Assessing alternatives in parallel with the proposal can aid decision-making by highlighting tradeoffs and actions that can be taken to achieve the desired outcome while minimizing harms. The committee notes that in addition to characterizing effects, HIAs may provide conclusions on the significanceor societal importanceof the effects, although this has been rare in U.S. practice. I and III, Breaking the Cycle, East London and the City Health Action Zone and Queen Mary. Acknowledgments o Who is ultimate decision maker if the event needs to be cancelled, postponed or similar? EC (European Communities). Section 1508.27). A screening recommendationfor example, no further action required; no HIA, but health advice and input to be offered in an alternative way; or proceed with HIA. The committee notes that outcome evaluation considers the effects of the whole decision, including changes made as a result of HIA recommendations. Issues surrounding uncertainty, literature review, and reliability and validity of predictions are discussed in greater depth in Chapter 4. 2007; ICMM 2010). 2017 Jul/Aug;23 Suppl 4 Suppl, Community Health Status Assessment:S14-S21. A related issue is incomplete disclosuresuch as disclosure of only summary information without data or analysis, disclosure only by electronic media in communities unlikely to have access, and English-only reports. In some cases, the timeline and available resources will prevent collection of new data to address gaps that are identified. Health-supportive measures that would generally support health but are not tied directly to a specific impact (for example, building a clinic in an underserved neighborhood that would be adversely affected by emissions from a new freeway). There are often not clear lines of authority between the team conducting the HIA and the decision-maker. Given that HIA led by the private sector appears to be a rapidly increasing practice, the issue of availability bears further consideration. If it is not possible to undertake complete, systematic literature reviews for an effect analyzed in an HIA, HIA practitioners must be vigilant to avoid selective searching and consideration of only studies that confirm particular conclusions (Mindell et al. The fact, however, that the team conducting the HIA is aware of the decision context allows the assessment to be decision-relevant. In each case, it is important to determine how the standards, policies, programs, and laws bear on how health is factored into a proposal. A variety of planning and zoning, funding, and environmental regulatory decisions were required for the BeltLines various components to be developed. Some decisions to conduct HIA may depend on a specific statutory requirement or mandated procedure. 2004). Some HIAs rely on proxy measures when rates of specific diseases are not available or are too small to calculate. Scoping also determines who will be part of the HIA team and establishes a plan for technical oversight and review, stakeholder participation and involvement, and involvement of and interaction with decision-makers. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. As discussed later in this section, recommendations can also establish a foundation for monitoring, and the results of the monitoring may indicate that the management strategies need to be adapted to respond to the observed outcomesa process known as adaptive management (Johnson 1999). Influences on practice include the timeline, resources and skills available to the HIA team, the factors being considered and the data available for analysis, and the legal and regulatory context of the decision-making process. 2010). For example, in Oregon, an independent health-oriented nonprofit organization conducted an HIA of a series of proposals to reduce vehicle miles traveled in a bill intended to reduce greenhouse- gas emissions (UPH 2009). Thus, it is generally not possible to attribute outcomes specifically to HIA recommendations because they are implemented with the decision. Questions that are important from a public-health perspective might include the severity of the health effect, the size and likelihood of the effect, and the potential of the effect to exacerbate health disparities. Ultimately, regardless of the specific tool used, the decision to conduct HIA in most cases relies on the practitioners or decision-makers judgment regarding the likelihood of impacts, the time and resources available, and the likelihood that the information produced by the HIA will be a valuable aid to decision-making. The HIAs also changed the debate in such a way that providing paid sick days for employees began to be presented as a public-health issue rather than a labor issue. This step suggests a modified version of CDC's evaluation guidelines, and may be used as a starting point to tailor an evaluation for a particular community health improvement effort, at . Community Health Assessment Toolkit. Various sources of population-health statistics at the national, state, and local levels are available. 