o Who is ultimate decision maker if the event needs to be cancelled, postponed or similar? Rethinking human health impact assessment. The fact, however, that the team conducting the HIA is aware of the decision context allows the assessment to be decision-relevant. Some decisions to conduct HIA may depend on a specific statutory requirement or mandated procedure. The discussion below briefly provides definitions and key features of HIA monitoring and evaluation. 2006). Unable to load your collection due to an error, Unable to load your delegates due to an error. The committees may be convened for several purposes, including providing technical guidance or peer review, ensuring adequate and fair representation of diverse interests and priorities among stakeholders, communicating the results of the HIA to decision-makers, and developing recommendations that address community needs and are compatible with the specific legal requirements of the decision- making process. IPIECA/OGP (International Petroleum Industry Environmental Conservation Association and International Association of Oil and Gas Producers). This list can then be used to set priorities. Knowing Your Community: Community Health Assessment as a Powerful Tool Bender, Kaye PhD, RN, FAAN Author Information Journal of Public Health Management and Practice: doi: 10.1097/PHH.0000000000000599 2017 Wolters Kluwer Health, Inc. All rights reserved. Alcohol-consumption effects of alcohol taxes. Mindell J, Ison E, Joffe M. A glossary for health impact assessment. 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. 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. Simply producing and disseminating a report may not be sufficient to secure adoption and implementation of HIA recommendations. A large and growing body of quantitative evidence is available; where specific additional information is needed and resources are available, HIA teams may collect new quantitative data in the course of conducting an assessment. A number of corporations and professional associations, such as the International Committee on Mining and Metals and the International Association of Oil and Gas Producers, have guidance for HIA, but relatively few completed industry-led HIAs or environmental, social, and health impact assessments are available on the Internet or on public Web sites that catalog HIA activity. The facts that resources were available and that timelines were appropriate were also relevant to the decision to conduct an HIA. For that reason, it is important that scoping begin with a systematic consideration of all potential effects rather than limiting consideration to a subset of issues predetermined by the teams research interests or regulatory requirements. 2008). 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. Given the breadth of decisions that are likely to warrant consideration, the approach taken will vary on the basis of who is initiating the HIA, the capacity and authority of the agency or entity undertaking it, and the objectives for contemplating an HIA. Cancer risk and changes in life expectancy associated with tobacco taxes. However, many HIA reports are available from public agencies, universities, and nonprofit organizations, and the committee found few examples of HIAs led or commissioned by the private sector that were available. Health impact assessment. Miranda ML, Keating MH, Edwards SE. In others, scoping may identify studies that can be carried out by the HIA team or studies that can be carried out by experts involved in some other aspect of the planning, permitting, or review process (such as air-quality or traffic-safety analysis). Although little has been written on the reasons for keeping HIA information confidential, the committee recognizes that there may be reasons for organizations conducting HIAs to decide not to disclose the results. Accessed at www.healthycommunities.org/assesstoolkit. The potential for the HIA to be completed in the time allotted and with the resources available. The approaches taken for stakeholder involvement vary widely. Thank you also to the ACHI Community Health Assessment Toolkit Workgroup for ongoing insight and contributions. Second, it allows findings to be reviewed and improved. HIAs in the private sector are increasingly common, pursuant to internal corporate guidelines or requirements of lending banks, such as the International Finance Corporation and World Bank (see Appendix A for further discussion) (Birley 2005; IPIECA/OGP 2005; McHugh et al 2006; ICMM 2010; IFC 2007, 2010).3 Few, however, are made public. The health-management plan suggests which stakeholder agency or entity could take responsibility for implementing each recommendation. Because HIA in the United States is often undertaken outside a formal legal mandate, it has not consistently included alternatives assessment. The top 10% of the census tracts within the study area were then identified as locations of the most vulnerable populations. Risk Assessment in the Federal Government: Managing the Process. The health issues were identified by determining the populations that would be affected and then considering how they would be affected. Membership is variable but may include representatives of affected communities or community-based organizations, industrial proponents or business groups, public-health experts, officials involved in the decision- making process, and others who have a stake in the outcome. Health impact assessment: A tool to help policy makers understand health beyond health care. Because of the timeframe of proposal implementation and effects on health, outcome evaluation often requires a long-term research commitment. The bulleted list below provides examples in which some health impacts or behavioral outcomes have been quantified. As previously described in the section on Recommendations, monitoring can refer to tracking changes in health indicators as a new project or policy is implemented and has been defined as outcome monitoring. Influences on practice include the timeline, resources and skills available to the HIA team, the factors being considered and the data available for analysis, and the legal and regulatory context of the decision-making process. Community Health Assessment (CHA) archived training Identifying and selecting indicators for the CHA Data Collection, Analysis and Synthesis Presenting the CHA Findings Community Health Improvement Plan (CHIP) archived training Prioritizing Issues Choosing Strategies Developing a CHIP and Implementation Plan The committee notes that outcome evaluation of policy experiments is a field independent of HIA, and many large-scale social interventionssuch as Head Start and Moving to Opportunityhave been subject to outcome evaluation that has included consideration of health or health determinants (Leventhal and Brooks-Gunn 2003; Schweinhart et al. Because the biologists on the EIS team were uncertain of the degree to which subsistence harvests might be favorably or adversely affected, the HIA did not attempt to make quantitative estimates of the probability or intensity of the impact. 