Sixth, because many established environmental risk factors are found at higher concentrations in vulnerable communities, disclosure of risks may be an important way to reduce health disparities and address concerns about environmental justice (Miranda et al. A Guide to Health Impact Assessment: A Policy Tool for New Zealand. However, the committee notes that no published studies in the United States have attempted to quantify the costs of undertaking an HIA across a variety of settings. 2009; Castro et al. Observing and documenting the HIA processsuch as methods of engaging stakeholders and interacting with decision-makers and approaches to addressing analytic challenges and interviewing participants and stakeholders are the main methods of process evaluation. In such cases, HIAs often rely on data on a larger region and consider whether the characteristics of the larger population can be generalized to the affected community. Available studies suggest that efforts to involve and inform decision- makers throughout the HIA process and a strong relationship between the HIA team and decision-makers are often critical for the HIAs effectiveness (Veerman et al. The bulleted list below provides examples in which some health impacts or behavioral outcomes have been quantified. However, where practical, the HIA team should aim to evaluate a variety of alternatives or, minimally, to identify the characteristics of proposed actions that would be health-protective or detrimental to health. 2010). New surveys to address data gaps or questions specific to the proposal in question are also common in comprehensive HIAs. A description of the proposed policy, program, plan, or project that will be the focus of the HIA, including the timeline for the decision and intervention points at which HIA information will be used. Veerman J, Barendregt J, Mackenback J. Quantitative health impact assessment: Current practice and future directions. Assessment: Northeast National Petroleum Reserve-Alaska. Determining the potential health effects to include in the HIA and proposing hypothetical causal pathways are the central tasks of scoping. HIA should not be assumed to be the best approach to every health-policy question but should instead be seen as part of a spectrum of public-health and policy-oriented approaches, some of which will be more appropriate than others, depending on the specific application. As discussed in greater depth in the section on scoping, it is common to convene advisory or steering committees, which can include both technical and policy experts and representatives from stakeholder groups that have an interest in the decision outcome. 2. The final HIA report should document the following: In addition to a final report, stand-alone executive summaries or fact sheets can help to disseminate and communicate the findings and recommendations of an HIA to various key audiences. As in the realm of health risk assessment, there remains a need to distinguish between the assessment and management phases to avoid manipulation of analytic components by decision-makers. Stakeholders, however, may have insights into local conditions and potential solutions for addressing concerns raised by the proposal under consideration. The committee is referring here to HIAs sponsored or led by private-sector entities that are not part of any formal government process, such as a permitting or regulatory requirement. One approach uses a logic framework that maps out the causal pathways by which health effects might occur (see Figure 3-1). Health Impact Assessment: SEIC (Sakhalin Energy Investment Company) Phase 2 Development. Dialogue with IRS staff and leadership on elements of the Revised 990, Schedule H Identification and examination of areas where: -There is a need for clarification (e.g., what constitutes meaningful community engagement, how to define community) -Selected reporting requirements as framed may yield unanticipated (and undesired . Expert judgment is central to HIA but must be grounded in a solid foundation of scientific neutrality and accepted public-health principles. CDC is not responsible for the content of materials not generated by CDC. Process evaluation assesses the design and execution of the HIA in light of its intended purpose and plan of action and applicable practice standards. It was not possible to derive mortality rates for demographic subgroups. 2003; ICMM 2010). Making recommendations is a well-accepted part of HIA practice, but relatively little attention has been paid to how they should be formulated. For example, in Oregon, an independent health-oriented nonprofit organization conducted an HIA of a series of proposals to reduce vehicle miles traveled in a bill intended to reduce greenhouse- gas emissions (UPH 2009). Box 3-2 provides an example of scoping for the HIA of a proposed development in Atlanta. The use of the information by the decision-maker is discussed at greater length in Chapter 4 in the section Managing Expectations.. However the literature review is conducted, the methods should be clearly described in the report, and any studies with conflicting results acknowledged. Because HIAs can address decisions that range from small, localized programs or projects to national policies, screening ensures that HIA is used judiciously and when it is most likely to be valuable. Such a plan is often referred to as a public-health management plan or a health-action plan (Quigley et al. Culturally competent care means providing care within the context of a patient's culture and beliefs. The process of describing pre-existing health issues, health disparities, and influences on health may also begin during scoping, although the full characterization of baseline health status generally takes place during assessment. Moving to opportunity: An experimental study of neighborhood effects on mental health. Characterization of health effects in HIA relies on qualitative and quantitative evidence. A logic framework was produced to guide the assessment. 