2019 Feb;22(1):25-31. doi: 10.1089/pop.2018.0049. National Public Health Performance Standards Program, National Center for State, Tribal, Local, and Territorial Public Health Infrastructure and Workforce, SDOH Research by CDC Authors: Frequently Asked Questions, Examples of How the SDOH Can Be Addressed Through the 10 Essential Public Health Services, Performance Management & Quality Improvement, National Public Health Improvement Initiative, National Public Health Performance Standards, Public Health Finance and Infrastructure Support, Competencies for Public Health Professionals, National Leadership Academy for the Public's Health, Supporting the Performance Improvement Workforce, Alerts About Current & Projected Funding Opportunities, Cooperative Agreements, Grants & Partnerships, Strengthening Public Health Systems & Services, USAPI Strengthening Public Health Systems & Services, Integrity & Accountability Review Offices, National Health Initiatives, Strategies & Action Plans, State & Territorial Health Department Websites, US Territories & Freely Associated States, Style for Referring to US Territories & Freely Associated States, About the Public Health Infrastructure Center, Implementing the Community Health Needs Assessment Process, U.S. Department of Health & Human Services, Multisector collaborations that support shared ownership of all phases of community health improvement, including assessment, planning, investment, implementation, and evaluation, Proactive, broad, and diverse community engagement to improve results, A definition of community that encompasses both a significant enough area to allow for population-wide interventions and measurable results, and includes a targeted focus to address disparities among subpopulations, Maximum transparency to improve community engagement and accountability, Use of evidence-based interventions and encouragement of innovative practices with thorough evaluation, Evaluation to inform a continuous improvement process, Use of the highest quality data pooled from, and shared among, diverse public and private sources, Improved organizational and community coordination and collaboration, Increased knowledge about public health and the interconnectedness of activities, Strengthened partnerships within state and local public health systems, Identified strengths and weaknesses to address in quality improvement efforts, Baselines on performance to use in preparing for accreditation, Benchmarks for public health practice improvements. In some cases, the HIA process allows a period for formal public comment on a draft of the HIA report. 2007; Harris-Roxas and Harris 2011). The goal was to incorporate health considerations into the decision-making process by predicting health consequences, informing decision makers and the public about health impacts, and providing realistic recommendations to prevent or mitigate negative health outcomes (p. 9). Regardless of whether effects are quantified, the assessment stage should include a characterization of each effect to the greatest extent. Drafting measures that address identified public-health risks and that fulfill the requirements of the legal framework governing a decision will increase the chances that HIA recommendations are implemented. Atlanta Beltline: Health Impact Assessment. Health Impact Assessment: A Practical Guide. Improving community health starts with knowing the factors that impact people's health, both inside and outside of the clinic. Community Health, Safety and Security. Community health assessments use such principles as. Bhatia R, Farhang L, Gaydos M, Gilhuly K, Harris-Roxas B, Heller J, Lee M, McLaughlin J, Orenstein M, Seto E, St Pierre L, Tamburrini AL, Wernham A, Wier M. Bhatia R, Branscomb J, Farhang L, Lee M, Orenstein M, Richardson M. Birley M. Health Impact Assessment in multinationals: A case study of the Royal Dutch/Shell Group. Public Health Accreditation Board Acronyms and Glossary of Terms Version 1.0 [PDF 536KB], July 2011, as adapted from Healthy People 2010 and CDCs National Public Health Performance Standards Program. Atlanta BeltLine Redevelopment Plan. Catholic Health Association, Guide to Assessing and Addressing Community Health Needs [PDF-1.5MB], June 2013. Bookshelf In those cases, it may be more appropriate to monitor exposuressuch as environmental concentrations of a carcinogen or the availability of safe walking corridorsthat are linked to the outcome of interest by public-health evidence. 2005 and Bhatia and Seto 2011. Health Impact Assessment on Policies Reducing Vehicle Miles Traveled in Oregon Metropolitan Areas. CDC is not responsible for the content of materials not generated by CDC. Sources of information used in a baseline profile might include census data, hospital-discharge records, disease registries, and population and behavior surveys, such as the Behavioral Risk Factor Surveillance Survey, in which information is collected on different geographic scales. The impacts of right-to-know: Information disclosure and the violation of drinking water standards. Public agencies might not disclose or might redact or otherwise limit disclosure of information. Health Impact Assessment for Regeneration Projects. Prospective health impact assessment: Pitfalls, problems, and possible ways forward. Gruber JB, Wang W, Quittner A, Salyakina D, McCafferty-Fernandez J. Popul Health Manag. A variety of screening tools and algorithms are commonly used (Cole et al. Turnock B. The committees may be convened for several purposes, including providing technical guidance or peer review, ensuring adequate and fair representation of diverse interests and priorities among stakeholders, communicating the results of the HIA to decision-makers, and developing recommendations that address community needs and are