Health impact assessment in the United States

The title of the book might suggest a rather systematic and perhaps dry overview of the achievements of the health impact assessment (HIA) community in the USA, but in reality the authors accomplish more as the content extends beyond the HIA technical aspects, and geographically the book has a global reach. The main aim of the book is ‘to give the reader a comprehensive view of Health Impact Assessment as it is practiced in the USA today, as well as some practical tools that are useful in conducting, commissioning, or evaluating HIA’.

The three key defining features of HIA highlighted by the book are informing decision-making, following a structured but flexible approach, and examining the full range of potential impacts on health outcomes and health determinants.

Twenty-five years have passed since the Gothenburg consensus, where the first HIA definition was drafted by a group of HIA pioneers. Since then HIA has become an internationally recognized process, either as stand-alone or as a key component of other types of impact assessment. As a decision-making process, it has been embraced by a variety of actors, such as public health agencies and national governments, private companies and financial institutions, communities and non-governmental organisations as well as academicians. In fact the process can be either a voluntary or regulated process depending on the country or the focus of the assessment, as HIA can be applied to projects, programs, plan and policies. The amount of national or industry guidance on HIA is growing exponentially as each actor attempts to define the best possible process and sequence of steps to satisfy its own requirements. Therefore, HIA is a structured process with flexibility as one of its strengths. But variety is also a challenge for practitioners, proponents and regulators as no perfect recipe or standard process can easily be developed to satisfy all the different uses of an HIA.

This book addresses this challenge in a very innovative way, not by attempting to provide a master recipe valid for all the HIAs, but by collecting examples and building on case studies from a wide variety of sectors and from different geographical areas. The case studies are used throughout the book to exemplify and present the purpose, methods and expected output of each step. This is a vital contribution of the book to the still growing HIA practice for two reasons. First, quite often HIA reports are hard to locate and review, and therefore, are not immediately accessible to those interested in learning more. Second, too often practitioners and officers expect to be given a straightforward guidance for conducting an HIA, forgetting the importance of learning the different methods and the challenges associated with each step of HIA.

The book has been written with a clear audience in mind: practitioners who need to undertake an HIA, decision-makers who use HIA to improve their decision-making process (being the object under assessment either a project or a policy) and in general ‘institutions’ (private or public) commissioning HIA to improve their health and sustainability commitments. Therefore, it is astutely targeting all the different specialists involved in a multidisciplinary process of impact assessment. In order to do so, it does provide an introduction to key disciplines such as public health and planning, and it does provide an overview of the different types of existing impact assessments. These introductory chapters are required to bring the variety of readers to the same level, before embarking on the more technical aspects of HIA steps.

A final key essential feature of the HIA process described in the book is its aim to examine the full range of potential impacts of any proposal on health outcomes and health determinants. This feature is distinctive as most environmental impact assessments focus on the negative impacts, while an HIA also addresses the positive effects on the population and identifies measures to enhance them. Furthermore, an HIA tries to unravel how a change in determinants of health might lead to health consequences. This is a cornerstone of HIA as the major health challenges today's society is facing are complex and multifactorial. Again through the use of case studies, the authors make this process easier to understand and visualize, and hopefully easier for the reader to adopt in their next HIA.

The book finally concludes with a reflection about the potential for HIA to improve the health status of Americans. The main conclusions are that HIA can contribute to continuous improvement in the health status of people and communities, but in order to grow as a process, HIA will need to rely on more partnerships and in expanding the networks of trained professionals. Second, there are multiple opportunities to include health considerations in other forms of impact assessments, and these should be seriously considered as a way to foster change. These conclusions are not only consistent with reflections conducted within the health section of the International Association for Impact Assessment, but are also supported by a series of arguments put forward by the authors. The book is, therefore, an important contribution to the steady advancement and worldwide adoption of HIA as a process to improve equality and sustainable development.