Making the Case for Health Impact Assessments

In 2007, developers of a planned senior-housing project in Oakland, California, decided to move the entrance from adjacent to a busy highway to a quiet courtyard. The change would make it safer for residents as they walked to and from home. The idea, from an Oakland-based group called Human Impact Partners, addressed a small but nonetheless important health concern that might otherwise have been ignored.

A report released yesterday by the National Academies' National Research Council (NRC) provides a ringing endorsement of such efforts, called a Health Impact Assessment (HIA). The report not only provides guidelines for conducting these analyses, but also argues for their value on both public and private construction projects, from urban farmers' markets to federal highways.

"I think there is a real need to incorporate health impact assessments into the future decisions of multiple layers of our society, starting with the United States government on down," says Richard Jackson of the University of California, Los Angeles, who chaired the NRC Committee on Health Impact Assessment. The first such report in the United States grew out of a 1999 proposal to boost the minimum wage paid workers employed by contractors hired by the city of San Francisco. In 2006, Washington state legislators authorized the State Board of Health to conduct reports similar to HIAs, although funding for those reports has since been cut, says Gordon MacCracken, a spokesperson for the board.

The panel's report recommends that every HIA should start with an evaluation of the baseline health in a particular community. In the case of the Oakland housing project, that might mean collecting data on pedestrian traffic accidents involving seniors. Planners would then estimate, using community surveys or epidemiological data, how the project is likely to affect that baseline.

Lili Farhang, associate director of Human Impact Partners, said she supports efforts to bring HIAs into the spotlight. But she acknowledges that HIAs might seem "faddish" to outsiders. "People just want to know, 'How do you do it?' and 'How do you do it well?' " she says.

The biggest obstacle facing HIAs may be the status quo, although the report notes that federal laws could already accommodate them. The U.S. National Environmental Policy Act (NEPA) requires federal agencies to conduct environmental impact statements on threats or boons to "the quality of the human environment" as well as the natural environment. That requirement has largely fallen by the wayside, says committee member Aaron Wernham, director of the Health Impact Project, a joint venture of the Pew Charitable Trusts and the Robert Wood Johnson Foundation, which helped pay for the study. He says the problem is often that particular mission agencies lack the expertise to explore the health consequences of their actions. "Health needs to be at the table," says Wernham.

Still, some experts have reservations about rolling HIAs into the NEPA process. "People are concerned that health impact assessments not become overly bureaucratic and not be another box that's checked off in a process," says Wernham.

Howard Frumkin, dean of the School of Public Health at the University of Washington, Seattle, sees the NEPA process as a "suitable framework" for some HIAs. In 2007, Wernham and his colleagues did exactly that when they examined the health consequences of leasing lands in Alaska's North Slope to oil and gas developers. This HIA, done in conjunction with other environmental assessments under NEPA, made several proposals relating to factors ranging from monitoring pollution to managing caribou herds for subsistence populations, , many of which were later accepted by the U.S. Bureau of Land Management. "I don't think anybody seriously disagrees with the notion that we should make policies as beneficial for health as possible," Frumkin says.

Economic realities, however, may prevent HIAs from spreading throughout the federal government. An agency like the U.S. Forest Service would probably need to partner with the U.S. Centers for Disease Control and Prevention (CDC), which co-sponsored the NRC report, says Frumkin. But CDC has been "very hard hit," financially, says Frumkin, who previously headed a center within CDC.

CDC is spending some money to train local governments in conducting HIAs, says Federico Feldstein, a spokesperson for the agency. "CDC's role under the NEPA process is currently under review," Feldstein adds. "As part of that process, opportunities for CDC leadership are being explored."