compatible with the specific legal requirements of the decision- making process. Identification of apparent data gaps and of data collection that could be undertaken to address the gaps or a rationale for not undertaking data collection. A community health assessment often yields a long list of public health needs, issues, and problems. It is also useful to assess the political context of the proposal to be assessed and consider, for example, the major political drivers of the proposal, the arguments made by political supporters and those opposed to the proposal, and any economic or technical constraints that limit the alternatives that can be considered. The scoping phase was used to identify the parameters of the assessment, the affected and most vulnerable populations, and potential key health effects. That issue is addressed again in Chapter 4. In the United States, HIAs have commonly been undertaken by people who have an MPH or equivalent degree and have attended a brief (2- to 5-day) training session. Scoping establishes the boundaries of the HIA and identifies the health effects to be evaluated, the populations affected, the HIA team, sources of data, methods to be used, and any alternatives to be assessed. This is the key link between a health profile and a health plan. Recommendations are often developed throughout the HIA process. Mapping out the timeline for the decision-making process can be helpful, and for large and complex programs and projects, identifying the agencies involved and their jurisdictions is important. 2008; Fredsgaard et al. A description of the research questions, data sources, methods to be used, and any alternatives to be assessed. A CHA is a systematic process involving the community to identify and analyze community health needs and assets, prioritize those needs and then implement a plan to address significant unmet needs.1Upon completing the assessment, hospitals develop implementation strategies to address the significant community health needs identified in the CHA.2A community health assessment process can focus your organizations efforts around community health improvement and provide structure for addressing the determinants of health and illness in your community. 54873. It may lack the objectivity and rigor of an external evaluation conducted by an experienced evaluator, but it is important because it contributes to a database that informs other efforts in the field and provides basic information about the applications of HIA, the methods and strategies used by HIA practitioners, and the success of and challenges to its use. Miranda ML, Keating MH, Edwards SE. National Research Council (US) Committee on Health Impact Assessment. The press coverage recognized the tension between the burden that this new requirement would place on businesses and how the health of employees and the wider community are affected by people who work while they are ill. Human Impact Partners noted that many including labor groups and fundersused the HIAs to assess work and family issues. Self-evaluation performed by the HIA teamfor example, against a set of process objectives or practice criteriaserves quality-assurance aims and can produce insights that will improve the field. Santa Monica Airport Health Impact Assessment (HIA): A Health-Directed Summary of the Issues Facing the Community near the Santa Monica Airport. One Step Forward, One Step Back: An Analysis of the IFCs Sustainability Policy, Performance Standards and Disclosure. Adoption of recommendations depends partly on the involvement of decision-makers in the HIA process (Elliot and Francis 2005; Davenport et al. HIA provides recommendations on monitoring and managing those effects. The process is analogous to the approach in the new risk-based decision- making framework proposed in Science and Decisions (NRC 2009), in which the primary objective of risk assessment is to help decision-makers choose among risk-management options by providing information on health risks that can be considered in the context of economic, social, and other factors. The https:// ensures that you are connecting to the The committee notes that qualitative social sciences and participatory-action research provide fertile ground for innovative methods for HIA. However, Science and Decisions (NRC 2009) emphasizes that a detailed understanding of the decision context is necessary for analyses to be scoped appropriately and that the conceptual distinction between assessment and management should not be interpreted as a firewall that prevents communication between parties. Selection of appropriate indicators will be discussed at greater length below in the section Monitoring and Evaluation.. Petticrew M, Cummins S, Sparks L, Findlay A. Validating health impact assessment: Prediction is difficult (especially about the future). Although a wide variety of excellent resources on community health assessment and CQI currently exist, those materials generally do not link assessment and CQI concepts and techniques in the way that is envisioned for . For each step, the committee describes the basic purpose, objectives, and practice elements; summarizes the main outputs; and presents conclusions regarding pertinent issues raised. Cookies used to make website functionality more relevant to you. Recommendations form the core of a health-management plan, but the plan also determines authority for and assigns responsibility