Health Impact Assessments Take on Broader Role in Cities and States

Cities and states have exponentially increased their use of the new policymaking tool in the last five years, and the trend shows no signs of stopping.
April 2, 2013

Cities and states have exponentially increased their use of a new policymaking tool—health impact assessments (HIAs)—in the last five years, and the trend shows no signs of stopping.

HIAs are similar to environmental impact assessments, but with an explicit focus on public health. So when a city wants to renovate its water sanitation plant or a state decides to retire a coal power plant, an HIA can provide a better sense of how the health of people living in the affected areas will fare. The assessments have pushed extensively by the Health Impact Project, a joint initiative by the Pew Charitable Trusts and the Robert Wood Johnson Foundation, which have both helped fund various projects nationwide.

Those efforts are making a difference. At the end of 2007, only 27 HIAs had ever been completed, according to the project; as of April 2013, more than 225 have been finished or are under way. That’s a more than 800 percent increase in the past five years. Policymakers at every level and across departments have started to realize their usefulness, says Aaron Wernham, director of the Health Impact Project.

“It’s here to stay. People understand it makes perfect sense, when making decisions that are important to health, to take health into account,” Wernham says. “Not doing so is like not looking both ways when you cross the street.”

The latest round of grantees, announced Tuesday, demonstrates the increasingly diverse projects for which officials are using HIAs. They include exploring the possibility of retrofitting or retiring the Shawnee coal plant in Paducah, Ky.; assessing the health impacts on Native Americans if a new solar plant is built in the Mojave Desert; and analyzing different proposals for overhauling the sanitation infrastructure in San Juan, Puerto Rico.

But one new project is perhaps the most ambitious yet for an HIA: the Detroit Urban Resource Center has received a grant to study the effect of reduced population and revenue in Detroit, as the city seeks to right itself financially and restore the blighted neighborhoods within its borders. As local officials and a newly installed state emergency financial manager ponder how to encourage economic growth in Detroit, the HIA will analyze those new proposals from the public health perspective.

In fact the Detroit plan may turn out to be the broadest HIA on record, incorporating various arms of an overall effort to rejuvenate a foundering American city.

“The city's been struggling for years with figuring out, how do you deal with a shrinking economy? How do you stock the police well enough? How do you keep schools open?” Wernham says. “They’re in a very politically challenging environment. We hope the HIA will prove to be a really useful lens, and it will help people think rationally and carefully about tradeoffs when you try to figure out how to help a community rebuild.”

HIA supporters say they’re beginning to have a tangible impact on policy. One common example is the 2011 Oregon Farm to School bill, which encourages public schools to purchase their foods from local farms. A nonprofit, Upstream Public Health, completed an HIA before the bill was finalized, and lawmakers incorporated several of its recommendations into the final legislation. Wording was altered to ensure qualified "local" food was actually produced in Oregon, and a pilot program was created that allowed schools to build school gardens to add an educational component to the "farm-to-school" concept.

“It was very gratifying. We could see how the language of the policy directly became the language of the program,” says Tia Henderson, research manager at Upstream. “You could see very clearly the continuity of how this all went through.”


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