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

https://doi.org/10.1016/j.amepre.2007.11.015Get rights and content

Objectives

To document the growing use in the United States of health impact assessment (HIA) methods to help planners and others consider the health consequences of their decisions.

Methods

Using multiple search strategies, 27 HIAs were identified that were completed in the U.S. during 1999–2007. Key characteristics of each HIA were abstracted from published and unpublished sources.

Results

Topics examined in these HIAs ranged from policies about living wages and after-school programs to projects about power plants and public transit. Most HIAs were funded by local health departments, foundations, or federal agencies. Concerns about health disparities were especially important in HIAs on housing, urban redevelopment, home energy subsidies, and wage policy. The use of quantitative and nonquantitative methods varied among HIAs. Most HIAs presented recommendations for policy or project changes to improve health. Impacts of the HIAs were infrequently documented.

Conclusions

These completed HIAs are useful for helping conduct future HIAs and for training public health officials and others about HIAs. More work is needed to document the impact of HIAs and thereby increase their value in decision-making processes.

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

References (51)

  • J.M. Parry et al.

    Criteria for use in the evaluation of health impact assessmentsEvaluation of Health Impact Assessment Workshop

    Public Health

    (2005)
  • Gothenburg Consensus PaperHealth impact assessment: main concepts and suggested approach

  • J. Kemm et al.

    Health impact assessment: concepts, theory, techniques, and applications

    (2004)
  • R. Bhatia et al.

    Estimation of health benefits from a local living wage ordinance

    Am J Public Health

    (2001)
  • B.L. Cole et al.

    The projected health impact of the Los Angeles City Living Wage Ordinance

    J Epidemiol Comm Health

    (2005)
  • A.L. Dannenberg et al.

    Growing the field of health impact assessment in the United States: an agenda for research and practice

    Am J Public Health

    (2006)
  • Feet FirstHIA-USA listserv

  • Flooring in public housing HIA

  • R. Bhatia

    Protecting health using an environmental impact assessment: a case study of San Francisco land use decisionmaking

    Am J Public Health

    (2007)
  • Eastern neighborhoods community health impact assessment

  • Eastern neighborhoods rezoning and area plans environmental impact report

  • Executive Park sub area planApplication of healthy development measurement tool

  • J. Heller et al.

    Jack London Gateway senior housing and retail expansion, Oakland

  • J. Heller et al.

    East Bay Greenway Health Impact Assessment

  • Oak to Ninth Avenue waterfront development project health impact assessment

  • MacArthur BART transit village health impact assessment

    (2007)
  • B.L. Cole

    Health impact assessment of after-school programs: California Ballot Proposition 49

  • B.L. Cole

    Health impact assessment of the 2002 Federal Farm Bill

  • B.L. Cole

    Health impact assessment of the Sacramento Safe Routes to School program

  • B.L. Cole

    Health impact assessment of NE Plaza/Buford Highway Redevelopment – Atlanta

  • B.L. Cole

    Health impact assessment of modifications to the Trenton Farmers’ Market

  • C.L. Ross

    Health impact assessment of the Atlanta BeltlineFinal report

  • Appendix F: Health Impact AssessmentPrepared by Center for Quality Growth and Regional Development, Georgia Institute of Technology

  • Simmons M, McLeod KB. Taylor Energy Center: Health Impact Assessment. Available online at:...
  • Affordable housing and child health: a child health impact assessment of the Massachusetts Rental Voucher Program, 2005

  • Cited by (0)

    View full text