Such evidence may come from a review of published literature on interventions to address the health outcomes of concern. Recommendations may be implemented through regulatory mandates or voluntary actions by stakeholders. 2001). Saving Lives, Protecting People. Example of a logic framework that maps out the possible causal pathways by which health effects might occur. Health-supportive measures that would generally support health but are not tied directly to a specific impact (for example, building a clinic in an underserved neighborhood that would be adversely affected by emissions from a new freeway). The committee notes that the diversity of approaches and decision contexts imposes challenges for determining the resources required for conducting an HIA. On the basis of its review, the committee synthesized the information from guidance, practice, and literature to propose criteria that define an HIA and draw several conclusions regarding HIA practice. Public concerns are a common trigger for a decision to screen, and the degree of concern or controversy about a proposal may be one of the factors weighed in the decision to undertake an HIA. In some cases, recommendations are developed by a decision-maker in response to an HIA report (Quigley et al. Within several of these components, we discuss characteristics that are critical to improving community health. Knowing Your Community: Community Health Assessment as a Powerful Tool Bender, Kaye PhD, RN, FAAN Author Information Journal of Public Health Management and Practice: doi: 10.1097/PHH.0000000000000599 2017 Wolters Kluwer Health, Inc. All rights reserved. The committee is not endorsing the HIAs or the recommendations, but simply providing examples. Health Impact Assessment on Policies Reducing Vehicle Miles Traveled in Oregon Metropolitan Areas. As described in Box 3-3, the HIA (more). Health Impact Assessment: International Best Practice Principles. It is critical for the credibility of the HIA that the measures or outcomes being promoted are grounded in full and transparent consideration of the evidence that supports and does not support the issue in question. Other groups have developed standard approaches to promote and evaluate practice quality, including the quality of analysis (see, for example, Fredsgaard et al. Thus, the assessment phase is separated from the management phase, as recommended elsewhere (NRC 1983). Bhatia R, Farhang L, Gaydos M, Gilhuly K, Harris-Roxas B, Heller J, Lee M, McLaughlin J, Orenstein M, Seto E, St Pierre L, Tamburrini AL, Wernham A, Wier M. Bhatia R, Branscomb J, Farhang L, Lee M, Orenstein M, Richardson M. Birley M. Health Impact Assessment in multinationals: A case study of the Royal Dutch/Shell Group. The American Hospital Associations review of the IRSs final rules for CHNAs and implementation strategies can be foundhere. Outcome evaluation should be undertaken when available resources and data will allow reasonable judgments regarding the association between the implementation of decisions and observed changes in health outcomes or health determinants. Health impact assessment: A tool to help policy makers understand health beyond health care. Atlanta Beltline: Health Impact Assessment. Improving Health in the United States: The Role of Health Impact Assessment. Sixth, because many established environmental risk factors are found at higher concentrations in vulnerable communities, disclosure of risks may be an important way to reduce health disparities and address concerns about environmental justice (Miranda et al. For each step, the committee describes the basic purpose, objectives, and practice elements; summarizes the main outputs; and presents conclusions regarding pertinent issues raised. The committee emphasizes that the effectiveness of recommendations depends not only on the scientific validity of the interventions identified but on their relevance to the affected communitys concerns and their applicability within the regulatory or legislative framework of the proposal being considered. In most cases, influencing decisions to protect or promote health is a central objective but by no means the sole outcome of value. Integrates stakeholder input into the analysis of effects. The toolkit provides a foundation for meeting the relevant IRS requirements. 2006; Bhatia 2010; ICMM 2010). The World Bank and International Finance Corporation have policies governing the disclosure of information, and although the policies differ, both provide for withholding or excluding documents that might contain proprietary information or information whose disclosure could damage a client or lenders financial, political, or legal interests (Halifax Initiative Coalition 2006; IFC 2006, 2010; McHugh et al. The wide array of evidence includes public testimony on local conditions and concerns, interviews with key informants, surveys, epidemiologic analysis (for example, observational cross-sectional surveys, longitudinal studies, and intervention or experimental studies), measurement of physical environmental conditions and modeling (for example, modeling of infectious-disease propagation or dispersion of noise and air pollutants), and expert opinion. Assignment of significance rests on the characterization of an effect as described above, but judgments regarding what constitutes a significant impact are ultimately determined partly on the basis of social and political values. Create structural or process change. Observations that might indicate some influence of the HIA include discussion about HIA by legislators debating a proposal. The process of implementing recommendations should be transparent and should include opportunities for public participation in the decision process and clear mechanisms of accountability. In some cases, the HIA process allows a period for formal public comment on a draft of the HIA report. 2009; Castro et al. Example of a Table Used for Systematic Scoping. Scoping also establishes a plan for stakeholder participation in later phases of the HIA. Any approach to determining which proposals will be screened should demonstrate a consistent rationale; should document the rationale in the HIA report; and should take account of public input. In 2009, an HIA was conducted to ensure that health impacts were considered in the design and development of The Crossings and in the broader policies that affected redevelopment in the area. For those reasons, the committee concludes that HIAs including, to the extent practical, the data used for the analysis, analytic methods, assumptions, findings, uncertainties, data gaps, and recommendations should be made public. 