The toolkit provides a foundation for meeting the relevant IRS requirements. Recommendations form the core of a health-management plan, but the plan also determines authority for and assigns responsibility for implementing each recommendation, establishes a monitoring plan, and creates or suggests mechanisms to verify that assigned responsibilities are being met. 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. Health Impact Assessment: A Practical Guide. Neidell M. Information, avoidance behavior, and health: The effect of ozone on asthma hospitalizations. It is critical for the credibility of the HIA that the measures or outcomes being promoted are grounded in full and transparent consideration of the evidence that supports and does not support the issue in question. An HIA does not have to accept community concern uncritically. Veerman J, Barendregt J, Mackenback J. Quantitative health impact assessment: Current practice and future directions. Although rapid or desktop HIAs may not involve stakeholders or consider their input, this often (although not uniformly) reflects a pragmatic response to limitations, such as the timeframe for the decision or resources available to the HIA team, rather than an optimal practice. Similarly, HIAs sponsored by private nonprofit organizations may not have requirements for disclosure inasmuch as most U.S. HIAs are not done under a legal mandate that requires disclosure. Life expectancy and physical function associated with income. Would you like email updates of new search results? [accessed May 24, 2011]. Source: Adapted from BLM 2007 and Wernham 2007. Bennear LS, Olmstead SM. 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. Federal government websites often end in .gov or .mil. That definition reflects the committees finding that the involvement of stakeholdersalthough the approaches used vary from little or no involvement to robust engagement and participation at every stephas consistently been described as a core element of HIA practice and should be considered essential to it. Culturally competent care means providing care within the context of a patient's culture and beliefs. Jones and Bartlett, 2009, as adapted in Public Health Accreditation Board Acronyms and Glossary of Terms Version 1.0 [PDF 536KB], July 2011. The final draft responds to public comments and incorporates necessary changes or new information. Davenport C, Mathers J, Parry J. In general, this approach describes effects directly related to the proposal (such as changes in air emissions) and traces them to health determinants (such as air quality) and finally to health outcomes (such as asthma). Some have suggested that evaluation should be considered as outside the HIA process itself because of the need for an independent and objective perspective, particularly for impact evaluation (Bhatia et al. Clipboard, Search History, and several other advanced features are temporarily unavailable. That explanation is particularly important when public funds are to be used for an HIA because the public may want to understand the basis for allocating sparse public resources. First, disclosure informs affected communities and individuals and possibly other stakeholders, such as government agencies and officials, of possible effects on their health and well-being, a core objective of HIA. Health Impact Assessment: SEIC (Sakhalin Energy Investment Company) Phase 2 Development. Comprehensive HIAs are most commonly differentiated from rapid and intermediate HIAs by the scope of potential impacts and the need for collection of new primary data. Remember, although this example uses boxes and arrows, you and your partners in change can use any format or imagery that communicates more effectively with your stakeholders. Given that HIA led by the private sector appears to be a rapidly increasing practice, the issue of availability bears further consideration. 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. 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. By examining the various components of the different assessment and planning models, we are able to identify areas for coordination, ways to maximize collaboration, and strategies to further improve community health. Indicators may be health outcomes in some cases, whereas health determinants may be more appropriate in others. Propose appropriate indicators for monitoring. The committee notes that in any assessment, it (more), Assessment should result in a report that. Conversely, to have the greatest relevance as an informational and planning document and to ensure judicious use of resources, the HIA should ultimately focus on the health effects of greatest potential importance. To address that concern, monitoring of concentrations of selected contaminants in local fish was proposed as a mitigation measure. Expert judgment is central to HIA but must be grounded in a solid foundation of scientific neutrality and accepted public-health principles. The decision to initiate an HIA is often made ad hoc when public-health advocates recognize that the proposal may have important health implications that would not otherwise be recognized or addressed. Steinemann A. In practice, therefore, the HIA team will be asking a decision-maker to consider the findings and recommendations. On the basis of its review, the committee synthesized the information from guidance, practice, and literature to propose criteria that define an HIA and draw several conclusions regarding HIA practice. An official website of the United States government. HIA and national policy in the Netherlands. 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. Variations were found in race, age, employment status, poverty, car ownership, and mortality. 