Monitoring and evaluation are often, although variably, described as the final stage of HIA (see Appendix E). Health in All Policies engages many stakeholders, including community members, policy experts, advocates, the private sector, and funders, to ensure that work is responsive to community needs and to identify policy and systems changes necessary to create meaningful and impactful health improvements. 2006). Seventh, disclosure allows people to take voluntary actions to avoid risk (Neidell 2009). I and III, Breaking the Cycle, East London and the City Health Action Zone and Queen Mary. Open communication is necessary to build trust and ensure mutual objectives. 2005; Bhatia and Seto 2011). Examples of Health and Behavioral Effects That Have Been Addressed Quantitatively in HIA. Menu labeling as a potential strategy for combating the obesity epidemic: A health impact assessment. For example, there may be concerns about risks to a proponents reputation or to the viability and public acceptance of a proposed project if a report discloses important unmitigated adverse impacts or potential impacts that are uncertain or for which strong evidence does not exist. Ibid. The quality of the report can be a criterion by which the quality of the process is judged; that is, How clearly does the final document present the results of the analysis? The dissemination strategy should be developed in a systematic manner, should consider what groups need or will rely on the information (including stakeholders and decision-makers), and should determine the most effective ways to present the information to these groups, taking into account any barriers or challenges. 2007; Harris-Roxas and Harris 2011). The results of the HIA were presented in different formats; the full report was accompanied by a summary and fact sheets. Assessment: Northeast National Petroleum Reserve-Alaska. Nurses rely on self-reported symptoms, visual observation, reported health histories, and a physical medical examination to make a health assessment. Such reviews of the existing literature are common. The variability in the practice has evolved in the absence of widely accepted practice standards or formal regulatory or procedural requirements for HIA outside NEPA and related state laws (see Appendix A). Adoption of recommendations depends partly on the involvement of decision-makers in the HIA process (Elliot and Francis 2005; Davenport et al. Impact evaluation attempts to judge whether the HIA influenced the decision- making process, that is, whether and to what degree the recommendations were adopted and implemented and how the HIA influenced the decision-making process. Parry J, Stevens A. Evaluation is important for the quality of individual HIAs and for the success of the HIA field as a whole. HHS Vulnerability Disclosure, Help and transmitted securely. Outcome evaluation will continue to be challenging, but it can generate useful information in well-selected cases. The information generated by the HIA process needs to be organized and presented in such a way that it can be readily understood by the intended audiences and present a compelling case for recommended actions. As discussed later in this section, recommendations can also establish a foundation for monitoring, and the results of the monitoring may indicate that the management strategies need to be adapted to respond to the observed outcomesa process known as adaptive management (Johnson 1999). Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. The committee concludes that when alternatives to the proposal being assessed are under consideration, the HIA team should assess the impacts of each alternative. Saving Lives, Protecting People. In those cases, the HIA team may need to rely on established principles of health promotion and disease prevention to develop approaches to minimizing or mitigating the identified effects. Community Health Assessment and Improvement Planning - NACCHO Skip to Main NavigationSkip to Content LHD Directory Virtual Communities Toolbox Contact Us Mobilizing for Action through Planning and Partnerships (MAPP) Jobs at NACCHO Education & Events MyNACCHO Login Mobilizing for Action through Planning and Partnerships (MAPP) Jobs at NACCHO The ultimate goal of a community health assessment is to develop strategies to address the communitys health needs and identified issues. The available data, however, may not be sufficient, and the HIA team may make a decision to dedicate resources to collection of new data. In 1998, the Bureau of Land Management (BLM) completed a Northeast National Petroleum Reserve-Alaska Integrated Activity Plan/Environmental Impact Statement (EIS). UPH (Upstream Public Health). Atlanta Beltline: Health Impact Assessment. Analyzes beneficial and adverse health effects and characterizes the changes in the indicators selected, to the extent possible, in terms of nature, direction, intensity, magnitude, distribution in the population, timing and duration, and likelihood. In many cases, a complete and accurate description of health and its determinants in the affected community may not be possible. National Library of Medicine Practice implications include better understanding of different models and requirements by health departments, hospitals, and others involved in assessment and planning to improve cross-sector collaboration, collective impact, and community health. The toolkit provides a foundation for meeting the relevant IRS requirements. The use of various types of evidence and approaches used to make predictions are discussed below. Here are 7 common components of a successful Community Health Needs Assessment (CHNA): Information, Research, and Data Collection Stage The local North Slope Borough governmentan agency that participated in preparing the EISconducted an HIA, which was integrated into the EIS report. Consortia may wish to adopt consensus definitions of key terms such as population health, community health, and social needs vs. determinants of health, among