Health Impact Assessment: "This is About Thinking Through What We Do Before We Act"
Perhaps the most interesting aspect of this morning’s briefing on the release of a new National Research Council report on Health Impact Assessments (HIA) is how familiar many of the attendees were with the term “health impact assessments,” which are data-driven evaluations that identify the health consequences of new policies and develop practical strategies to enhance their health benefits and minimize adverse effects.
A staffer from the Federal Highway Administration said that HIA is “on the agency’s radar”; a physician from California said that more and more he attends conferences on public health and finds that HIA is frequently discussed topic.
With the release of the new report, “Improving Health in the United States: The Role of Health Impact Assessment,” growing familiarity with the concept can only help speed up both the numbers of HIAs conducted and the knowledge base of stakeholders who will review them.
The report released today provides guidance to officials in the private and public sectors on conducting HIAs. “Increasingly, we learn the ways that economic, social, planning and other policies can harm but also promote health,” said Richard Jackson, M.D., M.P.H., chair of the HIA report committee and professor and chair of environmental health sciences at the UCLA. “HIA is a way to help make these impacts evident both to policy makers and the public.”
Pamela Russo, a senior program officer with the Robert Wood Johnson Foundation (RWJF), one of the funders of the report, added in an interview: “It’s clear that as more and more HIAs are done, more people become aware of them. And you’re going to have a whole variety of parties wanting to perform HIAs from health departments to interest groups to industry.” Other sponsors of the report included the National Institute of Environmental Health Sciences, California Endowment and the Centers for Disease Control and Prevention. RWJF also is a funder of the Health Impact Project, a collaboration of RWJF and The Pew Charitable Trusts designed to promote the use of HIA as a decision-making tool for policymakers.
In the report, the committee presents a six-step framework for conducting HIAs of proposed policies, programs, plans and projects at federal, state, tribal and local levels and identified several challenges to the successful use of HIA, such as balancing the need to provide information with variations in data.
Aaron Wernham, M.D., M.P.H., director of the Health Impact Project, says the report “can be a game-changer.” Wernham says a similar National Research Council publication released in the 1980s helped establish the use of risk assessments for toxic substances, which has become one of the most widely used tools for bringing science into decision making.
Wernham says setting clear standards for HIAs could not have come at a better time because more and more states and communities are making HIAs a routine part of decision making in an effort to avoid unintended health consequences and build healthier communities. Says Wernham: “This is about thinking through what we do before we act.”
The Health Impact Project will announce a new set of HIA grants in December.
NewPublicHealth spoke with committee chair Richard Jackson about the report.
NPH: What was the make-up of your committee?
Dr. Jackson: The committee was really a remarkable group. We had experts in health impact assessment who lead programs; we had general public health people like myself and Jonathan Fielding [M.D., M.P.H., director of public health for Los Angeles], and we had international health experts as well as well as experts in risk assessments.
NPH: What was the thinking in choosing to address the issue?
Dr. Jackson: I think there’s a very strong feeling that society makes major decisions that have impacts on health, and that we can’t go into these decisions without adequately examining the health impacts--both positive and negative.
NPH: Were most of the committee members familiar with health impact assessments prior to beginning to meet?
Dr. Jackson: Each came from a different discipline. There were members who had very deep experience in the whole area of topologic risk assessment but really have not thought about the more holistic process of health impact assessment. And there were those of us who had pretty practical experience in how you maneuver public health decisions through the public policy process. So I would say that everyone learned a lot from the conversations that took place during our meetings.
NPH: What was the overarching question of your committee?
Dr. Jackson: The overarching question was whether this is a tool that our society should be using, and if it is, how do we scale it up? One of the things I came away appreciating more deeply was how important stakeholder involvement is and how important it is to have the community involved early on in the whole process--being knowledgeable and being aware of what it is that is at stake. There is a need to be aware at multiple levels in our society that big decisions can impact. Knowing that will lead to better decisions.