Use Of Health Impact Assessment Research Articles

6.P. Scientific session: Economic evaluation of health impacts for better decision choices

Abstract The strategy of Health in All Policies (HiAP) pursues to analyse the wider determinants of health affected by the decision-making process of traditionally non-health sectors, seeking to enhance population health benefits while avoiding health inequalities. This usually involves the use of health impact assessment (HIA) or health lens analysis to any policy, program, plan or project (PPPP), preferably prior to its implementation. On the other hand, decision-makers from a wide range of public and private sectors also demand a better insight of the meaning of the health impacts quantified under HIA. Assuming the (ubiquitous) situation of limited resources and budgets, decisions need to be based on cost effectiveness criteria and, whenever possible, direct and indirect health costs should be part of the impact assessment. Economic appraisal attempts to define whether a proposal makes a net contribution to social welfare, quantifying and valuing changes to individuals’ utility from the societal perspective, taking into account the impact of health on the individual, their family, employers, healthcare providers and the state. This approach can incorporate different components of the welfare costs of illness, including direct medical and paid care expenses, indirect lost opportunity costs such as productivity and the value of informal care time, as well as a value that monetises the disutility or pain and suffering associated with disease. The range of methods and estimated benefits can make it challenging to identify a best practice approach. The present session aims to address certain methodological aspects related to the economic evaluation of health impacts, which still generate some controversy and debate, with particular emphasis on the following topics: • Approaches for synthesizing evidence on health impact pathways and economic evaluation of health impacts for a better decision choice; • Health metrics: influence on the conclusions of economic analysis within HIA; • Sources of metrics used for economic analysis; • Uncertainties inherent to economic valuation of health outcomes: how to deal with it. Key messages • The economic analysis of health impacts can help prioritizing aspects with the greatest impact on population health, facilitating a more effective use of human and economic resources. • The economic analysis within HIA can improve decision-making but requires careful consideration of health metrics, sourcing of data, and management of uncertainties.

Towards healthier places: understanding local authority implementation of health impact assessments in urban planning projects in England

ABSTRACT Health Impact Assessment is a tool increasingly used by local authorities in the urban planning process to support the delivery of healthy places. However, there is a lack of evidence on the use of health impact assessments, including how they fit into planning decision-making processes. This paper reports on a qualitative study with nine participants in public and private sectors involved in the health impact assessment process in England. Using the language of policy theory, a model of how health impact assessments work to promote health in urban planning projects is proposed: in part by forcing change from developers through regulation, but more so by persuading them to make healthier developments voluntarily through a process of collaboration and dialogue. This model can help stakeholders involved in health impact assessments understand and manage the process more effectively. Findings also highlight enablers and barriers of effective practice which form the basis of recommendations for local authorities implementing Health Impact Assessment.

Health Impact Assessment in protected areas: a proposal for urban contexts in Brazil.

The use of Health Impact Assessment (HIA) in the establishment of an urban protected area can enhance the positive impacts and mitigate the negative impacts resulting from its implementation. Brazil hosts some of the most important biodiversity hotspots in the world and the HIA may benefit biodiversity and human health. These areas are commonly created without any preceding survey to assess their impacts on health. Protected areas located in urban zones are essential to maintain environmental balance and quality of life in cities. It promotes positive impacts on health, providing ecosystem services and salutogenic benefits. However, they can generate negative impacts such as the violation of human rights, property speculation, spread of vectorial diseases, and psychosocial stress. Based on the identification of the potential impacts of urban protected areas on health and best practices, this qualitative and exploratory study justifies the use of HIA in urban protected areas, especially in the Brazil, and indicates the main elements for the construction of a methodological approach to contribute to the Sustainable Development Goals and one of its alternatives, the Buen Vivir approach.

Facilitators, Barriers and Views on the Role of Public Health Institutes in Promoting and Using Health Impact Assessment-An International Virtual Scoping Survey and Expert Interviews.

Public health institutes have an important role in promoting and protecting the health and well-being of populations. A key focus of such institutes are the wider determinants of health, embracing the need to advocate for ‘Health in All Policies’ (HiAP). A valuable tool to support this is the health impact assessment. This study aims to support public health institutes to advocate more successfully for the use of health impact assessments and HiAP in order to promote and protect health, well-being and equity. During July 2021, a quantitative online survey was undertaken across international networks with 17 valid responses received. Semi-structured interviews were also administered with nine expert representatives and analysed thematically. In total, 64.7% (n = 11) of survey respondents were aware of health impact assessments and 47.1% (n = 8) currently conducted health impact assessments. It was noted that there are differing approaches to HIAs, with a need for a clear set of standards. Barriers to use included lack of knowledge, training and resources. Overall, 64.7% (n = 11) of survey respondents would like to do more to develop knowledge and capacity around health impact assessments. The results from this study can serve as a platform to help build knowledge, networks and expertise, to help support a ‘Health in All Policies’ approach and address inequalities which exist in all societies.