for implementing each recommendation, establishes a monitoring plan, and creates or suggests mechanisms to verify that assigned responsibilities are being met. As discussed in greater depth in the section on scoping, it is common to convene advisory or steering committees, which can include both technical and policy experts and representatives from stakeholder groups that have an interest in the decision outcome. Nurses rely on self-reported symptoms, visual observation, reported health histories, and a physical medical examination to make a health assessment. The potential for irreversible or catastrophic effects (including effects of low likelihood). Johnson BL. Identifying data gaps and questions for future research. As discussed above, additional benefits may include, for example (Wismar et al. An initial brief summary of the pathways through which health could be affected and the health effects to be addressed, including a rationale for how the effects were chosen and an account of any potential health effects that were considered but were not selected and why. 2006). The phrase desktop HIA has also been used to refer to a rapid HIA that entails little or no public engagement. It follows a systematic process that includes screening, scoping, assessment, recommendations, reporting, and monitoring and evaluation. It was concluded during the screening phase that an HIA would add value to project outcomes. Identification of the population and vulnerable groupssuch as children, the elderly, racial or ethnic minorities, low-income people, and communities that are likely to be affected. Articles in Google Scholar by Kaye Bender, PhD, RN, FAAN A community health improvement plan is critical for developing policies and defining actions to target efforts that promote health. 2010). In practice, the categories are rarely used consistently, and a single HIA often encompasses a blend of various approaches to stakeholder engagement and participation, analytic methods, and interactions with the formal decision-making process. Describes data sources and analytic methods and methods used to engage stakeholders. Program on Health Equity and Sustainability, San Francisco Department of Public Health. The committee recognizes that undue bias in an HIA may compromise its credibility and efficacy. Bhatia R, Wernham A. It can also include information from social-science and epidemiologic studies regarding the strength of associations between the social and physical environment (such as air and water quality and economic impacts) and health outcomesinformation essential in the quantitative prediction of health effects. 3Elements of a Health Impact Assessment Chapter 2established the rationale for examining the potential effects of decisions on health and health disparities and highlighted health impact assessment (HIA) as a potential tool for assessing the health implications of various decisions. Fehr R. Environmental health impact assessment: Evaluation of a 10 step model. Although HIA may not always include or provide resources for independent evaluation, more in-depth, independent evaluation will generate more robust conclusions about HIAs effectiveness and best practices in the field and should be given high priority. Assessing and addressing community health needs. 2006). The Crossings is a proposed housing development in Los Angeles that will provide 450 units in a newly rezoned residential area that needs affordable housing. In other cases, a draft may be submitted to an internal body, such as a steering group, whose comments are incorporated into a final public version. For example, rather than providing an estimate of lung-cancer rates in a small community, an HIA might identify smoking rates and important sources of airborne pollutants in the communitys airshed. Behavioral Risk Factor Surveillance System data were used for the county and the state and stratified by race. Simply producing and disseminating a report may not be sufficient to secure adoption and implementation of HIA recommendations. Bhatia R, Seto E. Quantitative estimation in Health Impact Assessment: Opportunities and challenges. This site needs JavaScript to work properly. Finally, it is appropriate to include issues that are the subject of community concern even if they seem unlikely to be substantiated by further analysis. Furthermore, HIA teams commonly rely on analyses by such experts as traffic-safety engineers or air-quality analysts who provide information on the links between the proposal and changes in health determinants. Characterization of health effects in HIA relies on qualitative and quantitative evidence. A community health improvement plan (or CHIP) is a long-term, systematic effort to address public health problems based on the results of community health assessment activities and the community health improvement process. The committee does not intend that the definition and criteria proposed in this chapter be considered rigid requirements but rather that they reflect an ideal of practice, deviation from which may occur but should be based on clear and well-articulated needs and rationale. Industrial proponents, government decision-making agencies, local health departments, and independent organizations (such as universities and nongovernment organizations) may all be in a position to implement measures recommended in the HIA.

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