The grouping of the elements in discrete stages or steps of an HIA is less consistent; some guides list as few as five steps, and others describe as many as nine (Quigley et al. 98224-MS. SPE International Health, Safety & Environment Conference; 24 April 2006; Abu Dhabi, UAE. Roles and responsibilities for key, onsite event personnel, e.g., Event Organizer, Security Manager, Police, Fire, EMS, etc. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. 2006). Red Dog Mine Extension Aqqaluk Project. Paper No. Careers. Some decisions to conduct HIA may depend on a specific statutory requirement or mandated procedure. As described in Appendix A, there are few laws in the United States that specifically require HIA, although manysuch as the National Environmental Policy Act (NEPA)require a consideration of health that can be accomplished through HIA. Any logic models or scoping tables that were completed should also be included. Or, in some cases, there may be unpublished evaluations of measures that have been implemented in similar scenarios. Drafting measures that address identified public-health risks and that fulfill the requirements of the legal framework governing a decision will increase the chances that HIA recommendations are implemented. 2004; Bhatia and Wernham 2008). Saving Lives, Protecting People. Rapid HIAs may be completed in a short time (weeks to months), are often focused on smaller and less complex proposals, and generally involve primarily literature review and descriptive or qualitative analysis. The HIA report describes the screening process but does not provide great detail about it. Selection of appropriate indicators will be discussed at greater length below in the section Monitoring and Evaluation.. 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. other key elements that will be important for the work moving forward. Action plans have mutually reinforcing activities. MeSH 3, Elements of a Health Impact Assessment, Improving Health in the United States: The Role of Health Impact Assessment. 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. I and III, Breaking the Cycle, East London and the City Health Action Zone and Queen Mary. Personal (income, employment; can include occupational risk), Revenue or expense to local, state, or tribal government (support for or drain on services, infrastructure), Need for new roads and transit, water, or sanitation systems, New services as a direct result of proposal, Drain on existing services resulting from proposed action. HHS Vulnerability Disclosure, Help Mindell J, Boaz A, Joffe M, Curtis S, Birley M. Enhancing the evidence base for health impact assessment. Chapter 4 discusses the extent to which an HIA can ensure the implementation of recommendations. Quigley R, den Broeder L, Furu P, Bond A, Cave B, Bos R. Roscam Abbing EW. Bhatia R, Wernham A. Having transparency throughout the process and clearly delineating the roles and responsibilities among various parties will help to limit real and perceived bias. For example, HIA reports can be disseminated in hard copy, in electronic format, at public meetings, to focus groups, or at different stages in the HIA process or policy cycle. . 2009; Bhatia et al. An official website of the United States government. Remember, although this example uses boxes and arrows, you and your partners in change can use any format or imagery that communicates more effectively with your stakeholders. Suicide in young people: screening, risk assessment, and intervention Federal government websites often end in .gov or .mil. A variety of planning and zoning, funding, and environmental regulatory decisions were required for the BeltLines various components to be developed. That definition reflects the committees finding that the involvement of stakeholdersalthough the approaches used vary from little or no involvement to robust engagement and participation at every stephas consistently been described as a core element of HIA practice and should be considered essential to it. 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). 2006; Jagannathan et al. 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. Improving Health in the United States: The Role of Health Impact Assessment. In contrast, the effect of decisions on some health outcomes (such as cancer or obesity) may take years to occur and may have multiple contributing factors. As discussed above, additional benefits may include, for example (Wismar et al. Disclaimer. Why Complete an Assessment and Improvement Plan? 2008). Well-executed scoping saves time, work, and resources in the later stages of the HIA (Harris et al. Past Projects: Paid Sick Days Legislation. Public Health: What It Is and How It Works. All information these cookies collect is aggregated and therefore anonymous. It is informed by a review of U.S. and international HIA literature and guidelines (see Appendixes A and E) and by the experience of committee members and others who provided input during the committee process. Findings of each stage of the HIA and a summary of outputs at the end of each stage. The discussion described pathways by which Iupiat health was likely to be affected. 2 Setting priorities considers pathways that appear most important from a public-health perspective and considers issues that have been raised prominently by stakeholders. The CH In: Kemm J, Parry J, Palmer S, editors. 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. 