By Pamela Russo, MD, MPH
Staying healthy, whether we’re talking about individuals or populations, is influenced by people’s access to high quality health care and clinical prevention - but there is powerful evidence that staying healthy is more strongly influenced by people’s education, job opportunities, economic status, and the social and physical environmental conditions where they are born, grow, live work, and age. This understanding needs to be conveyed in a useful way to those making decisions on policies, programs and projects in non-health sectors such as transportation, energy production, labor, or education, who rarely consider the consequences of their decisions on factors that influence health. Absent the consideration of effects on human health, we have often unintentionally created conditions that are either hazardous to human health or create barriers for people to adopt and maintain healthy behaviors. How can we convert the evidence on the multiple factors that drive population health into something decision-makers can use to build health into their equations?
The National Research Council (NRC) concluded that Health Impact Assessment (HIA) is a promising and practical tool for factoring health into decisions on proposed projects and policies in sectors outside the health and health care sectors. An NRC report, The Role of Health Impact Assessment to Improve Health in the United States, was released on September 8th, 2011. The report provides a framework, terminology, and guidance for conducting a health impact assessment at the local, state, tribal and federal levels. The NRC committee concurred that HIAs can help decision makers identify unintended risks, reduce unnecessary costs and leverage opportunities to improve the health of their communities.
The report sets standards for the practice of HIA, and developed a six step framework. The first step is to screen – to decide whether there is a need and value to do an HIA on a proposed policy or project. In other words, it is important to consider if health could be affected – but not all policies or projects require an HIA. A key standard is including stakeholders in the process from beginning to end - including agencies, populations that will be affected, developers and others. Another key standard is to balance the need to provide timely, valid information within the reality of data and time constraints. The committee recommended using diverse types of evidence from multiple disciplines, critically selecting the strongest available evidence and methods, and acknowledging and managing the uncertainties from the beginning of the process to ensure the credibility of the report and recommendations.
HIAs have been used extensively in other countries, by development agencies such as the World Bank, and by some international corporations as part of their project planning. The number of HIAs performed in the U.S. has risen exponentially over the past few years, with some localities and states adopting policies to integrate HIAs into decision-making. The Health Impact Project is keeping an up to date inventory that maps the sites of HIA and shows that they are occurring across the country. Places that have been active in applying HIAs have seen substantial growth in interagency collaboration and the systematic consideration of health in proposed projects and policies. It is clear that factoring health into decisions made in other sectors offers a huge opportunity to shape healthy conditions, minimize new health risks and maximize benefits for health, and ultimately reduce health care costs. The guidance from the National Research Council on HIAs gives us a way to improve the nation’s health.
Pamela Russo, MD, MPH, is a Senior Program Officer with the Robert Wood Johnson Foundation's Public Health Team.
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