The diversity of practice owes partly to the fact that HIAs are undertaken for a wide array of policy-making that spans many sectors, levels of government, types of proposal (policies, plans, programs, and projects), and degrees of complexity. 2006). The HIA team was assisted by an advisory committee, but it appears that the committee was not involved in the scoping. The potential for HIA-based information to alter a decision or help a decision-maker discriminate among decision options. Cole BL, Shimkhada R, Fielding JE, Kominski G, Morgenstern H. Methodologies for realizing the potential of health impact assessment. 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. Robust and continuing efforts to inform decision-makers of the findings and recommendations of the HIA and efforts by HIA practitioners and other stakeholders to champion choices that will benefit health can be an essential part of an effective HIA. As described in Appendix A, there are few laws in the United States that specifically require HIA, although manysuch as the National Environmental Policy Act (NEPA)require a consideration of health that can be accomplished through HIA. As noted above, the iterative process is known as adaptive management in the field of environmental management. A community health assessment (sometimes called a CHA), also known as community health needs assessment (sometimes called a CHNA), refers to a state, tribal, local, or territorial health assessment that identifies key health needs and issues through systematic, comprehensive data collection and analysis. Bethesda, MD 20894, Web Policies The committee notes that in addition to characterizing effects, HIAs may provide conclusions on the significanceor societal importanceof the effects, although this has been rare in U.S. practice. 2006). 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. It was concluded during the screening phase that an HIA would add value to project outcomes. Scoping should therefore entail a deliberative process that involves engagement of stakeholders. Monitoring and evaluation are often, although variably, described as the final stage of HIA (see Appendix E). The Crossings is a proposed housing development in Los Angeles that will provide 450 units in a newly rezoned residential area that needs affordable housing. 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. The Collective Impact Framework has five key elements: Participants have a common agenda with a joint approach for solving an agreed-upon problem. Here are 7 common components of a successful Community Health Needs Assessment (CHNA): Information, Research, and Data Collection Stage Health in All Policies engages many stakeholders, including community members, policy experts, advocates, the private sector, and funders, to ensure that work is responsive to community needs and to identify policy and systems changes necessary to create meaningful and impactful health improvements. HHS Vulnerability Disclosure, Help In 1998, the Bureau of Land Management (BLM) completed a Northeast National Petroleum Reserve-Alaska Integrated Activity Plan/Environmental Impact Statement (EIS). Assignment of significance rests on the characterization of an effect as described above, but judgments regarding what constitutes a significant impact are ultimately determined partly on the basis of social and political values. A Guide to Health Impact Assessment: A Policy Tool for New Zealand. The committee does not intend that the definition and criteria proposed in this chapter be considered rigid requirements but rather that they reflect an ideal of practice, deviation from which may occur but should be based on clear and well-articulated needs and rationale. Thus, the assessment phase is separated from the management phase, as recommended elsewhere (NRC 1983). Within several of these components, we discuss characteristics that are critical to improving community health. 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). Others have proposed categorizing HIAs as participatory (emphasizing shared governance, public participation, and a focus on socioeconomic and environmental determinants), quantitative or analytic (concentrating on the methods and rigor of the analysis), or procedural (drawing on elements of the other two approaches but emphasizing the procedural steps required and often undertaken within a specified administrative or regulatory context) (Cole and Fielding 2007). The impacts of right-to-know: Information disclosure and the violation of drinking water standards. The decision-maker must ultimately balance health considerations with the many technical, social, political, and economic concerns that bear on the proposal. Recommendations are often developed throughout the HIA process. One approach uses a logic framework that maps out the causal pathways by which health effects might occur (see Figure 3-1). Because HIAs can address decisions that range from small, localized programs or projects to national policies, screening ensures that HIA is used judiciously and when it is most likely to be valuable. In such cases, HIAs often rely on data on a larger region and consider whether the characteristics of the larger population can be generalized to the affected community. 