Image Source: Davidson, NC.

A Health Impact Assessment (HIA) is a tool that provides guidance on how to improve health and wellness by involving public health experts in the community planning process and decision making. Through an HIA process, the community is able to evaluate potential health impacts of a plan, project, or policy before it is built or implemented. The HIA process not only enhances communication between policy makers and public health professionals, it can also reduce unintended consequences of public investments, expenditures, and policies that may inadvertently produce negative impacts on public health, or missed opportunities to improve public health through design enhancements.

Why is this important to your community?

In the US, health outcomes are often tied to where a person lives and their overall quality of life and access to services. In the CONNECT region, the counties located around Charlotte exhibit more positive health status outcomes overall when compared with most of the surrounding counties. The CONNECT Public Health Disparities Assessment found disparities in public health based on where people live and their ethnicity or race. To address these disparities (and the overall public health of the region), the report recommends that local and regional planning efforts should increasingly incorporate health considerations in plans and funding for capital improvement projects. Health Impact Assessments are one tool to help counties, municipalities, and even state Departments of Transportation evaluate policies and alternatives and in the context of public health and equity.

How does it work?

A Health Impact Assessment is a very structured way of considering the health impacts of policies and projects on those affected, considering both the input of potential users, and known and validated research concerning impacts and outcomes of various policies, programs, and even design features of infrastructure. For example, research has shown that inclusion of a very attractive, ergonomically-appropriate, and highly-visible stairway in public buildings will increase the number of people who use the stairs rather than taking an elevator to go from the ground floor to a first or second floor. Similarly, an HIA may be used to help determine if and what kind of sidewalks will best enhance walkability of a new development or road. And since increases in physical activity are known to support improved public health, HIAs can be a valuable tool to improve health. A recent study by the Center for Community Health and Evaluation shows how decision making is altered in a various number of ways when HIAs are utilized. The recommendations that result from the HIA are intended to increase positive health outcomes and reduce potential negative outcomes. Including public health as a consideration in all types of decision making at the community level is essential for confronting the nation’s health problems and improving overall quality of life in our region.

Ready to get started?

Using the Tool

  • Partner with local health professional to determine whether a Health Impact Assessment (HIA) is likely to add value to a particular project or planning process.
  • If not pursuing an HIA for a particular planning process, invite health organizations to review draft plans and provide comments to integrate public health considerations and perspective into the planning efforts.
  • If pursuing an HIA process, involve health representatives directly in the planning process, either in an advisory / review role or as part of the local steering committee or working group.
    • Have the staff leading the planning process partner with public health representatives and develop an assessment that describes the baseline health of people and groups affected by the plan or project, and then predicts the potential impacts.
    • Develop recommendations, including alternative ways to develop a project, plan, or policy, its location or timing to benefit public health—which may require interviews with potential users (sidewalks are great to promote walking—but the public may have very definite opinions about what type of sidewalk would be needed to promote walking in a specific location). You may need to consider mitigation strategies to lessen potential negative health impacts of a decision or project.
    • Assign responsibilities for ensuring compliance with agreements and monitoring the results of the HIA process.
  • Regularly engage public health professionals in the community’s plans, policies, and projects, particularly in parks and recreation, transportation, land use, and community facilities planning. Consider developing a “protocol” after you have conducted several HIAs, as a guide for when, where, and how HIAs will be used.
  • Monitor and evaluate health indicators and changes in the community’s health status.

Where has it worked?

Davidson Design for Life (DD4L) - Davidson, NC

Image Source: TCDavis. Source License: CC BY-NC-ND 2.0. Adaptations: cropped.



Katherine Hebert

About the Program

The mission of the Davidson Design for Life (DD4L) program is to create a community that is healthy today and even healthier in the future while serving as a model for other small towns by implementing healthy design. Davidson uses the HIA process to evaluate and inform decisions and investments about the built environment in the town, as well as at the regional and statewide level. Through the program, Davidson is able to collaborate with health experts in the planning process and more fully engage residents in discussion about healthier lifestyle options. The program start-up was funded by a CDC grant to conduct HIAs and provide community training to others municipalities.

Why it works

Since initiating the program, Davidson has completed several HIAs and has started to revise the town’s Street Design Standards to improve air quality, promote more walking and biking, and reduce the number of people injured in car accidents. The HIA process was also part of the town’s new Pedestrian and Active Transportation Plan, which included a committee on aging to understand what type of transportation options are needed to allow older adults to remain independent and in their own homes. Since 2011, the program has engaged residents throughout the small town through focus groups, town newsletter surveys, and everyday conversations. One key element of the program is the collaboration that occurs between the planning department and DD4L. By physically sharing an office, staff is able to use resources more efficiently, broaden involvement in the public process, and cross-pollinate ideas between groups that had not previously been at the same table.