Health impact assessment and agricultural land use: A case study of the Hawaii County Agricultural Development Plan

Health impact assessment (HIA) is a tool used to consider health outcomes of proposed policy or planning decisions in order to inform the decision-making process. Most HIAs to date have been conducted in urban settings, and have addressed transportation, the built environment, or proposed legislation. We present the processes and outcomes of an HIA of the Agricultural Development Plan in rural Hawaii County, Hawaii. During the screening process, the multidisciplinary HIA team identified four specific agricultural plan policies likely to have significant health impact: promotion of food cultivation for the local market; institutional purchasing of locally grown agricultural products; promotion of policies to support home and community food gardens; and new development of land for biofuel production. The domains of health impact identified through a stakeholder engagement process included food security, food safety, obesity, employment, economic growth, and social well-being. HIA findings were employed to craft policy recommendations improve positive or mitigate negative health outcomes of the agricultural plan. Assessment methods included literature review, estimations of changes in disease incidence, and economic forecasting of income and revenue generated as a result the proposed changes. Stakeholders were informed of HIA results through circulation of an Executive Summary, media outreach, and stakeholder and public meetings. We expect that HIA findings will result in adoption of health-promoting policy as decision-makers appear open to the health impact discussion. We discuss challenges and problems encountered in the course of conducting this HIA and present recommendations for conducting HIA in rural or remote locations.