National Academies Press: OpenBook
Suggested Citation:"Front Matter." National Research Council. 2011. Improving Health in the United States: The Role of Health Impact Assessment. Washington, DC: The National Academies Press. doi: 10.17226/13229.
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IMPROVING


HEALTH

IN THE

UNITED STATES

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

NATIONAL RESEARCH COUNCIL
                          OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.

www.nap.edu

Suggested Citation:"Front Matter." National Research Council. 2011. Improving Health in the United States: The Role of Health Impact Assessment. Washington, DC: The National Academies Press. doi: 10.17226/13229.
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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 Institute 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 expressed 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

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http://www.nap.edu

Copyright 2011 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America.

Suggested Citation:"Front Matter." National Research Council. 2011. Improving Health in the United States: The Role of Health Impact Assessment. Washington, DC: The National Academies Press. doi: 10.17226/13229.
×

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine

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 responsibility 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 National 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.

www.national-academies.org

Suggested Citation:"Front Matter." National Research Council. 2011. Improving Health in the United States: The Role of Health Impact Assessment. Washington, DC: The National Academies Press. doi: 10.17226/13229.
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Suggested Citation:"Front Matter." National Research Council. 2011. Improving Health in the United States: The Role of Health Impact Assessment. Washington, DC: The National Academies Press. doi: 10.17226/13229.
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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

Suggested Citation:"Front Matter." National Research Council. 2011. Improving Health in the United States: The Role of Health Impact Assessment. Washington, DC: The National Academies Press. doi: 10.17226/13229.
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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

_________________

1This study was planned, overseen, and supported by the Board on Environmental Studies and Toxicology.

Suggested Citation:"Front Matter." National Research Council. 2011. Improving Health in the United States: The Role of Health Impact Assessment. Washington, DC: The National Academies Press. doi: 10.17226/13229.
×

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)

Page viii Cite
Suggested Citation:"Front Matter." National Research Council. 2011. Improving Health in the United States: The Role of Health Impact Assessment. Washington, DC: The National Academies Press. doi: 10.17226/13229.
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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
www.nap.edu

Suggested Citation:"Front Matter." National Research Council. 2011. Improving Health in the United States: The Role of Health Impact Assessment. Washington, DC: The National Academies Press. doi: 10.17226/13229.
×

Preface

A growing body of evidence indicates that many factors outside the traditional 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 ensuring that health considerations are factored into projects, programs, plans, and policies in non-health-related sectors, such as transportation, housing, agriculture, 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 reinvention of the field but a synthesis of guidance provided in other documents and publications. Thus, the reader will find many similarities between the committee’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, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We thank the following for their review of this report: Jason Corburn, Uni-

Suggested Citation:"Front Matter." National Research Council. 2011. Improving Health in the United States: The Role of Health Impact Assessment. Washington, DC: The National Academies Press. doi: 10.17226/13229.
×

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 Liverpool; 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 report was carried out in accordance with institutional procedures and that all review 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 presentations: Marice Ashe, Public Health Law and Policy; John Balbus, National Institute 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. Senate 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 Rudolph, 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 effort are Ellen Mantus, project director; Heidi Murray-Smith, program officer; Keri Schaffer, research associate; James Reisa, director of the Board on Environmental Studies and Toxicology; Norman Grossblatt, senior editor; Mirsada Karalic-Loncarevic, manager, Technical Information Center; Radiah Rose, manager, 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

Suggested Citation:"Front Matter." National Research Council. 2011. Improving Health in the United States: The Role of Health Impact Assessment. Washington, DC: The National Academies Press. doi: 10.17226/13229.
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Factoring health and related costs into decision making is essential to confronting the nation's health problems and enhancing public well-being. Some policies and programs historically not recognized as relating to health are believed or known to have important health consequences. For example, public health has been linked to an array of policies that determine the quality and location of housing, availability of public transportation, land use and street connectivity, agricultural practices and the availability of various types of food, and development and location of businesses and industry.

Improving Health in the United States: The Role of Health Impact Assessment offers guidance to officials in the public and private sectors on conducting HIAs to evaluate public health consequences of proposed decisions -- such as those to build a major roadway, plan a city's growth, or develop national agricultural policies -- and suggests actions that could minimize adverse health impacts and optimize beneficial ones.

Several approaches could be used to incorporate aspects of health into decision making, but HIA holds particular promise because of its applicability to a broad array of programs, consideration of both adverse and beneficial health effects, ability to consider and incorporate various types of evidence, and engagement of communities and stakeholders in a deliberative process. The report notes that HIA should not be assumed to be the best approach to every health policy question but rather should be seen as part of a spectrum of public health and policy-oriented approaches.

The report presents a six-step framework for conducting HIA of proposed policies, programs, plans, and projects at federal, state, tribal, and local levels, including within the private sector. In addition, the report identifies several challenges to the successful use of HIA, such as balancing the need to provide timely information with the realities of varying data quality, producing quantitative estimates of health effects, and engaging stakeholders.

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