Health Impact Assessments

Health Impact Assessment (HIA) is a decision-support tool being utilized by EPA to promote sustainable and healthy communities. The foundation of a healthy community is strongest when built upon a decision-making process that balances environmental, social, and economic factors to promote the health and well-being of its members. HIA is a tool designed to investigate how a proposed program, project, policy, or plan may impact health and well-being and inform decision-makers of these potential outcomes before the decision is made.

HIAs:

determine the potential effects of a proposed decision on the health of a population and the distribution of those effects within the population;
consider input from stakeholders, including those impacted by the decision;
use different types of qualitative and quantitative evidence and analytical methods;
are flexible based on available time and resources; and
provide evidence and recommendations to decision-makers in a timely manner.

HIAs consider the full range of potential impacts of the proposed decision — both positive and negative — on health and those factors known to directly and indirectly affect human health (known as health determinants). HIAs provide recommendations for maximizing the potential positive health impacts and minimizing and/or avoiding the potential negative health impacts of the decision. In addition to promoting human health considerations, HIAs also encourage democracy, health equity, a comprehensive approach to individual and community health, and sustainability in decision-making.

Proctor Creek Watershed: The Intersection of Green Infrastructure and Health

In 2013, the Proctor Creek watershed (Atlanta, GA) was designated an Urban Waters Federal Partnership location. Grassroots organizations, EPA, the Urban Waters Federal Partnership, City of Atlanta, and others work together to improve and protect the health of Proctor Creek and address the environmental and health-related issues facing the community. In collaboration with the Proctor Creek community, EPA conducted a health impact project to evaluate the expansion of green infrastructure throughout the watershed – a recommendation of the Boone Boulevard Green Street Project Health Impact Assessment (HIA) previously conducted by EPA.

Proctor Creek Boone Boulevard Health Impact Assessment (HIA) Final Report
This is the final report of the EPA-led Proctor Creek Boone Boulevard HIA, which aims to help inform the City of Atlanta’s decision on whether to implement the proposed Boone Boulevard Green Street Project as designed and to provide an avenue for stakeholders, including state environmental and public health agencies, city and county departments, advocacy groups, and the community, to be engaged in the decision-making process.

Related Resources

HIA Resources and Tool Compilation

Health Impact Assessment (HIA) is a relatively new and rapidly emerging field in the U.S. An inventory of available HIA resources and tools was conducted, with a primary focus on resources developed in the U.S. The resources and tools available to HIA practitioners in the conduct of their work were identified through multiple methods and compiled into a comprehensive list.

The HIA Resource and Tool Compilation is a free, publicly-accessible compilation of tools and resources being developed by EPA that can be utilized by HIA practitioners at all levels of experience to guide them through the HIA process. The compilation includes tools and resources related to the HIA process itself and those that can be used to collect and analyze data, establish a baseline profile, assess potential health impacts, and establish benchmarks and indicators for monitoring and evaluation. These resources include literature and evidence bases, data and statistics, guidelines, benchmarks, decision and economic analysis tools, scientific models, methods, frameworks, indices, mapping, and various data collection tools.

The HIA resources and tools contained in the Compilation were identified through:

the “HIA Information Toolkit: Data, Methods, and Models from the HIA Community of Practice” Working Group at the Inaugural National Health Impact Assessment Meeting in Washington D.C. in 2012;
a review of EPA tools, databases, and other resources relevant to HIA;
data sources, tools, and models identified in the EPA report, A Review of Health Impact Assessments in the U.S.: Current State-of-Science, Best Practices, and Areas for Improvement;
a general online search;
and an extensive, although not comprehensive, review of tools used in completed HIAs.

The HIA Resource and Tool Compilation is designed to provide an extensive list of resources that apply to the HIA process itself and the themes present throughout the process, such as equity and community participation, as well as tools that can be used to collect and analyze data, establish a baseline profile, assess potential health impacts, and establish benchmarks and indicators for recommendations and monitoring. The Compilation is divided into several primary categories based on the resource or tool type (e.g., HIA Process Resources, Databases, Guidance Documents, Analysis Tools, Models, Mapping Tools, and Data Collection Tools). The resources and tools are further categorized by the topic (or in some cases, the HIA step) to which that resource or tool pertains (e.g., Monitoring and Evaluation, Demographics, Housing, Transportation, etc.).

HIA Resource and Tool Compilation (pdf)

A Review of Health Impact Assessments in the U.S.