2006). Environmental justice implications of reduced reporting requirements of the Toxics Release Inventory Burden Reduction Rule. The discussion described pathways by which Iupiat health was likely to be affected. Failure to disclose HIA results and incomplete disclosure are not restricted to industry. In those cases, it may be more appropriate to monitor exposuressuch as environmental concentrations of a carcinogen or the availability of safe walking corridorsthat are linked to the outcome of interest by public-health evidence. Community input during the development of recommendations can ensure that they address specific aspects of living conditions and community design that may not be obvious to an outside researcher, and it provides an opportunity to ensure that the recommendations address high-priority issues in a manner that is acceptable to the affected community. International Finance Corporation Performance Standard 4 Rev -0.1, Community Health, Safety, and Security. Decisions are often based on incomplete information and must often be made within a specified time rather than waiting for more complete information. The HIA report describes the screening process but does not provide great detail about it. As in the realm of health risk assessment, there remains a need to distinguish between the assessment and management phases to avoid manipulation of analytic components by decision-makers. The various categories of HIAs, although useful for describing distinct themes in the field, do not necessarily represent consistently distinct strains of practice. For private corporations undertaking an HIA, the decision of whether to make an HIA public and what to disclose may be governed by internal corporate policies, by the standards of lenders supporting the project, or by a government that has jurisdiction over the project (McHugh et al. 1 Upon completing the assessment, hospitals develop implementation strategies to address the significant community health needs identified in the CHA. Literature review provides much of the empiric evidence for most HIAs, and whenever possible, assessors should conduct a systematic review of the literature for any health effects and determinants identified as high-priority issues in scoping. 2 Setting priorities considers pathways that appear most important from a public-health perspective and considers issues that have been raised prominently by stakeholders. In the United States, HIAs have commonly been undertaken by people who have an MPH or equivalent degree and have attended a brief (2- to 5-day) training session. The programs and policies, however, may not provide any guidance on how health should be considered (see, for example, Pub. Public concerns are a common trigger for a decision to screen, and the degree of concern or controversy about a proposal may be one of the factors weighed in the decision to undertake an HIA. In some cases, the lack of a recommendation may reflect a desire to avoid a perception that the HIA is a one-sided advocacy exercise, particularly when options for recommendations would involve adopting a position wholly supportive of or opposed to the proposal being assessed. Health impact assessment: A tool for healthy public policy. Therefore, scoping should be thought of as a two-part process that starts with a systematic effort to identify all potentially important effects and that continues with selection of the most important and well-substantiated effects for further analysis at later stages. Under NEPA, a federal agency must determine whether a federal environmental decision is likely to have significant effects, and if so, the level of analysis required (40 C.F.R. As discussed in greater depth in the section on scoping, it is common to convene advisory or steering committees, which can include both technical and policy experts and representatives from stakeholder groups that have an interest in the decision outcome. HIAs are also done by private consultants who are hired by a project proponent or decision-maker or by private-industry stakeholders. A CHA is a systematic process involving the community to identify and analyze community health needs and assets, prioritize those needs and then implement a plan to address significant unmet needs. The toolkit presents the key elements of HRC development. . HIA provides recommendations on monitoring and managing those effects. sharing sensitive information, make sure youre on a federal Human Impact Partners. Mindell JS, Boltong A, Forde I. A major alternative to a proposal (for example, routing a proposed highway away from a vulnerable population or building a light-rail line rather than widening a road). The HIA team identified the pathways in which the expansion would affect the lives of the primarily Iupiat residents of the area. HIAs are also differentiated according to whether they are integrated into an environmental impact assessment or done independently. A community health improvement plan (or CHIP) is a long-term, systematic effort to address public health problems based on the results of community health assessment activities and the community health improvement process. Additional modeling approaches, such as system-dynamic modeling and agent-based models, are also promising and emerging tools that could have applications to health. Steinemann A. Criteria for use in the evaluation of health impact assessments. In some cases, the impact of the HIA on a decision is clear-cut. L 91-190, 42 U.S.C. 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. In practice, however, reporting may occur at earlier stages of the HIA process and include public meetings; meetings with decision-makers, other stakeholders, and advisers; and dissemination of interim public reports, such as a scoping summary. Jones and Bartlett, 2009, as adapted in Public Health Accreditation Board Acronyms and Glossary of Terms Version 1.0 [PDF 536KB], July 2011. Mindell J, Boaz A, Joffe M, Curtis S, Birley M. Enhancing the evidence base for health impact assessment. Depending on the nature of the proposal being assessed and the specific impacts, recommendations can take various forms (see Box 3-5), such as the following: HIA Recommendations. Washington (DC): National Academies Press (US); 2011. 