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 (more). Bhatia R, Farhang L, Gaydos M, Gilhuly K, Harris-Roxas B, Heller J, Lee M, McLaughlin J, Orenstein M, Seto E, St Pierre L, Tamburrini AL, Wernham A, Wier M. Bhatia R, Branscomb J, Farhang L, Lee M, Orenstein M, Richardson M. Birley M. Health Impact Assessment in multinationals: A case study of the Royal Dutch/Shell Group. Assessment: Northeast National Petroleum Reserve-Alaska. Environmental justice implications of reduced reporting requirements of the Toxics Release Inventory Burden Reduction Rule. Human Impact Partners; 2010. Assignment of significance rests on the characterization of an effect as described above, but judgments regarding what constitutes a significant impact are ultimately determined partly on the basis of social and political values. SFDPH (San Francisco Department of Public Health). However, Science and Decisions (NRC 2009) emphasizes that a detailed understanding of the decision context is necessary for analyses to be scoped appropriately and that the conceptual distinction between assessment and management should not be interpreted as a firewall that prevents communication between parties. A smaller set of related indicators was endorsed for use in monitoring key elements of community health status (CDC, 1991). Parry JM, Kemm JR. Community Health Assessment aNd Group Evaluation (CHANGE): Building a Foundation of Knowledge to . Chapter 4 discusses the extent to which an HIA can ensure the implementation of recommendations. 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. Describes data sources and analytic methods and methods used to engage stakeholders. A growing population of families that have children. 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. Links to nonfederal materials are provided as a public service and do not constitute an endorsement of the materials by CDC or the federal government, and none should be inferred. Describes the baseline health status of the affected population with appropriate indicators, including prevalent health problems, health disparities, and social, economic, and environmental factors that affect health. 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. Scoping also establishes a plan for stakeholder participation in later phases of the HIA. An initial brief summary of the pathways through which health could be affected and the health effects to be addressed, including a rationale for how the effects were chosen and an account of any potential health effects that were considered but were not selected and why. That description is consistent with the earlier characterizations of HIA as a combination of procedures, methods, and tools (WHO 1999; Quigley et al. Step 7: Plan Implementation Strategies | ACHI The Importance of Common Metrics for Community, Social - Health Leads By necessity, therefore, impact assessment is a pragmatic exercise and reflects a balance between scientific rigor and professional judgment. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Clipboard, Search History, and several other advanced features are temporarily unavailable. 98224-MS. SPE International Health, Safety & Environment Conference; 24 April 2006; Abu Dhabi, UAE. The use of the information by the decision-maker is discussed at greater length in Chapter 4 in the section Managing Expectations.. The American Hospital Associations review of the IRSs final rules for CHNAs and implementation strategies can be foundhere. Suicide is the fourth leading cause of death among young people worldwide and the third leading cause of death among those in the US. 2006). In some cases, the team may draw on outside consultants who have expertise in a specific health issue or method. Benefits include The definition also notes that recommendations should incorporate monitoring, which is essential for effective continuing management as a decision is implemented. Findings of each stage of the HIA and a summary of outputs at the end of each stage. Seventh, disclosure allows people to take voluntary actions to avoid risk (Neidell 2009). 2006; World Bank 2010). It was not possible to derive mortality rates for demographic subgroups. One approach uses a logic framework that maps out the causal pathways by which health effects might occur (see Figure 3-1). A description of the research questions, data sources, methods to be used, and any alternatives to be assessed. Menu labeling as a potential strategy for combating the obesity epidemic: A health impact assessment. National Public Health Performance Standards Program, National Center for State, Tribal, Local, and Territorial Public Health Infrastructure and Workforce, SDOH Research by CDC Authors: Frequently Asked Questions, Examples of How the SDOH Can Be Addressed Through the 10 Essential Public Health Services, Performance Management & Quality Improvement, National Public Health Improvement Initiative, National Public Health Performance Standards, Public Health Finance and Infrastructure Support, Competencies for Public Health Professionals, National Leadership Academy for the Public's Health, Supporting the Performance Improvement Workforce, Alerts About Current & Projected Funding Opportunities, Cooperative Agreements, Grants & Partnerships, Strengthening Public Health Systems & Services, USAPI Strengthening Public Health Systems & Services, Integrity & Accountability Review Offices, National Health Initiatives, Strategies & Action Plans, State & Territorial Health Department Websites, US Territories & Freely Associated States, Style for Referring to US Territories & Freely Associated States, About the Public Health Infrastructure Center, Implementing the Community Health Needs Assessment Process, U.S. Department of Health & Human Services, Multisector collaborations that support shared ownership of all phases of community health improvement, including assessment, planning, investment, implementation, and evaluation, Proactive, broad, and diverse community engagement to improve results, A definition of community that encompasses both a significant enough area to allow for population-wide interventions and measurable results, and includes a targeted focus to address disparities among subpopulations, Maximum transparency to improve community engagement and accountability, Use of evidence-based interventions and encouragement of innovative practices with thorough evaluation, Evaluation to inform a continuous improvement process, Use of the highest quality data pooled from, and shared among, diverse public and private sources, Improved organizational and community coordination and collaboration, Increased knowledge about public health and the interconnectedness of activities, Strengthened partnerships within state and local public health systems, Identified strengths and weaknesses to address in quality improvement efforts, Baselines on performance to use in preparing for accreditation, Benchmarks for public health practice improvements. HIA provides recommendations on monitoring and managing those effects. 