Improving Health in the United States The Role of Health Impact Assessment (2011) / Chapter Skim
Currently Skimming:
4 Current Issues and Challenges in the Development and Practice of Health Impact Assessment
4 Current Issues and Challenges in the Development and Practice of Health Impact Assessment
Pages 90-118
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From page 90... ...
The committee next reviews several methodologic issues for HIA, including the need to balance timely information with variable data quality, expectations for quantitative estimates, synthesizing conclusions on dissimilar health effects, assigning monetary values to health outcomes, enabling stakeholder participation, and the benefits of a peer-review process for HIA. The committee then examines the potential for conflicts of interest among HIA practitioners, sponsors, and funders and considers whether it is realistic to expect the practice of HIA to result in a change in the decision being made.
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From page 91... ...
Ultimately, broadening the definition of health creates the setting where tradeoffs among health and other social objectives can be made transparently. Recent calls for public agencies to consider and take actions to improve health indicate changing attitudes and the need to create a more multidisciplinary approach to public health (CSDH 2008)
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From page 92... ...
ARE ALL DECISIONS POTENTIAL CANDIDATES FOR HEALTH IMPACT ASSESSMENT? A frequent question -- given the breadth of potential applications of HIA -- is whether there is a limit on the types of decisions to which the practice might be applied.
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From page 93... ...
TABLE 4-1 Health Impact Assessment by Sector Sectora European Unionb United Statesc Transport 27 (17%)
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From page 94... ...
Department of Health and Human Services or on the basis of the most realistic opportunities to address environmental injustice or to reduce health inequities. Institutional rules could effectively narrow a large number of candidate decisions to a manageable ordered set, enhance the use of HIA, and advance its rationale and equitable use.
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From page 95... ...
The committee notes that society regularly accepts such practical limitations in making policy decisions and that predictive certainty or causal certainty would be an impractical standard for HIA. Practical and agreed-on methods for addressing concerns about validity are needed, and the committee offers three strategies, discussed below, that should help to improve the validity of health-effects judgments made in the context of variable evidence: Consider diverse evidence sources by using expertise in multiple disciplines.
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From page 96... ...
. Consider Diverse Evidence Sources by Using Expertise in Multiple Disciplines As discussed in Chapter 3, many types of evidence can be used in HIA, including peer-reviewed academic studies; unpublished, publicly available studies and databases, that is, gray literature; survey, monitoring, or interview data specific to the affected population or to the policy, plan, program, or project in question; the experience of people who will be affected by the proposed changes; and expert opinion.
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From page 97... ...
Characterize and Manage Uncertainty Uncertainty will always be present, and impact assessments -- including HIAs -- should characterize and manage the uncertainty to the extent possible and practicable that is inherent in the analyses and decisions. Although uncertainty should not be ignored in HIA, it should also not paralyze the decision process.
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From page 98... ...
In other words, HIA practitioners should evaluate and document the uncertainty of their conclusions by describing the evidence on which their conclusions are based and by identifying any limitations, gaps, or weaknesses in the assumptions. That exercise should go beyond parametric uncertainty described in individual studies to consider broader questions, such as whether a measure of exposure used in HIA was a reliable proxy for personal exposure or whether an exposureresponse function extracted from the literature can be generalized to the population of interest.
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From page 99... ...
BENEFITS AND CHALLENGES OF QUANTITATIVE ESTIMATION Some decision-makers and HIA users expect HIA to provide 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 (see section "Assigning Monetary Values to Health Consequences" below)
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From page 100... ...
In other situations, such as when assumptions are not defensible, quantitative estimates should not be advanced. HIAs have applied quantitative techniques to decisions to estimate health effects related to expected changes in infectious-disease risks, traffic hazards, environmental pollutants, housing conditions, and tobacco and alcohol consumption (see Box 3-4; Veerman et al.
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From page 101... ...
Generally, decision-makers must balance multiple desirable and adverse effects related to a decision and will need to "weight" or assign values to them on the basis of institutional rules, constituent preferences, or some other approach. Keeping effects separate and assigning values allow decision-makers to consider tradeoffs among health and nonhealth effects clearly.
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From page 102... ...
ASSIGNING MONETARY VALUES TO HEALTH CONSEQUENCES The health consequences of a decision can be characterized according to their economic or monetary valuation. Although monetary effects clearly are not health effects themselves, many decision-makers and stakeholders may give substantial consideration to the economic value of effects, and economic valuation of health effects can facilitate comparison with the costs and benefits of competing alternatives (Brodin and Hodge 2008)
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From page 103... ...