2004, 2010). Public-health professionals reviewed the results of the analysis. Unable to load your collection due to an error, Unable to load your delegates due to an error. Various sources of population-health statistics at the national, state, and local levels are available. These common components included preplanning; developing partnerships; developing vision and scope; collecting, analyzing, and interpreting data; identifying community assets; identifying priorities; developing and implementing an intervention plan; developing and implementing an evaluation plan; communicating and receiving feedback on the That issue is discussed at greater length in Chapter 4. International Finance Corporation Performance Standard 4 Rev -0.1, Community Health, Safety, and Security. It is informed by a review of U.S. and international HIA literature and guidelines (see Appendixes A and E) and by the experience of committee members and others who provided input during the committee process. The dissemination strategy should be developed in a systematic manner, should consider what groups need or will rely on the information (including stakeholders and decision-makers), and should determine the most effective ways to present the information to these groups, taking into account any barriers or challenges. Qualitative data can be gathered through, for example, focus groups, one-on-one interviews, surveys, individual meetings with stakeholder organizations, testimony in community meetings, Web-based or other written input, and running a stand or exhibition in a public place. It discusses intersectionality as an emerging framework to guide research on prevention of suicide in young people and highlights several clinical and community settings that . Building evaluation into the plans for an HIA early in the process may support and reinforce a more deliberate and careful approach to designing and implementing the HIA itself. We identified 11 common assessment and planning components across 18 models and requirements, with a particular focus on health department, health system, and hospital models and requirements. Given the volume and breadth of decisions at the local, state, tribal, and federal levels that can potentially affect health in some way, one of the challenges for HIA practice is to determine which proposals to screen. Chapter 4 discusses the extent to which an HIA can ensure the implementation of recommendations. Environmental, Social and Health Impact Assessment (ESHIA) Process. Fehr R. Environmental health impact assessment: Evaluation of a 10 step model. Northeast National Petroleum Reserve-Alaska, Supplemental Integrated Activity Plan, Record of Decision. Calculations were conducted to develop a vulnerability score. All rights reserved. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. Although deviation from the criteria may occur, a valid and clearly articulated rationale for such deviation should be described when the HIA is reported. Scholars point to a remarkable consistency in the basic elements that are generally included in descriptions of HIA (Mindell et al. A matrix can be a useful way to organize a qualitative analysis and to convey results in a manner that is easy to understand, but a matrix may also be misinterpreted as being more objective than a simple description. Furthermore, HIA teams commonly rely on analyses by such experts as traffic-safety engineers or air-quality analysts who provide information on the links between the proposal and changes in health determinants. In contrast, the effect of decisions on some health outcomes (such as cancer or obesity) may take years to occur and may have multiple contributing factors. Because of the timeframe of proposal implementation and effects on health, outcome evaluation often requires a long-term research commitment. Decisions are often based on incomplete information and must often be made within a specified time rather than waiting for more complete information. In some cases, the team may draw on outside consultants who have expertise in a specific health issue or method. Bhatia R. A Guide for Health Impact Assessment. Qualitative approaches can more easily present the causal pathways in terms used by participants; this ensures that different voices are presented in the HIA and can increase the legitimacy and stakeholders ownership of the process and results. To receive email updates about this page, enter your email address: We take your privacy seriously. The information generated by the HIA process needs to be organized and presented in such a way that it can be readily understood by the intended audiences and present a compelling case for recommended actions. Major issues and challenges for HIA development and practice are considered in Chapter 4. The press coverage recognized the tension between the burden that this new requirement would place on businesses and how the health of employees and the wider community are affected by people who work while they are ill. Human Impact Partners noted that many including labor groups and fundersused the HIAs to assess work and family issues. PMC Benefits include It should define the vision for the health of the community through a collaborative process and should address the gamut of strengths, weaknesses, challenges, and opportunities that exist in the community to improve the health status of that community. The potential for HIA-based information to alter a decision or help a decision-maker discriminate among decision options. Acknowledgement of plans for future outcome evaluation or discussion of limitations that prevent such an evaluation. As discussed in greater depth in the section on scoping, it is common to convene advisory or steering committees, which can include both technical and policy experts and representatives from stakeholder groups that have an interest in the decision outcome. The decision-maker must ultimately balance health considerations with the many technical, social, political, and economic concerns that bear on the proposal. Cole BL, Fielding JE. PDF Best Practices for Community Health