others. Special thanks to the Community Guide Branch, CDC, the Community Preventive Services Task Force, and the Public Health Foundation for their support. The committee notes that effective dissemination requires consideration of barriersincluding those associated with language, availability of child care, disability, access to transportation, disenfranchisement, or literacyand that multiple approaches may be required for disseminating a single HIA so that all appropriate audiences can be reached. The process mirrors the one set out by NEPA for an environmental impact statement, but the practice is far more variable for HIA. Observations that might indicate some influence of the HIA include discussion about HIA by legislators debating a proposal. It is important for nonprofit hospitals to be knowledgeable about the Internal Revenue Services regulations for CHNAs. In: Kemm J, Parry J, Palmer S, editors. Kemm J. Practice Standards for Health Impact Assessment (HIA), Version 1. These cookies may also be used for advertising purposes by these third parties. The specific methods used in assessment are discussed in depth in the next section. This is the key link between a health profile and a health plan. 2019 Feb;22(1):25-31. doi: 10.1089/pop.2018.0049. In selecting the analytic methods that will be used, the HIA practitioner should consider not only technical limitations but what type of information will be most useful to decision-makers. Turnock B. Frank DA, Neault NB, Skalicky A, Cook JT, Wilson JD, Levenson S, Meyers AF, Heeren T, Cutts DB, Casey PH, Black MM, Berkowitz C. Heat or eat: The Low Income Home Energy Assistance Program and nutritional and health risks among children less than 3 years of age. One of the first steps in identifying the parameters of the assessment was to establish an understanding of the BeltLine, a complex project that had been evolving for several years and was expected to be constructed over a 30-year period. Review of literature and a consideration of the social, economic, and political context of the eventual decision are also important. Federal government websites often end in .gov or .mil. Sixth, because many established environmental risk factors are found at higher concentrations in vulnerable communities, disclosure of risks may be an important way to reduce health disparities and address concerns about environmental justice (Miranda et al. 3, Elements of a Health Impact Assessment, Improving Health in the United States: The Role of Health Impact Assessment. For example, the San Francisco Department of Public Health routinely screens major projects and plans to ensure adequate analysis and mitigation of environmental health impacts. Example of a Table for Rating Importance of Health Effects. Bennear LS, Olmstead SM. About the Annie E. Casey Foundation, Baltimore, Maryland. A variety of screening tools and algorithms are commonly used (Cole et al. The selection of analytic methods for HIA is driven by the complex pathways and the multiple, sometimes conflicting, influences on any given health outcome and is also affected by the decision-making context. Would you like email updates of new search results? In the United States, HIAs have commonly been undertaken by people who have an MPH or equivalent degree and have attended a brief (2- to 5-day) training session. A description of the research questions, data sources, methods to be used, and any alternatives to be assessed. The population, subgroups, vulnerable populations, and stakeholders likely to be affected and how they were involved in the HIA process. As noted above, the iterative process is known as adaptive management in the field of environmental management. Unauthorized use of these marks is strictly prohibited. [accessed May 24, 2011]. Although deviation from the criteria may occur, a valid and clearly articulated rationale for such deviation should be described when the HIA is reported. Noncommercial use of original content on www.aha.org is granted to AHA Institutional Members, their employees and State, Regional and Metro Hospital Associations unless otherwise indicated. The most vulnerable populations were identified as people of low economic status, children, older adults, renters, and the carless. In other cases, it may not be possible to attribute a particular decision to the influence of an HIA (Wismar et al. Industrial proponents, government decision-making agencies, local health departments, and independent organizations (such as universities and nongovernment organizations) may all be in a position to implement measures recommended in the HIA. Conversely, to have the greatest relevance as an informational and planning document and to ensure judicious use of resources, the HIA should ultimately focus on the health effects of greatest potential importance. In those cases, it may be more appropriate to monitor exposuressuch as environmental concentrations of a carcinogen or the availability of safe walking corridorsthat are linked to the outcome of interest by public-health evidence. Mindell J, Ison E, Joffe M. A glossary for health impact assessment. 2010). Suicide is the fourth leading cause of death among young people worldwide and the third leading cause of death among those in the US. The Catholic Health Association defines a community health needs assessment as a systematic process involving the community to identify and analyze community health needs and assets in order to prioritize these needs, and to plan and act upon unmet community health needs. Health impact assessment: A tool for healthy public policy. Public Health: What It Is and How It Works. A community health assessment often yields a long list of public health needs, issues, and problems. The definition also notes that recommendations should incorporate monitoring, which is essential for effective continuing management as a decision is implemented. A plan is typically updated every three to five years. Decisions are often based on incomplete information and must often be made