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. The choice of what to evaluate will reflect the specific social, political, and policy context of the decision; the needs, interests, and questions of stakeholders and decision-makers; and the health status of the affected population. Source: SFDPH 2011. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. This review outlines the epidemiology of suicide and suicidal behavior in young people. Qualitative approaches can more easily present the causal pathways in terms used by participants; this ensures that different voices are presented in the HIA and can increase the legitimacy and stakeholders ownership of the process and results. 2005; Frank et al. For example, in the context of NEPA, the lead federal agency must consider the degree to which the proposed action affects public health or safety to determine whether a proposal is likely to have significant effects and therefore require an environmental impact statement (40 CFR 1508.27). The committee finds that an HIA report should at least describe the proposal and alternatives that are the subject of the HIA, the data sources and analytic methods used, the groups and individuals that were consulted in the course of the HIA, the process and findings of each step of the HIA, and the overall conclusions and recommendations. 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. BLM later considered amending (more). The Collective Impact Framework has five key elements: Participants have a common agenda with a joint approach for solving an agreed-upon problem. Another method of scoping is to develop a table that facilitates a systematic and rapid appraisal of all the potential ways in which a proposal might affect health (see Table 3-1). It is important for nonprofit hospitals to be knowledgeable about the Internal Revenue Services regulations for CHNAs. Community Health Assessment Toolkit. Injuries and fatalities associated with changes in vehicle traffic or speeds. In Alaska, all large natural-resources development proposals are now screened for the need for HIA in a new program begun by the state health department. HIAs are also done by private consultants who are hired by a project proponent or decision-maker or by private-industry stakeholders. A growing population of families that have children. This chapter describes the types, structure, and content of HIAs and summarizes the HIA process, methodologic approaches, and variations in practice. Another variation, rapid-appraisal HIA, has been described and in some texts includes explicit public engagement through an initial half-day workshop for stakeholders (Parry and Stevens 2001; Mindell et al. 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. The Catholic Health Association defines a community health needs assessment as a systematic process involving the community to identify and analyze community health needs and assets in order to prioritize these needs, and to plan and act upon unmet community health needs. Fifth, transparent reporting of possible environmental and health impacts has proved in many studies to lead to risk reduction because it motivates changes, such as improved pollution controls, on the part of industry and governments (Wolf 1996; Bennear and Olmstead 2008; Vaccaro and Madsen 2009). Furthermore, some policies may focus on determinants of healthfor example, economic development, transportation, or housingrather than explicitly mentioning health. The committee notes that outcome evaluation of policy experiments is a field independent of HIA, and many large-scale social interventionssuch as Head Start and Moving to Opportunityhave been subject to outcome evaluation that has included consideration of health or health determinants (Leventhal and Brooks-Gunn 2003; Schweinhart et al. Screening establishes the need for and value of conducting an HIA. 2005; Bhatia and Seto 2011). Identification of apparent data gaps and of data collection that could be undertaken to address the gaps or a rationale for not undertaking data collection. It follows a systematic process that includes screening, scoping, assessment, recommendations, reporting, and monitoring and evaluation. Presidential/Congressional Commission on Risk Assessment and Risk Management. 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. It develops the scope of health effects for analysis through systematic consideration of all factors associated with the proposed action that have a potential to influence health, and it narrows the scope to effects that are judged most important for health. A plan for continuous monitoring, adaptation of mitigation measures, and verification of performancealthough not currently a uniform aspect of HIA practice helps to ensure that measures are carried out and achieving their objectives. In 1998, the Bureau of Land Management (BLM) completed a Northeast National Petroleum Reserve-Alaska Integrated Activity Plan/Environmental Impact Statement (EIS). Cancer risk and changes in life expectancy associated with tobacco taxes. 