Improving Health in the United States The Role of Health Impact Assessment (2011) / Chapter Skim
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Pages 3-13
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From page 3... ...
It has been defined in various ways but essentially is a structured process that uses scientific data, professional expertise, and stakeholder input to identify and evaluate public-health consequences of proposals and suggests actions that could be taken to minimize adverse health impacts and optimize beneficial ones. HIA has been used throughout the world to evaluate the potential health consequences of a wide array of proposals that span many sectors and levels of government.
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From page 4... ...
In fact, it can be argued that major improvements in public health cannot be achieved without considering the root causes of ill health. Indeed, it has been argued that major health problems, such as the obesity epidemic and its associated health and monetary costs, are essentially unintended consequences of various social and policy factors related, for example, to the mass production and distribution of energy-dense foods and the engineering of physical activity out of daily life through changes in how transportation is organized and how neighborhoods are designed and built.
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From page 5... ...
DEFINING HEALTH IMPACT ASSESSMENT AND ITS ELEMENTS On the basis of its review of HIA definitions, practice, published guidance, and peer-reviewed literature, the committee recommends the following technical definition of HIA, which is adapted from the definition of the International Association for Impact Assessment: 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 the distribution of those effects within the population. HIA provides recommendations on monitoring and managing those effects.
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From page 6... ...
The committee concludes that the following factors are the most important to consider in determining whether to conduct an HIA: the potential for substantial adverse or beneficial health effects or irreversible or catastrophic effects, even if the effects have a low likelihood; the ability of information from the HIA to alter a decision or help a decisionmaker to discriminate among options; the possibility that a disproportionate burden of the health effects is placed on vulnerable populations; the existence of public concern or controversy regarding health effects of a proposal; the opportunity to incorporate health information into a decision-making process that may not otherwise include such information; and the ability of the HIA team to complete the assessment within the time and with the resources available. Scoping identifies the populations that might be affected, determines which health effects will be evaluated in the HIA, identifies research questions and develops plans to address them, identifies the data and methods to be used and alternatives to be assessed, and establishes the HIA team and a plan for stakeholder participation throughout the HIA process.
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From page 7... ...
• Describes the baseline health status of affected populations. • Analyzes and characterizes beneficial and adverse health effects of the proposal and each alternative.
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From page 8... ...
At present, there is little uniformity in the content of an HIA report. The committee recommends that, at a minimum, the written HIA report describe the proposed action or policy and alternatives that are the subject of the HIA, document the data sources and analytic methods used, identify the people consulted during the HIA process, and provide a clear, concise, and easily understood description of the process, findings, and recommendations.
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From page 9... ...
Consequently, the committee concludes that the lack of attention to evaluation is a barrier that will need to be overcome if HIA is to be advanced in the United States and notes that unbiased evaluation of its effectiveness and value will require participation of evaluators independent of the HIA team, stakeholders, decision-makers, and fiscal sponsors. The committee emphasizes that the definitions and criteria recommended here should not be considered rigid requirements but rather reflect an ideal of practice.
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From page 10... ...
Many expect HIA to produce quantitative estimates of health effects. Quantitative estimates of health effects have a number of desirable properties: they provide an indication of the magnitude of health effects, they can be easily compared with existing numerical criteria or thresholds that define the significance of particular effects, they allow one to make more direct comparisons among alternatives, and they provide inputs for economic valuation.
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From page 11... ...
Ensuring that stakeholders are able to participate effectively in the HIA process is widely described as an essential element of practice, although stakeholders often are not engaged or are only minimally engaged in the process. That discrepancy can be attributed to several factors, including the time and resources available; the methods, guidance, and standards used to conduct HIA; the importance that the practitioner or sponsor places on stakeholder participation; and a view that stakeholder participation may interfere with or impede progress.
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From page 12... ...
The committee emphasizes that the appropriate assessment of direct, indirect, and cumulative health effects in EIA under NEPA is a matter of law and not discretion, and recent efforts have successfully integrated the HIA framework into EIA. Thus, where legal standards under NEPA or applicable state EIA laws require an integrated analysis of health effects, one should be conducted with the same procedures that would be used to assess any other required factor.
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From page 13... ...
First, few evaluations of HIA effectiveness have been conducted in the United States, especially because it has emerged so recently. Because conducting HIA will probably require the investment of substantial public and private resources, research is needed to document HIA practices and their effectiveness in influencing decision-making processes and promoting public health.
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