Understanding Pathways to Health Equity through Health Impact Assessments

It’s often hard to see the connection between big-picture policy decisions and the effects those have on a specific person’s or community’s health. This is especially true in fields where the connections to health aren’t as obvious—like housing, transportation, and education. Health Impact Assessment (HIA) is a tool that helps identify the potential positive and negative effects of proposed federal, state, regional, or local level policies on health. It is especially useful for showing how different groups can be disproportionately affected by certain policies—and how this inequity contributes to worse health outcomes for some communities.

In 2016, we began working with the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, to study the long-term impact of HIAs’ influence on the social, economic, and environmental factors that shape health. We took a close look at how parts of the HIA process, such as community empowerment, can promote health equity. We’re excited to share these initial findings as we continue this work and recommend you check out the Health Impact Project’s Issue Brief or our peer-reviewed article titled “Avenues of Influence: the Relationship between Health Impact Assessment and Determinants of Health and Health Equity” in the Journal of Urban Health for more information on this project.

Building trust and strengthening relationships

One of our big findings was that HIAs help increase trust and strengthen relationships between decision-makers and community residents. The HIA Practice Standards encourage practitioners to seek feedback from a variety of stakeholders and use it to prioritize recommendations. Through this process, residents interact with local government representatives and other decision-makers—leading to better relationships.

For example, one HIA practitioner in Florida talked about how the HIA process helped a local health department seem more relatable to community members and as a result, residents became more receptive to their messages and programs. This process enabled community engagement and helped repair historically-strained relationships between residents and decision-makers.

Increasing equitable access to resources

Our study also found that HIAs contribute to better access to health-promoting resources, such as affordable transit, safe water, and quality housing. Study participants noted that their HIAs affected how decision-makers prioritized projects and changed resource distribution in communities.

In one instance highlighted in the Issue Brief, an HIA on a comprehensive plan for a Midwestern city revealed large areas of the city without sidewalks or bicycle lanes, mostly in low-income neighborhoods. While plans existed to increase transportation infrastructure, the HIA findings influenced the location of these projects and led to the development of an allocation system that prioritized under-resourced communities. Our research shows that HIAs enable decision-makers to see community needs and make evidence-based choices that have the potential to reduce disparities between neighborhoods.

Reducing exposure to environmental risks

Findings from HIAs often assist in uncovering unintended health consequences and provide opportunities to more effectively deal with environmental hazards. We saw an example of this in an HIA used in the South to advise an Environmental Protection Agency decision in a primarily low-income, black neighborhood. The purpose of the HIA was to examine how to address water quality issues and deliver community improvements. The assessment found that tire waste was contributing to water contamination in the area. The HIA helped community members get the hazardous dumped tires removed. Because of the HIA, decision-makers and residents collaborated and strengthened their relationship, which led to lower environmental risks through increased enforcement of illegal dumping and the removal of the tires.

Understanding the impact of HIAs

HIAs are powerful tools that document how proposed policies can affect the social, economic, and environmental factors that shape health and health disparities. Through our continued work with the Health Impact Project, we are now digging deeper into how HIAs contribute to shaping the factors that drive the health of individuals and communities. We plan to explore how HIAs are associated with changes in specific components of health—including housing quality and affordability, employment, and access to healthy foods—as well as how HIAs impact the systems and structures that drive disparities across populations. We hope to confirm findings from our initial research and broaden our understanding of how HIAs can help advance health equity and change public policy.