EPA performed a review of 81 Health Impact Assessments (HIAs) from the U.S. to obtain a clear picture of how HIAs are being implemented nationally and to identify potential areas for improving the HIA community of practice. The review was focused on HIAs from four sectors that the EPA’s Sustainable and Healthy Communities Research Program has identified as target areas for empowering communities to move toward more sustainable states. These four sectors are:

Transportation;
Housing/Buildings/Infrastructure;
Land Use; and
Waste Management/Site Revitalization.

The Minimum Elements and Practice Standards for Health Impact Assessment was chosen from the broad body of HIA guidance documents as the benchmark against which to review the HIAs. The HIA Review systematically documented organizations involved in conducting the HIAs; funding sources; the types of community-level decisions being made; data, tools, and models used; self-identified data needs/gaps; methods of stakeholder engagement; pathways and endpoints; characterization and prioritization of impacts; decision-making outcomes/recommendations; monitoring and follow-up measures; HIA defensibility and effectiveness; attainment of the Minimum Elements of HIA; areas for improvement; and identification of best practices.

The results of the HIA review were synthesized to identify the current state of the HIA practice in the U.S., best practices in HIA, and areas for improvement.

A Review of Health Impact Assessments in the U.S. Fact Sheet (pdf)
A Review of Health Impact Assessments in the U.S.: Current State-of-Science, Best Practices, and Areas for Improvement (pdf)

EPA's Health Impact Assessment Case Studies

EPA has undertaken several Health Impact Assessment (HIA) case studies to learn how its science can be used in the HIA process and how HIA can be incorporated into its decision-support tools, actions, and mission.

HIA Gerena School Renovation Project (Springfield, MA)

Gerena Community School, located in Springfield, MA, is undergoing renovations to improve the environmental conditions for its users. The facility functions as an elementary school and community center, serving students and residents of the North End Community. EPA collaborated with stakeholders, including departments within the City of Springfield and community-based groups, to perform an HIA.

The purpose of this HIA is to provide valuable health-focused information to help the City of Springfield narrow down and prioritize those renovation actions that best address the existing environmental conditions and reduce the potential negative health impacts to students, faculty, staff, and community members who use the facility. The HIA also provided an avenue for the community and other stakeholders to be engaged in the decision-making process. Community stakeholders have raised concerns related to Gerena School, which include indoor air quality issues related to motor vehicle emissions, flooding, moisture, mold, and other indoor environment conditions; negative perceptions of the school facilities among the community; differing priorities between school and city administrators; absenteeism; and classroom noise.

The HIA utilized on-site observations, reviewed evidence, and professional expertise to judge each of the proposed renovation options for potential impacts to respiratory health, classroom acoustics, and community perception. Based on the predicted impacts to health, the HIA provided recommendations for renovation actions that aim to maximize potential benefits to health and mitigate and/or avoid potential adverse impacts to health.

Gerena School HIA Final Report - This is the final report of the EPA-led Gerena Community School HIA, which aims to provide valuable health-focused information to help the City of Springfield narrow down and prioritize renovation actions at the school that best address the existing environmental conditions and reduce the potential negative health impacts to students, faculty, staff, and community members who use the facility.

HIA Proctor Creek Boone Boulevard Green Street Project (Atlanta, GA)

Proctor Creek is one of the most impaired creeks in metro-Atlanta and has been placed on the impaired waters list because it does not meet state water quality standards for fecal coliform. The topography, prevalence of impervious surfaces in the watershed, and a strained combined sewer system have contributed to pervasive flooding in the Proctor Creek community and created environmental, public health, economic, and redevelopment issues. A green infrastructure project, aimed at supporting water quality and revitalization improvement efforts, was proposed in a headwater community of Proctor Creek.

The purpose of this HIA was to help inform the City of Atlanta’s decision on whether to implement the proposed project as designed and to provide an avenue for stakeholders, including state environmental and public health agencies, city and county departments, advocacy groups, and the community, to be engaged in the decision-making process. The HIA evaluated the proposed Boone Boulevard Green Street Project for its potential to impact twelve determinants of health identified by stakeholders ‒ water quality; flood management; climate and temperature; air quality; traffic safety; exposure to greenness; urban noise; access to goods, services, greenspace, and healthcare; crime; social capital; household economics, and community economics.

The results of the HIA suggested that the proposed green infrastructure project would have a positive impact on health overall and provided recommendations for implementation and expansion of green infrastructure projects throughout the watershed. The City of Atlanta is implementing the Boone Boulevard Green Street Project and has decided to expand the length of the green street to maximize its predicted health benefits.

