The Role of
Health Impact Assessment

Committee on Health Impact Assessment

Board on Environmental Studies and Toxicology

Division on Earth and Life Studies

National Research Council

                          OF THE NATIONAL ACADEMIES


Washington, D.C.

The National Academies of Sciences, Engineering, and Medicine
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Committee on Health Impact Assessment Board on Environmental Studies and Toxicology Division on Earth and Life Studies National Research Council

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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Insti- tute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This project was supported by contracts between the National Academy of Sciences and Robert Wood Johnson Foundation, Grant No. 66737; The California Endowment, Grant No. 20091397; DHHS/CDC, Contract No. 200-2005-13434; and DHHS/NIH, Contract No. N01-OD-4-2139. Any opinions, findings, conclusions, or recommendations ex- pressed in this publication are those of the authors and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number-13: 978-0-309-21883-2 International Standard Book Number-10: 0-309-21883-7 Library of Congress Control Number: 2011939904 Additional copies of this report are available from The National Academies Press 500 Fifth Street, NW Box 285 Washington, DC 20055 800-624-6242 202-334-3313 (in the Washington metropolitan area) Copyright 2011 by the National Academy of Sciences. All rights reserved. Printed in the United States of America.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the re- sponsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the Na- tional Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council.

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COMMITTEE ON HEALTH IMPACT ASSESSMENT Members RICHARD J. JACKSON (Chair), University of California, Los Angeles DINAH BEAR, Attorney at Law, Washington, DC RAJIV BHATIA, San Francisco Department of Public Health; University of California, San Francisco SCOTT B. CANTOR, The University of Texas MD Anderson Cancer Center, Houston BEN CAVE, Ben Cave Associates, Ltd., Leeds, United Kingdom ANA V. DIEZ ROUX, University of Michigan, Ann Arbor CARLOS DORA, World Health Organization, Geneva, Switzerland JONATHAN E. FIELDING, Los Angeles County Department of Public Health, Los Angeles, CA JOSHUA S. GRAFF ZIVIN, University of California, San Diego JONATHAN I. LEVY, Boston University School of Public Health, Boston, MA JULIA B. QUINT, California Department of Public Health (retired), Berkeley SAMINA RAJA, University at Buffalo, State University of New York, Buffalo AMY JO SCHULZ, University of Michigan, Ann Arbor AARON A. WERNHAM, Pew Charitable Trusts, Washington, DC Staff ELLEN K. MANTUS, Project Director HEIDI MURRAY-SMITH, Program Officer KERI SCHAFFER, Research Associate NORMAN GROSSBLATT, Senior Editor MIRSADA KARALIC-LONCAREVIC, Manager, Technical Information Center RADIAH ROSE, Manager, Editorial Projects PANOLA GOLSON, Program Associate Sponsors ROBERT WOOD JOHNSON FOUNDATION CALIFORNIA ENDOWMENT NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES U.S. CENTERS FOR DISEASE CONTROL AND PREVENTION v

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BOARD ON ENVIRONMENTAL STUDIES AND TOXICOLOGY1 Members ROGENE F. HENDERSON (Chair), Lovelace Respiratory Research Institute, Albuquerque, NM PRAVEEN AMAR, Clean Air Task Force, Boston, MA TINA BAHADORI, American Chemistry Council, Washington, DC MICHAEL J. BRADLEY, M.J. Bradley & Associates, Concord, MA JONATHAN Z. CANNON, University of Virginia, Charlottesville GAIL CHARNLEY, HealthRisk Strategies, Washington, DC FRANK W. DAVIS, University of California, Santa Barbara RICHARD A. DENISON, Environmental Defense Fund, Washington, DC CHARLES T. DRISCOLL, JR., Syracuse University, New York H. CHRISTOPHER FREY, North Carolina State University, Raleigh RICHARD M. GOLD, Holland & Knight, LLP, Washington, DC LYNN R. GOLDMAN, George Washington University, Washington, DC LINDA E. GREER, Natural Resources Defense Council, Washington, DC WILLIAM E. HALPERIN, University of Medicine and Dentistry of New Jersey, Newark PHILIP K. HOPKE, Clarkson University, Potsdam, NY HOWARD HU, University of Michigan, Ann Arbor SAMUEL KACEW, University of Ottawa, Ontario ROGER E. KASPERSON, Clark University, Worcester, MA THOMAS E. MCKONE, University of California, Berkeley TERRY L. MEDLEY, E.I. du Pont de Nemours & Company, Wilmington, DE JANA MILFORD, University of Colorado at Boulder, Boulder FRANK O’DONNELL, Clean Air Watch, Washington, DC RICHARD L. POIROT, Vermont Department of Environmental Conservation, Waterbury KATHRYN G. SESSIONS, Health and Environmental Funders Network, Bethesda, MD JOYCE S. TSUJI, Exponent Environmental Group, Bellevue, WA Senior Staff JAMES J. REISA, Director DAVID J. POLICANSKY, Scholar RAYMOND A. WASSEL, Senior Program Officer for Environmental Studies SUSAN N.J. MARTEL, Senior Program Officer for Toxicology ELLEN K. MANTUS, Senior Program Officer for Risk Analysis EILEEN N. ABT, Senior Program Officer RUTH E. CROSSGROVE, Senior Editor MIRSADA KARALIC-LONCAREVIC, Manager, Technical Information Center RADIAH ROSE, Manager, Editorial Projects 1 This study was planned, overseen, and supported by the Board on Environmental Studies and Toxicology. vi

