10/22/2009 - The last two decades of health research have demonstrated the profound importance of social, economic and environmental decisions to American’s health. Yet it is often the case that legislators and regulators make policy without fully considering the impact of their decisions on public health. Will the construction of a new highway negatively affect air quality in nearby playgrounds and drive up children’s asthma rates? Do agricultural policies support the purchase of nutrient-rich foods for federal school lunch programs? Do zoning laws favor full-service grocery stores over fast-food establishments in low-income neighborhoods to encourage healthier food choices? Can education policies be structured to promote physical education that increases physical activity and helps lower rates of obesity and Type II diabetes?
To help policy makers better understand how a proposed policy or project can impact health and to make recommendations for cost-effective ways to mitigate unintended consequences, researchers have pioneered the use of health impact assessment (HIA). Widely used in Europe, Austria and Canada, HIAs have been employed in a number of ways—looking, for example, at the effects of dams on rates of water-borne disease and assessing the relationship between housing and need for mental health services. Because the U.S. has been slower to embrace this innovative approach, the Robert Wood Johnson Foundation (RWJF) and the Pew Health Group recently launched a collaboration—the Health Impact Project, housed at Pew—to advance HIA as an evidence-based tool for policy making that promotes health.
HIA is a flexible, data-driven approach that uses rigorous scientific evidence, translated for a policy-maker audience. HIA defines the health risks and opportunities, analyzes costs and shapes practical policy alternatives that lead to long-term health benefits. A good HIA produces an “ah-ha” moment that encourages policy makers in non-health fields, such as transportation, housing, employment and agriculture, to think about health when drafting laws and regulations. HIA can help decision makers assess policy proposals, avoid unintended consequences and costs, and advance smarter, cost-effective policies that promote health.
Given Pew Health Group’s strategic focus on promoting a safer food supply, the Health Impact Assessment team is considering conducting an HIA on the federal agricultural legislation, the so-called farm bill, which we expect Congress may reauthorize by 2013. Among its many provisions, the farm bill sets the rules and budget for the nation’s school nutrition program, which provides meals to nearly 30 million students each day at a cost of $8 billion. Yet, despite growing evidence of the relationship between the food we feed our children and health impacts such as obesity and diabetes, there has been relatively little debate about whether and how this program might better use taxpayer dollars to promote healthy, nutritious meals. An HIA of the farm bill would evaluate the content of school lunch programs and the potential health concerns and costs, providing policy makers with an independent, evidence-based perspective on this federal program.
The RWJF/Pew partnership will fund a series of competitively selected demonstration projects to conduct HIA on a variety of policy issues at the local, state and tribal levels. In addition to financial support, the project will provide training and technical assistance to assure that grantees use the best evidence to diagnose the health risk and recommend actions to promote health. The project will also engage in a variety of outreach and research activities to promote the use of HIA by policy makers and community groups.
To learn more visit the Health Impact Project's Web site.