An Evaluation of Health Impact Assessments in the United States, 2011–2014

Abstract

IntroductionThe Center for Community Health and Evaluation conducted a 3-year evaluation to assess results of health impact assessments (HIAs) in the United States and to identify elements critical for their success.MethodsThe study used a retrospective, mixed-methods comparative case study design, including a literature review; site visits; interviews with investigators, stakeholders, and decision makers for 23 HIAs in 16 states that were completed from 2005 through 2013; and a Web-based survey of 144 HIA practitioners.ResultsAnalysis of interviews with decision makers suggests HIAs can directly influence decisions in nonhealth-related sectors. HIAs may also influence changes beyond the decision target, build consensus and relationships among decision makers and their constituents, and give community members a stronger voice in decisions that affect them. Factors that may increase HIA success include care in choosing a project or policy to be examined’ selecting an appropriate team to conduct the HIA; engaging stakeholders and decision makers throughout the process; crafting clear, actionable recommendations; delivering timely, compelling messages to appropriate audiences; and using multiple dissemination methods. Challenges to successful HIAs include underestimating the level of effort required, political changes during the conduct of the HIA, accessing relevant local data, engaging vulnerable populations, and following up on recommendations.ConclusionResults of this study suggest HIAs are a useful tool to promote public health because they can influence decisions in nonhealth-related sectors, strengthen cross-sector collaborations, and raise awareness of health issues among decision makers.

Insights into How HIAs are Characterized in the Press: Findings from a Media Analysis of Widely Circulated United States Newspapers

“…Readers of these newspaper documents therefore may end the pieces without a sense of the HIA process or what happens next. Perhaps even more surprising, while scholars have found that HIAs can be useful in emphasizing the connections between health outcomes and some of their causes (Bourcier et al, 2015), these connections appeared infrequently in the documents we analyzed. Although there were references to costs (n=30) and economic impacts (n=15), we found only 19 phrases specifically mentioning health impacts related to an HIA and 29 references to health outcomes data.…”

“…Employing such a strategy may require that practitioners work with trained communications experts or receive additional training on both how to work with media effectively and how to portray and frame their work around HIA processes, projected impacts, recommendations, and values. Such a strategy would be consistent with the major strengths of HIAs: inserting health concerns into non-health sector decisions and empowering communities (Bourcier et al, 2015;Dannenberg, 2016).…”

“…HIAs are especially useful for bringing health concerns to decisions and issues that originate outside of the health sector, enhancing relationships across sectors, and empowering communities (Bourcier, Charbonneau, Cahill, & Dannenberg, 2015;Dannenberg, 2016). In particular, HIAs can be instruments to address the social determinants of health, defined by the World Health Organization (2017) as "conditions in which people are born, grow, live, work and age [which] are shaped by the distribution of money, power and resources at global, national and local levels [and] are mostly responsible for health inequities -the unfair and avoidable differences in health status."…”

“…Studies demonstrate that HIAs can be useful in emphasizing the connections between health outcomes and some of their causes, both for policymakers and communities (Bourcier et al, 2015). Proponents frequently point to the ability of HIAs to raise awareness about health and public policy connections across sectors and communities (Winkler et.…”

Incorporating health into environmental assessments in Canada

“…In addition, the use of Health Impact Assessment (HIA) tools (Wismar et al, 2007;Lauzière, 2008;Bourcier et al, 2015;Metro Vancouver, 2015) can allow for a more systematic and consistent integration of health into EAs (Bhatia, 2007;Wernham, 2007;Bhatia and Wernham, 2008). HIA is a decision support tool used to predict future health impacts of a program, policy, or development that involves the use of logic and a variety of mixed methods including epidemiology, toxicology, and sociological reasoning (Wismar et al, 2007).…”