Because HIA in the United States is often undertaken outside a formal legal mandate, it has not consistently included alternatives assessment. Possible Elements of a Community Team. The committee concludes that when alternatives to the proposal being assessed are under consideration, the HIA team should assess the impacts of each alternative. Monitoring focuses on measures that are likely to be sensitive and early indicators of change. As described in Appendix A, there are few laws in the United States that specifically require HIA, although manysuch as the National Environmental Policy Act (NEPA)require a consideration of health that can be accomplished through HIA. Issues surrounding uncertainty, literature review, and reliability and validity of predictions are discussed in greater depth in Chapter 4. EPA (U.S. Environmental Protection Agency). Alerting decision-makers to the more general need to focus on health in future decisions. 1999; Roscam Abbing 2004). Improving relationships and collaboration between stakeholders. Propose a system to verify that measures are being implemented as planned. The source of public funding for the project was the Tax Allocation District (TAD), and only within the districts boundaries could funding be collected and bond money spent. The Atlanta Development Authoritys BeltLine Redevelopment Plan (November 2005) was identified as a coherent and publicly accepted vision that had been approved by local elected officials (ADA 2005). A well-designed dissemination strategy is critical for the success of an HIA. Describes the baseline health status of the affected population with appropriate indicators, including prevalent health problems, health disparities, and social, economic, and environmental factors that affect health. The characteristics and approaches of evaluation should be chosen to fit the time, resources, and data available to the HIA team. For example, there may be concerns about risks to a proponents reputation or to the viability and public acceptance of a proposed project if a report discloses important unmitigated adverse impacts or potential impacts that are uncertain or for which strong evidence does not exist. It was not possible to derive mortality rates for demographic subgroups. Health Impact Assessment: SEIC (Sakhalin Energy Investment Company) Phase 2 Development. Because of the timeframe of proposal implementation and effects on health, outcome evaluation often requires a long-term research commitment. It is important for nonprofit hospitals to be knowledgeable about the Internal Revenue Services regulations for CHNAs. CDC twenty four seven. Recommendations identify specific actions that could be taken to avoid, minimize, or mitigate harmful effects identified during the course of the HIA or to take maximal advantage of opportunities for a proposal to improve health. Thank you also to the ACHI Community Health Assessment Toolkit Workgroup for ongoing insight and contributions. To request permission to reproduce AHA content, please, https://www.chausa.org/communitybenefit/assessing-and-addressing-community-health-needs, Step 5: Prioritize Community Health Issues, Association for Community Health Improvement (ACHI). For example, under Alternative A, diabetes and metabolic disorders would be expected to increase if impacts on subsistence led to declining subsistence harvests (through declining populations of subsistence resources, displacement of resources that made hunting less successful, or displacement of hunters by oil activity and infrastructure). By necessity, therefore, impact assessment is a pragmatic exercise and reflects a balance between scientific rigor and professional judgment. Although rapid or desktop HIAs may not involve stakeholders or consider their input, this often (although not uniformly) reflects a pragmatic response to limitations, such as the timeframe for the decision or resources available to the HIA team, rather than an optimal practice. Others have proposed categorizing HIAs as participatory (emphasizing shared governance, public participation, and a focus on socioeconomic and environmental determinants), quantitative or analytic (concentrating on the methods and rigor of the analysis), or procedural (drawing on elements of the other two approaches but emphasizing the procedural steps required and often undertaken within a specified administrative or regulatory context) (Cole and Fielding 2007). Third, it informs government agencies and officials of potential changes in demand for services, such as health care, emergency response, and public safety; this can facilitate an appropriate response. 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. Lifetime Effects: The High/Scope Perry Preschool Study through Age 40. A large and growing body of quantitative evidence is available; where specific additional information is needed and resources are available, HIA teams may collect new quantitative data in the course of conducting an assessment. The available data, however, may not be sufficient, and the HIA team may make a decision to dedicate resources to collection of new data. SFDPH (San Francisco Department of Public Health). 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. PDF Table of Contents The American Hospital Associations review of the IRSs final rules for CHNAs and implementation strategies can be foundhere. National Research Council (US) Committee on Health Impact Assessment. A decision-making bodysuch as a department of planning or transportation can conduct an HIA to inform its own decision. 