2 Setting priorities considers pathways that appear most important from a public-health perspective and considers issues that have been raised prominently by stakeholders. Propose appropriate indicators for monitoring. Therefore, scoping should be thought of as a two-part process that starts with a systematic effort to identify all potentially important effects and that continues with selection of the most important and well-substantiated effects for further analysis at later stages. The most vulnerable populations were identified as people of low economic status, children, older adults, renters, and the carless. The degree to which they are systematic varies, and some authors have suggested frameworks and guidance for conducting systematic reviews (Mindell et al. This assessment of needs then informs a project's overall plan and approaches by helping you identify targeted strategies and prioritize resources. Cancer risk and changes in life expectancy associated with tobacco taxes. Integrating human health into environmental impact assessment: An unrealized opportunity for environmental health and justice. Outcome evaluation will continue to be challenging, but it can generate useful information in well-selected cases. One Step Forward, One Step Back: An Analysis of the IFCs Sustainability Policy, Performance Standards and Disclosure. Bethesda, MD 20894, Web Policies 8600 Rockville Pike Characteristics unique to the affected community may not be obvious to HIA practitioners who are outside the community. Shortened life expectancy associated with air pollution. Becoming culturally competent is an ongoing process. It is critical to arrange the information logically so that readers can navigate easily through the document, to provide a lay summary that accurately describes the main findings and conclusions of the study, and to reference all data and sources accurately (Fredsgaard et al. Whereas HIA aims to predict the effects of a decision before it occurs, outcome evaluation assesses whether the implementation of a decision has actual effects on health or health determinants (Parry and Kemm 2005). MAPP brings four assessments together to drive the development of a community strategic plan MAPP Framework Organizing Visioning Assessments Strategic Issues Goals/Strategies Action Cycle Organize for Success Organizing the planning process and developing partnerships Organize for Success Determine the necessity of undertaking the MAPP process. Epub 2018 Jun 19. The committee notes that in any assessment, it would be difficult or impossible to quantify all potential health impacts. Saving Lives, Protecting People. On the basis of its review of current guidance and practice, the committee recommends that scoping should result in a framework for the HIA and a written project plan that includes the following: The credibility and relevance of HIA to the decision-making process rest on a balanced and complete examination of the health risks, benefits, and tradeoffs presented by the project, policy, program, or plan being assessed. Seven Steps for Conducting a Successful Needs Assessment - NICHQ The potential for substantial adverse or beneficial health effects and the potential to make changes in the proposal that could result in an improved health risk-benefit profile. The top 10% of the census tracts within the study area were then identified as locations of the most vulnerable populations. Example of a logic framework that maps out the possible causal pathways by which health effects might occur. The baseline should be focused on the issues that are likely to be affected by the proposal. Qualitative data can be gathered through, for example, focus groups, one-on-one interviews, surveys, individual meetings with stakeholder organizations, testimony in community meetings, Web-based or other written input, and running a stand or exhibition in a public place. CDC twenty four seven. Nurses rely on self-reported symptoms, visual observation, reported health histories, and a physical medical examination to make a health assessment. Some lawssuch as NEPA, state environmental-policy acts, and various local zoning ordinancesmay establish protection of health as a requirement or priority. Mindell J, Boaz A, Joffe M, Curtis S, Birley M. Enhancing the evidence base for health impact assessment. Because it will often not be practical or possible to address all direct and indirect health effects that appear theoretically possible, it is important to select issues carefully. Sources: Adapted from Cook et al. A lack of access to needed goods and services. Alerting decision-makers to the more general need to focus on health in future decisions. The steps can be described as follows: The following sections provide an overview of the process of conducting an HIA. Clipboard, Search History, and several other advanced features are temporarily unavailable. 