Center for Community Health and Evaluation Releases First National Evaluation of HIAs: Q&A with Tatiana Lin

May 12, 2014, 4:07 PM


Health impact assessments (HIAs) are evidence-based analyses that estimate future health benefits and risks of proposed laws, regulations, programs and projects. They provide decision makers with an opportunity to minimize health risks and enhance health benefits. HIA practitioners say the tool allows for more informed—and potentially healthier—decisions related to land use, transportation, housing, education, energy and agriculture.

The Center for Community Health and Evaluation, a division of Group Health Research Institute, a nonprofit based in Seattle, recently published a national study on HIAs that looked at their utility and potential improvements.

The new study outlines how HIAs change decision making and highlights evidence that HIAs can also lead to stronger cross-sector relationships, greater attention to community voices and longer-term changes beyond the initial decision the HIA is focused on.

Key findings of the Center’s evaluation include:

  • HIAs can contribute directly to the decision-making process and help achieve policy outcomes that are better for health.
  • There are opportunities to advance the HIA field in the areas of stakeholder and decision-maker engagement, dissemination and follow-up.
  • Attention to specific elements can increase likelihood of HIA success.

A past HIA funded by a grant from the Health Impact Project, a program of the Robert Wood Johnson Foundation and the Pew Charitable Trusts, was conducted in 2012 by the Kansas Health Institute (KHI) and looked at the health impacts of building a casino in Southeast Kansas (a law that would move such a project forward was enacted last month).

NewPublicHealth recently spoke with Tatiana Lin, the author of the HIA and a senior analyst at KHI, about the recent HIA evaluation and lessons learned from the HIAs KHI has worked on so far. 

NewPublicHealth: Two of the key findings of the recent HIA evaluation were that HIAs can contribute directly to the decision-making process and help achieve policy outcomes that are better for health, and also that there are opportunities to advance the HIA field in the areas of stakeholder and decision maker engagement, dissemination and follow-up. Have the HIAs you have conducted—two completed and two in process—shown these findings to be the case?

Tatiana Lin: Yes, I think they have. Our first HIA was published in October 2012 and we testified before several committees reviewing the bill, which decreases the minimum investment required for a prospective casino developer and became law last month.

If a casino is built in the region, the Kansas Health Institute will be available to work with the casino manager to incorporate the HIA recommendations during the development process, including the potential for job growth and the impact of secondhand smoke.

A critical thing we learned is to make sure that that policy makers are truly engaged in the process, so that they participate in the meetings and meaningfully contribute, in order to get buy in for what you’re trying to do and what you’re trying to look at.

And we did a local level HIA on the potential health impacts from proposed changes to the city’s transit system for buses. Exposure to  secondhand smoke in outdoor transit waiting areas and a two-grocery bag limit for bus riders were among key HIA findings and recommendations which Wichita Transit used to  make changes to  current practices. [Editor’s note: News stories published about the recommendation noted that the bag limit made it difficult for low-income shoppers in particular to stock up on healthier groceries during shopping trips, since they would often do the trip once a week. They would then rely on closer-in convenience stores, which were less likely to have healthy foods, for items beyond what they could carry in the two bags.] 

We had a lot of dissemination to different levels of the community, including sessions with city council members who then presented at the public meeting on the proposals. We presented to the transit board and conducted a webinar which was open to anybody. We made it available online and it continues to be downloaded, and just recently the results of the HIA were featured in the front page of the Wichita Eagle, one of the largest newspapers in the state. HIA recommendations about limiting smoking at the bus stops and increasing the bag limit from 2 to 6 were considered and implemented by Wichita transit authorities.

NPH: Another assessment in the recent evaluation is for HIAs to concentrate on specificity. Has that been your thinking as well?

Lin: Yes, we definitely think this is a very valuable criterion and that an HIA practitioner should be as specific as possible with findings as well as with the recommendation. We certainly did that following our first HIA, including the design of each assessment, the findings and the recommendations. A high degree of specificity really makes the HIA much more practical for decision makers and helps them understand their options and how to implement those options.

NPH: What are some other lessons learned that underscore the findings of the recent HIA evaluation report?

Lin: During the HIA on casinos, we really learned that health impact assessment requires diverse capacities, and so your team needs to have subject matter expertise. You also need to have somebody very versed in how to engage stakeholders and decision makers. And especially important is that you really need to understand the political environment in the state when you do an HIA, as well as bring together different sectors to enhance the work.

It’s important to have as much engagement as possible with policy makers during the HIA process front end and to identify which partners can potentially implement the recommendations, and then have them on board very early in the process.

NPH: Have you found that you’ve been able to rely on HIA experts for guidance?

Lin: Yes, and that network of experts is critical to have in order to help the field progress and to make sure that the HIAs are quality products and that they remain at a certain standard. At the Kansas Health Institute, we’ve gotten support and technical assistance from Health Impact Project, as well as from the National Network of Public Health Institutes and from member institutes including the Oregon and Georgia Public Health Institutes. 

Each time we conduct an HIA we rethink the lessons learned from the previous ones and what should we do differently to make sure that our next product is as helpful for policymakers as it can be. We work at really trying to get the pulse of the issues from the decision makers, asking them what was helpful and what we can do differently. We always try to get their feedback on what they would like to see as part of an HIA and how they want the results communicated back to them. It has been very encouraging that some of the work that we have done is really producing results such as seeing that health is being integrated in the conversation, has been considered in some of the decisions that they are making and that they are really using the report findings. Hopefully we will see better health outcomes at the end.

This commentary originally appeared on the RWJF New Public Health blog.