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. The most vulnerable populations were identified as people of low economic status, children, older adults, renters, and the carless. The committee finds that an HIA report should at least describe the proposal and alternatives that are the subject of the HIA, the data sources and analytic methods used, the groups and individuals that were consulted in the course of the HIA, the process and findings of each step of the HIA, and the overall conclusions and recommendations. For example, in Alaska, one of the adverse impacts of a proposed mine expansion was the feared contamination of water and wildlife, and evidence suggested that a fear of contamination might lead communities to shy away from eating a traditional diet. Action plans have mutually reinforcing activities. Decisions are often based on incomplete information and must often be made within a specified time rather than waiting for more complete information. For example, the planning of the Atlanta Beltline, as described later in this chapter, involved the regional planning commission, local legislative bodies, state and federal environmental regulators, and private developers. Conversely, to have the greatest relevance as an informational and planning document and to ensure judicious use of resources, the HIA should ultimately focus on the health effects of greatest potential importance. Monitoring and evaluation are often, although variably, described as the final stage of HIA (see Appendix E). 3, Elements of a Health Impact Assessment. Presidential/Congressional Commission on Risk Assessment and Risk Management. It would then fall to the decision-makers to determine routes that met those criteria. Alcohol-consumption effects of alcohol taxes. A plan is typically updated every three to five years. Comprehensive HIAs are most commonly differentiated from rapid and intermediate HIAs by the scope of potential impacts and the need for collection of new primary data. Community Health Assessment (CHA) archived training Identifying and selecting indicators for the CHA Data Collection, Analysis and Synthesis Presenting the CHA Findings Community Health Improvement Plan (CHIP) archived training Prioritizing Issues Choosing Strategies Developing a CHIP and Implementation Plan It characterizes health effects according to their nature, direction, intensity, magnitude, distribution, timing and duration, and likelihood. Bookshelf Community Health Assessment and Improvement Planning - NACCHO Skip to Main NavigationSkip to Content LHD Directory Virtual Communities Toolbox Contact Us Mobilizing for Action through Planning and Partnerships (MAPP) Jobs at NACCHO Education & Events MyNACCHO Login Mobilizing for Action through Planning and Partnerships (MAPP) Jobs at NACCHO Scoping also establishes a plan for the analytic methods that will be used during the assessment phase. It solicits and responds to input from stakeholders throughout all stages of the process and includes publicly available and accessible documentation of processes, products, and sponsors. The assessment also highlighted several potential benefits, such as funding for infrastructure and health care; increased employment and income; and continued funding of existing infrastructure (BLM 2007, p. 500). It identified which areas and villages were most likely to be affected and when. Source: ICMM 2010. Another variation, rapid-appraisal HIA, has been described and in some texts includes explicit public engagement through an initial half-day workshop for stakeholders (Parry and Stevens 2001; Mindell et al. As a final note, it is important to remember the context in which HIAs are conducted when considering the recommendations phase. Mindell JS, Boltong A, Forde I. The site is secure. Depending on the nature of the proposal being assessed and the specific impacts, recommendations can take various forms (see Box 3-5), such as the following: HIA Recommendations. Adopting a position for or against a proposal (for example, support for or opposition to a legislative proposal). Process evaluation can range from a simple self-assessment that is undertaken at the end of an HIA and focuses on a few variables that are relatively simple to describe, track, or measuresuch as the methods used, degree of certainty of predictions, and approach to stakeholder engagementto a more comprehensive case study that seeks to evaluate the HIA process holistically. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services. Public-health professionals reviewed the results of the analysis. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. The impacts of right-to-know: Information disclosure and the violation of drinking water standards. The committee emphasizes that the effectiveness of recommendations depends not only on the scientific validity of the interventions identified but on their relevance to the affected communitys concerns and their applicability within the regulatory or legislative framework of the proposal being considered. Commonly, a core team is responsible for the bulk of writing and analysis. Would you like email updates of new search results? HIAs conducted as part of a formal government process are generally subject to disclosure and freedom-of-information requirements. For example, U.S. priorities for improving public health are expressed in the Healthy People 2020 Program of the U.S. Department of Health and Human Services (DHHS 2010). A description of the HIAs impact on decision-making (to the extent that salient decisions have occurred by that time) as measured by an accounting of HIA recommendations that were adopted and an evaluation of available evidence that suggests whether and how the HIA played a role in decisions or contributed to changes in decision-makers knowledge, attitudes, or positions. Screening involves making an initial rapid judgment of whether an HIA is likely to be feasible and valuable. But few data may be available on the geographic scale of some decisions addressed in an HIA, such as decisions related to projects that would affect a rural area or a single neighborhood. 