Health Impact Assessments Postcard


Health impact assessments (HIAs) are tools to help determine the potential effects of proposed policies on people’s health, and to inform considerations of health during decision-making.

HIAs take health into account in policies across various sectors, including transportation, agriculture, education, criminal justice, energy and the environment. The HIA process encourages practitioners to examine how different populations—such as a rural community or low-income neighborhood—may be affected by a proposed policy. HIAs can add new information to the process and propose recommendations to minimize health risks or negative effects and capitalize on health benefits.

In the United States, more than 400 HIAs have been conducted at the federal, state, and local levels. Depending on scope and length, costs may range from approximately $10,000 to $125,000. Since the 2012 legislative sessions, at least 38 HIA-related bills have been introduced across the country. Some may incorporate elements of HIAs, while others explicitly require comprehensive HIAs. Below are three examples of recent state action related to HIAs.

  • Vermont enacted legislation in 2012 directing the department of health to recommend “a plan to institute a public health impact assessment process” for policy and planning decisions made by state and local agencies. The department has conducted HIAs for road corridors, zoning, paid sick leave and marijuana regulation.
  • The Washington Legislature enacted SB 6099 in 2007 requiring an HIA for a project to replace a 1.5-mile bridge connecting Seattle with a major suburb by calculating “the project's impact on air quality, carbon emissions, and other public health issues.” The final HIA recommended numerous interventions that were incorporated into the project, such as transit, bicycling and pedestrian improvements, additional green space and stormwater upgrades.
  • The Massachusetts legislature created a healthy transportation compact in 2009 to increase interagency collaboration between the state’s department of transportation and other agencies. The law required the use of HIAs to determine the effects of transportation projects on public health. The first HIA was conducted on an elevated highway corridor in the Somerville area that carries a large volume of traffic, but also limits mobility and connectivity within the city.

Sources: NCSL, Health Impact Project and Temple University Law Atlas.


HIAs are tools that bring together data, stakeholder input and other expertise to help determine the potential health effects of proposed policies.

Determine whether an HIA is needed and likely to be useful.
In consultation with stakeholders, including policymakers such as state lawmakers, develop a plan for the HIA including the identification of potential health risks and benefits.
Describe the baseline health of affected communities and assess the potential impacts of the decision.
Develop practical solutions that can be implemented within the political, economic or technical limitations of the project or policy being assessed.
Disseminate the findings to decision makers, affected communities and other stakeholders.
Evaluate the HIA process as a whole, and monitor the HIA’s impact on decision-making and the effects of the implemented decision on health and health risk factors.

The HIA process encourages stakeholder engagement at each step.
Adapted from the Health Impact Project.