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OTHER REPORTS OF THE BOARD ON ENVIRONMENTAL STUDIES AND TOXICOLOGY A Risk-Characterization Framework for Decision-Making at the Food and Drug Administration (2011) Review of the Environmental Protection Agency’s Draft IRIS Assessment of Formaldehyde (2011) Toxicity-Pathway-Based Risk Assessment: Preparing for Paradigm Change (2010) The Use of Title 42 Authority at the U.S. Environmental Protection Agency (2010) Review of the Environmental Protection Agency’s Draft IRIS Assessment of Tetrachloroethylene (2010) Hidden Costs of Energy: Unpriced Consequences of Energy Production and Use (2009) Contaminated Water Supplies at Camp Lejeune—Assessing Potential Health Effects (2009) Review of the Federal Strategy for Nanotechnology-Related Environmental, Health, and Safety Research (2009) Science and Decisions: Advancing Risk Assessment (2009) Phthalates and Cumulative Risk Assessment: The Tasks Ahead (2008) Estimating Mortality Risk Reduction and Economic Benefits from Controlling Ozone Air Pollution (2008) Respiratory Diseases Research at NIOSH (2008) Evaluating Research Efficiency in the U.S. Environmental Protection Agency (2008) Hydrology, Ecology, and Fishes of the Klamath River Basin (2008) Applications of Toxicogenomic Technologies to Predictive Toxicology and Risk Assessment (2007) Models in Environmental Regulatory Decision Making (2007) Toxicity Testing in the Twenty-first Century: A Vision and a Strategy (2007) Sediment Dredging at Superfund Megasites: Assessing the Effectiveness (2007) Environmental Impacts of Wind-Energy Projects (2007) Scientific Review of the Proposed Risk Assessment Bulletin from the Office of Management and Budget (2007) Assessing the Human Health Risks of Trichloroethylene: Key Scientific Issues (2006) New Source Review for Stationary Sources of Air Pollution (2006) Human Biomonitoring for Environmental Chemicals (2006) Health Risks from Dioxin and Related Compounds: Evaluation of the EPA Reassessment (2006) Fluoride in Drinking Water: A Scientific Review of EPA’s Standards (2006) State and Federal Standards for Mobile-Source Emissions (2006) Superfund and Mining Megasites—Lessons from the Coeur d’Alene River Basin (2005) Health Implications of Perchlorate Ingestion (2005) Air Quality Management in the United States (2004) Endangered and Threatened Species of the Platte River (2004) Atlantic Salmon in Maine (2004) Endangered and Threatened Fishes in the Klamath River Basin (2004) Cumulative Environmental Effects of Alaska North Slope Oil and Gas Development (2003) Estimating the Public Health Benefits of Proposed Air Pollution Regulations (2002) Biosolids Applied to Land: Advancing Standards and Practices (2002) vii

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The Airliner Cabin Environment and Health of Passengers and Crew (2002) Arsenic in Drinking Water: 2001 Update (2001) Evaluating Vehicle Emissions Inspection and Maintenance Programs (2001) Compensating for Wetland Losses Under the Clean Water Act (2001) A Risk-Management Strategy for PCB-Contaminated Sediments (2001) Acute Exposure Guideline Levels for Selected Airborne Chemicals (ten volumes, 2000-2011) Toxicological Effects of Methylmercury (2000) Strengthening Science at the U.S. Environmental Protection Agency (2000) Scientific Frontiers in Developmental Toxicology and Risk Assessment (2000) Ecological Indicators for the Nation (2000) Waste Incineration and Public Health (2000) Hormonally Active Agents in the Environment (1999) Research Priorities for Airborne Particulate Matter (four volumes, 1998-2004) The National Research Council’s Committee on Toxicology: The First 50 Years (1997) Carcinogens and Anticarcinogens in the Human Diet (1996) Upstream: Salmon and Society in the Pacific Northwest (1996) Science and the Endangered Species Act (1995) Wetlands: Characteristics and Boundaries (1995) Biologic Markers (five volumes, 1989-1995) Science and Judgment in Risk Assessment (1994) Pesticides in the Diets of Infants and Children (1993) Dolphins and the Tuna Industry (1992) Science and the National Parks (1992) Human Exposure Assessment for Airborne Pollutants (1991) Rethinking the Ozone Problem in Urban and Regional Air Pollution (1991) Decline of the Sea Turtles (1990) Copies of these reports may be ordered from the National Academies Press (800) 624-6242 or (202) 334-3313 viii

