Establishing the practice of health impact assessment in the United States.

I t’s 4:00 p.m., Friday afternoon, and some­ one unfamiliar is knocking on your of­ fice door. She introduces herself as a city planner and asks whether you could help her with an upcoming redevelopment deci­ sion. She knows the health department has environmental health, chronic disease, and injury programs, and that redevelopment affects these issues. She came to your office first because she perceives redevelopment as a change in the environment. Through her planning education she has heard of “Health Impact Assessment” (HIA) and thinks it would help this situation. The practice of HIA acknowledges that de­ cisions made outside of the health sector can profoundly affect public health. Furthermore, the health sector’s engagement can promote evidence-based policy change. HIA practice is growing and environmental health profession­ als frequently lead the charge. The National Pre­ vention Strategy states that HIA can facilitate ac­ complishing the key strategy of building healthy and safe community environments (National Prevention Council, 2011). As the provided sce­ nario implies, awareness of HIA has reached city planners and associated professionals. HIA is a method to incorporate health into decision making. The National Research Council’s (NRC’s) formal definition of HIA is as follows: HIA is a systematic process that uses an ar­ ray of data sources and analytic methods and considers input from stakeholders to determine the potential effects of a pro­ posed policy, plan, program, or project on the health of a population and the distri­ bution of those effects within the popula­ tion. HIA provides recommendations on monitoring and managing those effects (National Research Council [NRC], 2011). What does this mean? HIA is akin to a pre­ operational physical for communities. Before patients undergo major surgery, their physi­ cians conduct thorough examinations, identify­ ing health issues that could be impacted by the surgery and recommending actions to improve outcomes. HIAs offer similar checkups for com­ munities, and environmental health profession­ als can be communities’ health consultants. HIA practice in the U.S. was reviewed last year by NRC. HIAs are completed in a six-step pro­ cess. The first is screening, which asks the ques­ tion, “Is the HIA worthwhile?” Scoping is next— determining what health outcomes to consider. Characterizing the beneficial and adverse health effects of the proposal (and alternatives) occurs during assessment. Identifying strategies to im­ prove health makes up the recommendation step. Documenting the process and communicating the findings occurs in the reporting step. Finally,