Healthy Communities Start with Health Impact Assessments

Guest blog by Cynthia Stone, DrPH, RN–

cindystoneHave you heard the term health impact assessment?  HIAs are becoming more common in the U.S. after being used in Australia, and the U.K. for over 20 years. HIA’s are endorsed by the World Health Organization, the World Bank, the U.S. National Research Council, Robert Wood Johnson Foundation and Pew Charitable Trust. The purpose is to get health into the discussion by decision makers as they consider a new program, policy or procedure.

For example, a school board is trying to decide where to locate a new school. It might only consider that land is cheaper 10 miles on the fringe of the town. It might NOT consider that building it near neighborhoods with young families will allow the children to walk and bike to school, improving their level of physical activity and slowing the rising levels of childhood obesity. The long term cost savings of less obesity, diabetes, and heart disease could be a larger savings than the lower cost of the land being considered.

A health impact assessment values social justice and strives to give voice to the residents potentially impacted by the project or policy. For example, the decision to tear down an apartment building and put up new condominiums has a severe health impact on the poor and elderly who live there. They would have to find a new place to live, which is very stressful, and they might not be able to afford the new building when it is done. If the developers would consider these concerns, they could build to accommodate more income variation.

The steps in the HIA process generally include the following:

SCREENING to determine if an HIA is needed and there are sufficient expertise and resources to complete the HIA.

SCOPING involves defining the community that will be impacted, the health determinants that could be compromised by the project and the plan to be followed.

ASSESSMENT includes gathering baseline health data about the community and input from the residents.

RECOMMENDATIONS will have actions that could further increase the positive health effects of the project and mitigate potential negative effects.

MONITORING is seeing if the recommendations were used and to what extent.

EVALUATION is to determine if the HIA plan was followed and what potential health outcomes were achieved.

The IU Richard M. Fairbanks School of Public Health has one of the ten graduate courses in the U.S. on health impact assessment. A service project with a community group is done with each HIA class and will be held in the fall.

Cynthia Stone, DrPH, RN is Clinical Associate Professor and Health Policy & Management Concentration Director for the IU Fairbanks School of Public Health at IUPUI. Dr. Stone joined the School of Public Health in 2007 after 15 years of teaching at the IU School of Nursing.

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