Relative excess measures of effect and their use in health impact assessment.

Housing affects health, yet health is seldom considered in housing decisions. Health impact assessment (HIA) is a tool that can improve housing-related policies, plans, programs, and projects by bringing together scientific data, health expertise, and stakeholder engagement to identify the potential health effects of proposed decisions. We systematically identified and reviewed HIAs of housing decisions in the United States, yielding 54 HIAs between 2002 and 2016. Two examined federal proposals; the others explored decisions in 20 states. A variety of organizations led the HIAs, including non-profits, public health departments, and academic institutions. The primary decision-makers each HIA sought to inform were housing, planning, and/or elected officials. Eighteen HIAs focused on housing policies, codes, design elements, and utilities in residential structures. The remaining 36 HIAs included housing as one element of broader community development and transportation planning decisions. HIA recommendations changed decisions in some cases, and the assessment process helped strengthen connections between public health and housing decision-makers. To illustrate key characteristics of housing HIAs, we purposefully selected three HIAs and described the decisions they informed in detail: off-campus student housing in Flagstaff, Arizona; a rental housing inspections program in Portland, Oregon; and revitalization plans for a major thoroughfare in a suburb of St. Louis, Missouri. With a few exceptions, federal, state, and local agencies in the U.S. are not required to consider the health impacts of housing decisions, such as where housing is sited, how it is designed and constructed, and policies for ensuring that it is affordable and safe. HIA has emerged as a tool for advocates, health and housing practitioners, and policymakers to fill this gap. However, few studies have examined whether HIAs do in fact change housing decisions, shift the way that decision-makers think, or ultimately shift determinants of health (e.g., housing affordability and quality). This review demonstrates that HIAs can facilitate the consideration of health during housing decision-making. Housing HIAs can also help decision-makers address commonly overlooked effects, such as changes to social cohesion, and improve civic participation by engaging communities in the decisionmaking process.

A10 Use of Health Impact Assessment to Promote Safe Built Environments for Active Transportation

<p><strong>Objective:</strong> To explore the use of Health Impact Assessments (HIAs) within non-profit hospital community benefit activities.</p><p><strong>Methods:</strong> We constructed case studies of three HIAs that were conducted in collaboration with Children’s Hospital Colorado as part of the hospital’s community benefit portfolio. These HIAs were part of a pilot that was funded by the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts.</p><p><strong>Results:</strong> HIAs provided Children’s Hospital Colorado with a transparent and systematic process for generating evidence-based recommendations with community and stakeholder feedback within the hospital’s community benefit activities. HIAs were used to generate recommendations to inform community benefit planning activities and to generate public policy recommendations to enhance child health. The case studies highlighted several issues that need to be addressed in order to further advance the use of HIA within hospital community benefit activities including: use of HIA on explicit health issues, hospital capacity for HIA, potentially broadening the scope of HIA recommendations, and the use of HIA to generate recommendations from broad priority areas.</p><p><strong>Conclusion: </strong>HIAs can help meet the need for established, evidence-based, and stakeholder responsive tools and processes to be used within non-profit hospital community benefit activities. In meeting this need, the non-profit hospital community benefit area can potentially serve as a major institutional home for the practice of HIA. There is a need for additional research and practice innovation to further explore and refine the use of HIA within non-profit hospital community benefit activities. </p>

IntroductionSince the 1990s, the use of health impact assessments (HIAs) has grown for considering the potential health impacts of proposed policies, plans, programs, and projects in various sectors. Evaluation of HIA impacts is needed for understanding the value of HIAs, improving the methods involved in HIAs, and potentially expanding their application. Impact evaluations examine whether HIAs affect decisions and lead to other effects.MethodsI reviewed HIA impact evaluations identified by literature review and professional networking. I abstracted and synthesized data on key findings, success factors, and challenges from 5 large evaluations conducted in the United States, Europe, Australia, and New Zealand and published from 2006 through 2015. These studies analyzed impacts of approximately 200 individual HIAs.ResultsMajor impacts of HIAs were directly influencing some decisions, improving collaboration among stakeholders, increasing awareness of health issues among decision makers, and giving community members a stronger voice in local decisions. Factors that contributed to successful HIAs included engaging stakeholders, timeliness, policy and systems support for conducting HIAs, having people with appropriate skills on the HIA team, obtaining the support of decision makers, and providing clearly articulated, feasible recommendations. Challenges that may have reduced HIA success were poor timeliness, underestimation of time and resources needed, difficulty in accessing relevant data, use of jargon in HIA reports, difficulty in involving decision makers in the HIA process, and absence of a requirement to conduct HIAs.ConclusionHIAs can be useful to promote health and mitigate adverse impacts of decisions made outside of the health sector. Stakeholder interactions and community engagement may be as important as direct impacts of HIAs. Multiple factors are required for HIA success. Further work could strengthen the role of HIAs in promoting equity, examine HIA impacts in specific sectors, and document the role of HIAs in a “health in all policies” approach.

