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A Health Impact Assessment (HIA) is a systematic method of gauging the potential health effects impact proposed decisions in a range of sectors. HIAs differ from Health Risk Assessments (HRA) and Environmental Impact Assessments (EIA) in that HIAs concentrate on examining both potential positive and negative human health impacts, rather than only the risks of adverse effects, as well as socioeconomic and environmental impacts.
Although widely used globally, HIAs in the U.S. are most commonly adopted on a voluntary basis, although some states or municipalities require or encourage their use to some extent. For example, the city of Denver, Colo., chose to use HIAs in the redevelopment plans for several neighborhoods.
Health in all policies is a similar, though less structured, approach that involves collaboration and stakeholder input across sectors in an effort to incorporate health considerations in decision-making processes. HIAs are one tool that can be used to support an overall health in all policies approach.
Regardless of the specific strategy, policymakers are acknowledging the larger contexts that affect health and using new tools such as HIAs to consider a wide variety of policies affecting public health. This page provides an overview of state legislation related to HIAs.
Existing State Laws and Programs
The following state program examples illustrate the various applications and methodologies that can be used in developing and implementing HIAs.
Massachusetts
The Massachusetts legislature created the healthy transportation compact in 2009 to increase interagency collaboration between the state’s department of transportation and other agencies as part of an effort to apply a health lens to policies—to “achieve positive health outcomes through the coordination of land-use, transportation and public health policy.” The law also requires using HIAs to determine the effects of transportation projects on public health. Under the provisions of M.G.L.A. 6C § 33, the compact must carry out 11 tasks, including:
- "(i) promote inter-secretariat cooperation and the establishment of a healthy transportation policy, including appropriate mechanisms to minimize duplication and overlap of state and federal programs and services.
- (ii) develop a healthy transportation framework that increases access to healthy transportation alternatives that reduce greenhouse gas emissions, improves access to services for persons with mobility limitations and increases opportunities for physical activities.
- (iii) develop methods to increase bicycle and pedestrian travel, incorporate the principles, findings and recommendations of the Massachusetts bicycle transportation plan and establish a framework for implementation of the Bay State Greenway Network.
- (iv) develop and implement, in consultation with the bicycle and pedestrian advisory board established in section 11A of chapter 21A, administrative and procedural mechanisms, including the promulgation of rules and regulations, consistent with the most current edition of the Project Development and Design Guide, or its successor, to encourage the construction of complete streets, designed and operated to enable safe access for pedestrians, bicyclists, motorists and bus riders of all ages to safely move along and across roadways in urban and suburban areas.
- (v) establish methods to implement the use of health impact assessments to determine the effect of transportation projects on public health and vulnerable populations [emphasis added].
- (vi) facilitate access to the most appropriate, cost-effective transportation services within existing resources for persons with mobility challenges.
- (vii) expand service offerings for the Safe Routes to Schools program.
- (viii) explore opportunities and encourage the use of public-private partnerships with private and nonprofit institutions.
- (ix) seek to establish an advisory council with private and nonprofit advocacy groups as the compact sees fit.
- (x) institute a health impact assessment for use by planners, transportation administrators, public health administrators and developers [emphasis added].
- (xi) develop and implement a method for monitoring progress on achieving the goals of this section and provide any other recommendations that would, in the judgment of the compact, advance the principles set forth in this section."
The Massachusetts Department of Public Health and the Bureau of Public Health conducted the first HIA in 2013 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. More information on this program is available here.
New Jersey
New Jersey requires HIA to be used for solid waste facilities as a component of Environmental and Health Impact Statements (EHIS). The size and scope of an EHIS varies in relation to the particular characteristics of a given facility. The EHIS consists of several review categories. Category III, known as the “culture category,” requires, in part:
“9. A health impact assessment for Class II and III sanitary landfills and thermal destruction facilities, which shall provide a detailed evaluation of the potential impacts of the proposed facility on human health resulting from ground or surface water discharges and air emissions, including, but not limited to the following:
- i. A description and discussion of the health risk assessment methodology to be employed, including detailed descriptions of the logical reasoning and assumptions employed in the method. A bibliography of reference material utilized in the preparation of the assessment shall be provided. Applicants shall contact the Department prior to the initiation of the assessment to obtain the current guidelines for such activities.
- ii. A discussion of the level of uncertainty involved in the overall assessment. This discussion shall address the uncertainty involved in the estimation of individual parameters such as emissions or discharge and decay rates, levels of exposure and health effects, as well as the implications of complex uncertainties.
- iii. A listing of all potential contaminants which may reasonably be expected to be released from the facility, and the amounts, concentrations and pathways of each.
- iv. A listing of contaminants which will be utilized to assess health risks. All known carcinogens listed in (c)9iii above shall be included; additional contaminants shall be included, based on professional judgment.
- This list, together with a description of the rationale employed in choosing those materials included on the list, shall be submitted to the department for review and approval before initiation of the toxicity profile and health impact assessment.
- v. For each of the contaminants listed in (c)9iv above, a toxicity profile shall be developed. This profile shall include data on the physical and chemical nature of the contaminant, as well as a description and discussion of data available regarding the environmental fate, acute effects (LD50, irritation), chronic effects (mutagenicity, teratogenicity, carcinogenicity) and epidemiology of the material. This profile shall include a listing of available toxicological, epidemiological or other acute or chronic health effects studies used or otherwise available on the material in question. Applicants should contact the department prior to the initiation of development of these profiles, to obtain the current guidelines for such activities.
- vi. A quantification of the potential health impacts, where possible. If such quantification is not included, an explanation of the reason for such omission shall be provided.
- vii. A detailed description of the mitigation techniques proposed to address any potential health impacts associated with the proposed facility.” N.J.A.C. 7:26–2.9
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This webpage is maintained by Douglas Shinkle, Transportation program director, Kate Blackman, Health program policy specialist and Ashley Noble, Health program policy specialist. This project is supported by the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The views expressed are those of the authors and do not necessarily reflect the views of the Health Impact Project, The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.