Health impact screening
Gulf Breeze Highway 98 utility undergrounding (CRA-financed), Santa Rosa County. A health impact assessment asks how a project will change people’s health, and for whom, before it is decided. Its published steps follow: what the public record can fill in, and what only people can supply.
What this can be called
Retrospective health review: the decision has already been made
The Society of Practitioners of Health Impact Assessment sets ten minimum elements. It says desktop assessments “do not meet the minimum elements for HIA without the stakeholder engagement component” (SOPHIA 2022). Software can screen; only engagement with the people affected makes it an assessment. Each element is marked met when this record contains it, which is not the same as anyone having checked it.
- Done before the decision, in time to inform it
The project is already under construction or complete. An assessment now looks back; it cannot inform the decision.Too late - Engages the people affected
No record of engaging the people affected. Without it this is a desktop screening, not an HIA.Missing - Considers a range of impacts
0 of 15 influences decided with a reason.Missing - Describes baseline conditions
Choose the census tract where the project is.Missing - Characterises impacts and documents the process
Nothing included in scope yet.Missing - Evidence-based recommendations with a responsible party
None recorded.Missing - A report documenting purpose, findings and methods
The report below is generated from this record; it needs the sponsor, the team and any conflicts of interest.Missing - Publicly available and shared with decision-makers
Record where the report was published.Missing - Monitoring of recommendations
None recorded.Missing - Evaluation of outcomes
Record how the process, the impact on the decision and the health outcomes will be evaluated.Missing
Step 1
Is a health assessment worth doing?
Screening “establishes the need for and value of conducting an HIA” (NRC 2011, Summary, p. 6). Start with the decision, then the six criteria the National Research Council lists.
- “The potential for substantial adverse or beneficial health effects or irreversible or catastrophic effects, even if the effects have a low likelihood”
From the record: The project record describes effects on 2 of 15 influences on health: work, income and the local economy, power, water and other essential services. - “The ability of information from the HIA to alter a decision or help a decision-maker to discriminate among options”
- “The possibility that a disproportionate burden of the health effects is placed on vulnerable populations”
From the record: Choose the tract in step 2 to see who lives there. - “The existence of public concern or controversy”
- “The opportunity to incorporate health information into a decision-making process that may not otherwise include such information”
From the record: No: the project is built. Health information can still guide operation and the next decision like it. - “The ability of the HIA team to complete the assessment within the time and with the resources available”
Step 2
Which effects, and on whom?
Scoping “identifies the populations that might be affected, determines which health effects will be evaluated” (NRC 2011). Decide each of the 15 influences on health in or out, with a reason (SOPHIA 3.5). Influences the project record already describes are marked; that is a suggestion, not a decision.
People and community
Noise, commutes, disasters, displacement and access to nature and to each other all bear on mental health.
Shared places, stable neighborhoods and how a project is decided change how well people know and help each other, which matters most in a disaster.
Lighting, crossings, sight lines and traffic speed change the risk of injury and how safe people feel walking.
Buyouts, rising values, assessments and repeat disasters can move people out of their neighborhood, breaking ties to work, school, care and neighbours.
Living conditions and environment
Projects raise or lower what households pay for housing and utilities, through rents, assessments, rates and the homes built or lost.
Roads, airports, plants and the traffic they draw change what people breathe, most for those living closest. Cleaner fuels, less driving and buffers work the other way.
Drainage, sewers, elevation and where homes are built decide who floods and how often. Floods injure, contaminate water, leave mould and push people out of their homes.
Paving, roofs and lost tree cover make places hotter; shade, trees and reliable cooling make them safer. Heat falls hardest on older people, outdoor workers and homes that cannot afford to run air conditioning.
Building at the edge of forest, and how land is managed, changes fire risk to homes and smoke exposure across the region.
Sewer, septic and water projects change whether drinking water and nearby waters carry disease. Failing septic systems and wells near homes are the local case.
Projects remove or restore woods, wetlands and parks, and change how near people live to them.
Economy and services
Jobs, wages and commutes created or lost change household income, one of the strongest predictors of health.
Where clinics, pharmacies and hospitals are, and whether people can reach them, decides how quickly they get care, including after a storm.
Roads, sidewalks, trails and transit change how far people must drive, whether they can walk, and how often they are hurt in traffic.
Power, water, sewer and food supply keep medical equipment running, food safe and homes habitable, and their failure after storms falls hardest on people who depend on them.
Step 3
What is there now, and what would change?
Assessment means “describing the baseline health status of the affected populations and then characterizing the expected effects on health (and its determinants)” (NRC 2011). The baseline comes from published data; the ratings are yours. The National Research Council warns that a rating matrix “may also be misinterpreted as being more objective than a simple description”, so every rating needs its reasons.
Who lives here
Choose the tract in step 2 to see the baseline.
Include at least one influence in step 2 to assess it here.
