A Framework and Guidance for Health Impact Assessment

Consensus

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Factoring health and related costs into decision making is essential to confronting the nation's health problems and enhancing public well-being. Some policies and programs historically not recognized as relating to health are believed or known to have important health consequences. For example, public health has been linked to an array of policies that determine the quality and location of housing, availability of public transportation, land use and street connectivity, agricultural practices and the availability of various types of food, and development and location of businesses and industry.

Improving Health in the United States: The Role of Health Impact Assessment offers guidance to officials in the public and private sectors on conducting HIAs to evaluate public health consequences of proposed decisions—such as those to build a major roadway, plan a city's growth, or develop national agricultural policies—and suggests actions that could minimize adverse health impacts and optimize beneficial ones.

Several approaches could be used to incorporate aspects of health into decision making, but HIA holds particular promise because of its applicability to a broad array of programs, consideration of both adverse and beneficial health effects, ability to consider and incorporate various types of evidence, and engagement of communities and stakeholders in a deliberative process. The report notes that HIA should not be assumed to be the best approach to every health policy question but rather should be seen as part of a spectrum of public health and policy-oriented approaches.

The report presents a six-step framework for conducting HIA of proposed policies, programs, plans, and projects at federal, state, tribal, and local levels, including within the private sector. In addition, the report identifies several challenges to the successful use of HIA, such as balancing the need to provide timely information with the realities of varying data quality, producing quantitative estimates of health effects, and engaging stakeholders.

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224 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-21883-7
ISBN Ebook: 0-309-21884-5
DOI: https://doi.org/10.17226/13229

Suggested citation

National Research Council. 2011. Improving Health in the United States: The Role of Health Impact Assessment. Washington, DC: The National Academies Press.

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Richard J. Jackson

Richard J. Jackson (Chair) is a professor and chair of environmental health sciences at the University of California, Los Angeles. He has worked extensively on the impact of the environment on public health, and over the past decade, much of his work has focused on how the “built environment” affects health. In 2004, he co-authored the book Urban Sprawl and Public Health. Dr. Jackson is currently working on policy analyses of environmental impacts on health ranging from chemical body burdens to climate change to urban design. In addition, he is evaluating the effects of farming, education, housing, and transportation policies on health. Dr. Jackson was director of the Centers for Disease Control and Prevention's National Center for Enviromental Health for 9 years and also served as the California State Health Officer. He has worked on pediatric boards at the University of California, San Francisco, chaired the American Academy of Pediatrics Committee on Environmental Health, and recently served on the Board of Directors for the American Institute of Architects. Dr. Jackson serves on the editorial boards of the American Journal of Industrial Medicine, Environmental Research, and Public Health Reports. He is currently a member of the Institute of Medicine Roundtable on Environmental Health Sciences, Research, and Medicine and the National Research Council Committee on “Sustainable” Products and Services. Dr. Jackson earned his MPH from the University of California, Berkeley and his M.D. from the University of California, San Francisco.

Dinah Bear

Dinah Bear is an attorney at law in Washington, DC, and previously served for over 25 years on the President’s Council on Environmental Quality (CEQ). She joined CEQ as deputy general counsel in 1981, was appointed general counsel in January 1983, and served in that capacity until October 1993. She resumed that position in January 1995 and was with CEQ until her retirement from government at the end of 2007. At CEQ, she was responsible for interpreting the legal requirements of the National Environmental Policy Act (NEPA) and assisted in overseeing the implementation of NEPA throughout the executive branch. Ms. Bear currently serves on the Board of Defenders of Wildlife, Humane Borders, a faith-based organization based in Tucson, Arizona, the Mt. Graham Coalition, and is an advisor to the Center for International Environmental Law. Ms. Bear earned her J.D. from McGeorge School of Law and has been admitted to practice by the District of Columbia Bar, the State Bar of California, and the U.S. Supreme Court. She has chaired the American Bar Association’s Standing Committee on Environmental Law and the District of Columbia Bar Association’s Section on Environment and Natural Resources. She has received the award for Distinguished Achievement in Environmental Law and Policy from the American Bar Association.

