Science and Decisions: Advancing Risk Assessment. The selection of qualitative and descriptive approaches will be informed by the scale and size of the proposal, the profile of the affected population, and the uses of the resulting information. Stakeholders, however, may have insights into local conditions and potential solutions for addressing concerns raised by the proposal under consideration. Thus, it is generally not possible to attribute outcomes specifically to HIA recommendations because they are implemented with the decision. Logic frameworks can be used as part of stakeholder engagement to develop a shared understanding of how a project will develop and the outcomes that can be expected (Cave and Curtis 2001a,b; Cave et al. The Association for Community Health ImprovementsCommunity Health Assessment Toolkitoffers a nine-step pathway for conducting a CHA and developing implementation strategies. Expert judgment is central to HIA but must be grounded in a solid foundation of scientific neutrality and accepted public-health principles. The phrase desktop HIA has also been used to refer to a rapid HIA that entails little or no public engagement. Furthermore, some policies may focus on determinants of healthfor example, economic development, transportation, or housingrather than explicitly mentioning health. To provide this care as a community health nurse, you need to continually acquire knowledge, refine skills, and assess yourself. 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. MAPP brings four assessments together to drive the development of a community strategic plan MAPP Framework Organizing Visioning Assessments Strategic Issues Goals/Strategies Action Cycle Organize for Success Organizing the planning process and developing partnerships Organize for Success Determine the necessity of undertaking the MAPP process. Because HIAs can address decisions that range from small, localized programs or projects to national policies, screening ensures that HIA is used judiciously and when it is most likely to be valuable. Mindell J, Ison E, Joffe M. A glossary for health impact 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. In selecting the analytic methods that will be used, the HIA practitioner should consider not only technical limitations but what type of information will be most useful to decision-makers. 2009; Bhatia et al. Observations that might indicate some influence of the HIA include discussion about HIA by legislators debating a proposal. Health impact assessment: A tool to help policy makers understand health beyond health care. For example, the Massachusetts Department of Public Health responded to citizen concerns regarding a proposed power plant by considering whether HIA would be an appropriate way to address them (McAuliffe 2009). Acknowledgement of plans for future outcome evaluation or discussion of limitations that prevent such an evaluation. An official website of the United States government. Benefits include The health issues were identified by determining the populations that would be affected and then considering how they would be affected. 2006). The World Bank and International Finance Corporation have policies governing the disclosure of information, and although the policies differ, both provide for withholding or excluding documents that might contain proprietary information or information whose disclosure could damage a client or lenders financial, political, or legal interests (Halifax Initiative Coalition 2006; IFC 2006, 2010; McHugh et al. 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 A Guide to Health Impact Assessment: A Policy Tool for New Zealand. Evaluation of whether a decision has changed specific health outcomes may often be difficult or impossible because of the complex and multifactorial causal pathways involved in many health outcomes, the length of time from implementation of a decision to observable changes in health indicators, and the lack of suitable comparison groups (Quigley and Taylor 2004; Parry and Kemm 2005). 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. Health Impact Assessment: SEIC (Sakhalin Energy Investment Company) Phase 2 Development. official website and that any information you provide is encrypted The committee notes that each approach for gathering and interpreting data may be conducted in ways that are more or less participatory, engaging stakeholders in shaping the research questions, interpreting the findings, and developing recommendations on the basis of the findings. Scoping identifies appropriate data sources for the analysis and should also identify important data gaps. Crossings at 29th St./San Pedro St. Area Health Impact Assessment. Any logic models or scoping tables that were completed should also be included. Membership is variable but may include representatives of affected communities or community-based organizations, industrial proponents or business groups, public-health experts, officials involved in the decision- making process, and others who have a stake in the outcome. Life expectancy and physical function associated with income. The HIA report describes the screening process but does not provide great detail about it. It identifies a baseline that describes the health status of populations that will be affected by the decision. The local North Slope Borough governmentan agency that participated in preparing the EISconducted an HIA, which was integrated into the EIS report. 2009). The HIA team was assisted by an advisory committee, but it appears that the committee was not involved in the scoping. As in the realm of health risk assessment, there remains a need to distinguish between the assessment and management phases to avoid manipulation of analytic components by decision-makers. Across the field, there is little uniformity in the content of written HIA reports. Second, it allows findings to be reviewed and improved. One approach uses a logic framework that maps out the causal pathways by which health effects might occur (see Figure 3-1). Robust and continuing efforts to inform decision-makers of the findings and recommendations of the HIA and efforts by HIA practitioners and other stakeholders to champion choices that will benefit health can be an essential part of an effective HIA. The effectiveness of Health Impact Assessment: Scope and Limitations of Supporting Decision-Making in Europe. Community health assessment and community health improvement planning are continuous, systematic processes for assessing and addressing health needs in a community. 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). Harris P, Harris-Roxas B, Harris E, Kemp L. Harris-Roxas B, Harris E. Differing forms, differing purposes: A typology of health impact assessment. Frank DA, Neault NB, Skalicky A, Cook JT, Wilson JD, Levenson S, Meyers AF, Heeren T, Cutts DB, Casey PH, Black MM, Berkowitz C. Heat or eat: The Low Income Home Energy Assistance Program and nutritional and health risks among children less than 3 years of age. 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. 2010). There could also be concerns that disclosure of such information would lead to litigation. The baseline profile also generally draws on data that describe the social, economic, and environmental conditions important to health, such as labor or housing reports, environmental impact assessments, and gray or unpublished data specific to the decision context. CHA/CHIP trainings and tools - NACCHO 2006; Bhatia 2010; ICMM 2010). Not all HIAs will meet all proposed criteria, but the criteria are intended to describe typical practice. Past Projects: Vehicle Miles Traveled Legislation. They expressed interest in developing The Crossings in a way that will address local community needs for affordable housing and for other community assets that are safe, healthy, and supportive (p. Intro-1). A description of the political and policy context of the decision and an analysis of the opportunities to influence decision-making or otherwise make health-oriented changes. 