within a specified time rather than waiting for more complete information. government site. The Public Health Accreditation Board defines a community health improvement plan as a long-term, systematic effort to address public health problems on the basis of the results of community health assessment activities and the community health improvement process. Depending on the nature of the proposal being assessed and the specific impacts, recommendations can take various forms (see Box 3-5), such as the following: HIA Recommendations. Scoping establishes the boundaries of the HIA and identifies the health effects to be evaluated, the populations affected, the HIA team, sources of data, methods to be used, and any alternatives to be assessed. The discussion described pathways by which Iupiat health was likely to be affected. In most cases, influencing decisions to protect or promote health is a central objective but by no means the sole outcome of value. The cornerstone of an assessment that is conducted to comply with NEPA is the presentation of a set of reasonable alternatives to the proposed action; the assessment then considers the impacts of the proposed action and the alternatives. In that case, a robust evaluation method, such as interviews conducted with decision-makers before and after the HIA, could provide the data needed to gauge the effect on decisions. Describes data sources and analytic methods and methods used to engage stakeholders. An explicit statement of data sources, methods, assumptions, and uncertainty is essential, but uncertainty does not negate the value of the information. This toolkit was partially supported by funding from the Centers for Disease Control and Prevention through Cooperative Agreement Number 5U38OT000211-03 with the Public Health Foundation. Available studies suggest that efforts to involve and inform decision- makers throughout the HIA process and a strong relationship between the HIA team and decision-makers are often critical for the HIAs effectiveness (Veerman et al. Public input while recommendations are being developed helps to ensure that proposed measures are locally relevant, address context-specific factors that might render them more or less effective, and address public concerns and hopes. The press coverage recognized the tension between the burden that this new requirement would place on businesses and how the health of employees and the wider community are affected by people who work while they are ill. Human Impact Partners noted that many including labor groups and fundersused the HIAs to assess work and family issues. Thus, the assessment phase is separated from the management phase, as recommended elsewhere (NRC 1983). Some have suggested that evaluation should be considered as outside the HIA process itself because of the need for an independent and objective perspective, particularly for impact evaluation (Bhatia et al. Another categorization is based on the breadth of the HIA and distinguishes HIAs that have a tight focussuch as ones that use a narrow definition of health and emphasize quantification from HIAs that have a broader, holistic focus shaped by the social determinants of health (Kemm 2001). Another method of scoping is to develop a table that facilitates a systematic and rapid appraisal of all the potential ways in which a proposal might affect health (see Table 3-1). For each step, the committee describes the basic purpose, objectives, and practice elements; summarizes the main outputs; and presents conclusions regarding pertinent issues raised. HIA should not be assumed to be the best approach to every health-policy question but should instead be seen as part of a spectrum of public-health and policy-oriented approaches, some of which will be more appropriate than others, depending on the specific application. However, Science and Decisions (NRC 2009) emphasizes that a detailed understanding of the decision context is necessary for analyses to be scoped appropriately and that the conceptual distinction between assessment and management should not be interpreted as a firewall that prevents communication between parties. A CHA is a systematic process involving the community to identify and analyze community health needs and assets, prioritize those needs and then implement a plan to address significant unmet needs. Using this generic model as a template, let's fill in the details with another example of a logic model, one that describes a community health effort to prevent tuberculosis. Given that HIA led by the private sector appears to be a rapidly increasing practice, the issue of availability bears further consideration. Expert judgment is central to HIA but must be grounded in a solid foundation of scientific neutrality and accepted public-health principles. Observing and documenting the HIA processsuch as methods of engaging stakeholders and interacting with decision-makers and approaches to addressing analytic challenges and interviewing participants and stakeholders are the main methods of process evaluation. Although the reasons and objectives for HIA are often not articulated at the outset of screening, establishing well-defined objectives will focus the screening process on determining whether HIA is likely to be an effective approach for achieving them. Improving community health starts with knowing the factors that impact people's health, both inside and outside of the clinic. Screening: HIA of a Residential Housing Program, Example of a logic framework that maps out the possible causal pathways by which health effects might occur, Example of a Table Used for Systematic Scoping, Example of a Matrix for Analyzing Health Effects, Example of a Table for Rating Importance of Health Effects, Assessment: Northeast National Petroleum Reserve-Alaska, Examples of Health and Behavioral Effects That Have Been Addressed Quantitatively in HIA, Presidential/Congressional Commission on Risk Assessment and Risk Management (1997).
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