2007; Bhatia 2010). For example, U.S. priorities for improving public health are expressed in the Healthy People 2020 Program of the U.S. Department of Health and Human Services (DHHS 2010). From Principles to Consider for the Implementation of a Community Health Needs Assessment Process [PDF 457KB] (June 2013), Sara Rosenbaum, JD, The George Washington University School of Public Health and Health Services, Department of Health Policy. 2004). It develops the scope of health effects for analysis through systematic consideration of all factors associated with the proposed action that have a potential to influence health, and it narrows the scope to effects that are judged most important for health. In practice, the categories are rarely used consistently, and a single HIA often encompasses a blend of various approaches to stakeholder engagement and participation, analytic methods, and interactions with the formal decision-making process. Thank you for taking the time to confirm your preferences. A variety of planning and zoning, funding, and environmental regulatory decisions were required for the BeltLines various components to be developed. The variability also reflects a lack of clear criteria that define HIA as a distinct field. Another method of scoping is to develop a table that facilitates a systematic and rapid appraisal of all the potential ways in which a proposal might affect health (see Table 3-1). 1. 2010). McAuliffe M. Developers of Proposed Springfield Biomass Plant tell Public Health Council: Nothing Less Than the Best. Mindell JS, Boltong A, Forde I. Moreover, because there is generally no written record of HIAs that stop at screening, still less is known about the reasons that have led to decisions not to proceed with HIA. Community health assessment and community health improvement planning are continuous, systematic processes for assessing and addressing health needs in a community. Intermediate HIAs require more time and resources and involve more complex pathways, more stakeholder engagement, and a more detailed analysis but include little collection of new data. It can also include information from social-science and epidemiologic studies regarding the strength of associations between the social and physical environment (such as air and water quality and economic impacts) and health outcomesinformation essential in the quantitative prediction of health effects. Some HIAs rely on proxy measures when rates of specific diseases are not available or are too small to calculate. It is also useful to assess the political context of the proposal to be assessed and consider, for example, the major political drivers of the proposal, the arguments made by political supporters and those opposed to the proposal, and any economic or technical constraints that limit the alternatives that can be considered. First, disclosure informs affected communities and individuals and possibly other stakeholders, such as government agencies and officials, of possible effects on their health and well-being, a core objective of HIA. It should define the vision for the health of the community through a collaborative process and should address the gamut of strengths, weaknesses, challenges, and opportunities that exist in the community to improve the health status of that community. 2009; Bhatia et al. The committee notes that each approach for gathering and interpreting data may be conducted in ways that are more or less participatory, engaging stakeholders in shaping the research questions, interpreting the findings, and developing recommendations on the basis of the findings. On the basis of its review of available literature, HIA guides, and practice standards, the committee has synthesized the key criteria that define HIA and that set it apart from related approaches to public-health practice and policy. The decision-maker must ultimately balance health considerations with the many technical, social, political, and economic concerns that bear on the proposal. The ultimate goal of a community health assessment is to develop strategies to address the communitys health needs and identified issues. Open communication is necessary to build trust and ensure mutual objectives. That issue is addressed again in Chapter 4. In contrast, the effect of decisions on some health outcomes (such as cancer or obesity) may take years to occur and may have multiple contributing factors. The toolkit provides a foundation for meeting the relevant IRS requirements. Although there are many potential benefits of undertaking an HIA, one common objective is to inform decisions to promote changes that support improvements in health determinants or health outcomes. Needs assessments serve as incredibly powerful tools for decision making, resource allocation, and ultimately reaching programmatic goals. Furthermore, some policies may focus on determinants of healthfor example, economic development, transportation, or housingrather than explicitly mentioning health. Environmental, Social and Health Impact Assessment (ESHIA) Process. Example of a Table Used for Systematic Scoping. The HIAs also changed the debate in such a way that providing paid sick days for employees began to be presented as a public-health issue rather than a labor issue. