Use of Health Impact Assessment to Examine Projects and Policies in the United States: 16 Case Studies, 1999-2006

Background: The use of health impact assessment (HIA), a tool to help planners and other decision-makers consider the health consequences of their decisions, has been growing in recent years in the U.S. Methods: Using multiple search strategies, we identified sixteen HIAs completed in the U.S. during 1999-2006. For each HIA, information abstracted included location, year, type of project or policy, organization that conducted HIA, funding sources, health determinants and populations affected by the project or policy, community involvement, health disparities issues, HIA methods, quantitative and qualitative health indicators examined, key results, communication of results, and impact of HIA on subsequent decisions. Results: Topics examined in these HIAs ranged from policies about livable wages, after school programs, and home heating subsidies, to projects about residential and commercial redevelopment, power plants, and public transit. Most HIAs were funded by local health departments, foundations, or federal agencies. Health disparities were especially important in HIAs related to housing, urban redevelopment, home energy, and wage policy. The use of quantitative and qualitative health measures varied among HIAs due to availability of data. Most HIAs presented recommendations for policy or project improvements to promote health. The impacts of the HIAs were documented in only a few cases. Discussion: These completed HIAs are useful for facilitating the conduct of future HIAs and for training public health officials and others about HIAs. More work is needed both to improve the communication of HIA findings to policy makers and to evaluate the impact of HIAs on subsequent decisions.