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. Characterization of health effects in HIA relies on qualitative and quantitative evidence. Cancer risk and changes in life expectancy associated with tobacco taxes. The top 10% of the census tracts within the study area were then identified as locations of the most vulnerable populations. The committee notes that outcome evaluation of policy experiments is a field independent of HIA, and many large-scale social interventionssuch as Head Start and Moving to Opportunityhave been subject to outcome evaluation that has included consideration of health or health determinants (Leventhal and Brooks-Gunn 2003; Schweinhart et al. It is critical to arrange the information logically so that readers can navigate easily through the document, to provide a lay summary that accurately describes the main findings and conclusions of the study, and to reference all data and sources accurately (Fredsgaard et al. To provide this care as a community health nurse, you need to continually acquire knowledge, refine skills, and assess yourself. Jagannathan R, Camasso MJ, Sambamoorthi U. A large and growing body of quantitative evidence is available; where specific additional information is needed and resources are available, HIA teams may collect new quantitative data in the course of conducting an assessment. 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. Cancer risk associated with exposure to hazardous chemicals. Vol. The committee finds that an HIA report should at least describe the proposal and alternatives that are the subject of the HIA, the data sources and analytic methods used, the groups and individuals that were consulted in the course of the HIA, the process and findings of each step of the HIA, and the overall conclusions and recommendations. As a final note, it is important to remember the context in which HIAs are conducted when considering the recommendations phase. PDF Community Health Assessment and Group Evaluation (CHANGE) Presentation A community health assessment (sometimes called a CHA), also known as community health needs assessment (sometimes called a CHNA), refers to a state, tribal, local, or territorial health assessment that identifies key health needs and issues through systematic, comprehensive data collection and analysis. Outcome evaluation should be undertaken when available resources and data will allow reasonable judgments regarding the association between the implementation of decisions and observed changes in health outcomes or health determinants. HIAs can be conducted by a variety of agencies, organizations, or individuals. Another variation, rapid-appraisal HIA, has been described and in some texts includes explicit public engagement through an initial half-day workshop for stakeholders (Parry and Stevens 2001; Mindell et al. 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. 2005). 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. A related issue is incomplete disclosuresuch as disclosure of only summary information without data or analysis, disclosure only by electronic media in communities unlikely to have access, and English-only reports. 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. This is the key link between a health profile and a health plan. First, disclosure informs affected communities and individuals and possibly other stakeholders, such as government agencies and officials, of possible effects on their health and well-being, a core objective of HIA. Establishing a foundation for appropriate monitoring. It is common for mitigation measures and design alternatives to be considered during scoping, to be refined as the assessment phase further characterizes the impacts and identifies their importance, and to be made final during the recommendations phase. The potential for health effects to place a disproportionate burden on or substantially benefit vulnerable populations. 2010). Culturally competent care means providing care within the context of a patient's culture and beliefs. The variability also reflects a lack of clear criteria that define HIA as a distinct field. ADA (Atlanta Development Authority). It can also include information from social-science and epidemiologic studies regarding the strength of associations between the social and physical environment (such as air and water quality and economic impacts) and health outcomesinformation essential in the quantitative prediction of health effects. Source: ICMM 2010. One of the first steps in identifying the parameters of the assessment was to establish an understanding of the BeltLine, a complex project that had been evolving for several years and was expected to be constructed over a 30-year period. Ensuring that the public has accurate and complete information on adverse and beneficial effects. The committee is not endorsing the HIAs or the recommendations, but simply providing examples. The committee recommends that HIAs be publicly released and disseminated. [online] Available: ICMM (International Council on Mining and Metals). Cook WK, Heller J, Bhatia R, Farhang L. A Health Impact Assessment of the Healthy Families Act of 2009. Identifies limitations and uncertainties clearly. 2. Prospective health impact assessment: Pitfalls, problems, and possible ways forward. But few data may be available on the geographic scale of some decisions addressed in an HIA, such as decisions related to projects that would affect a rural area or a single neighborhood. It follows a systematic process that includes screening, scoping, assessment, recommendations, reporting, and monitoring and evaluation. Santa Monica Airport Health Impact Assessment (HIA): A Health-Directed Summary of the Issues Facing the Community near the Santa Monica Airport. However, in some cases, the relationships between the implemented decision and health determinants may be more direct and measurable. Before The committee concludes that when alternatives to the proposal being assessed are under consideration, the HIA team should assess the impacts of each alternative. Additional modeling approaches, such as system-dynamic modeling and agent-based models, are also promising and emerging tools that could have applications to health. Assessing the Health Impacts of Road Pricing Policy Proposals. Understanding Risk: Informing Decisions in a Democratic Society. PMC Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. 