Needs Assessment (CHNA - NACCHO Issues surrounding uncertainty, literature review, and reliability and validity of predictions are discussed in greater depth in Chapter 4. National Academies Press (US), Washington (DC). Mindell J, Ison E, Joffe M. A glossary for health impact assessment. Reporting is the communication of the findings and recommendations of an HIA to decision-makers, the public, and other stakeholders. The research was funded by the Annie E. Casey Foundation as an initiative with the potential to encourage long-term strategies and partnerships to strengthen families and communities. Conversely, to have the greatest relevance as an informational and planning document and to ensure judicious use of resources, the HIA should ultimately focus on the health effects of greatest potential importance. Vaccaro A, Madsen P. Corporate dynamic transparency: The new ICT-driven ethics. other key elements that will be important for the work moving forward. An initial brief summary of the pathways through which health could be affected and the health effects to be addressed, including a rationale for how the effects were chosen and an account of any potential health effects that were considered but were not selected and why. Past Projects: Vehicle Miles Traveled Legislation. A variety of information was used to inform the process, Scoping: Atlanta BeltLine HIA. II, Selected Evidence Base Breaking the Cycle, East London and the City Health Action Zone and Queen Mary. It was not possible to derive mortality rates for demographic subgroups. Key elements of community health include: Identifying top public health concerns within the specific geographic area, such as environmental and social factors that affect healthy life choices. An evaluation report should be produced at the conclusion of the HIA that includes the following: Few HIA evaluation data have been published in the United States and relatively few elsewhere. 1. Review of literature and a consideration of the social, economic, and political context of the eventual decision are also important. Examples of Health and Behavioral Effects That Have Been Addressed Quantitatively in HIA. This list can then be used to set priorities. Because the assessment of health effects depends on an in-depth understanding of changes that may affect healthsuch as changes in traffic flow, roadway design, air quality, or community revenue sourcesHIAs are inherently multidisciplinary; public-health experts may lead the effort but must draw on resources and expertise from other disciplines. Mindell J, Biddulph J, Taylor L, Lock K, Boaz A, Joffe M, Curtis S. Improving the use of evidence in health impact assessment. Click on the icon for each step to read about that part of the process. Impact evaluation attempts to judge whether the HIA influenced the decision- making process, that is, whether and to what degree the recommendations were adopted and implemented and how the HIA influenced the decision-making process. Accessed at www.healthycommunities.org/assesstoolkit. Community Health, Safety and Security. Association for Community Health Improvement. Reprinted with permission; copyright 2010, International Council on Mining and Metals. Characterization of health effects in HIA relies on qualitative and quantitative evidence. Selection of appropriate indicators will be discussed at greater length below in the section Monitoring and Evaluation.. Assessment: Northeast National Petroleum Reserve-Alaska. Health impact assessment: A tool for healthy public policy. Such reviews of the existing literature are common. Shortened life expectancy associated with air pollution. The population, subgroups, vulnerable populations, and stakeholders likely to be affected and how they were involved in the HIA process. PDF Table of Contents The final HIA report should document the following: In addition to a final report, stand-alone executive summaries or fact sheets can help to disseminate and communicate the findings and recommendations of an HIA to various key audiences. Furthermore, impact assessments, including HIAs, may rely on proprietary business information whose disclosure is legally barred or could damage a proponents business edge or competitiveness. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. The baseline should be focused on the issues that are likely to be affected by the proposal. Having transparency throughout the process and clearly delineating the roles and responsibilities among various parties will help to limit real and perceived bias. The assessment phase includes two tasks. There are often not clear lines of authority between the team conducting the HIA and the decision-maker. Comprehensive HIAs are most commonly differentiated from rapid and intermediate HIAs by the scope of potential impacts and the need for collection of new primary data. More structured approaches have also been used. The health effects that are included, the data sources and methods that are used, and the recommendations that are made are therefore determined by the HIA practitioners rather than according to a legal or regulatory standard (Wernham 2011). Cole BL, Wilhelm M, Long PV, Fielding JE, Kominski G, Morgenstern H. Prospects for health impact assessment in the United States: New and improved environmental impact assessment or something different? The facts that resources were available and that timelines were appropriate were also relevant to the decision to conduct an HIA. Moving to opportunity: An experimental study of neighborhood effects on mental health. It characterizes health effects according to their nature, direction, intensity, magnitude, distribution, timing and duration, and likelihood. Key health effects: Issues were identified through analysis of newspaper coverage; outreach to such groups as local officials, members of the public, and businesses; development of a logic framework; and a survey of people living, working, or attending school near the BeltLine. The findings of the HIA were covered by newspapers and Web sites in California, Maine, Massachusetts, and New Hampshire; and the HIA researchers were interviewed on radio. Community Health Assessment and Improvement Planning - NACCHO Screening involves making an initial rapid judgment of whether an HIA is likely to be feasible and valuable.
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