The use of health impact assessments performed in Quebec City (Canada) – 2013–2019: Stakeholders and participants' appreciation

Health impact assessment (HIA) is an approach that aims to prospectively assess the potential effects of a policy, program or project on the health of the population and to formulate recommendations to minimize the negative effects, and to maximize the positive effects. In Quebec City, a particular process has been put in place to perform HIA. This paper presents the impacts and outcomes of the performed health impact assessments, based on the HIA participants (stakeholders)’ perceptions. More specifically the aims were to 1) analyze the implementation of the HIA procedure in the urban planning process and to identify levers, constraints and potential for improvement; 2) analyze the deployment of the HIA approach, including the stakeholders' involvement, the ability of HIA to support decision making and to make changes in the stakeholders' practice; and 3) identify success factors and challenges for the integration of HIA into the urban planning process. A survey was developed to question the HIA participants (stakeholders) (response rate 62.5%, n = 25/40). Themes were created according to the provided answers. This study provided a positive feedback on the implemented HIA process. It allowed the identification of issues regarding its use in the urban planning process and a better understanding of the stakeholders' evaluation of HIA. The results indicate the potential HIA has at enhancing the interdisciplinary decision-making process in urban planning. Improvements in the practices used were also identified and many were similar to those presented in other contexts. The obtained results can be useful to HIA practitioners and municipalities wishing to implement HIA.

'Health in All Policies'-A Key Driver for Health and Well-Being in a Post-COVID-19 Pandemic World.

Policy in all sectors affects health, through multiple pathways and determinants. Health in all policies (HiAP) is an approach that seeks to identify and influence the health and equity impacts of policy decisions, to enhance health benefits and avoid harm. This usually involves the use of health impact assessment or health lens analysis. There is growing international experience in these approaches, and some countries have cross-sectoral governance structures that prioritize the assessment of the policies that are most likely to affect health. The fundamental elements of HiAP are inter-sectoral collaboration, policy influence, and holistic consideration of the range of health determinants affected by a policy area or proposal. HiAP requires public health professionals to invest time to build partnerships and engage meaningfully with the sectors affecting the social determinants of health and health equity. With commitment, political will and tools such as the health impact assessment, it provides a powerful approach to integrated policymaking that promotes health, well-being, and equity. The COVID-19 pandemic has raised the profile of public health and highlighted the links between health and other policy areas. This paper describes the rationale for, and principles underpinning, HiAP mechanisms, including HIA, experiences, challenges and opportunities for the future.

A meta-analysis of the association of aircraft noise at school on children's reading comprehension and psychological health for use in health impact assessment

Whilst the effects of aircraft noise on children's cognition are well-accepted, their application in Health Impact Assessment (HIA) and methodologies to monetise the effects of noise on health have been limited. This paper presents the first meta-analysis of the effect of aircraft noise at school on children's reading comprehension and psychological health assessed with the Strengths and Difficulties Questionnaire. Data from three methodologically similar studies carried out in 106 schools near London Heathrow, Amsterdam Schiphol, and Madrid Barajas airports (the Schools Environment and Health Study, the West London Schools Study, and the RANCH study) were analysed finding that a 1 dB increase in aircraft noise exposure at school was associated with a −0.007 (95%CI −0.012 to −0.001) decrease in reading score and a 4% increase in odds of scoring well below or below average on the reading test. The analyses also found that a 1 dB increase in aircraft noise exposure at school was associated with a 0.017 (95%CI 0.007–0.028) increase in hyperactivity score. No effects were observed for emotional symptoms, conduct problems or Total Difficulties Score. Meta-analyses confirm existing evidence for effects of aircraft noise exposure on children's reading comprehension, providing a pooled estimate and exposure-effect relationship, as well as additional estimates and relationships for effects on scoring ‘well below or below average’ on the reading test offering flexibility for taking reading comprehension into account in HIA and monetisation methodologies in a wide-range of contexts.

A Systems Understanding Underpins Actions at the Climate and Health Nexus.

Multiple sectors—health and non-health—can determine the health and well-being of people and the condition of the socio-ecological environment on which it depends. At the climate and human health nexus, a systems-based understanding of climate change and health should inform all stages of the policy process from problem conceptualization to design, implementation, and evaluation. Such an understanding should guide countries, their partners, and donors to incorporate health in strategic climate actions based on how health is affected by, and plays a role in, the dynamic interactions across economic, environmental, and societal domains. A systems-based approach to sustainable development has been widely promoted but operationalizing it for project level and policy development and implementation has not been well articulated. Such an approach is especially valuable for informing how to address climate change and health together through policy actions which can achieve multiple, mutually reinforcing goals. This commentary article describes strategic steps including the complementary use of health impact assessment, quantification of health impacts, and linking climate and health actions to national and global policy processes to apply a systems-based approach for developing climate mitigation and adaptation actions with human health benefits.

