define health broadly in the practice of HIA but recognizes that implementation will require some care to balance health with the many other considerations that are important to any given decision.

ARE ALL DECISIONS POTENTIAL CANDIDATES FOR HEALTH IMPACT ASSESSMENT?

A frequent question—given the breadth of potential applications of HIA—is whether there is a limit on the types of decisions to which the practice might be applied. For example, is HIA better suited to decisions in particular policy sectors (such as education, urban planning, and finance), to a particular scale (such as policy vs project) or jurisdictional level, or to particular health outcomes? The question is important because there are few formal requirements for analyzing the health effects of decisions except for the requirements for health analysis under NEPA and state environmental policy acts (SEPAs), and as demand for HIA grows, there will be a greater need to target its applications efficiently.

The broad definition of health discussed above suggests that a wide array of decisions—including some of those made in almost all government sectors on local, state, national, and international scales—may be appropriate candidates for HIA (Harris-Roxas and Harris 2011). A review of the sectors in which HIAs have been completed in the European Union (EU) (Wismar et al. 2007) and in the United States (Dannenberg et al. 2008; HIA-CLIC 2010; RWJF/PEW 2011) underscores this breadth of potential applications (see Table 4-1). Although most U.S. examples reflect applications in the transportation, housing, or urban-planning sectors, there is growing diversity in the United States and a wider diversity in the existing spectrum of EU applications. The growth may be because of greater experience with and public support for HIA and increased public recognition of the many determinants of health.

In the committee’s view, restricting the spectrum of HIA practice to particular decisions, sectors, decision scales, jurisdictional levels, or health issues is unwarranted. At this early stage, there is no evidence to suggest that HIA is more important, appropriate, or effective in any particular decision context. On the contrary, HIA may be useful across a broad array of decision contexts, including many decision types to which it has not yet been applied. Furthermore, new global health challenges are likely to emerge from issues related to atmospheric and climate change, population growth, food and land scarcity, revolutionary industrial technologies (such as nanotechnology and gene modification), globalization, and economic inequities (WWF/ZSL/Global Footprint Network 2010). For example, a changing climate and an increase in extreme weather events will have many effects, including widespread effects on health (Costello et al. 2009; Luber and Prudent 2009). Public policy in general and public health and HIA in particular must recognize the emerging challenges and support the



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