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. It would then fall to the decision-makers to determine routes that met those criteria. ACTION STEP 1: Assemble the Community Team Representation from diverse sectors is key ACTION STEP 2: Develop Team Strategy Decide whether to complete CHANGE as a whole team or divide into subgroups Qualitative data can be gathered through, for example, focus groups, one-on-one interviews, surveys, individual meetings with stakeholder organizations, testimony in community meetings, Web-based or other written input, and running a stand or exhibition in a public place. Most vulnerable populations: Less information was provided about this step. Centers for Disease Control and Prevention. The committee selected a six-step framework as a clear way to organize and describe the critical elements of an HIA. Given the broad scope of HIA practice settings, applications, and data sources, the committee chose not to develop specific standards or criteria for what constitutes adequate evidence or analysis for HIA. The potential for health effects to place a disproportionate burden on or substantially benefit vulnerable populations. It identifies a baseline that describes the health status of populations that will be affected by the decision. Scoping also determines who will be part of the HIA team and establishes a plan for technical oversight and review, stakeholder participation and involvement, and involvement of and interaction with decision-makers. A central tenet is that peoples experience offers an invaluable perspective on the potential effects of the proposal. For example, in the Alaskan oil and gas HIA mentioned in Box 3-3, the HIA team drafted recommendations in collaboration with the decision-maker, the Bureau of Land Management, which formally adopted the recommendations as mitigation measures. Health Impact Assessment on Policies Reducing Vehicle Miles Traveled in Oregon Metropolitan Areas. Wernham A. Inupiat health and proposed Alaskan oil development: Results of the first Integrated Health Impact Assessment/Environmental Impact Statement of proposed oil development on Alaskas North Slope. Screening involves making an initial rapid judgment of whether an HIA is likely to be feasible and valuable. That permits recommendations to form the basis of effective implementation and management rather than merely providing a static system without the capacity to adapt. The committee proposes on the basis of its review the following adaptation of the current working definition of the International Association of Impact Assessment (Quigley et al. Outcome evaluation will continue to be challenging, but it can generate useful information in well-selected cases. The health effects that are included, the data sources and methods that are used, and the recommendations that are made are therefore determined by the HIA practitioners rather than according to a legal or regulatory standard (Wernham 2011). Health Impact Assessment: Main Concepts and Suggested Approaches-the Gothenburg Consensus Paper. The World Bank Policy on Access to Information. 1. Evaluation is important for the quality of individual HIAs and for the success of the HIA field as a whole. Consequently, the committee concludes that the lack of attention to evaluation is a barrier that will need to be overcome if HIA practice is to be advanced in the United States. For example, U.S. priorities for improving public health are expressed in the Healthy People 2020 Program of the U.S. Department of Health and Human Services (DHHS 2010). Assessing the baseline health status of the affected population provides a reference point with which the predicted changes in health status may be compared; it identifies any groups that could be more vulnerable than the general population to the impacts of the proposal; and it provides an understanding of the factors that are responsible for determining health in the affected communities, and this, in turn, allows for a better understanding of how any changes in those factors may affect health. Red Dog Mine Extension Aqqaluk Project. Science and Decisions: Advancing Risk Assessment. This site needs JavaScript to work properly. Some provide a checklist of factors to consider and often focus on health determinants that might be affected by the proposal. The definition also notes that recommendations should incorporate monitoring, which is essential for effective continuing management as a decision is implemented. 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). This information can help develop a community health improvement plan by justifying how and where resources should be allocated to best meet community needs. Assessing alternatives in parallel with the proposal can aid decision-making by highlighting tradeoffs and actions that can be taken to achieve the desired outcome while minimizing harms. Lifetime Effects: The High/Scope Perry Preschool Study through Age 40. Because of the timeframe of proposal implementation and effects on health, outcome evaluation often requires a long-term research commitment. Atlanta BeltLine Redevelopment Plan. It recommends measures, in the context of the proposed action, to protect and promote health and reduce health disparities. (2015). It is also common for local, state, or tribal health departments to undertake an HIA to inform another agencys decision-making. 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. A local community-based organization worked (more). This list can then be used to set priorities. It can also include information from social-science and epidemiologic studies regarding the strength of associations between the social and physical environment (such as air and water quality and economic impacts) and health outcomesinformation essential in the quantitative prediction of health effects. A statement of why the proposal was selected for screening. Morgan RK. For example, there may be concerns about risks to a proponents reputation or to the viability and public acceptance of a proposed project if a report discloses important unmitigated adverse impacts or potential impacts that are uncertain or for which strong evidence does not exist. The World Bank and International Finance Corporation have policies governing the disclosure of information, and although the policies differ, both provide for withholding or excluding documents that might contain proprietary information or information whose disclosure could damage a client or lenders financial, political, or legal interests (Halifax Initiative Coalition 2006; IFC 2006, 2010; McHugh et al. Moreover, because there is generally no written record of HIAs that stop at screening, still less is known about the reasons that have led to decisions not to proceed with HIA. Framework for Environmental Health Risk Management Final Report. Analyzes beneficial and adverse health effects and characterizes the changes in the indicators selected, to the extent possible, in terms of nature, direction, intensity, magnitude, distribution in the population, timing and duration, and likelihood. 