Health impact assessment: A tool to increase health in decision-making
Featured Organzation & Article by Human Impact Partners, Oakland, CA
Throughout the past decade there has been increasing recognition that health outcomes are influenced by factors beyond individual behavior. For example, the World Health Organization’s Commission on the Social Determinants of Health reports that 55 percent of a person’s health status is determined by social conditions such as employment, education, housing and transportation, with genetics (5 percent), health care (10 percent) and behavior (30 percent) determining the rest.
One challenge in addressing this fact is that many decisions related to economic, environmental and social determinants of health are made outside the domains of health and mental health, and decision-makers rarely consider impacts beyond the fiscal realm. Without critical information on health and mental health impacts, however, these decisions lead to poor outcomes that disproportionately affect certain communities more than others. We see these unfortunate consequences and disparities through the placement of toxic dumps, abundance of fast food chains and liquor stores, and lack of economic investment in low-income communities and communities of color.
Internationally, the practice of health impact assessment (HIA) is emerging as an approach to tackle this paradigm and elevate the role of health in decision-making. Health impact assessment, performed in several countries around the world including the United States, is commonly defined as “a combination of procedures, methods and tools by which a policy, plan or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population.” HIA is a structured, yet flexible, process that conforms to the following steps: screening, scoping, assessment, recommendations, reporting and monitoring.
The fundamental goal of HIA is to ensure that health and health disparities are considered in decision-making using an objective and scientific approach, all the while engaging stakeholders in the process. Health impact assessment typically includes an analysis of a broad array of issues and should ultimately contribute to an increased understanding of the connections between a proposed decision and health. Importantly, the HIA model advances the idea that health should be defined comprehensively to include physical as well as mental health, including, for example, stress and social supports. While there are examples of HIAs that consider these impacts, there is growing interest in addressing mental health impacts more comprehensively.
HIAs have demonstrated success in a variety of issue areas, ranging from land use and transportation to housing policies, labor standards, natural resource extraction, education and economic policies. For example, as a result of one HIA conducted in Oakland, California, a housing developer agreed to install a central ventilation system inside residential units and modified building design in order to address air quality and noise impacts identified through the HIA. As a result of another HIA conducted on a proposed paid sick days policy, findings were directly considered in legislative hearings and discussions about the proposed legislation shifted to include a strong public health frame. In another HIA assessing the demolition of affordable housing in San Francisco, California, arguments related to displacement and the loss of community networks and social cohesion led to a developer agreeing to on-site replacement of all demolished affordable units.
Health impact assessment presents one approach to addressing the myriad of factors that influence health. Overall, evidence indicates that when policy-makers, project planners, and community organizations participate in and have data provided by a HIA, proposals are better informed and have far stronger opportunities to provide the best outcomes for communities.
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