A systematic review on the use of Health Impact Assessments in the design of built environments to promote healthy outcomes in underserved communities in the United States

Studies have shown that various factors such as poor housing, food deserts and a lack of recreational space contribute to poor health. This general lack of a built environment has contributed to chronic medical conditions particularly in underserved communities. A Health Impact Assessment (HIA) has the potential to influence policy decisions across many non- health sector industries involved in developing built environments. This research will evaluate how HIAs can lead to health in all policies thus creating built environments that promote healthy outcomes. There are many underserved communities that suffer from access to fresh and affordable produce, green spaces, and, public transportation which promote healthy lifestyles.  Although chronic illness can be due to genetic factors, there has been an increase in poor health associated with poorly built living environments. When HIA’s are used in conjunction with non-health sector designs for creating built environments, the results are healthier communities and fewer adverse health outcomes. A systematic review of journal articles, reports, and policy briefs to assess the association between the use of HIAs in built environment designs, and improved health outcomes was conducted. PubMed, Galileo, EBSCO, and other databases were searched for articles from 1990-2014. Search words included, but were not limited to health impact assessment, built environment,  health outcomes, chronic conditions, and urban, underserved communities.  Research revealed that when HIAs were conducted decisions led to policies that created built environments that positively impacted the health of communities. Results included cleaner air, improved recreational space, and design elements such as sidewalks, bike trails, parks, and well-lit neighborhoods leading to a reduction in chronic diseases, including obesity, diabetes and hypertension. In addition, the inclusion of public health departments in the HIA process allows for an assessment of non-health sector policies on health outcomes pre and post the development of a built environment.