Rajiv Bhatia

Rajiv Bhatia is director of occupational and environmental health for the San Francisco Department of Public Health and holds a clinical appointment at the University of California, San Francisco. He is responsible for developing, implementing, and evaluating environmental health policy in San Francisco. Under Dr. Bhatia’s leadership, the Department of Public Health has expanded environmental health practice to ensure safe and adequate housing, to support worker health rights, to enhance connections between regional agriculture and urban consumers, and to integrate public health and urban planning. As part of those initiatives, the department is developing and evaluating tools for health impact assessment (HIA) and has conducted HIAs on local land use and transportation plans and projects, local and state workplace and employment regulations, regional maritime port development proposals, and California state climate change mitigation strategies. Dr. Bhatia developed and currently teaches a graduate course on HIA at the University of California at Berkeley and regularly conducts HIA trainings for peers, federal, state, and local public institutions, and community organizations. He is a co-founder and scientific director of the non-profit Human Impact Partners, which conducts HIAs and HIA training and facilitation for other organizations. Dr. Bhatia was a founding member of the Health and Social Justice Team for the National Association of County and City Health Officials and a former board member of Pesticide Action Network and the Asian Pacific Environmental Network. Dr. Bhatia earned an M.D. from Stanford University and a MPH from the University of California at Berkeley.

Scott B. Cantor

Scott B. Cantor is a professor in the Section of Health Services Research in the Department of Biostatistics at The University of Texas M. D. Anderson Cancer Center. He also holds adjunct professor positions at The University of Texas Health Science Center at Houston School of Public Health and Rice University, and he is a faculty member for the Program in Biomathematics and Biostatistics at The University of Texas Graduate School of Biomedical Sciences at Houston. Dr. Cantor’s research focuses on the theoretical issues concerning cost-effectiveness analysis and diagnostic testing and on clinical issues in cancer prevention, particularly prostate cancer screening and cervical precancer diagnosis. He is a past president of the Society for Medical Decision Making and is a member of the Decision Analysis Society, the Society for Judgment and Decision Making, and the Institute for Operations Research and the Management Sciences. Dr. Cantor earned a Ph.D. in decision sciences from Harvard University.

Ben Cave

Ben Cave is chief executive of Ben Cave Associates. He has specialized in health and social impact assessment for the past 13 years. His work has two broad themes. The first addresses health in statutory assessments. At a policy level, he advises the World Health Organization and the UK Department of Health on requirements and methodologies for strategic environmental assessment. At project level, he integrates health into environmental assessments by leading health impact assessments in conjunction with environmental assessments in a wide range of sectors. The second major theme of his work is to improve the consideration of health issues within the wider planning process and the consideration of environmental issues by health stakeholders. Mr. Cave is associated with several professional organizations and is the chair of the health section of the International Association for Impact Assessment and an associate member of the Institute for Environmental Management and Assessment. He earned a M.Sc. in health promotion sciences from the London School of Hygiene and Tropical Medicine.

Ana V. Diez Roux

Ana V. Diez Roux is professor of epidemiology and director of the Center for Social Epidemiology and Population Health at the University of Michigan. Her research interests are in the areas of social epidemiology, neighborhood health effects, cardiovascular disease epidemiology, air pollution and cardiovascular risk, multilevel analysis, race and ethnic disparities, and systems approaches in population health. Some of the projects she is involved with include neighborhoods and cardiovascular risk in multiethnic populations, social and geographic predictors of heterogeneity in cardiovascular risk in African Americans, stress and cardiovascular disease and urban health and social patterning of health in Latin America. Dr. Diez Roux is affiliated with the American Public Health Association and the Society for Epidemiologic Research. She is a member of the Institute of Medicine (IOM), is currently a member of the IOM Committee on Public Health Priorities to Reduce and Control Hypertension, and served as a member of the National Research Council Planning Committee for Workshop on the Public Health Effects of Food Deserts. Dr. Diez Roux earned a Ph.D. from the Johns Hopkins School of Hygiene and Public Health and an M.D. from the University of Buenos Aires, Argentina.

Carlos Dora

Carlos Dora is coordinator of a global program on health impact assessment within the Public Health and the Environment Department of the World Health Organization (WHO). He leads a unit on interventions for healthy environments, which is focused on improving the health consequences of policies in different sectors of the economy. Prior to that role, Dr. Dora developed a program on the environmental health implications of transport policies and worked on policy frameworks for environmental health, including the Strategic Environmental Assessment Protocol and Environment and Health Performance Reviews, and on risk assessment, including ones on the Chernobyl disaster and depleted uranium. He also served as a senior policy analyst at the office of the WHO director general. Dr. Dora earned a Ph.D. from the London School of Hygiene and Tropical Medicine.