2005; Bhatia and Seto 2011). Building evaluation into the plans for an HIA early in the process may support and reinforce a more deliberate and careful approach to designing and implementing the HIA itself. For example, under Alternative A, diabetes and metabolic disorders would be expected to increase if impacts on subsistence led to declining subsistence harvests (through declining populations of subsistence resources, displacement of resources that made hunting less successful, or displacement of hunters by oil activity and infrastructure). HIAs conducted as part of a formal government process are generally subject to disclosure and freedom-of-information requirements. Johnson BL. Mindell J, Boaz A, Joffe M, Curtis S, Birley M. Enhancing the evidence base for health impact assessment. In other cases, it may not be possible to attribute a particular decision to the influence of an HIA (Wismar et al. 2008; Fredsgaard et al. Integrating human health into environmental impact assessment: An unrealized opportunity for environmental health and justice. The variability in the practice has evolved in the absence of widely accepted practice standards or formal regulatory or procedural requirements for HIA outside NEPA and related state laws (see Appendix A). Most HIAs in the United States are therefore undertaken outside the formal decision-making process by organizations (such as nonprofit community-based groups), universities, or health departments that do not have decision-making authority over the proposals being addressed. It is important for nonprofit hospitals to be knowledgeable about the Internal Revenue Services regulations for CHNAs. 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. Drafting measures that can be readily incorporated into statutes, regulations, zoning provisions, or permit conditions with little adaptation may also increase chances of implementation. 8600 Rockville Pike The HIA team was assisted by an advisory committee, but it appears that the committee was not involved in the scoping. The committee recommends that HIAs be publicly released and disseminated. 2006). The variation partly reflects the wide array of applications of HIA; for example, it is not necessary or feasible to use the same approaches to involve stakeholders for a local project and for a high-level state or national policy. Or, in some cases, there may be unpublished evaluations of measures that have been implemented in similar scenarios. In other cases, a draft may be submitted to an internal body, such as a steering group, whose comments are incorporated into a final public version. Screening should result in a simple statement that includes the following: Screening is essential for high-quality HIA. Alternative to a proposal. A community health assessment often yields a long list of public health needs, issues, and problems. Scoping also establishes a plan for the analytic methods that will be used during the assessment phase. Health in All Policies engages many stakeholders, including community members, policy experts, advocates, the private sector, and funders, to ensure that work is responsive to community needs and to identify policy and systems changes necessary to create meaningful and impactful health improvements. The core issues that are commonly addressed are as follows: Some HIA guides recommend using a matrix, such as those shown in Tables 3-2 and 3-3, to characterize effects (Harris et al. Any logic models or scoping tables that were completed should also be included. Behavioral Risk Factor Surveillance System data were used for the county and the state and stratified by race. In those cases, it may be more appropriate to monitor exposuressuch as environmental concentrations of a carcinogen or the availability of safe walking corridorsthat are linked to the outcome of interest by public-health evidence. Even when there is substantial uncertainty, an assessment can illuminate potential causal pathways thateven when there appear to be conflicting influences on a specific outcomecan point the way toward a flexible framework for monitoring and managing any impacts that might occur as the proposal is implemented. Reporting: Legislation on Paid Sick Days. Given the broad scope of HIA practice settings, applications, and data sources, the committee chose not to develop specific standards or criteria for what constitutes adequate evidence or analysis for HIA. The committee notes that in addition to characterizing effects, HIAs may provide conclusions on the significanceor societal importanceof the effects, although this has been rare in U.S. practice. The potential for HIA-based information to alter a decision or help a decision-maker discriminate among decision options. . It was not possible to derive mortality rates for demographic subgroups. 