Proctor Creek Boone Boulevard Fact Sheet - This fact sheet provides an overview of the Proctor Creek watershed and community, green infrastructure, the Boone Boulevard Green Street Project Conceptual Design, and the added value and application of Health Impact Assessment (HIA) to the project.
Proctor Creek Boone Boulevard HIA Executive Summary - This document provides a summary of the main findings and recommendations of the Proctor Creek's Boone Boulevard Green Street Project Health Impact Assessment (HIA).
Proctor Creek Boone Boulevard HIA Final Report - This is the final report of the EPA-led Proctor Creek Boone Boulevard HIA, which aims to help inform the City of Atlanta’s decision on whether to implement the proposed Boone Boulevard Green Street Project as designed and to provide an avenue for stakeholders, including state environmental and public health agencies, city and county departments, advocacy groups, and the community, to be engaged in the decision-making process.

HIA Proposed Code Changes Regarding Individual Sewerage Systems (Suffolk County, NY)

As part of the Hurricane Sandy recovery efforts, EPA conducted an HIA to evaluate potential beneficial and adverse health impacts that may result from proposed sanitary code changes regarding individual sewerage systems (ISS) for residential properties in Suffolk County, New York. ISS are an alternative to centralized municipal sewage disposal systems and are the primary mode of sewage disposal for residential properties in the county. The Suffolk County Government proposed the sanitary code changes to address a growing issue of nutrient loading to Suffolk County soil, surface waters, and ground waters. Overloading of nutrients, particularly nitrogen, has been linked to the impairment of surface and ground waters, beach closures, shellfish population die offs, harmful algal blooms, and damage to marine coastlines. Suffolk County agreed to host an HIA, guided by the EPA, to help inform the decision about the code changes.

Based on input from stakeholders, community members, and scientific experts, pathways were identified through which the proposed code changes might impact health. Five pathways were prioritized for inclusion in the HIA analysis: individual sewerage system performance and failure; water quality; community and household economics; vector control; and resiliency to natural disaster.

This HIA provided evidence-based recommendations to maximize potential benefits and mitigate potential adverse impacts to health that could result from the decision.

Fact Sheet for Suffolk County HIA
Suffolk County HIA Summary Report
Suffolk County HIA Final Report
Learn more about the HIA Suffolk County Report

HIA Former Chesapeake Supply Brownfield Revitalization Assessment (Dover, DE)

From summer 2017 until early 2018, EPA conducted a rapid Health Impact Assessment (HIA) with the City of Dover and Kent County, Delaware to help the City and County make decisions concerning the redevelopment of a downtown Dover property. This property is a brownfield site – a formerly contaminated property – that has been cleaned up. The City and County are interested in using the property to produce food, including fresh produce and fish. This would help stimulate economic development and increase access to food in downtown Dover.

EPA assisted local and state officials with investigating a plan to use the site to produce food, including the use of aquaponics. Aquaponics is a farming system that grows plants and fish together in a way that benefits them both. To help with the effort, an abbreviated form of HIA (i.e., rapid HIA) was developed with EPA staff along with partners from City of Dover, Kent County, the State of Delaware, U.S. Department of Agriculture, and Delaware State University.

The HIA process involved the application of multiple methods, including the use of different types of data, geographic information, and a review of the scientific literature, to estimate what impacts the food production project might have on the health of people living in the community. The HIA report shows the analyses that were conducted, the findings of those analyses, and the recommendations for the City of Dover and Kent County to consider in making revitalization plan decisions for the property, and highlights future assessment and development opportunities.

This HIA report outlined the potential health benefits of using brownfield sites to address food access issues in urban environments. While the soil and groundwater at the property might be currently unusable for agriculture without further investigation and treatment, this HIA demonstrated that brownfield sites could still be suitable for agriculture with the use of alternative farming methods, such as hydroponics and aquaponics. Recommendations included in the report can be more broadly applied to future projects in the area and replicated in other urban environments nationwide.

