Health Impact Assessment: Bringing Public Health Data to Decision Making

Health Impact Assessment: Bringing Public Health Data to Decision Making


Preventable health problems, including many cases of heart disease, diabetes, asthma and injuries, are taking a huge toll on American families. For the first time in U.S. history, data suggest that today’s children may live shorter lives than their parents. These problems also threaten our nation’s economic vitality. Heart disease and diabetes alone now account for more than 700,000 deaths in the United States annually and cost the nation over $650 billion in medical expenses, disability, missed work and financial losses associated with premature death. (1–5) These costs are rising every year.

To improve Americans’ health, the root causes of these illnesses must be addressed. By factoring health consequences into the process when drafting new laws and regulations, building a major roadway, planning for a city’s growth or developing a school curriculum, policy makers can capitalize on hidden opportunities to improve health, save on health-related costs and use limited resources more wisely. Health Impact Assessment (HIA) is a practical, evidence-driven tool to accomplish these goals. Many nations, large lending banks and major industries such as oil, gas and mining are adopting HIA to improve health, control costs and build trust with communities.

HIA in Decision Making: A Flexible Approach

HIA brings together scientific data, health expertise and public input to identify the potential health effects of a new proposal and to help craft policy recommendations that minimize risks and capitalize on opportunities to improve health. HIA gives federal, tribal, state and local leaders the information they need to make better decisions today to prevent health problems in their communities tomorrow.

The basic HIA process can be readily adapted to fit the scope, resources and timeline of a given decision. In a recent survey by the Health Impact Project, HIA practitioners reported that most HIAs take from six weeks to a year to complete and cost $10,000 to $200,000—a fraction of the time and resources that often go into environmental studies and permitting procedures.

HIA also shows promise as a way to help policy makers who are facing difficult budgetary decisions. For example, the New Hampshire Center for Public Policy Studies is conducting an HIA to shed light on the health implications of proposed budget changes for 2011 in order to help legislators make the difficult choices necessary to balance the state budget.

International and Business Perspectives on HIA

In the United States and abroad, policy makers, health officials and industry are turning to HIA as a practical and structured way to collaborate with other sectors—such as transportation, energy, education, urban planning or agriculture— and provide the information needed to discern hidden health risks and capitalize on opportunities to improve health.

Over the last 20 years, more and more countries—among them Canada, members of the European Union, Australia, New Zealand and Thailand—are using this tool. Multinational corporations are beginning to use HIA as a best practice for planning new projects. 

Benefits and Best Uses of HIA

  • HIA can build community support and reduce opposition to a proposed project. By ensuring that decisions are made with full attention to community concerns, HIA helps reduce conflicts that can delay projects. For example, an Alaska Native community considered litigation over plans to allow oil and gas lease sales in their traditional hunting areas. Instead, the Bureau of Land Management (BLM) worked with the local government to complete an HIA, which resulted in new protections that addressed community concerns while still allowing development to go forward. Owing in part to the success of this HIA, an environmental impact statement associated with the lease sales was never challenged in court. Since then, the BLM has begun using HIA more commonly in similar planning and permitting decisions. (6)
  • HIA facilitates collaboration across sectors. HIA provides a structured, pragmatic way for those in public health to collaborate with officials in other agencies and sectors, ensuring that these officials have the health data they need to make better decisions.
  • HIA is not always necessary. If health is already a focus of a proposed policy or project, or if the potential health effects are too hypothetical, HIA may not offer any new information to decision makers. To avoid unnecessary time and expense, an effective approach to screening can determine whether HIA will add value.

Opportunities for HIA

Momentum is building in the HIA field as more and more cities, states, tribal and federal agencies seek better ways to factor health into their decisions. The Health Impact Project and the Centers for Disease Control and Prevention (CDC) have identified nearly 120 HIAs that have been completed or are in progress in 24 states. Local planning departments, state environmental regulators and federal agencies carrying out environmental impact statements are beginning to request health impact assessments as well. 

As initiatives progress at all levels of government, many opportunities exist to incorporate HIA and build healthier policies. Examples include:

  • Government officials at all levels should use HIA for important new decisions outside the health sector—including, for example, transportation, housing and urban planning, educational programming, agricultural policy, and energy and natural resource projects—to minimize unnecessary risks and unanticipated costs and to help create healthier communities.
  • Executive branch agencies involved in major infrastructure projects, such as Housing and Urban Development and the Department of Transportation, should consider ways to use HIA as a means to integrate health considerations in current and future initiatives.
  • The newly established, cabinet-level and multi-agency National Prevention, Health Promotion, and Public Health Council should recommend that any federal agency that is making decisions with potentially significant health effects should use HIA.
  • In spring 2011, the National Academy of Sciences plans to release a report on HIA, which is intended to provide guidance to federal, tribal, state and local agency officials and others. Once this report becomes available, agencies should consult it to determine where there are opportunities to apply HIA in decisions that have a potential for significant health effects.


1. Agency for Health Care Research and Quality. National Health Disparities Report 2009. AHRQ Publication No. 10-0004. Rockville, MD; March 2010. 

2. American Heart Association. Heart Disease and Stroke Statistics – 2010 Update. Dallas, TX: American Heart Association; 2010.

3. Heron MP, Hoyert DL, Xu J, et al. Deaths: Preliminary data for 2006. National vital statistics reports; Vol. 56 No. 16. Hyattsville, MD: National Center for Health Statistics; 2008.

4. National Center for Health Statistics. Health, United States, 2009: With Special Feature on Medical Technology. Hyattsville, MD; 2010.

5. American Diabetes Association. Economic Costs of Diabetes in the U.S. in 2007. Diabetes Care. 2008;31(3):596–615.

6. U.S. Department of the Interior, Bureau of Land Management, 2008. Northeast National Petroleum Reserve Final Supplemental Environmental Impact Statement (see subsections on Public Health). Anchorage, AK: Bureau of Land Management.

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