Study aim: The aim of this project is to identify from a range of sources the factors associated with the success of a health impact assessment (HIA) in integrating health...

Mini-symposium — Public Health Observatories: Supporting health impact assessment in practice

A health impact assessment (HIA) is a tool that can be used to inform transportation planners of the potential health consequences of their decisions. Although dozens of transportation-related HIAs have been completed in the United States, the characteristics of these HIAs and the interactions between public health professionals and transportation decision makers in these HIAs have not been documented. A master list of completed HIAs was used to identify transportation-related HIAs. Seventy-three transportation-related HIAs conducted in 22 states between 2004 and 2013 were identified. The HIAs were conducted for projects such as road redevelopments, bridge replacements, and development of trails and public transit. Policies such as road pricing, transit service levels, speed limits, complete streets, and safe routes to schools were also assessed. Five HIAs in which substantial interactions between public health and transportation professionals took place during and after the HIA were examined in detail and included HIAs of the road pricing policy in San Francisco, California; a bridge replacement in Seattle, Washington; new transit lines in Baltimore, Maryland, and Portland, Oregon; and the BeltLine transit, trails, and parks project in Atlanta, Georgia. Recommendations from the HIAs led to changes in decisions in some cases and helped to raise awareness of health issues by transportation decision makers in all cases. HIAs are now used for many topics in transportation. The range of involvement of transportation decision makers in the conduct of HIAs varies. These case studies may serve as models for the conduct of future transportation-related HIAs, because the involvement of transportation agencies may increase the likelihood that an HIA will influence subsequent decisions.

ObjectivesThis study examined the use of health impact assessment (HIA) as a tool for intersectoral collaboration using the case of an HIA project conducted in Gwang Myeong City, Korea.MethodsA typical procedure for rapid HIA was used. In the screening step, the Aegi-Neung Waterside Park Plan was chosen as the target of the HIA. In the scoping step, the specific methods and tools to assess potential health impacts were chosen. A participatory workshop was held in the assessment step. Various interest groups, including the Department of Parks and Greenspace, the Department of Culture and Sports, the Department of Environment and Cleansing, civil societies, and residents, discussed previously reviewed literature on the potential health impacts of the Aegi-Neung Waterside Park Plan.ResultsPotential health impacts and inequality issues were elicited from the workshop, and measures to maximize positive health impacts and minimize negative health impacts were recommended. The priorities among the recommendations were decided by voting. A report on the HIA was submitted to the Department of Parks and Greenspace for their consideration.ConclusionsAlthough this study examined only one case, it shows the potential usefulness of HIA as a tool for enhancing intersectoral collaboration. Some strategies to formally implement HIA are discussed.

Operationalising planetary health as a game-changing paradigm: health impact assessments are key

The U.S. spends more per person on medical care than any other country, yet we have worse health indicators than many comparable wealthy nations. Research increasingly shows that social, economic, and environmental factors determine our health; however, there is still an emphasis on curing illnesses rather than addressing these underlying causes of disease. The Health Impact Project is a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, established in 2009 to promote and support the use of health impact assessment (HIA). As of January 2016, there were 386 HIAs either completed or in progress in the US in a variety of sectors—up from 62 HIAs in 2009. Although built environment HIAs still make up the largest sector of practice, other topics are emerging including education, criminal justice, and labor and employment. As the field matures, we are presented with new opportunities and challenges. In this article we offer lessons learned from our experience over the last seven years, and a view into the future of HIA. Specifically, we discuss the challenges and promises of making health a routine consideration in decision-making, translating HIA recommendations into policy, monitoring and evaluating the impact and outcomes associated with HIAs, promoting health considerations in federal decisions, and using HIAs as a tool for promoting health equity.