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). A variety of screening tools and algorithms are commonly used (Cole et al. . Example of a Table Used for Systematic Scoping. In many cases, a complete and accurate description of health and its determinants in the affected community may not be possible. Monitoring should provide information that allows one to conduct the evaluations noted above. The decision-maker must ultimately balance health considerations with the many technical, social, political, and economic concerns that bear on the proposal. Reprinted with permission; copyright 2010, International Council on Mining and Metals. 2003; ICMM 2010). Thomson H. HIA forecast: Cloudy with sunny spells later? Any approach to determining which proposals will be screened should demonstrate a consistent rationale; should document the rationale in the HIA report; and should take account of public input. The population, subgroups, vulnerable populations, and stakeholders likely to be affected and how they were involved in the HIA process. Although deviation from the criteria may occur, a valid and clearly articulated rationale for such deviation should be described when the HIA is reported. 2009; Castro et al. Improving Health in the United States: The Role of Health Impact Assessment. Menu labeling as a potential strategy for combating the obesity epidemic: A 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. Physical activity associated with changes in pedestrian infrastructure. The results of the HIA were presented in different formats; the full report was accompanied by a summary and fact sheets. The source of public funding for the project was the Tax Allocation District (TAD), and only within the districts boundaries could funding be collected and bond money spent. Lester C, Hayes S, Griffiths S, Lowe G, Hopkins S. Implementing a strategy to address health inequalities: A health authority approach. FOIA Because any actions taken on the basis of HIA recommendations need to be implemented within a specific legal and policy context, screening needs to establish a clear description of the decision-making process and context. Thus, the assessment phase is separated from the management phase, as recommended elsewhere (NRC 1983). Management of the health effects of a proposal as it moves from planning into implementation should be a dynamic process in which monitoring results may drive continued adaptation of the health-management plan. Good Practice Guidance on Health Impact Assessment. Observing and documenting the HIA processsuch as methods of engaging stakeholders and interacting with decision-makers and approaches to addressing analytic challenges and interviewing participants and stakeholders are the main methods of process evaluation. In selecting the analytic methods that will be used, the HIA practitioner should consider not only technical limitations but what type of information will be most useful to decision-makers. Action plans have mutually reinforcing activities. A Guide to Health Impact Assessments in the Oil and Gas Industry. The variability also reflects a lack of clear criteria that define HIA as a distinct field. A summary of how stakeholders were engaged, the main issues that the stakeholders raised, and how they will be addressed or why they will not be addressed. Wolf S. Fear and loathing about the public right to know: The surprising success of the emergency planning and community Right-to-Know Act. Example of a logic framework that maps out the possible causal pathways by which health effects might occur. In this approach, the aspects of a proposal that may affect health are listed and considered in major categories of health and illness. Instead, it appears that the specific methods and approaches used in a single HIA often evolve within the basic framework described above and develop as a pragmatic response to context. There could also be concerns that disclosure of such information would lead to litigation. Ultimately, regardless of the specific tool used, the decision to conduct HIA in most cases relies on the practitioners or decision-makers judgment regarding the likelihood of impacts, the time and resources available, and the likelihood that the information produced by the HIA will be a valuable aid to decision-making. A review of health impact assessment frameworks. Participatory approaches that actively engage stakeholders in the process can yield rich information and provide opportunities for stakeholdersincluding community membersto influence the questions asked and to participate in the interpretation of findings. An HIA, however, might not provide any recommendations; this could occur if the HIA failed to reveal any important health effects. 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. The process of implementing recommendations should be transparent and should include opportunities for public participation in the decision process and clear mechanisms of accountability.

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