Review and special articleUse of Health Impact Assessment in the U.S: 27 Case Studies, 1999–2007
Introduction
The use of health impact assessment (HIA) has been increasing in the United States in recent years, fueled by a growing recognition among public health, planning, and transportation professionals that land-use and transportation-planning decisions can have a substantial impact on the public’s health. HIA is a tool to help planners and other decision-makers better recognize the health consequences of the decisions they make. HIA is defined as “a combination of procedures, methods, and tools by which a policy, program, 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.”1
Health impact assessments have been widely used in Europe and elsewhere,2 and methods are similar in Europe and the U.S. However, domestic examples are needed: (1) to increase awareness of their use across the country, (2) to document that HIAs are applicable in U.S. settings, (3) to increase their political acceptability, (4) to serve as models for further HIAs, and (5) to be used as examples in U.S.-based HIA training courses. Fewer resources may be needed to conduct new HIAs if investigators can draw on the literature reviews and methods from similar HIAs previously completed in the U.S., noting the differences in local environment and project/policy specifications. For example, the U.S.-based analysis of the health impacts of additional income from a living wage ordinance3, 4 may be useful as part of an analysis of health effects attributable to employment generated by a new commercial development in the U.S.; data on links between health and income from Europe would be less applicable for such an analysis because of differing social, economic, and political conditions.
In 2004, an expert panel examined the potential for increased use of HIAs in the U.S. and suggested next steps that could advance the use of HIAs.5 These steps included conducting pilot HIA projects, developing a database of completed HIAs, increasing the capacity to train people to conduct HIAs, developing practical forecasting methods, developing incentives to increase the demand for HIAs by decision-makers, and evaluating the impacts of completed HIAs on decision processes.5
This paper summarizes characteristics of 27 HIAs completed in the U.S. between 1999 and 2007. This assemblage of completed HIAs may be useful for public health professionals and others who are considering conducting an HIA.
Section snippets
Methods
The initial list was derived from HIAs in which the co-authors were involved as primary investigators or consultants. Additional HIAs were identified through networking at professional meetings and through inquiries received by the co-authors related to their previous publications and presentations about HIA. In September 2007, a literature search was conducted on Medline, SocIndex, TRIS (Transportation Research Information Services), Environmental Science and Pollution Management, and Google
Results
The key characteristics of the 27 HIAs completed in the U.S. between 1999 and 20073, 4, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31 are summarized in Table 1. The HIAs were conducted in California (n=15), Alaska (n=3), Georgia (n=3), Massachusetts (n=2), Colorado (n=1), Florida (n=1), Minnesota (n=1), and New Jersey (n=1). The types of policies and projects examined included wage policies, walk-to-school programs, residential and commercial
Discussion
After many years of HIA use in Europe and elsewhere, HIAs are emerging in the U.S.; this report reviews that experience. The issues examined in these HIAs are diverse, suggesting that HIA methods may be useful for a wide range of projects and policies. These studies highlight the multidisciplinary nature of HIAs and the need for effective collaboration between public health practitioners and nontraditional partners such as land-use and transportation planners.
Health impact assessments are
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