Chapter Eight - Health impact assessment in transport related to children

FOR THE PAST 4 DECADES, THE ENVIRONMENTAL IMpact statement (EIS) process has been used to assess the environmental effects of major projects and policies that involve federal funds, such as designing highways, altering waterways, extracting resources on federal lands, and setting Corporate Average Fuel Economy standards. Created under the National Environmental Policy Act of 1969, EISs do not determine policy but rather ensure that stakeholders have full information about unintended environmental impacts before reaching a decision. By evaluating alternative proposals and their relative risks and benefits, an EIS helps decision makers choose options that promote favorable outcomes and mitigate adverse environmental consequences. A natural extension of this work is the use of health impact assessment (HIA) to examine the effects that a policy, program, or project may have on the health of a population. An HIA is defined as “a combination of procedures, methods and tools that systematically judges the potential, and sometimes unintended, effects of a policy, plan, programme or project on the health of a population and the distribution of those effects within the population. HIA identifies appropriate actions to manage those effects.” Most health professionals are probably more familiar with EISs and their intent and usage than with HIAs. Yet there has been a movement to adopt HIAs in public policy settings and legislation and in a recently emerging health policy literature that describes and advocates for this process. HIAs offer great potential for promoting health by encouraging decisions that protect and enhance health and health equity. There is increasing recognition that many contemporary health issues are profoundly influenced by factors outside the traditional realm of health and health care. Factors such as literacy, poverty, employment, and racism contribute to disparities in life expectancy as well as to health-related quality of life. Concerns about how to address these factors have led to a focus on “health in all policies,” in which policies in social sectors such as transportation, housing, employment, and agriculture ideally would contribute to health and health equity. An HIA offers a vehicle to make these health effects explicit. Unfortunately, the evaluation of health effects in policy making has been slow to take hold. The United States lags behind many European nations, Canada, and other countries in the use of HIAs. This situation is somewhat surprising, given that US environmental policy explicitly requires the examination of health effects as part of the National Environmental Policy Act. Although most EISs in the United States incorporate little about health effects, experience in California and Alaska has demonstrated that a wide range of health effects can be successfully integrated into the EIS process. Beyond increasing attention to health outcomes within EISs, the potential applications of HIAs are clearly evident. For example, although air pollution and injury prevention are often considered in major transportation projects, the influence of road design on physical activity and obesity is not. An HIA that recommends the addition of pedestrian and bicycle facilities (“complete streets”) to a transportation plan would contribute to a built environment that promotes the public’s health. The agriculture sector seeks to maximize productivity, meet consumer demand, and sustain livelihoods. From a health perspective, agricultural policy determines food quantity, quality, and prices that directly affect consumption patterns and therefore affect health. HIAs could be used to examine the health effects of proposed agricultural policies, such as ones that enhance production of energy-dense, nutrient-poor foods that contribute to the increasing obesity epidemic. HIAs of proposed zoning plans, which would contribute to decreased density of fast-food and liquor stores or increased density of restaurants and full-service grocery stores, especially in low-income areas, could result in changes that better promote health. In education, a timely HIA might have reduced the inadvertent effects of the No Child Left Behind legislation on physical education programs and health curricula by pro-

BackgroundMeasuring the broader health impacts and social value of public health initiatives is crucial for demonstrating value and securing sustainable funding. This research investigates the use of Health Impact Assessment (HIA) and Social Return on Investment (SROI) as tools to highlight the potential social, economic, and health outcomes of public health investments. The study focuses on integrating these tools to create more comprehensive evaluations and support policy decisions that foster a Well-being Economy.MethodsThe research employed a mixed-methods approach, including systematic scoping reviews of peer-reviewed and grey literature to assess the application of HIA and SROI in public health. In-depth case studies, expert interviews, and a national survey of Public Health Institutes (PHIs) provided additional insights. The study also explored the practical integration of HIA and SROI, including a case study of a self-administered service for Sexually Transmitted Infections.FindingsThe findings reveal that while HIA and SROI are typically used independently, their combined use can offer a more holistic view. However, challenges remain in standardising methodologies, particularly in stakeholder engagement and outcome valuation. The research identified key barriers, such as limited resources and a lack of expertise in PHIs, hindering the full potential of these frameworks. A case study demonstrated the practical application of both frameworks.ConclusionsThis research promotes the value of integrating HIA and SROI and emphasises the importance of fostering greater awareness and understanding of these frameworks. The research provides practical recommendations for advancing the use of HIA and SROI, including policy levers, workforce development, and standardised practices. The findings advocate for a Well-being Economy, where the value of public health is recognised beyond financial returns, fostering long-term investment.Key messages• Using both Health Impact Assessment and Social Return on Investment provides a comprehensive evaluation of public health initiatives, capturing both health outcomes and broader social value.• To capture the wider impacts and social value of investment in public health, greater awareness, standardised practices, and policy levers are essential for securing long-term investment.

Use of Health Impact Assessment in the U.S: 27 Case Studies, 1999–2007

Air pollution contributes to asthma, allergies, lung function impairment, cardiovascular disease, and premature mortality. Transit-oriented development, roadway expansion, new residential and commercial development, and pollution mitigation projects impact local and regional air quality. This article discusses the use of Health Impact Assessment (HIA) by community advocates, public health and city planning departments, and regulatory agencies to ensure health impacts are considered in decision-making processes that affect air quality. HIAs encourage collaboration among diverse stakeholders, including communities facing health inequities. HIAs also use data and analysis to predict health outcomes of proposed planning and policy decisions. This article describes the collaborations, empirical assessment tools, communication and advocacy strategies, findings, recommendations, and outcomes of the following HIAs: a transit-oriented station area plan in Pittsburg, CA, grade separations funded through a policy to levy a fee on all port containers passing through major ports in California, and a freeway expansion in Los Angeles, CA.