2009; Castro et al. Sources: Adapted from Cook et al. Kuo T, Jarosz CJ, Simon P, Fielding JE. Major issues and challenges for HIA development and practice are considered in Chapter 4. The use of the information by the decision-maker is discussed at greater length in Chapter 4 in the section Managing Expectations.. Notwithstanding those considerations, the committee considers the public disclosure of HIAs to be an important ideal of practice but recognizes that it may not be realistic to expect widespread disclosure in the absence of requirements or incentives for it. In other cases, it may not be possible to attribute a particular decision to the influence of an HIA (Wismar et al. A community health assessment gives organizations comprehensive information about the community's current health status, needs, and issues. We identified 11 common assessment and planning components across 18 models and requirements, with a particular focus on health department, health system, and hospital models and requirements. Final Supplemental Environmental Impact Statement. Some provide a checklist of factors to consider and often focus on health determinants that might be affected by the proposal. University researchers have conducted HIAs, and community-based organizations have conducted HIAs with technical assistance from public-health experts to inform officials who are deliberating on a legislative or administrative proposal. 2005; Bhatia and Seto 2011). MeSH In that case, a robust evaluation method, such as interviews conducted with decision-makers before and after the HIA, could provide the data needed to gauge the effect on decisions. A lack of access to needed goods and services. The variation partly reflects the wide array of applications of HIA; for example, it is not necessary or feasible to use the same approaches to involve stakeholders for a local project and for a high-level state or national policy. With clear language in mind, partners should come to agreement on the This information can help develop a community health improvement plan by justifying how and where resources should be allocated to best meet community needs. 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. Issues surrounding uncertainty, literature review, and reliability and validity of predictions are discussed in greater depth in Chapter 4. Ensuring that the public has accurate and complete information on adverse and beneficial effects. HIA practice is often defined in terms of several categories. The recommendations should be provided in the final HIA report and should document available supporting evidence, stakeholder input, and a health-management plan, which should do the following: If no recommendations are made in the HIA report, an explicit rationale should be provided for the decision not to include them. It can also assess whether the HIA had other important effects, such as building new collaborations among agencies, ensuring that stakeholder perspectives were considered, and increasing awareness of previously unrecognized health considerations. As discussed above, additional benefits may include, for example (Wismar et al. Bookshelf Lester C, Hayes S, Griffiths S, Lowe G, Hopkins S. Implementing a strategy to address health inequalities: A health authority approach. 2007; Harris-Roxas and Harris 2011). Agreeing on a target population. That description is consistent with the earlier characterizations of HIA as a combination of procedures, methods, and tools (WHO 1999; Quigley et al. The fact, however, that the team conducting the HIA is aware of the decision context allows the assessment to be decision-relevant. Recommendations may be implemented through regulatory mandates or voluntary actions by stakeholders. HIA should not be assumed to be the best approach to every health-policy question but should instead be seen as part of a spectrum of public-health and policy-oriented approaches, some of which will be more appropriate than others, depending on the specific application. The grouping of the elements in discrete stages or steps of an HIA is less consistent; some guides list as few as five steps, and others describe as many as nine (Quigley et al. Citation for Toolkit Third, it informs government agencies and officials of potential changes in demand for services, such as health care, emergency response, and public safety; this can facilitate an appropriate response. It is also common for local, state, or tribal health departments to undertake an HIA to inform another agencys decision-making. AHA does not claim ownership of any content, including content incorporated by permission into AHA produced materials, created by any third party and cannot grant permission to use, distribute or otherwise reproduce such third party content. In many cases, a complete and accurate description of health and its determinants in the affected community may not be possible. 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. 