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Preface A growing body of evidence indicates that many factors outside the tradi- tional health field affect public health. The idea that our health is determined only by our own behavior, choices, and genetics is no longer tenable. Many now recognize that substantial improvements in public health will occur only by en- suring that health considerations are factored into projects, programs, plans, and policies in non-health-related sectors, such as transportation, housing, agricul- ture, and education. Health impact assessment (HIA) is a tool that can help decision-makers identify the public-health consequences of proposals that potentially affect health. Because of the potential that HIA offers to improve public health, the Robert Wood Johnson Foundation, the National Institute of Environmental Health Sciences, the California Endowment, and the U.S. Centers for Disease Control and Prevention asked the National Research Council to develop a framework, terminology, and guidance for conducting HIA. In this report, the Committee on Health Impact Assessment discusses the need for health-informed decision-making and policies and reviews the current practice of HIA. The committee provides a definition, framework, and criteria for HIA; discusses issues in and challenges to the development and practice of HIA; and closes with a discussion on structures and policies for promoting HIA. The committee notes that the framework provided in this report is not a reinven- tion of the field but a synthesis of guidance provided in other documents and publications. Thus, the reader will find many similarities between the commit- tee’s descriptions and characterizations and those of other guides. The present report has been reviewed in draft form by persons chosen for their diverse perspectives and technical expertise in accordance with procedures approved by the National Research Council Report Review Committee. The purpose of the independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards of objectivity, evi- dence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative proc- ess. We thank the following for their review of this report: Jason Corburn, Uni- ix

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x Preface versity of California, Berkeley; William H. Dow, University of California, Berkeley; Jonathan C. Heller, Human Impact Partners; Murray Lee, Habitat Health Impact Consulting; Jonathan Levine, University of Michigan; Linda A. McCauley, Emory University; David O. Meltzer, University of Chicago; Keshia M. Pollack, Johns Hopkins Bloomberg School of Public Health; Lindsay Rosenfeld, Northeastern University; Alex Scott-Samuel, University of Liver- pool; Nicholas C. Yost, SNR Denton; Lauren Zeise, California Environmental Protection Agency. Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations, nor did they see the final draft of the report before its release. The review of the report was overseen by the review coordinator, Joseph V. Rodricks, Environ, and the review monitor, Gilbert S. Omenn, University of Michigan Medical School. Appointed by the National Research Council, they were responsible for making certain that an independent examination of the re- port was carried out in accordance with institutional procedures and that all re- view comments were carefully considered. Responsibility for the final content of the report rests entirely with the committee and the institution. The committee gratefully acknowledges the following for their presenta- tions: Marice Ashe, Public Health Law and Policy; John Balbus, National Insti- tute of Environmental Health Sciences; Ronald Bass, ICF International; Larry Cohen, Prevention Institute; Andrew Dannenberg, U.S. Centers for Disease Control and Prevention; Paul Farmer, American Planning Association; Ed Fogels, Alaska Department of Natural Resources; Robert Gould, Partnership for Prevention; Ralph Keeney, Duke University; Jenelle Krishnamoorthy, U.S. Sen- ate Committee on Health, Education, Labor, and Pensions; Angelo Logan, East Yard Communities for Environmental Justice; April Marchese, U.S. Department of Transportation; John Norquist, Congress for the New Urbanism; Linda Ru- dolph, California Department of Public Health; Pamela Russo, Robert Wood Johnson Foundation; and Terry Williams, Tulalip Natural Resources Treaty Rights Office. The committee is also grateful for the assistance of the National Research Council staff in preparing this report. Staff members who contributed to the ef- fort are Ellen Mantus, project director; Heidi Murray-Smith, program officer; Keri Schaffer, research associate; James Reisa, director of the Board on Envi- ronmental Studies and Toxicology; Norman Grossblatt, senior editor; Mirsada Karalic-Loncarevic, manager, Technical Information Center; Radiah Rose, man- ager, editorial projects; and Panola Golson, program associate. I would especially like to thank the members of the committee for their efforts throughout the development of this report. Richard J. Jackson, Chair Committee on Health Impact Assessment