2005; PHAC 2005; Harris et al. Disclosure requirements and practices vary considerably among development lenders and private-sector proponents. 2006). 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. Open communication is necessary to build trust and ensure mutual objectives. 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 findings of the HIA were covered by newspapers and Web sites in California, Maine, Massachusetts, and New Hampshire; and the HIA researchers were interviewed on radio. By examining the various components of the different assessment and planning models, we are able to identify areas for coordination, ways to maximize collaboration, and strategies to further improve community health. Public concerns are a common trigger for a decision to screen, and the degree of concern or controversy about a proposal may be one of the factors weighed in the decision to undertake an HIA. Atlanta Beltline: Health Impact Assessment. The committee is not endorsing the HIAs or the recommendations, but simply providing examples. SFCC (Federation of Swedish County Councils). 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. 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. 2005; Frank et al. The variation partly reflects the wide array of applications of HIA; for example, it is not necessary or feasible to use the same approaches to involve stakeholders for a local project and for a high-level state or national policy. 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. Another consideration is whether the proposal is likely to place a disproportionate burden of risk on vulnerable populations in the affected community; screening proposals on this basis helps to ensure that the HIA addresses the risk factors that underlie observed disparities in the rates of illness among various populations. Moreover, disease rates in small populations can vary substantially, and it may not be possible to calculate them reliably. University researchers have conducted HIAs, and community-based organizations have conducted HIAs with technical assistance from public-health experts to inform officials who are deliberating on a legislative or administrative proposal. A comprehensive profile will include many indicators; those related to selected priorities For example, desktop HIAs may consider indirect stakeholder input through review of public comments submitted outside the HIA process, comprehensive HIAs may have relatively little stakeholder engagement, and rapid-appraisal HIAs of smaller-scale proposals may involve collection of some new data to inform the analysis. In general, the baseline profile focuses on health issues and health determinants that may be affected by the proposal rather than on attempting to provide a complete assessment of community health. The role of adaptive management as an operational approach for resource management agencies. Decisions are often based on incomplete information and must often be made within a specified time rather than waiting for more complete information. Saving Lives, Protecting People. PDF Best Practices for Community Health Needs Assessment (CHNA - NACCHO International Finance Corporation Performance Standard 4 Rev -0.1, Community Health, Safety, and Security. Additional modeling approaches, such as system-dynamic modeling and agent-based models, are also promising and emerging tools that could have applications to health. Box 3-4 provides several examples of topics that have been addressed in HIA by using quantitative methods. Cook WK, Heller J, Bhatia R, Farhang L. A Health Impact Assessment of the Healthy Families Act of 2009. The HIA team identified the following critical issues that could affect the health of the study area population: access and social equity, physical activity, safety, social capital, and environment (including air quality, noise, and water management). Northeast National Petroleum Reserve-Alaska, Supplemental Integrated Activity Plan, Record of Decision. 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. Since there are different models to guide assessment and planning, as well as a variety of organizations and agencies that carry out these activities, there may be confusion in choosing among approaches. II, Selected Evidence Base Breaking the Cycle, East London and the City Health Action Zone and Queen Mary. 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. Finally, effects that are plausible but are not supported by available evidence include fewer hospitalizations because workers are able to receive the preventive primary care needed to maintain good health. There are, however, no current examples of HIAs in the United States that include outcome evaluation as described here. government site. The central considerations include whether the proposal in question might cause important changes in health, whether health is already a major focus of the decision-making process, whether the legal framework provides an opportunity for health to be factored into the decision, and whether data, staff, resources, and time are adequate to complete a successful HIA in time to provide useful input into the decision-making process (that is, can information be provided within the timeline for the decision). PDF Key Elements of Community Health Improvement Planning: From Assessment This information can help develop a community health improvement plan by justifying how and where resources should be allocated to best meet community needs. Describes data sources and analytic methods and methods used to engage stakeholders. Healthy People. It includes the information that was taken into account and the final output of the screening process, which was a decision on whether to commission and proceed with an HIA. Because the assessment of health effects depends on an in-depth understanding of changes that may affect healthsuch as changes in traffic flow, roadway design, air quality, or community revenue sourcesHIAs are inherently multidisciplinary; public-health experts may lead the effort but must draw on resources and expertise from other disciplines. Step 9: Evaluate Progress | ACHI 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. A well-designed dissemination strategy is critical for the success of an HIA. 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. 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. 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. 2007; Harris-Roxas and Harris 2011). The specific methods used in assessment are discussed in depth in the next section. The committee recognizes that undue bias in an HIA may compromise its credibility and efficacy. Mindell J, Biddulph J, Taylor L, Lock K, Boaz A, Joffe M, Curtis S. Improving the use of evidence in health impact assessment. The Catholic Health Association defines a community health needs assessment as a systematic process involving the community to identify and analyze community health needs and assets in order to prioritize these needs, and to plan and act upon unmet community health needs. A decision-making bodysuch as a department of planning or transportation can conduct an HIA to inform its own decision. 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. The HIA conclusions and recommendations should be presented in a manner that is clear and easily understood.

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