2005; Bhatia and Seto 2011). Ensuring that the public has accurate and complete information on adverse and beneficial effects. Health Impact Assessment: Main Concepts and Suggested Approaches-the Gothenburg Consensus Paper. McHugh S, Maruca S, Lilien J, Manning A. Not all HIAs will meet all proposed criteria, but the criteria are intended to describe typical practice. Life expectancy and physical function associated with income. The potential for the HIA to be completed in the time allotted and with the resources available. Scoping identifies appropriate data sources for the analysis and should also identify important data gaps. Health Impact Assessment for Regeneration Projects. Process evaluation assesses the design and execution of the HIA in light of its intended purpose and plan of action and applicable practice standards. Iteration during scoping and between scoping and assessment often results in additional changes in the final list of issues included in the HIA. Northeast National Petroleum Reserve-Alaska (NPR-A) Draft Supplemental Integrated Activity Plan/Environmental Impact Statement (IAP/EIS). Chapter 4 discusses the extent to which an HIA can ensure the implementation of recommendations. Screening: HIA of a Residential Housing Program, Example of a logic framework that maps out the possible causal pathways by which health effects might occur, Example of a Table Used for Systematic Scoping, Example of a Matrix for Analyzing Health Effects, Example of a Table for Rating Importance of Health Effects, Assessment: Northeast National Petroleum Reserve-Alaska, Examples of Health and Behavioral Effects That Have Been Addressed Quantitatively in HIA, Presidential/Congressional Commission on Risk Assessment and Risk Management (1997). Accessed at www.healthycommunities.org/assesstoolkit. Rethinking human health impact assessment. It is important for event staff to know exactly who has final decision-making power to eliminate potential conflicts. Castro A, Chen L, Edison B, Huang J, Mitha K, Orkin M, Tejani Z, Tu D, Wells L, Yeh J. Cave B, Curtis S. Developing a practical guide to assess the potential health impact of urban regeneration schemes. CDC is not responsible for the content of materials not generated by CDC. Parry JM, Kemm JR. The toolkit presents the key elements of HRC development. In such cases, HIAs often rely on data on a larger region and consider whether the characteristics of the larger population can be generalized to the affected community. The potential for health effects to place a disproportionate burden on or substantially benefit vulnerable populations. National Library of Medicine For example, in the Alaskan oil and gas HIA mentioned in Box 3-3, the HIA team drafted recommendations in collaboration with the decision-maker, the Bureau of Land Management, which formally adopted the recommendations as mitigation measures. 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. We identified 11 common assessment and planning components across 18 models and requirements, with a particular focus on health department, health system, and hospital models and requirements. For those reasons, the committee concludes that HIAs including, to the extent practical, the data used for the analysis, analytic methods, assumptions, findings, uncertainties, data gaps, and recommendations should be made public. Monitoring should provide information that allows one to conduct the evaluations noted above. The associations between expected disturbances and changes in health were then analyzed in more depth to look at the alternatives proposed for the expansion and at the cumulative effects of oil exploration and extraction. In others, scoping may identify studies that can be carried out by the HIA team or studies that can be carried out by experts involved in some other aspect of the planning, permitting, or review process (such as air-quality or traffic-safety analysis). The choice of what to evaluate will reflect the specific social, political, and policy context of the decision; the needs, interests, and questions of stakeholders and decision-makers; and the health status of the affected population. For example, in the context of NEPA, the lead federal agency must consider the degree to which the proposed action affects public health or safety to determine whether a proposal is likely to have significant effects and therefore require an environmental impact statement (40 CFR 1508.27). McAuliffe M. Developers of Proposed Springfield Biomass Plant tell Public Health Council: Nothing Less Than the Best. Key elements of the model include: Disseminating surveys Conducting key informant interviews and focus groups Incorporating county-level data on health Small rural hospitals may lack the required resources to successfully address issues that may be identified as a result of a CHNA. HHS Vulnerability Disclosure, Help 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. Identifying high-priority issues has been addressed in numerous contexts outside HIA, including human-health and ecologic risk assessment (see, for example, EPA 1989, 1992; NRC 1996, 2009). Regardless of whether effects are quantified, the assessment stage should include a characterization of each effect to the greatest extent. Such programs and projects involve many agencies and entities that have authority over some aspect of planning and implementation. Box 3-3 provides an example of an assessment step that was based on interviews with people who were likely to be affected by a decision and that considered their impressions of the effects that industrial activities were having and were likely to continue to have on individual, family, and community life. Retrieved fromhttps://www.chausa.org/communitybenefit/assessing-and-addressing-community-health-needs Second, recommendations are effective only if they are adopted and implemented. The approaches can provide useful information on how people view the proposal, that is, how it is expected to affect them and potentially improve or harm their quality of life. 