The HIA conclusions and recommendations should be presented in a manner that is clear and easily understood. Variations were found in race, age, employment status, poverty, car ownership, and mortality. 2006). official website and that any information you provide is encrypted The potential for the HIA to be completed in the time allotted and with the resources available. In practice, not all HIAs have conducted systematic literature reviews or documented review methods. The baseline profile characterizes the health status of affected populations and includes trends and factors (social, economic, and environmental) known to affect health. Past Projects: Vehicle Miles Traveled Legislation. 2006). That permits recommendations to form the basis of effective implementation and management rather than merely providing a static system without the capacity to adapt. 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. Bhatia R. A Guide for Health Impact Assessment. Moreover, disease rates in small populations can vary substantially, and it may not be possible to calculate them reliably. The American Hospital Associations review of the IRSs final rules for CHNAs and implementation strategies can be foundhere. 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. Bennear LS, Olmstead SM. Scoping should therefore entail a deliberative process that involves engagement of stakeholders. As described by Ross (2007, p. 9), the Atlanta BeltLine is a transit, trails, parks, and redevelopment project that uses a 22-mile loop of largely abandoned freight rail line that lies between two and four miles from the city center and affects about 45 neighborhoods. Minimum Elements and Practice Standards for Health Impact Assessment (HIA), Version 2. Thus, it is generally not possible to attribute outcomes specifically to HIA recommendations because they are implemented with the decision. It is important to note that a matrix does not explain how evidence was used to reach conclusions. [accessed May 24, 2011]. In practice, however, reporting may occur at earlier stages of the HIA process and include public meetings; meetings with decision-makers, other stakeholders, and advisers; and dissemination of interim public reports, such as a scoping summary. Acknowledgement of plans for future outcome evaluation or discussion of limitations that prevent such an evaluation. Cancer risk and changes in life expectancy associated with tobacco taxes. Community health assessment and community health improvement planning are continuous, systematic processes for assessing and addressing health needs in a community. These 7 components are oftentimes divided into three stages: (1) information, research, and data collection stage, (2) a prioritization and strategy design stage, and (3) an implementation and action stage. Morgan RK. 2019 Feb;22(1):25-31. doi: 10.1089/pop.2018.0049. A lack of access to needed goods and services. As noted above, the iterative process is known as adaptive management in the field of environmental management. International Finance Corporation Performance Standard 4 Rev -0.1, Community Health, Safety, and Security. The committee notes that qualitative social sciences and participatory-action research provide fertile ground for innovative methods for HIA. A summary of how stakeholders were engaged, the main issues that the stakeholders raised, and how they will be addressed or why they will not be addressed. The potential for HIA-based information to alter a decision or help a decision-maker discriminate among decision options. Community Health Assessment Toolkit. A variety of planning and zoning, funding, and environmental regulatory decisions were required for the BeltLines various components to be developed. The degree to which they are systematic varies, and some authors have suggested frameworks and guidance for conducting systematic reviews (Mindell et al. . A community health improvement plan is critical for developing policies and defining actions to target efforts that promote health. Integrates stakeholder input into the analysis of effects. Using this generic model as a template, let's fill in the details with another example of a logic model, one that describes a community health effort to prevent tuberculosis. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. The committee notes that in addition to characterizing effects, HIAs may provide conclusions on the significanceor societal importanceof the effects, although this has been rare in U.S. practice. Box 3-2 provides an example of scoping for the HIA of a proposed development in Atlanta. 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. Failing to undertake a systematic review may mean overlooking evidence that would lead an assessor to a different conclusion. An explicit statement of data sources, methods, assumptions, and uncertainty is essential, but uncertainty does not negate the value of the information. Evaluation should be planned throughout the community health assessment (CHA) process to assess the impact of your strategies and progress toward your goals. Northeast National Petroleum Reserve-Alaska, Supplemental Integrated Activity Plan, Record of Decision. Observations that might indicate some influence of the HIA include discussion about HIA by legislators debating a proposal. A Guide to Health Impact Assessments in the Oil and Gas Industry. The ultimate goal of a community health assessment is to develop strategies to address the communitys health needs and identified issues. The goal was to incorporate health considerations into the decision-making process by predicting health consequences, informing decision makers and the public about health impacts, and providing realistic recommendations to prevent or mitigate negative health outcomes (p. 9). The discussion recognizes that the practice of HIA varies because it is adapted for use in different decision-making contexts. The HIA team was assisted by an advisory committee, but it appears that the committee was not involved in the scoping. However, decision-makers are often overwhelmed by today's proliferation of fragmented indicator sets. The most vulnerable populations were identified as people of low economic status, children, older adults, renters, and the carless. It uses the best available evidence to analyze effects on health and health disparities. The toolkit provides a foundation for meeting the relevant IRS requirements. The committee concludes that the following are the most important factors to consider in determining whether to do an HIA: Ultimately, the HIA report should provide a rational and consistent explanation of how proposals are selected for screening. 