Health Impact Assessment (HIA)

Need a tool to include health in the decision making process for a policy, plan, program or project?  A Health Impact Assessment (HIA) may be your answer.  HIA is a tool to help make healthier choices.  HIA is a process using data, health expertise, and input from stakeholders to consider the potential positive and negative effects of a policy, plan, program or project.  HIAs can provide recommendations to increase positive health outcomes and minimize adverse health outcomes.  An HIA often includes a written report or summary prepared for decision makers or the public.

photograph of new curb and sidewalk outside a school

What are the benefits of HIA?

According to The PEW Charitable Trusts’ Health Impact Project  Health Impact Assessment:

  • looks at health from a broad perspective that considers social, economic and environmental influences;
  • brings community members, business interests and other stakeholders together, which can help build consensus;
  • acknowledges the trade-offs of choices under consideration and offers decision makers comprehensive information and practical recommendations to maximize health gains and minimize adverse effects;
  • puts health concerns in the context of other important factors when making a decision; and
  • considers whether certain impacts may affect vulnerable groups of people in different ways.

According the Centers for Disease Control and Prevention, another important benefit of HIA is how it brings potential public health impacts and considerations to the decision-making process for policies, plans, programs and projects that fall outside the traditional public health arenas, such as transportation and land use.

When can an HIA be useful?

When social factors that contribute to health such as education, income, or place are important to a policy, plan, program, or project a HIA may be helpful.  When stakeholder or public involvement is needed a HIA can be very helpful.  HIA work best when there is time to prepare, analyze, and critique before the implementation of the policy, plan, program or project.  However, HIAs sometimes can be done rapidly to respond to an on-going issue or discussion.

Health Impact Assessments have been performed for a wide variety of topics including land use, transportation, housing, food, labor and employment, natural resources, and economic and community development.  HIA can help to amplify community voices and set long-term goals.  Completing the HIA process before a policy, plan, program, or project is begun can help to ensure it will be accepted and useful before it payed for and completed.

Who performs HIAs?

There are no requirements or certifications a person or agency needs to use the HIA tool.  HIAs have been done by city planners, academic researchers, and public health officials.  Funding for HIAs has come from diverse sources, including private foundations; federal, state, tribal and local government granting agencies; and public health and planning departments.  While HIAs do follow a general process, there are no requirements for what an HIA must include.  This is intentional to allow HIAs to be widely used as tool to benefit public health. 

What are the six steps of a HIA?

There are six steps to a Health Impact Assessment:

     1. Screening – determine if an HIA is likely to be useful
     2. Scoping – make a plan for doing the HIA
     3. Assessment – describe baseline community health and assess potential impacts
     4. Recommendations– provide solutions
     5. Reporting– share findings 
     6. Monitoring and Evaluation– monitor changes in health risk factors and evaluate the HIA

How long does an HIA take to complete?

A few HIAs get done rather quickly in only weeks.  These are called rapid or desktop HIAs.  Many HIAs take months to complete.  Some HIAs take years to finish.  The length of time it takes to complete an HIA depends on how soon it is needed, how much community input is collected, how complex is the situation, how many stakeholders are involved, and other factors.  Similar to time, some HIAs have been completed with almost no expenses.  Large, long-term HIAs often require their own budget.  Some HIAs have provided recommendations which were predicted to save lots more money or health-related costs than the cost of performing the HIA.

Where to find guidance for doing an HIA?

Yes.  There are lots of resources to help perform or learn about Health Impact Assessment.  Click through some of the partner links below.  The Society of Practitioners of Health Impact Assessment is a good resource for how to do HIA.

What kinds of HIAs have been done in TN?

The Memphis and Shelby County Office of Sustainability performed an HIA as part of the Mid-South Regional Greenprint and Sustainability Plan.  The plan is a 25-year project aimed at connecting communities in the Tennessee, Mississippi, and Arkansas tri-state region where all residents would have equal access to economic, social, and natural opportunities.

The Prevention Research Center of St. Louis, MO, in partnership with the Tennessee Obesity Taskforce, conducted an HIA of Tennessee Senate Bill 1176 in 2012.  The bill would have authorized the uses of bonds and loans to develop property food desert relief enterprises (FDRE).  The HIA focused on the proposed policy change would impact rural and urban residents’ access to healthful, affordable foods.  The bill was not passed.

The Knox County Health Department performed an HIA to assist with the placement and maintenance of community gardens within the county.  The HIA was aimed at educating policy makers about why certain communities might be better suited for community gardens.  The HIA enabled the changing of city zoning to allow for more community gardens in Knoxville.

As part of a corridor mobility study, the Nashville Area Metropolitan Planning Organization in cooperation with two interns from the Vanderbilt University did a pilot HIA of a proposed transit-oriented development.  The HIA developed a set of criteria to be used with planning for transit-oriented development.  As the development moved forward, the developer asked the Nashville Area MPO to identify a possible location of a new school within Middle Tennessee’s first transit-oriented development.  In partnership with the Brown School of Public Health at Washington University a rapid HIA was completed about school siting.  The HIA concluded the school should be located a half-mile from homes to enable children to walk and bike to school.

Government partners

Centers for Disease Control and Prevention (CDC)
Healthy Impact Assessment
Tracking Network Data Can Inform HIAs

U.S. Environmental Protection Agency (EPA)
Health Impact Assessments

Additional Resources

The PEW Charitable Trusts
Health Impact Project – HIA Process

Health Impact Partners 
New to HIA?

Society of Practitioners of Health Impact Assessment 

National Association of County and City Health Officials 
Health Impact Assessment

Association of State and Territorial Health Officials 
Health Impact Assessments

Helpful documents

Stakeholder Participation Working Group of the 2010 HIA of the Americas Workshop 
Guidance and Best Practices for Stakeholder Participation in Health Impact Assessments – Version 1.0

The Chronicles of Health Impact Assessment (CHIA)
open access online journal