Avenues of Influence: the Relationship between Health Impact Assessment and Determinants of Health and Health Equity

Abstract

This study aims to identify perceived impacts of Health Impact Assessment (HIA) on decision-making, determinants of health, and determinants of health equity and outline the mechanisms through which these impacts can occur. The research team conducted a mixed-methods study of HIAs in the USA. First, investigators collected data regarding perceived HIA impacts through an online questionnaire, which was completed by 149 stakeholders representing 126 unique HIAs. To explore in greater depth the themes that arose from the online survey, investigators conducted semi-structured interviews with 46 stakeholders involved with 27 HIAs related to the built environment. This preliminary study suggests that HIAs can strengthen relationships and build trust between community and government institutions. In addition, this study suggests that HIA recommendations can inform policy and decision-making systems that determine the distribution of health-promoting resources and health risks. HIA outcomes may in turn lead to more equitable access to health resources and reduce exposure to environmental harms among at-risk populations. Future research should further explore associations between HIAs and changes in determinants of health and health equity by corroborating findings with other data sources and documenting potential impacts and outcomes of HIAs in other sectors.

How Do We Define and Measure Health Equity? The State of Current Practice and Tools to Advance Health Equity

“…Frequently referenced in the peer-reviewed literature, HIAs are a key tool for decision makers. HIAs aim to protect and promote health and to reduce inequities in health during a decision-making process by encouraging decision makers to consider the needs of underserved populations in policy and program development and implementation 30. However, some articles noted that HIAs do not adequately address equity due to inadequate guidance for doing so, absence of clear definitions, poor data and evidence, perceived lack of methods and tools, and practitioner unwillingness or inability to address values such as fairness and social justice 31.…”

Tools for Approaching Policy With Equity in Mind

“…They also center equity by involving an array of stakeholders at every step of the process, including community members who will be affected by a decision, policy makers, and others with an interest in the outcome. Evaluations of HIAs show that they help impacted populations and decision makers weigh trade-offs and understand the direct and indirect health impacts of a proposal, as well as increase community capacity and address community concerns 4,5…”

Advancing universal health coverage in South Asian cities: a framework

“…The CSDH knowledge networks have used health assessment to both monitor and act on urban health inequities. The results are promising, albeit in cities outside South Asia 5051. Frameworks guiding efforts towards universal healthcare focus on service coverage and its financing, with priority given to financial protection of the poor and disadvantaged.…”