Jonathan E. Fielding

Jonathan E. Fielding is the director of the Los Angeles County Department of Public Health and the county health officer and is responsible for all public health functions, including surveillance and control of both communicable and noncommunicable diseases and health protection, including emergency preparedness, for the County’s 10 million residents. He is also a commissioner of the Los Angeles First 5 Commission, which grants over $100 million per year to improve the health and development of children 0-5. Dr. Fielding chairs the U.S. Community Preventive Services Task Force and was a founding member of the U.S. Clinical Preventive Services Task Force. He also chairs the Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020 and was appointed to the California Department of Public Health Advisory Board. Dr. Fielding is a professor in the Schools of Medicine and Public Health at the University of California, Los Angeles, and has authored over 175 peer-reviewed publications, editorials, and book chapters on public health, health policy, health economics, emergency preparedness, and evidence-based public health practice issues. He has been the principal investigator on grants to develop health impact assessment methods and to use these in assessing the health effects of existing or proposed policies in other sectors. He is editor of the Annual Review of Public Health and chairman of Partnership for Prevention. He also serves on the Board of the American Legacy Foundation and is an elected member in the Institute of Medicine. He formerly served as Massachusetts Commissioner of Public Health and Vice President of Johnson & Johnson. Dr. Fielding has received numerous awards, including the Sedgwick Memorial Medal from the American Public Health Association, the Distinguished Alumni Achievement award from the Harvard School of Public Health, and the UCLA Medal, which is the University’s highest honor. He received his M.D. and MPH from Harvard University and an MBA in finance from the Wharton School of Business.

Joshua S. Graff Zivin

is an associate professor of economics in the Graduate School of International Relations and Pacific Studies at the University of California, San Diego (UCSD). He is also a research associate at the National Bureau of Economic Research and Research Director for International Environmental and Health Studies at the Institute for Global Conflict and Cooperation, and from 2004 to 2005, he served as Senior Economist for Health and the Environment for the White House Council of Economic Advisers. Prior to joining the faculty at UCSD, Dr. Graff Zivin was an associate professor of economics in the Mailman School of Public Health at Columbia University. Dr. Graff Zivin’s research spans three fields of economics–health, the environment, and international development–and focuses on how uncertainty and heterogeneity affect both individual and societal decision-making. He is currently engaged in three large and distinct projects. The first makes use of primary data collected over the past several years to examine the economic impacts of the AIDS crisis in Africa. The second relies on a unique, matched dataset to understand the role of institutions, social networks, and financial incentives in the production of new scientific knowledge within the life sciences. The third examines behavioral responses to poor air quality and its implications for the economic costs of climate change. Dr. Graff Zivin earned his Ph.D. from University of California, Berkeley.

Jonathan I. Levy

Jonathan I. Levy is the Mark and Catherine Winkler Associate Professor of Environmental Health and Risk Assessment in the Departments of Environmental Health and Health Policy and Management at Harvard University. Dr. Levy's research centers on developing models to quantitatively assess the environmental and health impacts of air pollution, from local to national scales, with a focus on urban environments and variability in exposures and risks. His work involves the evaluation of exposure using a combination of atmospheric dispersion modeling, predictive statistical models, and field measurements. Health risks are quantified through epidemiologic investigations, interpretation of past epidemiologic studies, and supporting physiologic and toxicologic evidence. Dr. Levy was the recipient of the Walter A. Rosenblith New Investigator Award from the Health Effects Institute in 2005, and he previously served as a member of the National Research Council Committee on Improving Risk Analysis Approaches Used by the U.S. Environmental Protection Agency and the Committee on the Effects of Changes in New Source Review Programs for Stationary Sources of Air Pollutants. He earned a Sc.D. in environmental science and risk management from the Harvard School of Public Health.