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 (more). Vaccaro A, Madsen P. Corporate dynamic transparency: The new ICT-driven ethics. They can take longer than a year to complete. Process evaluation assesses the design and execution of the HIA in light of its intended purpose and plan of action and applicable practice standards. Evaluation of whether a decision has changed specific health outcomes may often be difficult or impossible because of the complex and multifactorial causal pathways involved in many health outcomes, the length of time from implementation of a decision to observable changes in health indicators, and the lack of suitable comparison groups (Quigley and Taylor 2004; Parry and Kemm 2005). A Guide to Health Impact Assessments in the Oil and Gas Industry. The success of recommendations ultimately depends on the publics trust in and support of them. The expected resource requirements of the HIA and the ability of the HIA team to meet them. An HIA does not have to accept community concern uncritically. National Academies Press (US), Washington (DC). Outcome evaluation should be undertaken when available resources and data will allow reasonable judgments regarding the association between the implementation of decisions and observed changes in health outcomes or health determinants. 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. The toolkit provides a foundation for meeting the relevant IRS requirements. McHugh S, Maruca S, Lilien J, Manning A. 2009). Box 3-3 provides an example of an assessment step that was based on interviews with people who were likely to be affected by a decision and that considered their impressions of the effects that industrial activities were having and were likely to continue to have on individual, family, and community life. Since there are different models to guide assessment and planning, as well as a variety of organizations and agencies that carry out these activities, there may be confusion in choosing among approaches. For example, under Alternative A, diabetes and metabolic disorders would be expected to increase if impacts on subsistence led to declining subsistence harvests (through declining populations of subsistence resources, displacement of resources that made hunting less successful, or displacement of hunters by oil activity and infrastructure). Clipboard, Search History, and several other advanced features are temporarily unavailable. Health Impact Assessment on Policies Reducing Vehicle Miles Traveled in Oregon Metropolitan Areas. Seventh, disclosure allows people to take voluntary actions to avoid risk (Neidell 2009). It identified which areas and villages were most likely to be affected and when. Several approaches for scoping are available. However, it is important to note that the use of qualitative approaches in HIA should not be interpreted as implying a need for less analytic rigor. Neidell M. Information, avoidance behavior, and health: The effect of ozone on asthma hospitalizations. It is critical to arrange the information logically so that readers can navigate easily through the document, to provide a lay summary that accurately describes the main findings and conclusions of the study, and to reference all data and sources accurately (Fredsgaard et al. Assessing the Health Impacts of Road Pricing Policy Proposals. Presidential/Congressional Commission on Risk Assessment and Risk Management. In the absence of mandates or formal procedures, topics for screening are often chosen on the basis of the interests of a group wishing to use HIA as opposed to a structured, strategic selection process. In other cases, all proposals in selected agencies or sectors have been screened by local governments (SFCC 1998; Lester et al. They expressed interest in developing The Crossings in a way that will address local community needs for affordable housing and for other community assets that are safe, healthy, and supportive (p. Intro-1). The Association for Community Health ImprovementsCommunity Health Assessment Toolkitoffers a nine-step pathway for conducting a CHA and developing implementation strategies. Accessed at www.healthycommunities.org/assesstoolkit. In contrast, independent evaluation can yield unbiased insights about an HIA from the perspectives of stakeholders and decision-makers, can contribute to a more robust external peer review, and can provide rich information regarding the strengths, weaknesses, and most effective methods and approaches in the field. For example, if a traffic-calming infrastructure was installed on a street that had a high rate of pedestrian injury, it may be appropriate to monitor injury rates directly because changes would be expected as soon as the installation was complete. Screening should result in a simple statement that includes the following: Screening is essential for high-quality HIA. One Step Forward, One Step Back: An Analysis of the IFCs Sustainability Policy, Performance Standards and Disclosure. In others, scoping may identify studies that can be carried out by the HIA team or studies that can be carried out by experts involved in some other aspect of the planning, permitting, or review process (such as air-quality or traffic-safety analysis). A local community-based organization worked (more). 2007; ICMM 2010). Frank DA, Neault NB, Skalicky A, Cook JT, Wilson JD, Levenson S, Meyers AF, Heeren T, Cutts DB, Casey PH, Black MM, Berkowitz C. Heat or eat: The Low Income Home Energy Assistance Program and nutritional and health risks among children less than 3 years of age. Scoping establishes the boundaries of the HIA and identifies the health effects to be evaluated, the populations affected, the HIA team, sources of data, methods to be used, and any alternatives to be assessed. Mechanisms to limit bias in decision-relevant analyses further are discussed in Chapter 4. The HIA report states that scoping was done by the HIA team and involved desk-based research and a web and postal survey. Culturally competent care means providing care within the context of a patient's culture and beliefs. 2006; Bhatia 2010; ICMM 2010).
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