Minimum element 2
People engaged
The assessment “involves and engages stakeholders affected by the proposal” (SOPHIA 2022). A synthesis of five evaluations, covering about 200 HIAs, names engaging stakeholders and timeliness among the factors behind those that influenced decisions (Dannenberg 2016). Record who was heard, how and what they said. This page cannot do it for you.
Step 4
What should change?
Recommendations “identify alternatives to the proposal or specific actions that could be taken to avoid, minimize, or mitigate adverse effects or to take advantage of opportunities” (NRC 2011). Each needs an entity with authority to act on it (SOPHIA 5.3). Strategies from the sources are offered for each included influence, with their evidence rating.
ULI rates a strategy evidence-based when “at least one supporting peer-reviewed publication” supports it, and best practice when it lacks “a published health-evidence base at this time”. ULI wrote for buildings and developments, not sewers or airports; applying it to public infrastructure is an extrapolation (ULI 2015).
Your recommendations
Step 5
Who did this, and where is it public?
Reporting is “the communication of findings and recommendations to decision-makers, the public, and other stakeholders” (NRC 2011). SOPHIA asks the report to name its sponsor, team and conflicts of interest, and to be public.
The report, from what is recorded above
Gulf Breeze Highway 98 utility undergrounding (CRA-financed)
Retrospective health review: the decision has already been made. Decision: not recorded.
Place: no tract chosen. Sponsor: not recorded. Team: not recorded. Conflicts: not recorded.
People engaged: none recorded.
In scope: nothing yet. Out of scope: nothing yet.
Recommendations: none recorded.
Limitations: none recorded Baseline indicators are area-level estimates and describe places, not people.
Step 6
How will anyone know?
Monitoring “tracks adoption of recommendations or health indicators” (NRC 2011). SOPHIA asks for indicators, who tracks them, and the “triggers or thresholds” that call for action.
A change in a tract indicator cannot be put down to the project alone: many other things move the same numbers. Say what you would compare against, such as a similar tract the project does not touch.
Method and sources
Definition: “HIA is a systematic process that uses an array of data sources and analytic methods and considers input from stakeholders to determine the potential effects of a proposed policy, plan, program, or project on the health of a population and the distribution of those effects within the population. HIA provides recommendations on monitoring and managing those effects.” (NRC 2011, Summary, p. 5)
The Gothenburg consensus names four values: democracy, equity, sustainable development and the ethical use of evidence (Gothenburg 1999).
No Florida statute requiring HIA was found, and no Panhandle HIA is listed in the national library. The nearest local work is a look back at the 2014 Escambia flood by the state and county health departments and the University of West Florida (Kintziger et al. 2017).
Does it work? In 11 of 23 HIAs studied, decision-makers said the decision would have been markedly different without it (Bourcier et al. 2015). Those samples were not random and influence was self-reported (Dannenberg 2016).
- National Research Council, Improving Health in the United States: The Role of Health Impact Assessment. National Academies Press, 2011. doi:10.17226/13229 · link
- Bever, Dills, Lindberg and Whitehead, Minimum Elements and Practice Standards for Health Impact Assessment, version 4. Society of Practitioners of Health Impact Assessment, August 2022 · link
- WHO European Centre for Health Policy, Health Impact Assessment: Main Concepts and Suggested Approach (Gothenburg Consensus Paper), 1999
- Urban Land Institute with the Center for Active Design, Building Healthy Places Toolkit: Strategies for Enhancing Health in the Built Environment. ULI, 2015
- Frumkin, Frank and Jackson, Urban Sprawl and Public Health. Island Press, 2004
- Wendel, Dannenberg and Frumkin, “Designing and building healthy places for children”, International Journal of Environment and Health 2(3/4):338–355, 2008
- Kintziger, Ortegren, DuClos et al., “Health Impact Assessments and Extreme Weather—Challenges for Environmental Health”, Journal of Public Health Management and Practice 23(5):S60–S66, 2017 · link
- Bourcier, Charbonneau, Cahill and Dannenberg, “An evaluation of health impact assessments in the United States, 2011–2014”, Preventing Chronic Disease 12:E23, 2015 · link
- Handbook of Health Impact Assessment (open access, ISBN 9781035328611, elgaronline.com): ch. 11 (Pyper and Cave) on evaluation, ch. 12 (Staatsen, Elberse and den Broeder) on participation, ch. 15 (Hirono, Chilaka and Haigh) on equity, ch. 17 (Dardier et al.) on road projects, ch. 19 (Meuter et al.) on data quality and frequency · link
- Dannenberg, “Effectiveness of health impact assessments: a synthesis of data from five impact evaluation reports”, Preventing Chronic Disease 13:E84, 2016 · link
- CDC Environmental Public Health Tracking, HIA Resources · link
Tract indicators are copied from the American Social Habitat Atlas with each source’s own status; positions compare a tract only with the tracts in its own county.
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