Julia B. Quint

Julia B. Quint is a research scientist, retired as chief of the Hazard Evaluation System and Information Service in the Occupational Health Branch of the California Department of Public Health. She was involved in identifying and evaluating reproductive toxicants, carcinogens, and other workplace chemical hazards and in developing research projects and other strategies to protect workers, communities, and the environment from the hazards of toxic chemicals. Dr. Quint is currently a member of the California Environmental Contaminant Biomonitoring Program Scientific Guidance Panel and the California Environmental Protection Agency Green Ribbon Science Panel. She is also a member of the National Research Council Committee on Tetrachloroethylene. Dr. Quint received a Ph.D. in biochemistry from the University of Southern California.

Samina Raja

Samina Raja is associate professor of urban and regional planning and adjunct associate professor of health behavior at the University at Buffalo, State University of New York. Her research focuses on planning and design for healthy communities, sustainable food systems, and the fiscal dimensions of planning. Her research on healthy communities examines the influence of the food and built environments on obesity and physical activity. Her interests in fiscal dimensions of planning pertain to the methods planners use for measuring the fiscal impacts of land development. Dr. Raja’s service to the community and the planning profession is linked to her research interests. She is an active member of the Food Interest Group of the national American Planning Association and serves on the Board of Directors of the Community Food Security Coalition. Dr. Raja earned a Ph.D. in urban and regional planning from the University of Wisconsin, Madison.

Amy Jo Schulz

Amy J. Schulz is associate professor in the Department of Health Behavior and Health Education and associate director of the Center for Research on Ethnicity, Culture and Health at the University of Michigan, School of Public Health, and associate research professor in the Institute for Research on Women and Gender. Dr. Schulz has a longstanding commitment and research record focused on the contributions of social factors to racial, ethnic, and socioeconomic disparities in health. Her current research focuses on community-based participatory approaches to understanding social inequalities as they influence health disparities with a particular focus on the health of urban residents. Since 2000, her work has focused on understanding social determinants of, and evaluating the impacts of interventions to reduce, obesity and cardiovascular disease in Detroit. She is principal investigator for the Lean & Green in Motown Project, which addresses associations between social and physical environments and risk factors associated with obesity and the Community Approaches to Cardiovascular Health intervention research project to improve cardiovascular health. She previously served as co-principal investigator for the Promoting Healthy Eating in Detroit project. In addition to directing a number of major studies of chronic conditions in multiethnic populations, she is a leader in the field of community-based participatory approaches to research and intervention design and is widely sought after as a speaker and trainer in this area. She has been a consistent contributor to the published literature on racial and ethnic disparities in health, on contributions of social factors to health disparities, and on the active engagement of representatives from communities disproportionately affected by health risks in researching and developing interventions to improve health. Dr. Schulz received her Ph.D. in sociology and her MPH in health behavior and health education from the University of Michigan.

Aaron A. Wernham

Aaron A. Wernham is director for the health impact project at Pew Charitable Trusts. This project involves the creation of a new national center to promote the use of health impact assessments (HIA) and support the growth of the field in the United States. Dr. Wernham is a nationally recognized HIA expert who has led these assessments at the state and federal level and conducted HIA trainings for, collaborated with, and advised numerous health and environmental regulatory agencies on integrating HIA into their programs. Prior to Pew, Dr. Wernham was a senior policy analyst with the Alaska Native Tribal Health Consortium, where he led the first successful efforts in the United States to formally integrate HIA into the federal environmental impact statement process. He also directed a collaborative state-tribal-federal working group on HIA and, with the assistance of this group, wrote HIA guidance for federal and state environmental regulatory and permitting efforts. Dr. Wernham received his M.D. from the University of California, San Francisco.

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A Framework and Guidance for Health Impact Assessment

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A Framework and Guidance for Health Impact Assessment

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Featured publication

Improving Health in the United States: The Role of Health Impact Assessment

Description

Collaborators

Committee

Sponsors

Staff

Major units and sub-units

Contact

Contact us

Provide feedback

Request materials

More like this

Review of the draft United by Nature assessment

Modernizing Mathematics Education for Grades 9-14

Health Care Financing to Improve Availability of Affordable Contraception: Identifying Promising Practices

Transit Cooperative Research Program

Health Care and Public Health Program Area

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Meeting of Experts: Discussion of Potential Impacts of the Camp Edwards Multipurpose Machine Gun Range Project on the Cape Cod Aquifer

Harm Reduction Services for People Who Use Drugs: Exploring Data Collection, Evidence Gaps, and Research Needs - A Workshop

Strategic Plan and Blueprint for Addressing Thalassemia in the United States