Health in All Policies: addressing the legal and policy foundations of Health Impact Assessment.

27 Introduction The concept of Health in All Policies aims to improve the health outcomes associated with policies in an attempt to mitigate health disparities and provide optimal environments for healthier living. This multidisciplinary framework seeks to improve health through effective assessment and reformation of policy for organizations of any level and stature. The importance of integrating health in policy assessment and decision making is a key concept in the growing field of Health Impact Assessment.1 The World Health Organization defines Health Impact Assessment (HIA) as “a combination of procedures, methods, and tools by which a policy, program, or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population.”2 HIA provides a mechanism for collaboration between various sectors and disciplines bridging the gap between research, policymaking, and implementation of policies, programs, and projects affecting health outcomes.3 In the United States, while some HIA efforts have focused on proposed public policies, HIA has been used primarily to analyze the health effects of proposed development projects and plans related to community design and transportation. However promising as an emerging practice in the U.S., HIA has yet to achieve broad integration and consideration within U.S. public policy.4 A fundamental and expanded understanding of HIA’s legal basis may help facilitate the integration of health impact considerations into a broad range of public policies, actions, and institutions.5 This article introduces a statutory and regulatory framework for HIA under the National Environmental Policy Act of 1969 (NEPA), and provides additional examples of HIA conducted within and outside the context of NEPA. The HIA examples set the stage for the broader question of how HIA might function within existing laws, policies, and processes, such as, What are the legal bases for HIA in existing federal law, state statutes, public regulations, and legal provisions? Answers to such questions may facilitate a broader understanding and approach toward health in all policies.