2008; Fredsgaard et al. In: Kemm J, Parry J, Palmer S, editors. Potential health effects have been estimated by using established approaches for quantitative analysis, such as the calculation of the fraction of disease rates in a population that can be attributed to the risk being analyzed and the application of available exposure-response functions to quantify cancer risk associated with incremental changes in exposure to carcinogens. The health issues were identified by determining the populations that would be affected and then considering how they would be affected. Careers. II, Selected Evidence Base Breaking the Cycle, East London and the City Health Action Zone and Queen Mary. Public Health Accreditation Board Acronyms and Glossary of Terms Version 1.0 [PDF 536KB], July 2011, as adapted from Healthy People 2010 and CDCs National Public Health Performance Standards Program. The available data, however, may not be sufficient, and the HIA team may make a decision to dedicate resources to collection of new data. Fourth, disclosure of potential impacts may benefit industry by reducing the risk of litigation and by reducing tort liability by fulfilling requirements to warn those potentially responsible and potentially affected before the effects occur. 2003; ICMM 2010). Jones and Bartlett, 2009, as adapted in Public Health Accreditation Board Acronyms and Glossary of Terms Version 1.0 [PDF 536KB], July 2011. Whereas HIA aims to predict the effects of a decision before it occurs, outcome evaluation assesses whether the implementation of a decision has actual effects on health or health determinants (Parry and Kemm 2005). On the basis of the findings, the HIA recommended a series of public-health mitigation measures that were selected to maximize any favorable impacts and to minimize harms. Health Impact Assessment for Regeneration Projects, Vols. A CHA is a systematic process involving the community to identify and analyze community health needs and assets, prioritize those needs and then implement a plan to address significant unmet needs.1Upon completing the assessment, hospitals develop implementation strategies to address the significant community health needs identified in the CHA.2A community health assessment process can focus your organizations efforts around community health improvement and provide structure for addressing the determinants of health and illness in your community. 2010). 2023 by the American Hospital Association. ADA (Atlanta Development Authority). Health-supportive measures that would generally support health but are not tied directly to a specific impact (for example, building a clinic in an underserved neighborhood that would be adversely affected by emissions from a new freeway). Any approach to determining which proposals will be screened should demonstrate a consistent rationale; should document the rationale in the HIA report; and should take account of public input. A matrix can be a useful way to organize a qualitative analysis and to convey results in a manner that is easy to understand, but a matrix may also be misinterpreted as being more objective than a simple description. 2010). 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). Identifies limitations and uncertainties clearly. The top 10% of the census tracts within the study area were then identified as locations of the most vulnerable populations. Accessed at www.healthycommunities.org/assesstoolkit. Identification of apparent data gaps and of data collection that could be undertaken to address the gaps or a rationale for not undertaking data collection. Making recommendations is a well-accepted part of HIA practice, but relatively little attention has been paid to how they should be formulated. Given the broad scope of HIA practice settings, applications, and data sources, the committee chose not to develop specific standards or criteria for what constitutes adequate evidence or analysis for HIA. Practice Standards for Health Impact Assessment (HIA), Version 1. Most HIAs in the United States are therefore undertaken outside the formal decision-making process by organizations (such as nonprofit community-based groups), universities, or health departments that do not have decision-making authority over the proposals being addressed. Document No. 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. In other cases, it may not be possible to attribute a particular decision to the influence of an HIA (Wismar et al. 2005; Bhatia and Seto 2011). Although a wide variety of excellent resources on community health assessment and CQI currently exist, those materials generally do not link assessment and CQI concepts and techniques in the way that is envisioned for . AHA does not claim ownership of any content, including content incorporated by permission into AHA produced materials, created by any third party and cannot grant permission to use, distribute or otherwise reproduce such third party content. Instead, it appears that the specific methods and approaches used in a single HIA often evolve within the basic framework described above and develop as a pragmatic response to context. On the basis of its review of available literature, HIA guides, and practice standards, the committee has synthesized the key criteria that define HIA and that set it apart from related approaches to public-health practice and policy. 