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Health impact assessment: building public health into decision-making.

IN RECENT years, interest has been growing around the issue of health impact assessment. As defined by the World Health Organization's European office, health impact assessment is "a combination of procedures, methods and tools by which a policy, program or project may be judged as to its potential effects on the health of a population and the distribution of those effects within the population." In short, its aim is to make sure policies and projects don't harm human health.

In the United States, health impact assessment is an outgrowth of the National Environmental Policy Act of 1969, which specified that effects on health, public health and safety be considered when creating policies or projects. Despite the law, broadly conceived health impact assessments have not been routinely included in environmental impact reports.

Some progress has been made, however. Aaron Wernham, MD, MS, of the Alaska Inter-Tribal Council in Fairbanks, Alaska--who has been a key informant for me on this issue--led the first reported health impact assessment formally integrated into a federal environmental impact assessment. In the project, Alaska Natives from the state's North Slope worked with public health professionals and regulatory agencies to include health assessments in federal environmental impact statements for oil and gas development. The assessment identified health risks of such development, including increased injury rates and exposure to pollutants, and recommended mitigation measures.

Among the reasons health impact assessment has been attracting attention is that it is based on the values of democracy, equity, sustainable development and the ethical use of evidence.

Health impact assessment can allow us to highlight a range of public health concerns, including a comprehensive definition of health, a holistic view of the interplay of human and environmental health, the direct and indirect effects of social determinants of health, issues of health disparity and health equity, and consideration of the effects of our actions on all segments of the affected populations, especially those who are most vulnerable.

The time seems ripe for us to put our own stamp on the development of the health impact assessment process in the United States. While experience with health impact assessment is relatively recent here, we have opportunities to advance its use, both as it is mandated in environmental impact assessments and on a voluntary basis. As such work moves forward, we need to be sure that the broadest consideration of health concerns and determinants are included and that health impact assessment is included in mandated environmental health assessments. We also should make certain that the outcomes of health impact assessments are comprehensively evaluated and lessons learned are available to inform future work.

Finally, we must ensure that as health impact assessments are conducted, attention is consistently paid to issues of health equity and social justice and that the voices of all involved stakeholders, including those of affected vulnerable populations, are heard.

Cheryl Easley, PhD, RN

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Title Annotation:VITAL SIGNS: Perspectives of the president of APHA
Author:Easley, Cheryl
Publication:The Nation's Health
Date:Apr 1, 2009
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