Evaluating Health Impact Assessment and the Role of Funding for Local Health Departments

By Ali Aslam, NACCHO Environmental Health Intern

This story originally ran in NACCHO’s Healthy People, Healthy Places blog.

In June 2017, NACCHO released a new report titled Evaluation of Technical Assistance for Local Health Departments. This report is part of NACCHO’s ongoing evaluation of Health Impact Assessment (HIA) at local health departments to examine implementation practices, common challenges, and resource gaps. The report provides practical recommendations for local health departments administering HIA and national organizations that support HIA at the local level. NACCHO’s evaluation showed that funding and staff time were the most significant barriers for local health departments conducting HIA. Furthermore, local health departments with HIA funding were shown to prioritize HIA activities while having a higher capacity than their non-funded counterparts.

Health Impact Assessment is becoming an increasingly popular tool for evaluating the potential health outcomes of proposed policies, programs, and projects. Health departments often use HIA for informing decision-makers about the potential health consequences of decisions, addressing health disparities, and promoting a health in all policies approach. Through the HIA program, NACCHO seeks to support local HIA by providing health departments with funding, technical assistance, and mentorship.

A number of local health departments have participated in NACCHO’s HIA program. NACCHO’s most recent HIA evaluation examined nine local health departments, including three that were new grantees and six that were not funded. NACCHO’s 2017 evaluation report builds on data collected during a previous HIA evaluation in 2014, which included a separate sample of fourteen local health departments that were also funded through NACCHO’s HIA Program.

Report Findings
As anticipated, the evaluation reported notable differences between the health departments that received NACCHO funding for HIA, compared with those that did not. Among funded local health departments, HIA was considered an organizational priority. Accordingly, the evaluation found that funded sites were more likely than non-funded sites to participate in future HIA projects. This shows that providing funding for HIA may help health departments prioritize HIA and encourage them to devote more organizational resources to HIA activities.

Similarly, non-funded health departments often reported lower capacity for HIA, when compared with funding recipients. Evaluation findings indicated that health departments’ capacity to conduct HIA depended on their ability to train staff, procure funding, and collaborate with partners. Increasing funding for HIA may help to improve organizational capacity, especially since non-funded sites may already face considerable resource limitations and constrained staff time.

The evaluation also highlighted some notable similarities between funded and non-funded health departments conducting HIA. First, most of the assessment participants reported considering HIA as a future core function in their health department. Second, the majority of respondents identified funding and staff time as their biggest barriers for carrying out HIA. These commonalities among the entire evaluation sample show that health departments are able to understand the benefits of HIA and may still be interested in implementing HIA projects despite access to funding. In order to overcome barriers related to funding and staff time, NACCHO developed a short list of recommendations to improve HIA utilization at the local level.

Report Recommendations
Funding, staff time, and organizational capacity are some of the major challenges identified by local health departments in the HIA evaluation. To address these challenges at the local level, NACCHO makes the following three recommendations to local health departments:

  1. Pursue sustainable funding for HIA by:
    • Applying for capacity-building grant opportunities;Establishing a dedicated HIA fund through private foundations or core operational budgets; and
    • Leveraging new and existing partnerships to get additional resources, in the form of staff time or funding support.
  1. Promote utilization of HIA by:
    • Sharing success stories and lessons from the field about how HIA increased opportunities to improve health within communities; and
    • Encourage local planning and transportation agencies to incorporate HIA into community design processes to promote and protect the health of communities.
  1. Adopt HIA strategies by:
    • Using HIA as a tool to implement a Health in All Policies approach to decision-making; and
    • Using HIA to support public health accreditation documentation where appropriate.

To address challenges of HIA funding, prioritization, and capacity at the national and regional level, NACCHO makes the following four recommendations to national organizations to support HIA practice:

  1. Develop tools to measure the efficacy of HIA processes and outcomes;
  2. Develop best practices for incorporating HIA into the core functions of public health;
  3. Support practitioners who are interested HIA; and
  4. Advocate for expansion of HIA resources at the local level.

The 2017 evaluation report identified several benefits of HIA involvement and the importance of funding for carrying out HIA activities. The reports also highlights the importance of providing support for local health departments to perform HIA. Certainly, health departments that received HIA funding were in a better position to complete their HIA compared to those without funding. However, some health departments chose to complete HIA despite resource limitations, and now they can use their experience to further develop and improve their HIA. Even if a site did not receive funding, participating in the HIA program still provided an opportunity to collaborate with peers, navigate resource challenges, and troubleshoot potential conflicts. Through the HIA process, each local health department learned how to take an evidence-based approach to improve the health of their communities and influence high stakes decisions.

NACCHO’s evaluation findings have consistently suggested that local health departments need dedicated staff time within the health department and from their partners, along with adequate funding to facilitate HIA implementation. National and regional organizations can support HIA by advocating for expansion of resources, supporting practitioners, and developing measures to enhance HIA implementation. As a member-based organization, NACCHO is well-positioned to respond to the capacity building needs of local health departments. NACCHO supports HIA implementation by providing customized technical assistance, tools and resources, on-site and online trainings, strategies for relationship-building, and leveraging resources at the local level. NACCHO’s HIA program supports local health departments in advancing the practice of HIA and improving local decisions that can have a major health impact.

For more resources and information about NACCHO’s Health Impact Assessment program, please visit our dedicated HIA webpage.