Prospects for Health Impact Assessment in the United States: New and Improved Environmental Impact Assessment or Something Different?

Abstract

Health impact assessment (HIA) has been advanced as a means of bringing potential health impacts to the attention of policy makers, particularly in sectors where health impacts may not otherwise be considered. This article examines lessons for HIA in the United States from the related and relatively well-developed field of environmental impact assessment (EIA). We reviewed the EIA literature and conducted twenty phone interviews with EIA professionals. Successes of EIA cited by respondents included integration of environmental goals into decision making, improved planning, and greater transparency and public involvement. Reported shortcomings included the length and complexity of EIA documents, limited and adversarial public participation, and an emphasis on procedure over substance. Presently, EIAs consider few, if any, health outcomes. Respondents differed on the prospects for HIA. Most agreed that HIA could contribute to EIA in several areas, including assessment of cumulative impacts and impacts to environmental justice. Reasons given for not incorporating HIA into EIA were uncertainties about interpreting estimated health impacts, that EIA documents would become even longer and more complicated, and that HIA would gain little from the procedural and legal emphasis in EIA. We conclude that for HIA to advance, whether as part of or separate from EIA, well-formulated methodologies need to be developed and tested in real-world situations. When possible, HIA should build on the methods that have been utilized successfully in EIA. The most fruitful avenue is demonstration projects that test, refine, and demonstrate different methods and models to maximize their utility and acceptance.Health impact assessment (HIA) has been advanced in a number of different nations and by the World Health Organization (WHO) as a means to facilitate the consideration of potential health consequences of proposed

Health Impact Assessment: A Tool to Help Policy Makers Understand Health Beyond Health Care

“…Our study of the state-of-the-art in EIA, which included consultation with a number of experts in that field, led us to conclude that at this point in time, while HIA can learn from EIA, efforts to advance HIA in the U.S. would yield the greatest dividend if focused on developing HIAs independent of existing EIA efforts (17,19). This conclusion largely derives from how environmental impact assessment has evolved in the U.S.…”

“…The categories of impacts considered in EIAs in the United States are determined largely by other federal statutes, such as the Clean Air Act, which require that a particular environmental impact be considered in EIAs, and conventional practice, along with some guidance from state and federal committees, such as the federal CEQ. California is one of the few states to require a consideration of human health impacts, but this is typically limited to a consideration of cancers linked to exposures to chemical pollutants subject to EIA (17). Because of concern about potential legal challenges, and the fact that it is the project proponent whose employees or consultants prepare an EIA, it is a highly prescribed process not particularly open to investigating areas of impacts that are not explicitly mandated, such as human health (17).…”

Health Impact Assessments Are Needed In Decision Making About Environmental And Land-Use Policy

“…Although many of these decisions may have substantial health effects, as the practice of conducting environmental impact assessments has evolved, health experts and officials have rarely been involved, and health considerations have either been narrowly defined-often limited to exposures to toxic substances and the risk of cancer or traffic-related injuries-or ignored altogether. 13,16,26,27 Clearly, decisions that are guided by environmental impact assessments constitute an important opportunity to protect and improve public health that is being missed.…”

“…12 Health impact assessments focus on multiple determinants and dimensions of health; inform a current decision-making process; apply mainly to proposals in which the health effects are not prominent or central; engage multiple stakeholders from the affected community, elected decision makers, and parties with an economic stake in the outcome; examine and consider vulnerable populations and equity issues; and employ multiple data sources and both qualitative and quantitative analytic methods. [13][14][15][16] The team leading an assessment typically includes people with public health expertise as well as experts in other fields, such as urban planning, transportation, or air quality.…”

Environmentally-related health impacts of coal seam gas development: An impact assessment approach in Queensland, Australia

“…Some assessment approaches, such as environmental impact assessment, have been criticised for either neglecting human health or considering health-related environmental impacts on the surface, but not actually addressing human health effects (Association of Public Health Observatories, 2007;Cole & Fielding, 2007;Cole et al, 2004). Conversely, others, such as health impact assessment (HIA), consider positive and negative impacts on human health, but have been criticised for the lack of sufficient rigour and for potential subjectivity (Parry & Stevens, 2001), as well as uncertainties associated with the validity of the methods and results (Veerman, Barendregt, & Mackenbach, 2005).…”