As a doctor, I’ve often seen children with asthma that doesn’t
improve because they live in housing with mold and bad ventilation.
I’ve seen diabetics who have a hard time following my diet
recommendations because they live in neighborhoods with fast food
outlets on every corner, but no grocery store for miles. And, while
narrowly dodging traffic on Washington, D.C.’s chaotic streets,
I’ve sometimes questioned if biking to work is really the
healthiest choice, or if I’m trading exercise for an increased
risk of injury.
Many of the most urgent health problems facing the nation—like
diabetes, asthma, obesity and injuries—are shaped by conditions
in the places where we live, work and play.
The United States spends more money on health care per person than
any other country—$2.5 trillion in 2009
, yet our health
statistics consistently lag behind other developed nations.
If our nation is going to reduce medical costs and build healthier
communities, we need to take health into account when making the
decisions that shape the world outside the doctor’s office.
One tool that can find hidden opportunities to improve health is a
health impact assessment (HIA).
An HIA is a type of
study that helps policy-makers identify the likely health impacts
of a decision in another field, like building a major roadway,
planning a city’s growth or developing a school curriculum. HIAs
can help decision makers identify unintended risks, reduce
unnecessary costs, find practical solutions and leverage
opportunities to improve the wellness of the community in which the
project or policy is proposed.
For example, building a new roadway could affect health by
increasing the amount of air pollutants and the resultant risk of
asthma for people living nearby. It could also increase (or
decrease) the risk of traffic-related injuries, or cut off popular
walking routes and make it harder for residents to get exercise. An
HIA on this proposed road might include practical recommendations,
like a plan to include safe places to cross the street, wider
sidewalks and better air filtration in buildings whose residents
might be exposed to increased air pollution.
Although the use of HIAs is common with large industry and
government in other parts of the world, it’s just catching on in
the United States. Four years ago, there were fewer than 30
completed assessments in this country. Now, there are well over 100
completed and in-progress HIAs. (You can see a searchable map
of all HIAs in the United States.)The
Health Impact Project
, a collaboration of the Robert Wood
Johnson Foundation and The Pew
, was established to support this growing
field. The project has funded 13 demonstration grants addressing
the health impacts of a wide range of policy decisions, including a
Farm to School bill
in Oregon, the state budget in New Hampshire
and a plan to re-develop an old automobile factory site
, and we’re in the process of reviewing proposals
for a second round of demonstration grants.
With interest in HIAs increasing so rapidly, the Health Impact
Project is receiving more and more requests for training or
expertise. The demand for well-trained HIA practitioners is
outstripping the supply. To tackle this problem, we recently
announced a collaboration with the National Network of Public
that will help create new regional training
centers around the country.
We also house a resource library
HIAs offer state, local and federal officials opportunities to help
stem the rising tide of illness and its associated costs. The
assessments can help policy-makers spend limited resources wisely,
which is timely given the budget crises happening around the
country from Capitol Hill to our town halls. The fact-based
approach can help decision makers do what they want to do, but
better, by building health considerations into the policies that
shape our homes, streets and cities. Just what the doctor
ordered.This information was developed by Aaron Wernham,
M.D., director of the Health Impact Project, a collaboration of the
Robert Wood Johnson Foundation and The Pew Charitable
Trusts.The Network for Public Health Law provides information and
technical assistance on issues related to public health. The legal
information and assistance provided in this document does not
constitute legal advice or legal representation. For legal advice,
readers should consult a lawyer in their state.