Effectiveness of Health Impact Assessments: A Synthesis of Data From Five Impact Evaluation Reports

Abstract

IntroductionSince the 1990s, the use of health impact assessments (HIAs) has grown for considering the potential health impacts of proposed policies, plans, programs, and projects in various sectors. Evaluation of HIA impacts is needed for understanding the value of HIAs, improving the methods involved in HIAs, and potentially expanding their application. Impact evaluations examine whether HIAs affect decisions and lead to other effects.MethodsI reviewed HIA impact evaluations identified by literature review and professional networking. I abstracted and synthesized data on key findings, success factors, and challenges from 5 large evaluations conducted in the United States, Europe, Australia, and New Zealand and published from 2006 through 2015. These studies analyzed impacts of approximately 200 individual HIAs.ResultsMajor impacts of HIAs were directly influencing some decisions, improving collaboration among stakeholders, increasing awareness of health issues among decision makers, and giving community members a stronger voice in local decisions. Factors that contributed to successful HIAs included engaging stakeholders, timeliness, policy and systems support for conducting HIAs, having people with appropriate skills on the HIA team, obtaining the support of decision makers, and providing clearly articulated, feasible recommendations. Challenges that may have reduced HIA success were poor timeliness, underestimation of time and resources needed, difficulty in accessing relevant data, use of jargon in HIA reports, difficulty in involving decision makers in the HIA process, and absence of a requirement to conduct HIAs.ConclusionHIAs can be useful to promote health and mitigate adverse impacts of decisions made outside of the health sector. Stakeholder interactions and community engagement may be as important as direct impacts of HIAs. Multiple factors are required for HIA success. Further work could strengthen the role of HIAs in promoting equity, examine HIA impacts in specific sectors, and document the role of HIAs in a “health in all policies” approach.

Review of Health Impact Assessments Informing Agriculture, Food, and Nutrition Policies, Programs, and Projects in the United States

“…The case studies, in particular, illustrate how HIA findings and recommendations can inform policy decisions and exemplify several characteristics common to effective HIAs. A recent review of over 200 HIAs identified several factors that influence the likelihood of an HIA having an impact (Dannenberg, 2016); the four cases reviewed here are consistent with the findings of this larger review. First, the timing of the study must be appropriate so that findings and recommendations are released sufficiently in advance of a final decision.…”

“…This is an important limitation of HIAs generally; in most cases, there is no monitoring and evaluation of impacts once an HIA is complete, particularly of impacts on health outcomes (Dannenberg, 2016). The evaluation of the Oregon Farm to School Policy HIA (case study 3) provides an example of an assessment of the HIA process, but without an evaluation of effects on health outcomes (Diep, Henderson, & Rader, 2011).…”

Tracking State-Level Health Impact Assessment Legislation from 2012-2016

“…Although HIAs do not require legislative authorization, policy support, including HIA legislation, has been identified as an enabling factor for HIA use (Dannenberg, 2016). Most bills introduced in state legislatures fail to pass, and this study was not designed to identify the reasons the proposed bills did not become law.…”

“…Monitoring these laws' effects on health determinants and outcomes, a formal step of HIAs that includes process, impact, and outcome evaluation, could also help advance HIA practice, since the monitoring step of the HIA process is often omitted in practice. (Dannenberg, 2016). Studying the implementation of these laws could also help to identify and establish the critical components that any HIA bill should contain in the future.…”

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

“…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."…”