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. Incomplete disclosure may substantially limit access to complete information regarding the process, data sources, methods, and findings of an HIA for those who will be affected by the proposal being assessed (McHugh et al. For example, if a traffic-calming infrastructure was installed on a street that had a high rate of pedestrian injury, it may be appropriate to monitor injury rates directly because changes would be expected as soon as the installation was complete. The results of the HIA were presented in different formats; the full report was accompanied by a summary and fact sheets. Community input on the proposal suggested that for the program to reassure community members effectively, the monitoring should be conducted by an independent third party, and there should be strong community oversight at each stage. Focusing on Health: How Can the Health Impact of Policy Decisions be Assessed? Because it will often not be practical or possible to address all direct and indirect health effects that appear theoretically possible, it is important to select issues carefully. Health Impact Assessment for Regeneration Projects. A description of the research questions, data sources, methods to be used, and any alternatives to be assessed. DHHS (U.S. Department of Health and Human Services). Bhatia R, Wernham A. The committee notes that in any assessment, it would be difficult or impossible to quantify all potential health impacts. Characterization of health effects in HIA relies on qualitative and quantitative evidence. 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. 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. Such evidence may come from a review of published literature on interventions to address the health outcomes of concern. A statement of why the proposal was selected for screening. Some decisions to conduct HIA may depend on a specific statutory requirement or mandated procedure. 2006). 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). 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. For example, in Oregon, an independent health-oriented nonprofit organization conducted an HIA of a series of proposals to reduce vehicle miles traveled in a bill intended to reduce greenhouse- gas emissions (UPH 2009). Recommendations may be implemented through regulatory mandates or voluntary actions by stakeholders. Although completed HIA reports are readily available, peer-reviewed or gray literature that discusses the impacts of specific HIAs is still rare. In some cases, the impact of the HIA on a decision is clear-cut. Qualitative evidence provides a context-specific view of peoples lives. A community health assessment gives organizations comprehensive information about the community's current health status, needs, and issues. Scoping also establishes a plan for stakeholder participation in later phases of the HIA. There are six elements that make up a health assessment. To receive email updates about this page, enter your email address: We take your privacy seriously. Box 3-4 provides several examples of topics that have been addressed in HIA by using quantitative methods. 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. 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 To provide this care as a community health nurse, you need to continually acquire knowledge, refine skills, and assess yourself. The potential for substantial adverse or beneficial health effects and the potential to make changes in the proposal that could result in an improved health risk-benefit profile. It also shows how HIA results can be disseminated widely in different formats through a number of channels. 2006). Turnock B. Analyzes beneficial and adverse health effects and characterizes the changes in the indicators selected, to the extent possible, in terms of nature, direction, intensity, magnitude, distribution in the population, timing and duration, and likelihood. The HIA study area was divided into five planning areas, and census (2000) and mortality data were used to analyze the population profiles. The research was funded by the Annie E. Casey Foundation as an initiative with the potential to encourage long-term strategies and partnerships to strengthen families and communities. Second, it allows findings to be reviewed and improved. 2007; Harris-Roxas and Harris 2011). 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. In practice, however, there is some inconsistency in how HIAs are conductedfor example, how stakeholders are engaged and how data are collected and analyzedand in the structure and content of the final work products of an HIA. 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. 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 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). Scholars point to a remarkable consistency in the basic elements that are generally included in descriptions of HIA (Mindell et al. A community health assessment, also known as community health needs assessment, refers to a state, tribal, local, or territorial health assessment that identifies key health needs and issues through systematic, comprehensive data collection and analysis. Mindell JS, Boltong A, Forde I. Directive 2001/42/EC of the European Parliament and of the Council of 27 June 2001 on the assessment of the effects of certain plans and programmes on the environment. Agreeing on a target population. UPH (Upstream Public Health). Impact evaluation attempts to judge whether the HIA influenced the decision- making process, that is, whether and to what degree the recommendations were adopted and implemented and how the HIA influenced the decision-making process. Health impact assessment. The definition also notes that recommendations should incorporate monitoring, which is essential for effective continuing management as a decision is implemented. 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. 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. 98224-MS. SPE International Health, Safety & Environment Conference; 24 April 2006; Abu Dhabi, UAE. A description of the proposed policy, program, plan, or project that will be the focus of the HIA, including the timeline for the decision and intervention points at which HIA information will be used. SFCC (Federation of Swedish County Councils).
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