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Psst! Health Impact Assessments Offer New Pathways to Healthier Environments

2014 August 14

By Aaron Wernham

It’s no secret that residents of low-income communities frequently experience serious health problems as a result of their living environments. Air pollution and substandard housing are a root cause of asthma and other respiratory diseases. Inadequate access to healthy foods increases the risk of diabetes and obesity. A growing body of research shows that a lack of economic and educational opportunity also results in poorer overall health. Seeking ways to respond to this challenge, policymakers across the country are turning to health impact assessments or HIAs.

A map of HIAs in the US

Click to see an interactive map of HIAs in the US

A health impact assessment is a fast-growing tool that helps ensure that proposed policy changes will improve health, especially in low-income and predominantly minority communities that are often disproportionately exposed to environmental risks such as air pollution and poor-quality housing. HIAs use a flexible approach that brings together public health expertise, scientific data, and input from community and other stakeholders to examine the potential health risks and benefits of key policy proposals. Based on the potential effects identified, HIAs provide practical recommendations to capitalize on opportunities to improve community health and to minimize any potential health risks before it’s too late to correct them.

HIAs can be used to inform decisions in a variety of policy areas, from transportation and housing to energy and education. A recent evaluation published by the Robert Wood Johnson Foundation found that federal, state, local, and tribal legislators, public agency officials, and many others are using HIAs to craft smarter policies that promote safer and healthier communities.


One assessment completed in 2013 gave low-income communities in North Minneapolis a voice in planning a new transit system. The Bottineau Transitway’s proposed light rail routes travel through several low-income neighborhoods where residents experience higher-than-average rates of serious health conditions such as asthma, diabetes, and obesity. With that in mind, Hennepin County’s Department of Housing, Community Works, and Transit conducted an HIA alongside the project’s environmental impact statement, a study that guides county, state, and federal planning.

The assessment found that the transitway system could significantly improve health in North Minneapolis by reducing traffic congestion, improving air quality, providing greater access to grocery stores and healthy food, and opening up employment and educational opportunities in other parts of the city. Based on the findings, county officials developed a set of recommended actions to maximize the transitway’s health benefits. Today these officials are increasing outreach to underrepresented minority stakeholders, promoting residential and commercial growth that will benefit low-income communities, and working to ensure that affordable housing remains available. As a result, the Bottineau Transitway will be more responsive to the community’s needs and ultimately support a healthier North Minneapolis.


Assessments carried out in Alaska beginning in 2007 to answer health questions raised by Alaska Native communities regarding proposed oil and gas and mining projects led to the use of HIAs as a routine part of the state’s permitting process. The first of these informed the U.S. Bureau of Land Management’s (BLM) consideration of proposed oil and gas leasing in the Northeast National Petroleum Reserve. Village residents raised questions about health effects related to air quality, the potential for contamination of local fish and game (a critical source of food), and social changes related to the influx of nonresident workers.

The HIA, which was completed in 2008, brought together the tribal government and the BLM to address these concerns. Ultimately, the BLM adopted additional protections for hunting and fishing areas to protect local food sources andprovide new monitoring for pollutants in the air and food supply near villages. Collaboration among tribal governments, state and federal regulators, and health officials on this and several other HIAs between 2007 and 2009 demonstrated the value of this approach and ultimately led to the establishment of the state’s HIA program.

The secret’s out. The voices of community members, influential champions, and other stakeholders can be deployed in ways that build momentum for considering and adopting HIA recommendations. Nationwide, more than 300 HIAs have been completed or are underway in diverse communities (view them on the Health Impact Project’s interactive map), demonstrating the power of HIAs as a tool to help decision makers develop healthier communities and environments.

About the Author: Aaron Wernham, M.D., is the Director of The Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The Project is a national initiative dedicated to promoting the use of health impact assessment in the United States.

Editor's Note: The opinions expressed here are those of the author. They do not reflect EPA policy, endorsement, or action, and EPA does not verify the accuracy or science of the contents of the blog.

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5 Responses leave one →
  1. Kim permalink
    August 16, 2014

    HIA’s should be a part of all the planning and decision making processes that governments do (Federal, State & Local). I think this would definitely help when deciding on priority areas for work. Thank you for the map it gave me a broader understanding of how these are being used.

    Does the EPA use HIA’s in their decision making process?

  2. Natalie Cox permalink
    August 17, 2014

    Aaron Wernham,

    I believe HIA is another form of abuse. Just sit there and watch.
    An application of WISDOM is to understand that HUD agreements with private and non for profit organizations are the CAUSE of illness. Why doesn’t HUD STOP abusing their business clientele, the poor. The owners are sicker than the houses that they try to rent. Why doesn’t monies go to demolish these houses that sicken not only section 8 business clientele, these houses/rental property also sicken innocent bystanders walking or driving by. My Health Assessment is that HUD needs to reexamine their ideas, policies and behavior. Don’t blame the poor: if you choose to not keep debt does that make you poor Aaron Wernham?

  3. kolp permalink*
    August 28, 2014

    Hi Kim, thanks for the Question. EPA’s Sustainable and Healthy Communities Research Program is supporting the use of HIAs for community decision making and exploring HIA for use at the state, regional and federal level. EPA is not using HIA in Agency decision making at this time.

  4. Rhonda permalink
    August 31, 2014

    I think HIA’s can be a positive aspect to a project as long as the voice and knowledge of the impacted communities plays a significant role in informing the decisions that will be made.

    Rhonda Rizzio

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