Tina Yuen, MPH, MCP, CPH, Program Analyst, NACCHO

With a growing emphasis for public health practitioners to address the root causes of health impacts and inequities, local health departments (LHDs) have been challenged with working “upstream” to tackle the determinants of health. Health impact assessment (HIA) has emerged as a promising approach to help LHDs partner with decision-makers and other stakeholders to examine the public health implications of policy decisions that impact health.

What is HIA?
HIA is a structured process that brings together scientific data, public health expertise, and stakeholder input to assess the potential health consequences of a proposed policy, project, plan, or program that does not have health as its primary objective and to craft health-based recommendations. It is often seen as one component of an overall Health in All Policies (HiAP) approach towards decision-making that emphasizes collaborations and partnerships across sectors. Typically thought to consist of six steps, HIA provides LHDs a structured process to engage an array of organizations, residents, public agencies, and elected officials and ensure that the proposed changes support health and equity.

HIA holds promise because of the following:

• Its applicability to a broad array of policies, programs, plans, and projects;
• Its consideration of both adverse and beneficial health effects;
• Its core principles and values of democracy, equity, sustainable development, ethical use of evidence, and a comprehensive approach to health;
• Its ability to consider and incorporate various types of evidence and assessment methods; and
• Its emphasis on engaging communities and other stakeholders in a deliberative process.

HIAs have multiple aims. Ultimately, the primary purpose of a HIA is to shape public decisions and the public discourse surrounding these decisions, and to make health a much more explicit part of the dialogue.

HIAs also have the ability to improve the process through which public decisions are made. The HIA process may be able to better engage a diverse array of stakeholders and empower impacted communities and residents to become involved in the decision-making process. HIAs are often used to expand public participation by emphasizing everyday experiences and help to build consensus among different stakeholders. Furthermore, LHDs have the capacity to build and strengthen relationships with other organizations or groups through the use of HIAs.

LHDs and HIA: A Path towards Advancing Healthy Public Policies
HIA provides LHDs with a structured approach and innovative opportunity to work collaboratively to create healthier and more equitable communities. NACCHO has supported the use of HIA among LHDs in various ways, such as the HIA Mentorship Project, and through its policy statements on HIA, healthy community design, and HiAP. Through different technical assistance and funding opportunities and simply through trial and error, LHDs have been able to increase their capacity to conduct HIAs and extend their role in public policies. The following are examples:

• Cuyahoga County Board of Health in Ohio became involved in learning more about HIA in 2007 and 2008 as part of cross-collaborative efforts focused on health equity and the built environment. The first HIA in Cuyahoga County was initiated in 2011, and their HIA program has been steadily expanding ever since, with two new HIAs planned for 2014.
• Crook County Health Department won the NACCHO’s 2013 LHD of the Year Award in the small LHD category for their work on a HIA related to bicycle and pedestrian safety in Prineville, OR.
• New Orleans Health Department has begun to use HIA as a way to advance broader HiAP objectives that were generated out of their community health assessment and community health improvement planning processes.
• San Francisco Department of Public Health was an early adopter of HIA and led one of the first HIA projects conducted in the United States. The agency now has well over ten years of HIA experience and a robust program dedicated to working in partnership with residents, public agencies, and private organizations to advance healthy environments and social justice.

Is your LHD involved in an HIA project? Tell us about it in the comments section.

For more information on HIA, visit NACCHO’s HIA webpage.