“Impact” in Health Impact Assessments: Effectiveness of HIAs as a Decision-Making Tool

Background: Health impact assessment (HIA) is a valuable tool that helps decision-makers in non-health sectors integrate relevant health information into the assessment and planning of proposed projects, programs, or policies. Despite nearly ten years of experience with HIA in the U.S., information about the impact that HIAs have had on the decisions they address is scarce. Methods: HIA characteristics and outcomes were defined through review of HIA documents and a survey of practitioners. We This was used to developed an evaluation framework for HIA that accounts for the diverse experiences that HIA practitioners reported, and allows for a broad range of definitions of success. Results: By January 2010, 56 U.S. HIAs were identified. Practitioners identified a range of potential mechanisms through which HIA could be “successful.” HIA practitioners commonly cited decision-maker support and community involvement as important. The diverse range of HIA practices creates challenges for evaluation. However, some common characteristics of effective HIAs were identified through this survey, such as the need for HIA to be timely and to involve decision-makers early and throughout the HIA process. We will present a series of case studies based on this research that highlight the range of potential applications of HIA across multiple sectors and levels of government, as well as the outcomes of HIAs and the factors practitioners identify as important contributors to effectiveness.