Assessing the Impacts of Health Impact Assessments

Health impact assessment (HIA) is an emerging approach to identify, describe, and communicate to stakeholders the health consequences of proposed programs, policies, or projects (PPP). Little is known about the impact of HIAs on finalized PPPs.

Using multiple search strategies, investigators identified HIAs completed in the United States during 1999-2007. HIA characteristics and influence on the decision-making process were abstracted from published and unpublished sources and interviews with authors of identified HIAs. Information collected on HIAs included decision-maker characteristics and involvement, HIA methodology, practitioner characteristics, and community interactions. HIAs were categorized into four outcomes related to influence on decision-makers: causing an alteration of the PPP, raising awareness among decision-makers, supporting the predestined decision, or no effect.

Of the 27 HIAs identified, 17 (63%) of the decision-makers were city councils or city planning commissions, 20 (74%) involved local PPP, and 20 (74%) included community involvement. Final decisions have not been made on 10 PPPs with HIAs. Most HIAs with known outcomes influenced or raised awareness among decision-makers; however, many HIAs had no formal process for tracking effects on decision-making. Common characteristics of the 11 HIAs known to have altered the PPP included decision-maker acceptance of HIA, community involvement, and coordinated timing with decision-making. The single HIA with no effect lacked these characteristics.

HIAs have led to the incorporation of health concerns into PPP decisions and raised awareness of health consequences among decision-makers. Improved tracking of HIA outcomes is necessary to fully assess the effectiveness of the practice of HIA.