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. Benefits include Assessing the baseline health status of the affected population provides a reference point with which the predicted changes in health status may be compared; it identifies any groups that could be more vulnerable than the general population to the impacts of the proposal; and it provides an understanding of the factors that are responsible for determining health in the affected communities, and this, in turn, allows for a better understanding of how any changes in those factors may affect health. You will be subject to the destination website's privacy policy when you follow the link. The process of implementing recommendations should be transparent and should include opportunities for public participation in the decision process and clear mechanisms of accountability. In those cases, it may be more appropriate to monitor exposuressuch as environmental concentrations of a carcinogen or the availability of safe walking corridorsthat are linked to the outcome of interest by public-health evidence. Notwithstanding those considerations, the committee considers the public disclosure of HIAs to be an important ideal of practice but recognizes that it may not be realistic to expect widespread disclosure in the absence of requirements or incentives for it. Click on the icon for each step to read about that part of the process. 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). Making recommendations is a well-accepted part of HIA practice, but relatively little attention has been paid to how they should be formulated. The process may include identifying communities and geographic regions; demographic, economic, racial, and ethnic groups; and vulnerable populations, such as children, elderly people, disabled people, low-income people, racial and ethnic minorities, and people who have pre-existing health conditions. Assessment and Plans - Community Health Assessment - STLT Gateway - CDC Observing and documenting the HIA processsuch as methods of engaging stakeholders and interacting with decision-makers and approaches to addressing analytic challenges and interviewing participants and stakeholders are the main methods of process evaluation. While CHNAs are a recent requirement, community health assessments (CHAs) have long been used as a tool by hospitals, public health departments and other social service agencies to identify key community health concerns. Decisions are often based on incomplete information and must often be made within a specified time rather than waiting for more complete information. Injuries and fatalities associated with changes in vehicle traffic or speeds. Although the reasons and objectives for HIA are often not articulated at the outset of screening, establishing well-defined objectives will focus the screening process on determining whether HIA is likely to be an effective approach for achieving them. Failing to undertake a systematic review may mean overlooking evidence that would lead an assessor to a different conclusion. Another issue that should be addressed in scoping is identifying alternatives to the proposed action. A logic framework was produced to guide the assessment. Across the field, there is little uniformity in the content of written HIA reports. Here are 7 common components of a successful Community Health Needs Assessment (CHNA): Information, Research, and Data Collection Stage 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. Thus, the assessment phase is separated from the management phase, as recommended elsewhere (NRC 1983). In this approach, the aspects of a proposal that may affect health are listed and considered in major categories of health and illness. More structured approaches have also been used. Process evaluation can range from a simple self-assessment that is undertaken at the end of an HIA and focuses on a few variables that are relatively simple to describe, track, or measuresuch as the methods used, degree of certainty of predictions, and approach to stakeholder engagementto a more comprehensive case study that seeks to evaluate the HIA process holistically. Because the biologists on the EIS team were uncertain of the degree to which subsistence harvests might be favorably or adversely affected, the HIA did not attempt to make quantitative estimates of the probability or intensity of the impact. For example, U.S. priorities for improving public health are expressed in the Healthy People 2020 Program of the U.S. Department of Health and Human Services (DHHS 2010). Create structural or process change. The baseline should be focused on the issues that are likely to be affected by the proposal. Recommendations may be implemented through regulatory mandates or voluntary actions by stakeholders. In some cases, the team may draw on outside consultants who have expertise in a specific health issue or method. The discussion recognizes that the practice of HIA varies because it is adapted for use in different decision-making contexts. Health impact assessment: A tool to help policy makers understand health beyond health care. Elements of a Health Impact Assessment - Improving Health in the United A variety of tools and processes may be used to conduct a community health assessment; the essential ingredients are community