The World Health Organization (WHO) identifies a health impact assessment (HIA) as a practical approach to judge potential health effects of a policy, program, or project on a population, particularly on vulnerable/disadvantaged groups. Recommendations to decision-makers aim at maximizing a proposal’s positive health benefits and minimizing negative health effects.
Originating in Europe, the first U.S. HIA was conducted in the 1990s. Since then, the World Bank has utilized HIAs on large projects, federal Environmental Impact Assessments (EIA) have integrated HIAs, and North American HIA Practice Standards have been published. As of 2012, 173 HIAs were completed or in progress across the United States.
The steps in an HIA include:
1. Screening - Determining the need.
2. Scoping - Determining which health impacts to evaluate.
3. Assessment - Profiling existing conditions and potential impacts.
4. Recommendations - Strategizing to manage adverse impacts and maximize benefits.
5. Reporting - Communicating findings/recommendations.
6. Evaluation/Monitoring - Tracking impacts of decisions/outcomes.
School districts, universities, and communities are using HIAs to review discipline policies, nutrition standards, school siting, integration strategies, bicycle/pedestrian planning, bullying and supportive safety, after-school education, safety funding, and more.
The Nashville Area Metropolitan Planning Organization partnered with the Brown School of Public Health at Washington University to conduct an HIA to locate a proposed school site in the Hamilton Springs Transit Oriented Development in Lebanon, Tenn. The assessment concluded that school sites located in close proximity to their student population with sidewalks/bikeways encourage physical activity over vehicular transportation. Attendees would live no more than a half-mile from the school, creating the potential for all students to walk/bicycle to school. Healthier retail food establishments near schools would potentially influence dietary choices promoting healthier diets for young people.
The Lebanon HIA findings influenced decisions regarding school building placement/features, supporting transportation networks and surrounding land uses. Now the city and developers have guidelines for health impacts on food and built environments for students/families living in the city and attending the schools.
The Public Health Law Center of William Mitchell Law School in Minneapolis is conducting an HIA for providing recommendations to the Minnesota Department of Education (MDE) as that agency updates its Guide for Planning School Construction Projects. Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and Pew Charitable Trusts, is funding the HIA with additional funds from the Blue Cross and Blue Shield of Minnesota Foundation. Steering committee participants include MDE, Minnesota Department of Health, American Planning Association, Minnesota School Nutrition Association, several public school districts, and architects.
The MDE HIA focuses on five key school design areas that impact healthy eating, physical activity, and active learning: food service facilities (kitchens/serving, cafeterias) or learning areas that promote student awareness and consumption of healthy foods/beverages; infrastructure (sidewalks, trails, crossings, traffic control) that supports walking/biking to school; proximity of schools to students served (living in “no-busing” areas); outdoor spaces that promote physical activities; learning spaces and common areas designed for “active learning”.
Education entities, communities, and federal/state agencies can effectively utilize HIAs in developing planning guidelines and standards for facilities design. Healthy living/learning go hand-in-hand; we can guide the future through data-driven HIAs.
Paul W. Erickson, AIA/NCARB/REFP, is president of ATS&R Planners/Architects/Engineers (www.atsr.com), Minneapolis, a firm specializing in pre-K to 12 and post-secondary school planning and design. He can be reached at [email protected].
