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A Review of Health Impact Assessments in the U.S.: Current State-of-Science, Best Practices, and Area for Improvement
Citation:
Rhodus, J., F. Fulk, Brad Autrey, S. O'Shea, AND A. Roth. A Review of Health Impact Assessments in the U.S.: Current State-of-Science, Best Practices, and Area for Improvement. U.S. Environmental Protection Agency, Washington, DC, EPA/600/R-13/354, 2013.
Impact/Purpose:
A review was conducted of 81 Health Impact Asessments (HIAs) from the U.S. to obtain a clear picture of how HIAs are being implemented nationally and to identify potential areas for improving the HIA community of practice. Improving HIAs across the US will lead to better informed decisions at the community level and ultimately to improvement in public health and the environment.
Description:
A systematic review was conducted of health impact assessments (HIAs) from the U.S. to obtain a clear picture of how HIAs are being implemented nationally and to identify potential areas for improving the HIA community of practice. The review was focused on HIAs from the four sectors that the U.S. Environmental Protection Agency’s (EPA’s) Sustainable and Healthy Communities Research Program has identified as target areas for empowering communities to move toward more sustainable states. These four sectors are Transportation, Housing/Buildings/ Infrastructure, Land Use, and Waste Management/Site Revitalization. The review systematically documented organizations involved in conducting the HIAs; funding sources; the types of community-level decisions being made; data, tools, and models used; self-identified data needs; methods of stakeholder engagement; pathways and endpoints; characterization of impacts; decision-making outcomes and recommendations; monitoring and follow-up measures; prioritization methods employed; HIA defensibility and effectiveness; attainment of the Minimum Elements of HIA; areas for improvement; and identification of best practices. The results of the HIA reviews were synthesized to identify the state of the HIA practice in the U.S., best practices in HIAs, and areas in the overall HIA process that could benefit from enhanced guidance, strategies, and methods for conducting community-based risk assessments and HIAs. While HIAs have helped to raise awareness and bring health into decisions outside traditional health-related fields, the effectiveness of HIAs in bringing health-related changes to pending decisions in the U.S. varies greatly. The review found that there are considerable disparities in the quality and rigor of HIAs being conducted. This, combined with the lack of monitoring, health impact management, and other follow-up in the HIAs could be limiting the overall utilization and effectiveness of this tool in the U.S.