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. 2010). Quigley R, den Broeder L, Furu P, Bond A, Cave B, Bos R. Roscam Abbing EW. IPIECA/OGP (International Petroleum Industry Environmental Conservation Association and International Association of Oil and Gas Producers). The ideal community health status assessment consists of three components: a household survey, community discussion groups, and an examination of existing data (secondary data) from a variety of other . Bookshelf Cole BL, Fielding JE. Assessing and addressing community health needs. A complete nursing health assessment requires a health professional to examine a patient in a systematic fashion, from head to toe. It would then fall to the decision-makers to determine routes that met those criteria. This chapter has described HIA categories, defined HIA, discussed current HIA practice, noted variations in practice, and provided the committees conclusions regarding each step of the HIA process. If there is a causal relationship between variables, a valid estimate of effect size, and data on how a decision will change the prevalence of a health-related factor (exposure), it is possible to make quantitative predictions of effects (Fehr 1999; Veerman et al. Finally, it is appropriate to include issues that are the subject of community concern even if they seem unlikely to be substantiated by further analysis. A preliminary opinion regarding the potential importance of the proposal for health. HIA is meant to assist decision-makers, so although the act of reporting is a formal step in the HIA process, it is also in the interest of decision-makers and the HIA team to keep in constant communication throughout the HIA process so that emerging results can be incorporated into the policy, plan, program, or project. Citation for Toolkit Acknowledgement of plans for future outcome evaluation or discussion of limitations that prevent such an evaluation. and transmitted securely. On the basis of its review, the committee synthesized the information from guidance, practice, and literature to propose criteria that define an HIA and draw several conclusions regarding HIA practice. Evaluation should be planned throughout the community health assessment (CHA) process to assess the impact of your strategies and progress toward your goals. Behavioral Risk Factor Surveillance System data were used for the county and the state and stratified by race. The health effects that are included, the data sources and methods that are used, and the recommendations that are made are therefore determined by the HIA practitioners rather than according to a legal or regulatory standard (Wernham 2011). In addition, federal and state policy and accreditation requirements may be revised or implemented to better facilitate assessment and planning collaboration between health departments, hospitals, and others for the purpose of improving community health. Expert judgment is central to HIA but must be grounded in a solid foundation of scientific neutrality and accepted public-health principles. Consequently, the committee concludes that the lack of attention to evaluation is a barrier that will need to be overcome if HIA practice is to be advanced in the United States. 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. In others, scoping may identify studies that can be carried out by the HIA team or studies that can be carried out by experts involved in some other aspect of the planning, permitting, or review process (such as air-quality or traffic-safety analysis). 2006). As discussed at the beginning of this chapter, HIAs in the United States are often conducted without a formal legal mandate and by an agency or organization that does not have decision- making authority. The bulleted list below provides examples in which some health impacts or behavioral outcomes have been quantified. The committee notes that public involvement is important in screening; information provided by stakeholders may provide insight into the potential effects of a proposal under consideration that contribute to the final determination of whether an HIA is warranted and likely to be useful. Scoping also establishes a plan for the analytic methods that will be used during the assessment phase. A review of health impact assessment frameworks. The key findings are provided in the opening section of the report, and they are categorized according to the strength of the evidence as highly likely, likely but less well-supported by the available evidence, and plausible, but not well-supported. For example, according to the report, a requirement for paid sick days is highly likely to lead to more workers taking leave to recuperate from an illness, to receive preventive care, or to care for ill children and dependents. The available data, however, may not be sufficient, and the HIA team may make a decision to dedicate resources to collection of new data. Although little has been written on the reasons for keeping HIA information confidential, the committee recognizes that there may be reasons for organizations conducting HIAs to decide not to disclose the results. Leventhal T, Brooks-Gunn J. Throughout the document recommendations and thoughts from community members' . The steps can be described as follows: The following sections provide an overview of the process of conducting an HIA. Although there are many potential benefits of undertaking an HIA, one common objective is to inform decisions to promote changes that support improvements in health determinants or health outcomes. In practice, some HIAs have focused on a specific health end point, such as obesity, or health concerns related to a single impact of the proposal, such as the health effects of air pollutants, most likely without using a systematic approach that considered and eliminated other impacts (see, for example, Kuo et al. Physical activity associated with changes in pedestrian infrastructure. Minimum Elements and Practice Standards for Health Impact Assessment (HIA), Version 2. Moving to opportunity: An experimental study of neighborhood effects on mental health. The committee notes that in any assessment, it (more), Assessment should result in a report that. Review of literature and a consideration of the social, economic, and political context of the eventual decision are also important. During scoping, the HIA team may produce an initial list, refine it on the basis of stakeholder input, and then make it final through research and analysis in the assessment phase. Quantitative evidence can include routinely collected information, such as mortality and census data, that can inform the baseline assessment. Because HIA in the United States is often undertaken outside a formal legal mandate, it has not consistently included alternatives assessment. 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. Mindell J, Boaz A, Joffe M, Curtis S, Birley M. Enhancing the evidence base for health impact assessment. In some cases, collaboration between a health department and other agencies has resulted in the identification of appropriate proposals for screening. 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. As in the realm of health risk assessment, there remains a need to distinguish between the assessment and management phases to avoid manipulation of analytic components by decision-makers. The approaches can provide useful information on how people view the proposal, that is, how it is expected to affect them and potentially improve or harm their quality of life. The training and credentials of HIA practitioners are variable, and there is no universally accepted standard for a level of training necessary to lead an HIA. Dialogue with IRS staff and leadership on elements of the Revised 990, Schedule H Identification and examination of areas where: -There is a need for clarification (e.g., what constitutes meaningful community engagement, how to define community) -Selected reporting requirements as framed may yield unanticipated (and undesired . Why Community Health Is Important for Public Health - Tulane University Environmental, Social and Health Impact Assessment (ESHIA) Process. In other cases, all proposals in selected agencies or sectors have been screened by local governments (SFCC 1998; Lester et al. Assessment and Plans - Community Health Assessment - STLT Gateway - CDC 3, Elements of a Health Impact Assessment, Improving Health in the United States: The Role of Health Impact Assessment. 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. HIAs in the private sector are increasingly common, pursuant to internal corporate guidelines or requirements of lending banks, such as the International Finance Corporation and World Bank (see Appendix A for further discussion) (Birley 2005; IPIECA/OGP 2005; McHugh et al 2006; ICMM 2010; IFC 2007, 2010).3 Few, however, are made public. HIA recommendations take various forms, and some examples are provided below. The baseline profile characterizes the health status of affected populations and includes trends and factors (social, economic, and environmental) known to affect health. Northeast National Petroleum Reserve-Alaska (NPR-A) Draft Supplemental Integrated Activity Plan/Environmental Impact Statement (IAP/EIS). Saving Lives, Protecting People. Mindell JS, Boltong A, Forde I. Fehr R. Environmental health impact assessment: Evaluation of a 10 step model. 2006; Jagannathan et al. The press coverage recognized the tension between the burden that this new requirement would place on businesses and how the health of employees and the wider community are affected by people who work while they are ill. Human Impact Partners noted that many including labor groups and fundersused the HIAs to assess work and family issues. What Is a Community Health Improvement Plan? 2 Setting priorities considers pathways that appear most important from a public-health perspective and considers issues that have been raised prominently by stakeholders. Instead, the committee focused its review on the characterization of effects and the use of evidence, although several recommendations to improve the quality of analysis are discussed in Chapter 4. Thus, the assessment phase is separated from the management phase, as recommended elsewhere (NRC 1983). It is also common for local, state, or tribal health departments to undertake an HIA to inform another agencys decision-making. Within several of these components, we discuss characteristics that are critical to improving community health. 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. Management of the health effects of a proposal as it moves from planning into implementation should be a dynamic process in which monitoring results may drive continued adaptation of the health-management plan. Another categorization is based on the breadth of the HIA and distinguishes HIAs that have a tight focussuch as ones that use a narrow definition of health and emphasize quantification from HIAs that have a broader, holistic focus shaped by the social determinants of health (Kemm 2001). 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. A variety of screening tools and algorithms are commonly used (Cole et al. Or, in some cases, there may be unpublished evaluations of measures that have been implemented in similar scenarios. Data and results are measured consistently across participants. Monitoring should provide information that allows one to conduct the evaluations noted above. The HIA study area was divided into five planning areas, and census (2000) and mortality data were used to analyze the population profiles. Ensuring that the public has accurate and complete information on adverse and beneficial effects. Robust and continuing efforts to inform decision-makers of the findings and recommendations of the HIA and efforts by HIA practitioners and other stakeholders to champion choices that will benefit health can be an essential part of an effective HIA. MeSH Health Impact Assessment: A Practical Guide. It solicits and responds to input from stakeholders throughout all stages of the process and includes publicly available and accessible documentation of processes, products, and sponsors. Process evaluation assesses the design and execution of the HIA in light of its intended