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Contents SUMMARY ........................................................................................................ 3 1 INTRODUCTION ............................................................................. 14 Health Impact Assessment, 14 The Committee’s Task and Approach, 18 Organization of Report, 19 References, 20 2 WHY WE NEED HEALTH-INFORMED POLICIES AND DECISION-MAKING ............................................................. 23 Knowledge of Root Causes of Health Consequences, 25 Why Assess the Health Consequences of Policies, Programs, Projects, and Planning Decisions?, 27 Why Assessments Are Not Being Conducted, 30 What are the Options for Assessment?, 31 Other Benefits of Systematic Assessment of Health Impacts, 33 Conclusions, 34 References, 35 3 ELEMENTS OF A HEALTH IMPACT ASSESSMENT .............. 43 Categories of Health Impact Assessment, 44 Definition of Health Impact Assessment, 45 Who Conducts Health Impact Assessments?, 46 Process for Health Impact Assessment, 47 Summary: What Criteria Define a Health Impact Assessment?, 82 References, 83 4 CURRENT ISSUES AND CHALLENGES IN THE DEVELOPMENT AND PRACTICE OF HEALTH IMPACT ASSESSMENT ................................................................. 90 Defining Health for Health Impact Assessment, 90 xi

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xii Contents Are All Decisions Potential Candidates for Health Impact Assessment?, 92 Balancing the Need to Provide Timely, Valid Information with the Realities of Varied Data Quality, 95 Benefits and Challenges of Quantitative Estimation, 99 Characterizing Multiple Health Effects, 101 Assigning Monetary Values to Health Consequences, 102 Valuing and Enabling Stakeholder Participation, 103 The Benefits of a Peer-Review Process for Health Impact Assessment, 106 Minimizing Conflicts of Interest of Sponsors and Practitioners of Health Impact Assessment, 107 Managing Expectations: Information May Not Change Decisions, 108 Advancing Requirements for Health Analysis in Environmental Impact Assessment, 110 Conclusions, 112 References, 114 5 STRUCTURES AND POLICIES FOR PROMOTING HEALTH IMPACT ASSESSMENT .............................................. 119 Structure and Policies to Support Health Impact Assessment, 120 Promotion of Education and Training in and Societal Awareness of Health Impact Assessment, 124 Increase in Research and Scholarship in Health Impact Assessment, 126 Development of Resources to Support Health Impact Assessment, 128 References, 128 APPENDIXES APPENDIX A: EXPERIENCES WITH HEALTH IMPACT ASSESSMENT .............................................................................. 130 APPENDIX B: BIOGRAPHIC INFORMATION ON THE COMMITTEE ON HEALTH IMPACT ASSESSMENT........................... 178 APPENDIX C: STATEMENT OF TASK OF THE COMMITTEE ON HEALTH IMPACT ASSESSMENT ..................................................... 184 APPENDIX D: GLOSSARY ......................................................................... 185

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xiii Contents APPENDIX E: SUMMARY OF HEALTH IMPACT ASSESSMENT GUIDES .............................................................................. 196 APPENDIX F: ANALYSIS OF HEALTH EFFECTS UNDER THE NATIONAL ENVIRONMENTAL POLICY ACT ............................ 204 BOXES, FIGURES, AND TABLES BOXES 3-1 Screening: HIA of a Residential Housing Program, 50 3-2 Scoping: Atlanta BeltLine HIA, 56 3-3 Assessment: Northeast National Petroleum Reserve-Alaska, 65 3-4 Examples of Health and Behavioral Effects That Have Been Addressed Quantitatively in HIA, 67 3-5 HIA Recommendations, 69 3-6 Reporting: Legislation on Paid Sick Days, 74 A-1 European Union Members and When They Joined, 137 FIGURES S-1 Framework for HIA, illustrating steps and outputs, 7 3-1 Example of a logic framework that maps out the possible causal pathways by which health effects might occur, 54 A-1 Number of requests for consultation received by the Québec Ministry of Health and Social Services, 2003-2008, 132 TABLES 1-1 Selected Definitions of Health Impact Assessment, 16 2-1 The Costs of Transportation-Related Health Outcomes, 2008, 29 3-1 Example of a Table Used for Systematic Scoping, 55 3-2 Example of a Matrix to Analyze Health Effects, 63 3-3 Example of a Table for Rating Importance of Health Effects, 64 4-1 Health Impact Assessment by Sector, 93 E-1 A Review of Health Impact Assessment Guides, 197 E-2 Health Impact Assessment Guides for Policies or Plans, 200

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