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). As described by Ross (2007, p. 9), the Atlanta BeltLine is a transit, trails, parks, and redevelopment project that uses a 22-mile loop of largely abandoned freight rail line that lies between two and four miles (more). Thus, it is generally not possible to attribute outcomes specifically to HIA recommendations because they are implemented with the decision. The degree to which they are systematic varies, and some authors have suggested frameworks and guidance for conducting systematic reviews (Mindell et al. The HIA team needed an authoritative description on which to base its assessment. It is important for event staff to know exactly who has final decision-making power to eliminate potential conflicts. In practice, however, there is some inconsistency in how HIAs are conductedfor example, how stakeholders are engaged and how data are collected and analyzedand in the structure and content of the final work products of an HIA. However, it is important to note that the use of qualitative approaches in HIA should not be interpreted as implying a need for less analytic rigor. The associations between expected disturbances and changes in health were then analyzed in more depth to look at the alternatives proposed for the expansion and at the cumulative effects of oil exploration and extraction. Health Impact Assessment on Policies Reducing Vehicle Miles Traveled in Oregon Metropolitan Areas. However, Science and Decisions (NRC 2009) emphasizes that a detailed understanding of the decision context is necessary for analyses to be scoped appropriately and that the conceptual distinction between assessment and management should not be interpreted as a firewall that prevents communication between parties. The quality of the report can be a criterion by which the quality of the process is judged; that is, How clearly does the final document present the results of the analysis? Evaluation can be thought of in two useful and complementary ways: self-evaluation of the HIA process and impacts and independent external evaluation. Mindell J, Biddulph J, Taylor L, Lock K, Boaz A, Joffe M, Curtis S. Improving the use of evidence in health impact assessment. Assignment of significance rests on the characterization of an effect as described above, but judgments regarding what constitutes a significant impact are ultimately determined partly on the basis of social and political values. Observations that might indicate some influence of the HIA include discussion about HIA by legislators debating a proposal. As discussed above, additional benefits may include, for example (Wismar et al. There are often not clear lines of authority between the team conducting the HIA and the decision-maker. Drafting measures that address identified public-health risks and that fulfill the requirements of the legal framework governing a decision will increase the chances that HIA recommendations are implemented. The local North Slope Borough governmentan agency that participated in preparing the EISconducted an HIA, which was integrated into the EIS report. The committee notes three considerations that may be particularly important for producing effective, actionable recommendations. The reader will notice that some of the committees descriptions and characterizations overlap with those of other guides; the similarities highlight the consistencies in the field. HIA and national policy in the Netherlands. UPH (Upstream Public Health). Funding Acknowledgement Affected populations: As the TAD constituted only a portion of the city that would be directly affected, the HIA team created the HIA study area by placing a 0.5-mile buffer around the BeltLine TAD. Society of Petroleum Engineers; 2006. The baseline profile also generally draws on data that describe the social, economic, and environmental conditions important to health, such as labor or housing reports, environmental impact assessments, and gray or unpublished data specific to the decision context. Those pathways and others were evaluated by using public-health data, literature on analogous populations, knowledge about accepted mechanisms of health and disease, witness testimony, and the effects analysis of other resources. A comprehensive profile will include many indicators; those related to selected priorities Developing new cross-disciplinary and interagency collaborations. Source: Adapted from BLM 2007 and Wernham 2007. Community Health Assessment and Improvement Planning - NACCHO Skip to Main NavigationSkip to Content LHD Directory Virtual Communities Toolbox Contact Us Mobilizing for Action through Planning and Partnerships (MAPP) Jobs at NACCHO Education & Events MyNACCHO Login Mobilizing for Action through Planning and Partnerships (MAPP) Jobs at NACCHO Additional modeling approaches, such as system-dynamic modeling and agent-based models, are also promising and emerging tools that could have applications to health. 2007). Atlanta Beltline: Health Impact Assessment. That explanation is particularly important when public funds are to be used for an HIA because the public may want to understand the basis for allocating sparse public resources. 2010). Environmental justice implications of reduced reporting requirements of the Toxics Release Inventory Burden Reduction Rule. Scoping should therefore entail a deliberative process that involves engagement of stakeholders. 2006; Bhatia 2010; ICMM 2010). Recommendations identify specific actions that could be taken to avoid, minimize, or mitigate harmful effects identified during the course of the HIA or to take maximal advantage of opportunities for a proposal to improve health. The specific methods used in assessment are discussed in depth in the next section. An initial brief summary of the pathways through which health could be affected and the health effects to be addressed, including a rationale for how the effects were chosen and an account of any potential health effects that were considered but were not selected and why. Iteration during scoping and between scoping and assessment often results in additional changes in the final list of issues included in the HIA. As described in Box 3-3, the HIA (more). Example of a logic framework that maps out the possible causal pathways by which health effects might occur. Comprehensive HIAs are most commonly differentiated from rapid and intermediate HIAs by the scope of potential impacts and the need for collection of new primary data. Bethesda, MD 20894, Web Policies Acknowledgments 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. The American Hospital Associations review of the IRSs final rules for CHNAs and implementation strategies can be foundhere. The HIA conclusions and recommendations should be presented in a manner that is clear and easily understood. Under NEPA, a federal agency must determine whether a federal environmental decision is likely to have significant effects, and if so, the level of analysis required (40 C.F.R. The opportunity to bring health information into a decision-making process that may otherwise not include this information. 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.
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