Factoring health and related costs into decision making is essential to confronting the nation's health problems and enhancing public well-being, says a new report from the National Research Council, which adds that a health impact assessment (HIA) is a promising tool for use by scientists, communities, and government and private sector policymakers. The report offers guidance to officials in the public and private sectors on conducting HIAs to evaluate public health consequences of proposed decisions -- such as those to build a major roadway, plan a city's growth, or develop national agricultural policies -- and suggests actions that could minimize adverse health impacts and optimize beneficial ones.
"Medical care alone is inadequate for managing the increasing rates of costly and chronic diseases in individuals and in our society," said Richard J. Jackson, chair of the committee that wrote the report and professor and chair of environmental health sciences at the University of California, Los Angeles. "Increasingly, we learn the ways that economic, social, planning, and other policies can harm, but also promote, health. HIA is a way to help make these impacts evident both to policymakers and to the public."
The committee said that some policies and programs historically not recognized as relating to health are believed or known to have important health consequences. For example, public health has been linked to an array of policies that determine the quality and location of housing, availability of public transportation, land use and street connectivity, agricultural practices and the availability of various types of food, and development and location of businesses and industry.
The Role of Health Impact Assessment
Many countries and organizations around the world use HIA, and its use in the U.S. has slowly increased over the last 10 years. No U.S. laws specifically require these assessments, although some -- such as the National Environmental Policy Act (NEPA) -- require a consideration of health, which could be accomplished through HIA. Several approaches could be used to incorporate aspects of health into decision making, but HIA holds particular promise, the committee said, because of its applicability to a broad array of programs, consideration of both adverse and beneficial health effects, ability to consider and incorporate various types of evidence, and engagement of communities and stakeholders in a deliberative process. The committee noted that HIA should not be assumed to be the best approach to every health policy question but rather should be seen as part of a spectrum of public health and policy-oriented approaches.
The committee presented a six-step framework for conducting HIA of proposed policies, programs, plans, and projects at federal, state, tribal, and local levels, including within the private sector. The six steps are: screening to see whether HIA is warranted; identifying populations that will be affected and health effects to evaluate; assessing beneficial and adverse health effects of the proposal and each alternative; recommending specific actions to minimize or mitigate adverse effects; reporting the findings and recommendations to decision makers and the public; and monitoring and evaluating, for example to track changes resulting from implementing HIA recommendations.
In addition, the committee identified several challenges to the successful use of HIA, such as balancing the need to provide timely information with the realities of variations in data, producing quantitative estimates of health effects, and engaging stakeholders. Moreover, HIA could be integrated into environmental impact assessment (EIA) because the steps and approaches of HIA and EIA are compatible. Under NEPA and some state laws, the identification and analysis of health effects is required when EIA is conducted. Although substantive challenges exist, bringing health into EIA practice under NEPA and state laws would advance the goal of improving public health, the committee concluded.
The study was sponsored by the Robert Wood Johnson Foundation, National Institute of Environmental Health Sciences, California Endowment, and Centers for Disease Control and Prevention. The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies. They are independent, nonprofit institutions that provide science, technology, and health policy advice under an 1863 congressional charter. Panel members, who serve pro bono as volunteers, are chosen by the Academies for each study based on their expertise and experience and must satisfy the Academies' conflict-of-interest standards. The resulting consensus reports undergo external peer review before completion.
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