Fact Sheet for Dover, Delaware Rapid HIA - From summer 2017 until early 2018, EPA conducted a rapid Health Impact Assessment (HIA) with the City of Dover and Kent County, Delaware to help the City and County make decisions concerning the redevelopment of a downtown Dover property. This property is a brownfield site – a formerly contaminated property – that has been cleaned up. The Fact Sheet linked below provides background information on the project and the final report.
Dover, Delaware Rapid HIA Report - The City of Dover, Delaware, and Kent County are interested in redeveloping a vacant and formerly contaminated property, or brownfield, to stimulate economic revitalization and increase food access in the Downtown Dover area. As a part of this effort, local and state officials sought assistance from EPA with examining a cleaned brownfield site for food production with a focus on aquaponics, a type of farming that grows fish and plants together in an integrated system. A rapid Health Impact Assessment (HIA), an abbreviated form of HIA, was piloted in partnership with EPA Region 3; EPA Office of Research and Development; EPA Office of Brownfields and Land Revitalization; City of Dover, Kent County, and Delaware State governments; and Delaware State University. EPA staff guided the HIA process and utilized a mixed methods approach, including qualitative and quantitative data, geographic information system (GIS), and scientific literature review, to evaluate the potential health impacts of a proposed food production project. The HIA report linked below documents the HIA analyses, findings, and recommendations for the City of Dover to consider health in decisions around its revitalization plans and outlines opportunities for further development and future assessments.

HIA Kingsbury Bay - Grassy Point Habitat Restoration Project (Duluth, MN)

EPA conducted an HIA in the St. Louis River Areas of Concern (AOC) to examine the potential public health impacts of habitat restoration work and subsequent park improvement projects at two project sites along the St. Louis River – Kingsbury Bay and Grassy Point. The purpose of the HIA was to inform the Minnesota Department of Natural Resources (MNDNR) and City of Duluth’s decisions regarding the design and implementation of these habitat restoration and park improvement projects. Based on input from stakeholders, community members, and scientific experts, pathways were identified through which the proposed projects could potentially impact health. Seven pathways were prioritized for inclusion in the HIA analysis: water quality and habitat; equipment operation, traffic, and transport; air quality; noise and light pollution; crime and safety; recreation, aesthetics, and engagement with nature; and social/cultural aspects.

In examining these pathways, the HIA specifically evaluated the potential health impacts associated with changes in ecosystem services (i.e., benefits people obtain from these ecosystems) and other determinants of health, as a result of the planned sediment remediation, wetland and riparian habitat restoration, and construction of potential waterfront amenities, including trails, boardwalks, bird watching stations, fishing piers, kayak launches, and swimming beaches. The HIA will help inform the decisions regarding habitat restoration and park improvements at these two sites and provide recommendations to maximize potential benefits and mitigate potential adverse impacts to health that may result from the decisions.

Southwest Rockford Revitalization Rapid Health Impact Assessment (Rockford, IL)

The City of Rockford, Illinois was seeking to revitalize the area around South Main Street in southwest Rockford (hereafter referred to as the South Main Corridor Area), along with other areas of the city, as part of its 2020-2024 Neighborhood Revitalization Area Strategy. The City received technical assistance from the EPA Office of Brownfields and Land Revitalization (OBLR) to design a Neighborhood Revitalization Strategy for the South Main Corridor Area.

In combination with the technical assistance contract, city officials agreed to a Health Impact Assessment (HIA), which would assess the health‐relevant social, environmental, and economic conditions in the South Main Corridor Area and identify how neighborhood revitalization could potentially impact health. A rapid HIA, an abbreviated form of HIA, was undertaken by the EPA Office of Research and Development (ORD) in partnership with EPA Office of Brownfields and Land Revitalization (OBLR), with input from EPA Region 5, the City of Rockford, and the Land Revitalization Technical Assistance Contractor.

A mixed methods approach was used in the HIA, including qualitative and quantitative data analysis, geographic information system (GIS) mapping, scientific literature review, and analysis of stakeholder input from multiple efforts that have taken place in the area, to evaluate the potential health impacts of proposed neighborhood revitalization in the South Main Corridor Area.

The HIA did not assess a specific revitalization strategy, program, policy, or decision, as one was not available at the time of the HIA, but rather examined evidence and examples of revitalization concepts being proposed for the South Main Corridor Area and their associations with public health impacts, positive and negative, with a particular emphasis on mental health and social determinants of health. The HIA examined six determinants of health: Housing, Neighborhood and Built Environment, Parks and Greenspace, Crime and Safety, Employment and Economy, and Social and Cultural Well-being.

The assessment identified the existing conditions in the study area related to these determinants of health, took into account community concerns and desires expressed in the City’s public meetings and interviews conducted as part of the Land Revitalization Technical Assistance Contract, and identified how neighborhood revitalization could potentially impact these health determinants and ultimately, human health. The HIA recommended strategies to maximize the potential health benefits and mitigate the potential adverse health impacts of neighborhood revitalization in the South Main Corridor.

Southwest Rockford Revitalization Rapid Health Impact Assessment (Rockford, Illinois)