Health impact assessment: Adoption and implementation in state policymaking

Background: Policy is a tool used to impact population health. This tool is not perfect and efforts to improve it are challenging. One approach is health impact assessment (HIA). Health impact assessment is an instrument for analyzing, evaluating and informing policymaking about consequences of decisions on population health. Objective: This study analyzes HIA adoption and implementation processes in other state models and examines their feasibility and utility for Arkansas. Methods: Two information sources were used; Key informant interviews and document reviews. Respondents were from California, Washington and Minnesota. Types of respondents included health officials, legislators, researchers and non-profit representatives. Responses were compared across states to assess variation in HIA adoption, implementation and policy impact. Document reviews provided corroborating evidence of information from interviews. Findings: Three distinct models of adoption emerged. These models were 1.) Local to state diffusion model 2.) State adoption model and 3.) Non-governmental model. Four major domains of implementation observed were 1.) Legal requirements 2.)Financing 3.)Administration and 4.) Methods for conducting HIAs. Policy impact was found through anecdotal evidence of HIA impact on decision making activity. Policy Implications: Knowledge of HIA varied among Arkansas stakeholders. Current state policy review and assessment procedures were compatible with HIA bolstering its potential adaptability for Arkansas. It is still premature to measure HIA policy impact but early indication shows promise of HIA impacting public health decision making. A pilot demonstration process for Arkansas would help further test HIA and contribute to building more evidence on HIA policy impact.