Use of health impact assessments in the housing sector to promote health in the United States, 2002-2016.

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.

Incentivizing Change Within Social Determinants of Health Using Blockchain Technology

There are growing initiatives and calls for focusing greater attention to social determinants of health and their impact on population health [1]. Several emerging strategies are being used to begin to address social determinants, such as the use of health impact assessments and applying health in all policies (HiAP). These strategies and tools are being implemented in an effort to review existing and needed policies, as well as propose new policies to lessen health disparities [2]. Efforts to further integrate social determinants of health through the use of health information technology and other emerging technologies, such as distributed ledger technology both in and outside of existing health care systems are also increasing [2]. Understanding and addressing the social determinants of health through both traditional and non-traditional sectors is key to further reducing health disparities [1, 3-4]. Through exploration of the current state of social determinants of health in the healthcare industry, an analysis of blockchain technology will render the acceleration and adoption of social determinants of health to effectively provide improved health outcomes.

Adding value to the use of Health Impact Assessment and social return on investment technologies

Abstract Health Impact Assessment (HIA) and Social Return on Investment (SROI) are beneficial public health methodologies that assess potential effects on health including social, economic and environmental factors and have synergies in their approaches. This paper explores how HIA and SROI can complement each other to capture and account for the impact and social value of an assessed intervention or policy. A scoping review of academic and grey literature was undertaken to identify case studies published between January 1996 and April 2019 where HIA and SROI methods have been used to complement each other. Semi-structured interviews were carried out with nine international experts from a range of regulatory/legislative contexts to gain a better understanding of past experiences and expertise of both HIA and SROI. A thematic analysis was undertaken on the data collected. The review identified two published reports which outline when HIA and SROI have both been used to assess the same intervention. Interview results suggest that both methods have strengths as standalone processes i.e. HIAs are well-structured in their approach, assessing health in its broadest context and SROI can add value by monetizing social value as well as capturing social/environmental impact. Similarities of the two methods were identified i.e. a strong emphasis on stakeholder engagement and common shared principles. When questioned how the two methods could complement each other in practice, the results indicate the benefits of using HIA to explore initial impact, and as a platform on which to build SROI to monetarize social value. HIA and SROI methodologies have cross-over. The research suggests potential benefits when used in tandem or combining the methods to assess impact and account for health and social value. Innovative work is now being carried out in Wales to understand the implications of this in practice and to understand how the results of the two methods could be used by decision-makers. Key messages HIA and SROI methods can be used in tandem to capture both the health impact and social value of policies and proposed interventions. HIA and SROI when used together can provide valuable information to inform decision makers around the health impact and social value of proposed policies and interventions.

Development of a quality assurance review framework for health impact assessments

ABSTRACTThe use of health impact assessments (HIAs) has rapidly increased over the last two decades and has been undertaken to evaluate the health implications of many new projects across the globe. In July 2017, Wales became the first country to legislate for broad approach HIAs, i.e. it considers not only environmental health effects but the social determinants of health, well-being and inequalities. Although the introduction of statutory HIA will ensure the use of HIAs, experts have expressed concerns that legislative measures could lead to poor-quality HIAs and associated reports. This paper outlines the development process and analytical reflections of a quality assurance (QA) review framework for HIAs. The framework has been developed over a 2-year period which allowed the collective intellectual capital behind it to evolve in response to practice-based learning. A standardised form of QA for all types and levels of HIA will provide greater clarity regarding the required criteria for conducting and completing an HIA and ensuring this takes place in a robust, interdisciplinary and inter-sectoral manner. Therefore, this QA review framework should fit into existing HIA practice and complement other tools such as best practice guidance to sustain the global reputation of HIA.

Health impact assessments in hospital community benefit: A multiple case study of the use of HIAs at Children’s Hospital Colorado

<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>

Slum Upgrading and Health Equity.

