Health Impact Assessments Offer New Pathways to Healthier Environments

By Aaron Wernham

It’s no secret that residents of low-income communities frequently experience serious health problems as a result of their living environments. Air pollution and substandard housing are a root cause of asthma and other respiratory diseases. Inadequate access to healthy foods increases the risk of diabetes and obesity. A growing body of research shows that a lack of economic and educational opportunity also results in poorer overall health. Seeking ways to respond to this challenge, policymakers across the country are turning to health impact assessments or HIAs.

A health impact assessment is a fast-growing tool that helps ensure that proposed policy changes will improve health, especially in low-income and predominantly minority communities that are often disproportionately exposed to environmental risks such as air pollution and poor-quality housing. HIAs use a flexible approach that brings together public health expertise, scientific data, and input from community and other stakeholders to examine the potential health risks and benefits of key policy proposals. Based on the potential effects identified, HIAs provide practical recommendations to capitalize on opportunities to improve community health and to minimize any potential health risks before it’s too late to correct them.

HIAs can be used to inform decisions in a variety of policy areas, from transportation and housing to energy and education. A recent evaluation published by the Robert Wood Johnson Foundation found that federal, state, local, and tribal legislators, public agency officials, and many others are using HIAs to craft smarter policies that promote safer and healthier communities.

One assessment completed in 2013 gave low-income communities in North Minneapolis a voice in planning a new transit system. The Bottineau Transitway’s proposed light rail routes travel through several low-income neighborhoods where residents experience higher-than-average rates of serious health conditions such as asthma, diabetes, and obesity. With that in mind, Hennepin County’s Department of Housing, Community Works, and Transit conducted an HIA alongside the project’s environmental impact statement, a study that guides county, state, and federal planning.

The assessment found that the transitway system could significantly improve health in North Minneapolis by reducing traffic congestion, improving air quality, providing greater access to grocery stores and healthy food, and opening up employment and educational opportunities in other parts of the city. Based on the findings, county officials developed a set of recommended actions to maximize the transitway’s health benefits. Today these officials are increasing outreach to underrepresented minority stakeholders, promoting residential and commercial growth that will benefit low-income communities, and working to ensure that affordable housing remains available. As a result, the Bottineau Transitway will be more responsive to the community’s needs and ultimately support a healthier North Minneapolis.

Assessments carried out in Alaska beginning in 2007 to answer health questions raised by Alaska Native communities regarding proposed oil and gas and mining projects led to the use of HIAs as a routine part of the state’s permitting process. The first of these informed the U.S. Bureau of Land Management’s (BLM) consideration of proposed oil and gas leasing in the Northeast National Petroleum Reserve. Village residents raised questions about health effects related to air quality, the potential for contamination of local fish and game (a critical source of food), and social changes related to the influx of nonresident workers.

The HIA, which was completed in 2008, brought together the tribal government and the BLM to address these concerns. Ultimately, the BLM adopted additional protections for hunting and fishing areas to protect local food sources andprovide new monitoring for pollutants in the air and food supply near villages. Collaboration among tribal governments, state and federal regulators, and health officials on this and several other HIAs between 2007 and 2009 demonstrated the value of this approach and ultimately led to the establishment of the state’s HIA program.

The secret’s out. The voices of community members, influential champions, and other stakeholders can be deployed in ways that build momentum for considering and adopting HIA recommendations. Nationwide, more than 300 HIAs have been completed or are underway in diverse communities (view them on the Health Impact Project’s interactive map), demonstrating the power of HIAs as a tool to help decision makers develop healthier communities and environments.