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 . Thomson H. HIA forecast: Cloudy with sunny spells later? That permits recommendations to form the basis of effective implementation and management rather than merely providing a static system without the capacity to adapt. Federal government websites often end in .gov or .mil. HIA is meant to assist decision-makers, so although the act of reporting is a formal step in the HIA process, it is also in the interest of decision-makers and the HIA team to keep in constant communication throughout the HIA process so that emerging results can be incorporated into the policy, plan, program, or project. Please enable it to take advantage of the complete set of features! 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. 2009; Bhatia et al. Framework for Environmental Health Risk Management Final Report. 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. 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. Notwithstanding those considerations, the committee considers the public disclosure of HIAs to be an important ideal of practice but recognizes that it may not be realistic to expect widespread disclosure in the absence of requirements or incentives for it. Society of Petroleum Engineers; 2006. A community health assessment gives organizations comprehensive information about the community's current health status, needs, and issues. (2015). CDC - Home - Community Health Assessment - STLT Gateway Health impact assessment: A tool to help policy makers understand health beyond health care. Agreeing on a target population. Needs assessments serve as incredibly powerful tools for decision making, resource allocation, and ultimately reaching programmatic goals. Other groups have developed standard approaches to promote and evaluate practice quality, including the quality of analysis (see, for example, Fredsgaard et al. Example of a Table Used for Systematic Scoping. A variety of information was used to inform the process, Scoping: Atlanta BeltLine HIA. Catholic Health Association of the United States. The Public Health Accreditation board defines community health assessment as a systematic examination of the health status indicators for a given population that is used to identify key problems and assets in a community. Similarly, HIAs sponsored by private nonprofit organizations may not have requirements for disclosure inasmuch as most U.S. HIAs are not done under a legal mandate that requires disclosure. The committee proposes on the basis of its review the following adaptation of the current working definition of the International Association of Impact Assessment (Quigley et al. The information generated by the HIA process needs to be organized and presented in such a way that it can be readily understood by the intended audiences and present a compelling case for recommended actions. In those cases, the HIA team may need to rely on established principles of health promotion and disease prevention to develop approaches to minimizing or mitigating the identified effects. 1. The local North Slope Borough governmentan agency that participated in preparing the EISconducted an HIA, which was integrated into the EIS report. Knowing Your Community: Community Health Assessment as a Powerful Tool Bender, Kaye PhD, RN, FAAN Author Information Journal of Public Health Management and Practice: doi: 10.1097/PHH.0000000000000599 2017 Wolters Kluwer Health, Inc. All rights reserved. The CH Bhatia R. A Guide for Health Impact Assessment. The committee notes that a variety of qualitative and quantitative approaches are often used to generate predictions, but regardless of the methods used, most available guidance emphasizes the importance of considering diverse forms of evidence, a consistent and unbiased approach to selecting and interpreting evidence, and a clear and transparent description of the analytic approach (WHO 1999; Mindell et al. The grouping of the elements in discrete stages or steps of an HIA is less consistent; some guides list as few as five steps, and others describe as many as nine (Quigley et al. In some cases, the timeline and available resources will prevent collection of new data to address gaps that are identified. SFCC (Federation of Swedish County Councils). The committee notes that outcome evaluation of policy experiments is a field independent of HIA, and many large-scale social interventionssuch as Head Start and Moving to Opportunityhave been subject to outcome evaluation that has included consideration of health or health determinants (Leventhal and Brooks-Gunn 2003; Schweinhart et al. IPIECA/OGP (International Petroleum Industry Environmental Conservation Association and International Association of Oil and Gas Producers). 2006) as a technical definition of HIA: HIA is a systematic process that uses an array of data sources and analytic methods and considers input from stakeholders to determine the potential effects of a proposed policy, plan, program, or project on the health of a population and the distribution of the effects within the population. Describes data sources and analytic methods and methods used to engage stakeholders.