Issue Brief

Health Impact Assessment Legislation in the States


Health care consumes a large percentage of state budgets, and legislators are looking for ways to reduce those costs and improve the public’s health. One way to meet these goals is by identifying and addressing the health risks and benefits of public policy decisions made outside the health sector in areas such as transportation, housing, education, natural resources and energy, and the economy. Health impact assessments (HIAs) bring together public health expertise, scientific data, and stakeholder input to evaluate the potential health effects of proposed policy changes and to develop practical solutions that minimize risks and maximize health benefits. Government officials, academics, nongovernmental organizations, and industry have used this flexible, data- driven approach in communities across the country.

HIAs can help state decision-makers and local communities craft smarter policies that protect the public’s health; facilitate collaboration between government agencies, health officials, and constituent groups; and streamline the way health concerns are integrated into policy decisions. According to the National Research Council, HIA is a promising tool to improve people’s health and decrease health care costs because of its “broad applicability, its focus on adverse and beneficial health effects, its ability to incorporate various types of evidence, and its emphasis on stakeholder participation.”1

The National Conference of State Legislatures (NCSL) in consultation with the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, recently examined states that are considering the use or aspects of HIAs. NCSL reviewed state legislation and conducted interviews  with state legislators, legislative staff, and personnel of state agencies responsible for implementing HIA policy to gain insight into the variety of approaches and respondents’ impressions of HIAs.

NCSL’s review found that since 2009, 17 states considered 56 bills that would create a mandate for some consideration of health effects when making decisions on proposed policies, plans, or projects.2 Many of the analyses proposed in these bills would not fit the strict definition of an HIA, but eight states have considered legislation that incorporated most elements of a formal HIA. (See examples in Table 1.) Although the majority of these bills were not enacted, NCSL’s review demonstrated that state policymakers are increasingly exploring how HIAs can help identify the potential and often overlooked health consequences of policies, plans, programs, and projects across a range of sectors.

This issue brief looks at several states’ legislative efforts to promote the use of HIAs and highlights key considerations for lawmakers interested in developing bills that can advance the implementation of assessments in their states to reduce costs and improve public health.


  1. National Research Council, Committee on Health Impact Assessment, Improving Health in the United States: The Role of Health Impact Assessment (Washington, DC: National Academies Press), 13.
  2. For a full list of bills reviewed, see the National Conference of State Legislatures’ Environmental Health Legislation Database at: The list of 56 bills in 17 states was compiled by searching the database for the keywords “health impact” across all years. It includes all bills identified using these keywords as of May 2014. Bills considered in legislative sessions prior to 2009 are not included in the database. However, NCSL’s review included select bills from before 2009.

Media Contact

Tami Holzman

Officer, Communications