Health Impact Assessments: A Promising Tool for Public Policy Decision-Making

Speakers

Rajiv Bhatia, M.D., M.P.H., Director, Occupational & Environmental Health, San Francisco Department of Public Health   
Aaron Wernham, M.D., M.S., Senior Environmental Health Policy Analyst, Alaska Native Tribal Health Consortium  
George Flores, M.D., M.P.H., Senior Program Officer, The California Endowment  
Pamela Russo, M.D., M.P.H., Senior Program Officer, The Robert Wood Johnson Foundation  

Summary:
The term Health Impact Assessment (HIA) is commonly used to describe structured, multi-disciplinary methods and processes that judge the potential health effects of a specific policy proposal.  Based on a broad model of population health that incorporates economic, political, social, psychological, and environmental influences, HIAs have been widely performed in Europe and Canada through both regulatory and voluntary mechanisms. Interest in these tools is growing rapidly in the United States and health funders have played a pivotal role in nurturing these developments. This audioconference considered how HIAs can be used to infuse health-related concerns into public policy debates and explored opportunities for health funders to advance the development and application of this emerging tool.   

Dr. Bhatia identified why human health impacts should be considered in a broad range of public policy decisions and described how HIAs can synthesize evidence, influence the policy process, and involve community stakeholders. He summarized the various methodological attributes of HIAs and discussed the policy settings appropriate to the application of this analytic tool. Dr. Bhatia provided several cases studies of HIAs that had been conducted in California, including studies of the health impacts of living wage legislation (1999), paid sick leave legislation (2008), residential infill proposals (2003), zoning changes (2007), a port expansion proposal (2009), a transportation fee proposal (2009) . Using these examples, he described the relationship between Environmental Impact Assessments and HIAs and summarized key lessons learned, including the importance of stakeholder involvement, the value of scientifically based, objective information, and the need to customize HIAs to individual circumstances. He concluded by reviewing the current status of HIA capacity, future research needs, and available resources to support HIA development.

Dr. Wernham focused his remarks on how HIAs can be incorporated into federal regulatory processes, illustrating these opportunities with examples from his own work in Alaska. He described a case study of a small, remote village that had historically been isolated, but recently experienced significant roadway development and an influx of oil workers in connection to an industrial project. Under the National Environmental Policy Act (NEPA) any major industrial development project requires the completion of an Environmental Impact Statement (EIS). Though EISs have traditionally been silent on health issues, NEPA actually requires consideration of health concerns. Local public health agencies leveraged this requirement to apprise federal regulators of potential health consequences through a rapid HIA which addressed a range of issues including environmental exposures, drug and alcohol consumption, injuries, sexually transmitted diseases, and the potential health benefits of economic development. Dr. Wernham briefly summarized other examples where local public health officials have successfully used NEPA requirements to ensure health has a role in planning and oversight efforts and stressed the opportunity for expanding the use of regulatory mechanism related to NEPA and other federal processes.

Dr. Flores described how The California Endowment first became interested in utilizing HIAs as a tool to address increasing obesity rates and funded training efforts, along with the development of model assessments related to physical education in schools and transportation policy. He noted this early work helped the foundation realize the importance of engaging stakeholders and the need to support the application of HIAs in communities. Dr. Flores described one example of how Human Impact Partners helped Humboldt County conduct HIAs related to land use decisions in the county's general plan. He stressed both the potential for, and challenges associated with, HIAs. Dr. Flores indicated that while public health agencies are often staffed by people with the substantive expertise in statistics and epidemiology involved in HIAs, additional efforts will often be required to allow them to develop the capacities needed to implement HIAs. He summarized The California Endowment's investments in developing HIA capacity, including directly funding a small number of assessment efforts, as well sponsoring numerous training and professional development opportunities for public health professionals, but noted that the field is still very much in its nascent stages.

Dr. Russo noted that while an awareness of the social determinants of health is increasing, health funders often struggle with how to translate this understanding into action. She discussed how HIAs can serve as a tool to help influence policy sectors outside of health, such as transportation, labor, education, and housing, in identifying and addressing the health effects of their decisions. Dr. Russo described how urban planners are extremely familiar and comfortable with scenario planning, described how HIAs can be incorporated into these types of planning models, but cautioned that planners may not seek out the input of public health experts unless facilitated to do so. She provided examples of the ten HIAs that the Robert Wood Johnson Foundation has funded, including assessments of city living wage ordinances, funding for after-school programs, farm markets, and the design of the Atlanta beltline. Dr. Russo re-iterated the importance of involving community groups in the HIAs and described community engagement as fundamental to the success of these efforts. She described future plans to demonstrate the utility of HIAs and noted how other funders, such as The California Endowment, the San Francisco Foundation, and the Northwest Health Foundation, have provided models for developing the field.

The discussion explored in greater depth the ways in which HIAs can support policy change, the challenges that can be encountered, and the ways foundations can support the use of HIAs.

Related Information

	HIA Overview (6500K) [download]
	Introduction to HIAs, Bhatia, RA (277K) [download]
	HIA Resource List, Bhatia, RA (225K) [download]
	HIA of the CA Healthy Families, Healthy Workplace Act, Human Impact Partners (477K) [download]
	Integrating Human Health Into Environmental Impact Assessment, Bhatia and Wernham (258K) [download]
	Building Health Impact Assessment (HIA) Capacity, Cole and Fielding (146K) [download]