In spite of those caveats, monetary valuation of health outcomes may be a useful approach in some decision contexts, such as those in which alternative decision choices might require implementing economically costly mitigations. If economic analysis is conducted as part of HIA, it is important to maintain the distinction between HIA, which provides judgments of health effects, and cost-benefit analysis, which provides a more comprehensive analysis of all economic benefits and costs of a decision.
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From page 104... ...
. The variation may be attributable to the time and resources available for the HIA, to how high a priority HIA practitioners or sponsors give to participation, to a concern that participation may interfere with or impede progress toward the sponsors' objectives, or to differences in the type and scale of the decision to which the HIA is to be applied (for example, local vs national level)
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From page 105... ...
An equitable HIA process depends on strong efforts to identify and minimize barriers to participation and to ensure adequate representation for those unable to participate directly, for example, through elected officials in the case of national decisions. For HIAs of local and regional decisions, factors that can inhibit or prevent participation by individuals or groups that may be affected by the decisions vary -- for example, structural issues, such as limited collective organization or lack of trust in public processes; poor access to elected decision-makers; and practical considerations, such as language or literacy barriers and the requirement to manage competing life needs.
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From page 106... ...
HIA is different from primary scientific research in that it involves the application and interpretation of evidence in a particular decision context. Although premises underlying HIA judgments are often based on peer-reviewed evidence, several additional aspects of the HIA process might benefit from peer review.
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From page 107... ...
. MINIMIZING CONFLICTS OF INTEREST OF SPONSORS AND PRACTITIONERS OF HEALTH IMPACT ASSESSMENT Impact assessments, including HIA, are conducted on decision proposals that are often contested among polarized and disparate interests and stakeholders.
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From page 108... ...
It may be useful for future practice guidance to establish a clear line between a practitioner's role in conducting HIA and later efforts toward advocacy of particular decision outcomes.3 Although public entities may be somewhat less vulnerable to influence because of public funding sources, oversight mechanisms, and requirements for transparency, they are not immune to influence. Public-health agencies that have the necessary experience and expertise and the confidence of stakeholders may be in good positions to conduct or coordinate HIA given their mandate to protect public health.
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From page 109... ...
Health is typically one of many objectives under consideration in a given policy question, and decision-makers and other stakeholders are reasonably influenced by factors and tradeoffs beyond the quality or findings of an HIA. Although HIA does not guarantee particular decision outcomes, providing publicly available information on health effects clearly is a mechanism of influence.
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From page 110... ...
ADVANCING REQUIREMENTS FOR HEALTH ANALYSIS IN ENVIRONMENTAL IMPACT ASSESSMENT This chapter has thus far discussed HIA as it is practiced outside the context of EIA. NEPA and some SEPAs explicitly require the identification and analysis of health effects when EIA is conducted, and there are various views on how HIA might be related to or support health-effects analysis in the EIA process (see Appendixes A and F for further discussion)
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From page 111... ...
When health effects are relevant to a proposed action, agencies responsible for conducting EIA should seek out appropriate public-health expertise and should invite tribal, federal, state, or local health agencies to participate as cooperating agencies (40 C.F.R Sections 1501.6, 15018.5)
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From page 112... ...
It is essential that those determinants be considered in defining the boundaries of HIA. It is not necessary or appropriate to conduct HIA for all decisions at the local, state, or federal levels; however, restricting the spectrum of HIA practice to particular decision types, institutional sectors, decision scales (for example, policy, program, or plan)
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From page 113... ...
It may be useful for future practice guidance to establish a clear line between the practitioner's role in conducting HIA and later advocacy of particular decision outcomes. A dedicated public funding source and a process of independent peer review of HIA may help in managing or mitigating conflicts of interest.
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From page 114... ...
2007. Protecting health using environmental impact assessment.
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From page 115... ...
2009. Methodological considerations in developing local-scale health impact assessments: Balancing national, regional and local data.
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From page 116... ...
2001. What do we need for robust, quantitative health impact assessment?
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2009. Quantitative health impact assessment of transport policies: Two simulations related to speed limit reduction and traffic re-allocation in the Nether lands.
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From page 118... ...
2007. Inupiat health and proposed Alaskan oil development: Results of the first Integrated Health Impact Assessment/Environmental Impact Statement of proposed oil development on Alaska's North Slope.
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