engagement and collaborative participation. Source: Adapted from BLM 2007 and Wernham 2007. Health impact assessments are needed in decision making about environmental and land-use policy. It uses the best available evidence to analyze effects on health and health disparities. In 1998, the Bureau of Land Management (BLM) completed a Northeast National Petroleum Reserve-Alaska Integrated Activity Plan/Environmental Impact Statement (EIS). Knowing Your Community: Community Health Assessment as a Pow - LWW Completing A Health Assessment In Nursing | NurseJournal.org In those cases, the HIA team may need to rely on established principles of health promotion and disease prevention to develop approaches to minimizing or mitigating the identified effects. The Collective Impact Framework has five key elements: Participants have a common agenda with a joint approach for solving an agreed-upon problem. Alerting decision-makers to the more general need to focus on health in future decisions. The HIA drew on public testimony, literature review, and accepted mechanisms of health and illness to establish the scope of health concerns that should be considered. Improving relationships and collaboration between stakeholders. 3Elements of a Health Impact Assessment Chapter 2established the rationale for examining the potential effects of decisions on health and health disparities and highlighted health impact assessment (HIA) as a potential tool for assessing the health implications of various decisions. 8600 Rockville Pike 2006). Quigley RJ, Taylor LC. Association for Community Health Improvement. The committee is not endorsing the HIAs or the recommendations, but simply providing examples. sharing sensitive information, make sure youre on a federal Community input during the development of recommendations can ensure that they address specific aspects of living conditions and community design that may not be obvious to an outside researcher, and it provides an opportunity to ensure that the recommendations address high-priority issues in a manner that is acceptable to the affected community. A growing population of families that have children. The degree to which they are systematic varies, and some authors have suggested frameworks and guidance for conducting systematic reviews (Mindell et al. Screening: HIA of a Residential Housing Program. CDC is not responsible for the content of materials not generated by CDC. The variability in the practice has evolved in the absence of widely accepted practice standards or formal regulatory or procedural requirements for HIA outside NEPA and related state laws (see Appendix A). By necessity, therefore, impact assessment is a pragmatic exercise and reflects a balance between scientific rigor and professional judgment. 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. Framework for Environmental Health Risk Management Final Report. In the United States, HIAs have commonly been undertaken by people who have an MPH or equivalent degree and have attended a brief (2- to 5-day) training session. Crossings at 29th St./San Pedro St. Area Health Impact Assessment. Use of health impact assessment in incorporating health considerations in decision making. 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. Evaluating health impact assessment. Chapter 2 established the rationale for examining the potential effects of decisions on health and health disparities and highlighted health impact assessment (HIA) as a potential tool for assessing the health implications of various decisions. The National Partnership for Women and Families commissioned Human Impact Partners and researchers at the San Francisco Department of Public Health to conduct an HIA of the federal Health Families Act of 2009, (more). In many cases, the first course of action is to gather information from published literature, unpublished reports, administrative data gathered for routine monitoring purposes, and other available documents. Improving community health starts with knowing the factors that impact people's health, both inside and outside of the clinic. 4321-4347 [1970]; EC 2001). Although HIA may not always include or provide resources for independent evaluation, more in-depth, independent evaluation will generate more robust conclusions about HIAs effectiveness and best practices in the field and should be given high priority. 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. The committees may be convened for several purposes, including providing technical guidance or peer review, ensuring adequate and fair representation of diverse interests and priorities among stakeholders, communicating the results of the HIA to decision-makers, and developing recommendations that address community needs and are compatible with the specific legal requirements of the decision- making process. Epub 2018 Jun 19. Major issues and challenges for HIA development and practice are considered in Chapter 4. Becoming culturally competent is an ongoing process. Various sources of population-health statistics at the national, state, and local levels are available. McHugh S, Maruca S, Lilien J, Manning A. To request permission to reproduce AHA content, please, https://www.chausa.org/communitybenefit/assessing-and-addressing-community-health-needs, Step 5: Prioritize Community Health Issues, Association for Community Health Improvement (ACHI). 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. Under NEPA, a federal agency must determine whether a federal environmental decision is likely to have significant effects, and if so, the level of analysis required (40 C.F.R. There are, however, no current examples of HIAs in the United States that include outcome evaluation as described here.