The A, B, C's of a Health Impact Assessment

By Chris Danley, WALC Institute Field Partner, Alta Planning & Design

What’s old is new again. Let’s not forget that the planning profession is rooted in consideration of public health. Our country is again facing significant public health challenges, albeit very different ones than 100 years ago. It’s time to answer the bell.

Think about this…why do the windows in your home open? To enjoy a breeze or the smells of a spring day? Sure. But the real reason is because ventilation and circulating air prevented the spread of communicable disease like typhoid and influenza. Even sunlight itself was not a building requirement until the values of daylighting were determined. Now windows and opening windows are common characteristics of residential living spaces all thanks to the bond between public health and planning. How many lives would have been saved and how would housing be different if medical professionals, designers, and other community stakeholders thoroughly evaluated tenement housing using a systematic process? Cue Health Impact Assessments.

Health Impact Assessments have been around formally for nearly 20 years and used throughout Europe. They have been used in the US for over a decade with the lion share of efforts conducted over the past five years. Traditionally, the HIA process is used to evaluate a policy, plan, program or project. HIA’s are now becoming common practice in many cities but many others are still learning about the merits and challenges of using the tool. For most cities, dipping their toe in the HIA waters has been fruitful. One key to this success is to recognize that an HIA does not have to be expensive, resource heavy or onerous. If the process is focused, has established goals, and is truly inclusive, the findings should be extensive.

Having led 15 health impacts assessments in three states and on several topics, I can tell you that being nimble, creative, and trusting in the process has been some of the key hallmarks of impactful assessments. HIA does have six specific steps and several required elements. However, by using engaging techniques, framing key data and by thinking outside that pesky box, community members, health professionals, and key stakeholders often walk away realizing how what is being proposed impacts health, what they can do about it and how they can work with others in ways they never imagined.

  •  In Boise, the building design and program offerings at a branch library were changed as a result of the assessment.
  • In western rural North Carolina, an entire region realized the dilemma they faced with sustaining regional and local food production and immediately began work towards ensuring a solid food systems network.
  • In Utah, the key projects in a bicycle and pedestrian plan were reprioritized because of the HIA, specifically because of the social equity and disparate population’s analysis component.
  • And is Asheville, New Belgium brewery paid for the design of a greenway after they saw the value of such a facility when an HIA determined the importance of a critical segment and what it did for the residents nearby.

HIA’s use qualitative and quantitative data, this is key. Numbers are helpful and can be objective, show things like costs, forecasts, equity statistics, or other critical metrics. But stories, observations, field assessments and anecdotes can give a sense of humanity. Mixing together both approaches is essential to a good assessment and help appeal to a larger audience. Assessments can also be done comprehensively, intermediately or rapidly. Not biting off more than can be chewed cannot be stressed enough. When cities have bad experiences with HIA’s, it typically results from an overly complicated, expensive and unfocused first outing. Knowing what is desired, what is affordable, and what outcomes are the measure of success needs to be articulated and repeated before any time is spent assessing.

If you are new to HIA, a few things for you to consider:

  • Make your first HIA on a topic that you expect to find significant research Identify one or two key goals and objectives and stick to them
  • Don’t limit your definition of “health” to physical health alone
  • Ensure your efforts match your time, budget and if you need help, ask for it
  • Make sure the project manager is dynamic and gets that balance between data and insight
  • Engage those who decide on the findings and make them part of the process
  • Be sure to assign responsibilities to partners for monitoring purposes

Health Impact Assessments are very helpful when done right. Trust in the steps, dig for understanding, challenge stakeholders and you too will find success.