Conference Highlights Rapid Growth of Health Impact Assessments in the United States

According to a recent poll in Washington State, 71 percent of voters supported a bill that would require the state to consider impacts on people’s health when planning new transportation projects. This poll speaks to the growing recognition that illnesses like asthma, obesity, and diabetes, as well as injuries are shaped by the conditions in the places where we live and work. To address this, we need to factor health into decisions in fields like transportation, energy, housing, and agriculture.

The level of interest in the inaugural National Health Impact Assessment (HIA) Meeting held April 3 and 4 in Washington, D.C., highlights that this approach has become a centerpiece of community, state, and national efforts to improve Americans’ wellness. An HIA is a type of study that allows decision makers to factor health into projects like planning roads, passing agriculture policy, and siting schools. I have been using HIAs for over eight years, and until recently, I knew most of the people in the field. In organizing the National HIA Meeting, I worried that we might not find 200 people to attend. Instead, we had to close registration six weeks early: more than 430 leaders in public health, urban planning, housing, transportation, agriculture, and environmental regulation participated, and many more were on the waiting list.

The Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, sponsored the two-day meeting, along with The California Endowment, the Centers for Disease Control and Prevention, and the National Network of Public Health Institutes.

Keynote speaker Jonathan Fielding, the director of the Los Angeles County Department of Public Health who also chairs the U.S. Community Preventive Services Task Force, gave an overview of the fast-growing approach. “The first HIAs were done roughly 12 years ago in the United States,” he said. “There has been huge progress in this field.”

At the Health Impact Project, we are tracking this growth. Today, nearly 200 HIAs have been completed or are ongoing. In 2007, there were only 27 such studies on the books.

Fielding and other speakers at the meeting said that these types of solutions are urgently needed now that the United States faces epidemic rates of obesity, diabetes, asthma, and other diseases. HIAs offer leaders in all sectors a systematic way of addressing some of the root causes of such illnesses, as well as finding insights that allow them to contribute to building healthier communities.

At the conference, a Legal Review was released, which found that many laws in sectors like agriculture, energy, and transportation actually require public and private actors to identify health risks and benefits underlying key policies. “These laws can open the door to using HIAs as a means to fulfill requirements for broad, systematic assessments of health effects to inform specific decisions or processes,” said Arizona State University Professor James G. Hodge, Jr., the lead researcher on the review.

Some examples of successful HIAs highlighted at the meeting include:

·         In a decision on oil and gas leasing on the North Slope of Alaska, local residents, who are generally supportive of development because of the revenue it brings, opposed expanding leasing into hunting and fishing areas vital to the community’s food supply. Collaboration on the HIA contributed to a compromise leasing plan that included several new protections for health, helped overcome a sharp divide and stemmed the threat of litigation. This was also the first HIA to be formally undertaken within the legal framework of the U.S. National Environmental Policy Act and laid the groundwork for Alaska’s HIA program.

·         An HIA that analyzed the implications of a bicycle and pedestrian plan in Clark County, WA. The HIA led county planners to create connected bike and walking paths that will help residents stay fit. The HIA was given Active Living Research’s 2012 Translating Research to Policy Award.

·         An HIA showed that a Farm to School and School Gardens bill in Oregon would improve health not only by improving kids’ diet while at school, but also by reducing hunger and creating jobs in the hard-hit farm industry and rural communities. The HIA offered recommendations for maximizing the benefits. It was also instrumental in generating broad support for a pilot project, which was signed into law.

The two-day meeting ended with a discussion of next steps and opportunities for continued collaboration on the HIA front so that leaders in all sectors can routinely factor health into plans, projects, and proposals. Participants noted that the connections made at the meeting will help facilitate that progress and push the United States toward the end goal of creating healthier communities across the country.  Looking ahead, the Health Impact Project will continue to work with industry, government agencies, and public health professionals to support this growing field.

Aaron Wernham is the director of the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The Health Impact Project is a national initiative dedicated to promoting the use of health impact assessments in the United States. To learn more about the projects and view a U.S. map of HIA activity visit www.healthimpactproject.org.