This report examines the legal foundations that support incorporating health considerations into policy and programmatic decisions made in non-health fields. The findings are intended to aid public health professionals and others who seek to ensure that such decisions are made with health in mind.
Many of most urgent health problems facing our nation—such as obesity, asthma, diabetes, heart disease, and injuries—are shaped by the conditions in the places where we live and work. For example, it has been estimated that many cases of asthma and serious injuries such as hip fractures can be attributed to substandard housing conditions due, in part, to environmental hazards like mold, infestations, and pests. Similarly, the planning and design of roads and highways in many regions have made it more difficult for people to exercise safely, a problem that is now recognized as an important contributor to the modern epidemics of obesity and diabetes. Conversely, some investments outside the health sector, such as comprehensive early childhood education programs, are now known to have documented benefits on physical and mental health outcomes in later childhood and adulthood.
To address skyrocketing medical costs, prevent illness, and improve the well-being of Americans, health must be taken into account when making decisions in other non-health sectors such as transportation, energy, and agricultural policy. One promising way to factor health into decisions in a systematic way is through the use of health impact assessments (HIAs). HIAs use a systematic process that determines the potential health risks, benefits, and trade-offs of a proposed policy, plan, program, or project. HIAs differ from other commonly used tools for health assessment such as HRAs and community health assessments (CHAs) in that HIAs:
- are intended to inform deliberations on a specific proposal—legislation, proposed rulemaking, and project permitting, for example.
- systematically assess the multiple influences on health that can occur as a result of social, economic, and environmental changes.
- use a broad definition of health that includes physical and psychological health and general well-being.
While HIAs are becoming more common in the United States, they remain underutilized. Most HIAs are done outside of any formal legal or regulatory requirement; however, some laws may require or support their use. The foundation provided by existing laws and policies creates important opportunities to factor health considerations into decisions made in non-health sectors using HIAs. At present, many such opportunities may be missed in part because public health professionals and others may not be aware of these laws.
To address this issue, the Health Impact Project—a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts—contracted with Arizona State University’s (ASU) Public Health Law and Policy Program to conduct a comprehensive review and analysis of statutes, regulations, and other laws that may support the promotion and use of HIAs.