purpose and plan of action and applicable practice standards. Source: SFDPH 2011. The committee notes that any limitations, incomplete data, and uncertainty in the baseline analysis should be clearly stated. It is also useful to assess the political context of the proposal to be assessed and consider, for example, the major political drivers of the proposal, the arguments made by political supporters and those opposed to the proposal, and any economic or technical constraints that limit the alternatives that can be considered. Washington (DC): National Academies Press (US); 2011. Health impact assessment: A tool for healthy public policy. In other cases, the initial scope is generated by stakeholders and then refined through research and input from advisory or steering committees. Qualitative data can be gathered through, for example, focus groups, one-on-one interviews, surveys, individual meetings with stakeholder organizations, testimony in community meetings, Web-based or other written input, and running a stand or exhibition in a public place. The World Bank and International Finance Corporation have policies governing the disclosure of information, and although the policies differ, both provide for withholding or excluding documents that might contain proprietary information or information whose disclosure could damage a client or lenders financial, political, or legal interests (Halifax Initiative Coalition 2006; IFC 2006, 2010; McHugh et al. Catholic Healthcare West Guidelines for Community Health Assessment This document is meant to help CHW hospitals identify and evaluate community health issues, and capacities for dealing with them. HIAs can be conducted by a variety of agencies, organizations, or individuals. Several approaches for scoping are available. Framework for Environmental Health Risk Management Final Report. Suicide in young people: screening, risk assessment, and intervention HIA guidance often points out the need for monitoring and continuing management and verification that mitigation measures are being implemented. 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). In such cases, HIAs often rely on data on a larger region and consider whether the characteristics of the larger population can be generalized to the affected community. They help us to know which pages are the most and least popular and see how visitors move around the site. For example, there may be concerns about risks to a proponents reputation or to the viability and public acceptance of a proposed project if a report discloses important unmitigated adverse impacts or potential impacts that are uncertain or for which strong evidence does not exist. 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. Not all HIAs will meet all proposed criteria, but the criteria are intended to describe typical practice. The Collective Impact Framework has five key elements: Participants have a common agenda with a joint approach for solving an agreed-upon problem. 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. Red Dog Mine Extension Aqqaluk Project. Evaluation is important for the quality of individual HIAs and for the success of the HIA field as a whole. 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. Funding Acknowledgement These cookies may also be used for advertising purposes by these third parties. With clear language in mind, partners should come to agreement on the 2010). Disclosure requirements and practices vary considerably among development lenders and private-sector proponents. Decision-making is rarely based solely on scientific evidence but instead takes into account an array of political, economic, technical, and practical considerations. 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. Thomson H. HIA forecast: Cloudy with sunny spells later? Because the degree to which the proposed action affects public health or safety is one factor considered, this process could be considered the equivalent of the screening step of an HIA. PDF Key Elements of Community Health Improvement Planning: From Assessment It was concluded during the screening phase that an HIA would add value to project outcomes. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. . Making recommendations is a well-accepted part of HIA practice, but relatively little attention has been paid to how they should be formulated. A central tenet is that peoples experience offers an invaluable perspective on the potential effects of the proposal. The HIA report describes the screening process but does not provide great detail about it. Guidance Note 4. SFCC (Federation of Swedish County Councils). The baseline should be focused on the issues that are likely to be affected by the proposal. A description of the political and policy context of the decision and an analysis of the opportunities to influence decision-making or otherwise make health-oriented changes. Sources: Veerman et al. Developing new cross-disciplinary and interagency collaborations. 2017 Jul/Aug;23 Suppl 4 Suppl, Community Health Status Assessment:S14-S21. Create structural or process change. Sixth, because many established environmental risk factors are found at higher concentrations in vulnerable communities, disclosure of risks may be an important way to reduce health disparities and address concerns about environmental justice (Miranda et al. For example, the chair of the California Assembly Labor Committee referred to the HIA and asked the opposition to the bill if they condoned the spread of disease through restaurant workers.. This plan is used by health and other governmental education and human service agencies, in collaboration with community partners, to set priorities and coordinate and target resources. Public and stakeholder participation during scoping can serve several important purposes, such as providing local knowledge regarding existing conditions and potential impacts, introducing alternatives or mitigation measures that stakeholders would endorse as effective ways to address key concerns, and allowing representative participation in shaping the terms of the HIA by groups affected by the proposal. In other cases, it may not be possible to attribute a particular decision to the influence of an HIA (Wismar et al. Lester C, Hayes S, Griffiths S, Lowe G, Hopkins S. Implementing a strategy to address health inequalities: A health authority approach.

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