Making
Pages 23-42
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. Despite major medical advances and large health expenditures, many Americans are unable to achieve their full health potential; this affects not only the quality and duration of their lives but their ability to be engaged and productive members of society.
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The prevention of today's major health problems requires understanding and intervention to affect the root causes of ill health and the policies that shape and affect the root causes. To address them effectively, a better understanding of the possible health consequences of proposed policies and planning decisions as they are being developed is needed so that adverse health effects can be anticipated and minimized and health benefits maximized.
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. In recent years, a broad and growing scientific literature has documented associations of various aspects of the physical and social environments of neighborhoods with health-related behaviors, such as diet and physical activity; these findings highlight important implications for the prevention of obesity, diabetes, and other chronic diseases (Brisbon et al.
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The factors that affect health are also root causes of health disparities associated with socioeconomic status, race, or ethnicity. Those health disparities are pronounced and persistent and do not appear to be declining despite medical advances.
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The health consequences of policies promoting the production of inexpensive, calorie-dense foods could thus be far-ranging but remain unknown in the absence of a systematic assessment. A second example of a failure to anticipate the health effects of policy and planning decisions is apparent in examining the health effects of transportation infrastructure.
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There is evidence that adverse health effects associated with transportation disproportionately affect members of racial and ethnic minorities and those in lower socioeconomic strata and thus contribute to persistent racial, ethnic, and socioeconomic disparities in health (Houston et al. 2004; Apelberg et al.
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compared birth outcomes among women who lived near toll booths where E-ZPass was introduced with birth outcomes among women who lived near busy roadways that were not close to E-ZPass tollbooths. The introduction of E-ZPass greatly reduced traffic congestion and motor-vehicle emissions in the vicinity of highway toll plazas.
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WHY ASSESSMENTS ARE NOT BEING CONDUCTED Scientific information on the importance of root causes is abundant and growing, but it is not being fully used in a practical sense -- that is, by applying it to the daily decisions made at the local, state, tribal, or federal level to enhance health and reduce health disparities. There are a number of reasons why health effects may not be systematically incorporated into decisions regarding policies, programs, projects, or plans, including the following: The absence of a mandate or funding to address root causes of ill health or health disparities or to assess the health impacts of planned policies and decisions.
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The failure to enforce existing regulations to assess health implications of policies, programs, projects, and plans -- for example, the failure to capture health impacts adequately in the context of environmental impact assessments. Given the potential to reduce harm and enhance health, it is imperative to overcome the barriers that have prevented the consideration of health in decision-making.
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Thus, LCA attempts to characterize typical situations often from a national or global perspective, whereas the types of policies and planning decisions in which health dimensions need to be considered are often local and have unique site-specific attributes that should be considered. Because of the limitations of existing tools in their ability to evaluate the health consequences of an array of policies, programs, projects, and plans systematically, health impact assessment (HIA)
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The conduct of systematic assessments of health impacts will explicitly identify data gaps and evidence needed to improve future assessments. It will stimulate policy-relevant scientific research more directly, whether to develop new empirical studies or to improve systematic evaluation and synthesis of existing evidence.
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Furthermore, the active engagement of representatives of communities whose health stands to be affected by proposed policies, programs, projects, and plans is an essential component of democratic decision-making. Public engagement may also enhance understanding of the pathways through which policies, programs, projects, and plans may affect health and could promote actions that contribute to the reduction of health disparities.
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2008. Integrating human health into environmental impact assessment: An unrealized opportunity for environmental health and justice.
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occupation-related physical activity and their associations with obesity.
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2009. A national plan for physical activity: The enabling role of the built environment.
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2005. Linking objec tively measured physical activity data with objectively measured urban form: Find ings from SMARTRAQ.
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1996. Do car diovascular risk factors explain the relation between socioeconomic status, risk of all-cause mortality, cardiovascular mortality, and acute myocardial infarction?
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. NHTSA (National Highway Traffic Safety Administration)
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University of California Berkeley Health Impact Group, June 2007 [online]
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2010. Race, socioeconomic status, and health: Complexities, ongoing challenges, and research opportunities.
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