Informal settlement upgrading is widely recognized for enhancing shelter and promoting economic development, yet its potential to improve health equity is usually overlooked. Almost one in seven people on the planet are expected to reside in urban informal settlements, or slums, by 2030. Slum upgrading is the process of delivering place-based environmental and social improvements to the urban poor, including land tenure, housing, infrastructure, employment, health services and political and social inclusion. The processes and products of slum upgrading can address multiple environmental determinants of health. This paper reviewed urban slum upgrading evaluations from cities across Asia, Africa and Latin America and found that few captured the multiple health benefits of upgrading. With the Sustainable Development Goals (SDGs) focused on improving well-being for billions of city-dwellers, slum upgrading should be viewed as a key strategy to promote health, equitable development and reduce climate change vulnerabilities. We conclude with suggestions for how slum upgrading might more explicitly capture its health benefits, such as through the use of health impact assessment (HIA) and adopting an urban health in all policies (HiAP) framework. Urban slum upgrading must be more explicitly designed, implemented and evaluated to capture its multiple global environmental health benefits.

Seven Years in the Field of Health Impact Assessment: Taking Stock and Future Directions

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.

A Brief History of Health Impact Assessment in the United States

In recent decades, several factors have contributed to the increasing use of health impact assessment (HIA) in the United States. Initially in California and subsequently in other states, communities that have been traditionally disenfranchised began seeing HIA as an opportunity to address the issues impacting their lives and to increase their ability to participate in decision-making processes about those issues. Second, public health professionals began to better understand the links between health and the natural and built environments, and to use HIA as a tool to improve cross-disciplinary communication. Third, public health professionals recognized that HIA could be valuable to address economic and social issues, such as educational and wage policies, in addition to built environment issues, such as land use and transportation.

Effectiveness of Health Impact Assessments: A Synthesis of Data From Five Impact Evaluation Reports.

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.

Equity focused health impact assessment: social determinants of health

Addressing health disparities during planning and delivery of services in health care requires an understanding of the health requirements of the disadvantaged population as well as key barriers to equitable quality care. To gain knowledge in social determinant of health it is important to have effective planning tools. Over the past two decades there has been continuous use of health impact assessment (HIA) to assess the health impacts of proposals, programs, policies, projects and even plans. The major problem affecting the implementation of HIA is the identification of the health issues in a policy since it depends on the judgment and the interpretation of the policy aspects by policy makers. The equity focused HIA has an opportunity to make important contributions to policy making processes. The main purpose of EFHIA (Equity Focused Health Impact Assessment) is to ensure that policies, plans, and programs being developed or proposed have observed health equity in order to promote social health.

Reducing health inequalities: the use of Health Impact Assessment on Rural Areas

Health is greatly influenced by social, economic and political determinants. Accordingly, decisions influencing people's health do not concern only health services or 'health policies', but decisions in many different policy areas have their influence on these health determinants. Health Impact assessment (HIA) is a predictive tool to support decisions in policy-making. The ultimate goal of this framework is to maximize health gains and, as far as possible, to reduce health inequalities. HIA presents a commitment to ensure that the rural dimension is routinely considered as part of the making and implementing of policy. The aim of this paper is to review the use of HIA on rural areas. Conclusions: HIA shows its great potential to contribute to local authority decision making. The use of HIA was identified in 2 key areas: strategic planning (sustainable development, EU Common Agricultural Policy, Federal Farm Bill, land-use planning work); and in specific smaller scale projects (rural health service redesign proposal, accessing healthy food, transport, health care disparities, etc.).

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

Background Health impact assessment (HIA) is rapidly growing approach to decision-making that identifies potential health impacts of proposed projects, policies, plans, and programs. HIAs provide valuable recommendations about how to maximize health benefits and avoid or mitigate unintended negative consequences of decisions. Proposed decisions that affect walking and bicycling often do not assess the unintended injury risks. This research examines the usefulness and characteristics of HIAs that have addressed injury risk as part of proposals promoting opportunities for active in U.S. communities. Methods HIAs were identified using the searchable Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, online database of self-reported HIAs. The database includes all HIAs conducted in the U.S. to date that have been reported to the Health Impact Project. A key word search identified HIAs as relevant to the built environment or transportation sectors. HIAs were excluded if active was not central to the purpose of the proposal. Results Twenty-one HIAs, conducted in both urban and rural jurisdictions, were completed between 2004 and 2013. Six of these HIAs addressed projects exploring walking and biking paths, greenways, and bicycle lanes; six addressed policies exploring complete streets, safe routes to school, and walking and biking; and nine addressed pedestrian and bicycling plans. HIAs used local and state data on to illustrate the potential injury risks, and also illustrated the effects on inequities. Evidence-based recommendations to address injury risk as part of these HIAs incorporated Crime Prevention through Environmental Design principles, traffic calming, and improving sidewalks near schools. Conclusions Proposed active decisions are generally favorable to health in their initial design, but they do not always consider injury risk. HIAs advance the field of injury prevention and control by illuminating the unintended injury and violence risks of proposals and proposing evidence-based injury strategies. Although the HIAs that were reviewed were conducted in the U.S. the findings provide important lessons for communities around the world. Keywords: SR2S