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. Additional modeling approaches, such as system-dynamic modeling and agent-based models, are also promising and emerging tools that could have applications to health. The final HIA report describes each factor (see below) and presents the results of the scoping. Crossings at 29th St./San Pedro St. Area Health Impact Assessment. A community health assessment gives organizations comprehensive information about the communitys current health status, needs, and issues. Guidance Note 4. Quantitative evidence can include routinely collected information, such as mortality and census data, that can inform the baseline assessment. Key elements that make up a health assessment at the - Course Hero Using Community Health Assessments to Understand the Social Key elements of the model include: Disseminating surveys Conducting key informant interviews and focus groups Incorporating county-level data on health Small rural hospitals may lack the required resources to successfully address issues that may be identified as a result of a CHNA. Having transparency throughout the process and clearly delineating the roles and responsibilities among various parties will help to limit real and perceived bias. The role of adaptive management as an operational approach for resource management agencies. The potential for irreversible or catastrophic effects (including effects of low likelihood). Action plans have mutually reinforcing activities. Evaluation can be thought of in two useful and complementary ways: self-evaluation of the HIA process and impacts and independent external evaluation. The committee notes that effective dissemination requires consideration of barriersincluding those associated with language, availability of child care, disability, access to transportation, disenfranchisement, or literacyand that multiple approaches may be required for disseminating a single HIA so that all appropriate audiences can be reached. Logic frameworks can be used as part of stakeholder engagement to develop a shared understanding of how a project will develop and the outcomes that can be expected (Cave and Curtis 2001a,b; Cave et al. Public agencies might not disclose or might redact or otherwise limit disclosure of information. It recommends measures, in the context of the proposed action, to protect and promote health and reduce health disparities. Agreeing on a target population. It would then fall to the decision-makers to determine routes that met those criteria. The local North Slope Borough governmentan agency that participated in preparing the EISconducted an HIA, which was integrated into the EIS report. Discuss what entity has the authority or ability to implement each measure and document any commitments to do so. It is important for event staff to know exactly who has final decision-making power to eliminate potential conflicts. 1999; Roscam Abbing 2004). The findings of the HIA were covered by newspapers and Web sites in California, Maine, Massachusetts, and New Hampshire; and the HIA researchers were interviewed on radio. Improving relationships and collaboration between stakeholders. The HIA team was assisted by an advisory committee, but it appears that the committee was not involved in the scoping. As a final note, it is important to remember the context in which HIAs are conducted when considering the recommendations phase. Decision-making is rarely based solely on scientific evidence but instead takes into account an array of political, economic, technical, and practical considerations. Reporting: Legislation on Paid Sick Days. Another consideration is whether the proposal is likely to place a disproportionate burden of risk on vulnerable populations in the affected community; screening proposals on this basis helps to ensure that the HIA addresses the risk factors that underlie observed disparities in the rates of illness among various populations. The first is to create a profile of the population affected, which includes information on the demographics, baseline health status, and social, economic, and environmental conditions that are important to health. The Public Health Accreditation board defines community health assessment as a systematic examination of the health status indicators for a given population that is used to identify key problems and assets in a community. Some provide a checklist of factors to consider and often focus on health determinants that might be affected by the proposal. As described in Appendix A, there are few laws in the United States that specifically require HIA, although manysuch as the National Environmental Policy Act (NEPA)require a consideration of health that can be accomplished through HIA. The population, subgroups, vulnerable populations, and stakeholders likely to be affected and how they were involved in the HIA process. For example, although rapid HIAs are small-scale, low-cost investigations, comprehensive HIAs that require new primary data collection can take longer than a year to complete and require substantially more resources. Remember, although this example uses boxes and arrows, you and your partners in change can use any format or imagery that communicates more effectively with your stakeholders. In this approach, the aspects of a proposal that may affect health are listed and considered in major categories of health and illness. Behavioral Risk Factor Surveillance System data were used for the county and the state and stratified by race.
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