key elements of a community health assessment

Health impact assessment is conducted to inform a decision-making process and is intended to be concluded and communicated in advance of the decision that is being assessed. 2007). Links to nonfederal materials are provided as a public service and do not constitute an endorsement of the materials by CDC or the federal government, and none should be inferred. Sources: Veerman et al. For private corporations undertaking an HIA, the decision of whether to make an HIA public and what to disclose may be governed by internal corporate policies, by the standards of lenders supporting the project, or by a government that has jurisdiction over the project (McHugh et al. A preliminary opinion regarding the potential importance of the proposal for health. On the basis of its review of current guidance and practice, the committee recommends that scoping should result in a framework for the HIA and a written project plan that includes the following: The credibility and relevance of HIA to the decision-making process rest on a balanced and complete examination of the health risks, benefits, and tradeoffs presented by the project, policy, program, or plan being assessed. Mindell J, Boaz A, Joffe M, Curtis S, Birley M. Enhancing the evidence base for health impact assessment. Evaluation can be thought of in two useful and complementary ways: self-evaluation of the HIA process and impacts and independent external evaluation. Knowing Your Community: Community Health Assessment as a Powerful Tool Bender, Kaye PhD, RN, FAAN Author Information Journal of Public Health Management and Practice: doi: 10.1097/PHH.0000000000000599 2017 Wolters Kluwer Health, Inc. All rights reserved. However, many HIA reports are available from public agencies, universities, and nonprofit organizations, and the committee found few examples of HIAs led or commissioned by the private sector that were available. Screening is often not well documented, and it is often not clear from an HIA report what factors were considered in making the decision to do an HIA. A growing population of families that have children. It develops the scope of health effects for analysis through systematic consideration of all factors associated with the proposed action that have a potential to influence health, and it narrows the scope to effects that are judged most important for health. Please enable it to take advantage of the complete set of features! Although little has been written on the reasons for keeping HIA information confidential, the committee recognizes that there may be reasons for organizations conducting HIAs to decide not to disclose the results. The potential for the HIA to be completed in the time allotted and with the resources available. Source: SFDPH 2011. Steinemann A. Improving relationships and collaboration between stakeholders. Given that HIA led by the private sector appears to be a rapidly increasing practice, the issue of availability bears further consideration. Another method of scoping is to develop a table that facilitates a systematic and rapid appraisal of all the potential ways in which a proposal might affect health (see Table 3-1). Key elements of community health include: Identifying top public health concerns within the specific geographic area, such as environmental and social factors that affect healthy life choices. The development of recommendations should be guided by a consideration of any available evidence regarding effectiveness. Thus, the assessment phase is separated from the management phase, as recommended elsewhere (NRC 1983). The facts that resources were available and that timelines were appropriate were also relevant to the decision to conduct an HIA. Some use pertinent screening questions, such as the ones noted, and apply a sequential yes-no query to each (Cole et al. Focusing on Health: How Can the Health Impact of Policy Decisions be Assessed? Would you like email updates of new search results? For example, the planning of the Atlanta Beltline, as described later in this chapter, involved the regional planning commission, local legislative bodies, state and federal environmental regulators, and private developers. Robust and continuing efforts to inform decision-makers of the findings and recommendations of the HIA and efforts by HIA practitioners and other stakeholders to champion choices that will benefit health can be an essential part of an effective HIA. If the HIA is based on a thorough analysis, provides complete information so that community members are able to critique the analysis, and is conducted openly, it may provide reassurance to affected communities even if the conclusions do not support the communitys concerns. 2005). As described by Ross (2007, p. 9), the Atlanta BeltLine is a transit, trails, parks, and redevelopment project that uses a 22-mile loop of largely abandoned freight rail line that lies between two and four miles from the city center and affects about 45 neighborhoods. Comprehensive HIAs are most commonly differentiated from rapid and intermediate HIAs by the scope of potential impacts and the need for collection of new primary data. Catholic Health Association of the United States. As noted above, the iterative process is known as adaptive management in the field of environmental management. Evaluation should be planned throughout the community health assessment (CHA) process to assess the impact of your strategies and progress toward your goals. Integrates stakeholder input into the analysis of effects. Criteria for use in the evaluation of health impact assessments. Cancer risk and changes in life expectancy associated with tobacco taxes. Bhatia R, Seto E. Quantitative estimation in Health Impact Assessment: Opportunities and challenges. This information can help develop a community health improvement plan by justifying how and where resources should be allocated to best meet community needs. A discussion of whether the HIA achieved its initial objectives. 2008). The reader will notice that some of the committees descriptions and characterizations overlap with those of other guides; the similarities highlight the consistencies in the field. A central tenet is that peoples experience offers an invaluable perspective on the potential effects of the proposal. A Review Package for Health Impact Assessment Reports of Development Projects. Bennear LS, Olmstead SM. IPIECA/OGP (International Petroleum Industry Environmental Conservation Association and International Association of Oil and Gas Producers). One of the first steps in identifying the parameters of the assessment was to establish an understanding of the BeltLine, a complex project that had been evolving for several years and was expected to be constructed over a 30-year period. The variability in the practice has evolved in the absence of widely accepted practice standards or formal regulatory or procedural requirements for HIA outside NEPA and related state laws (see Appendix A). In general, the baseline profile focuses on health issues and health determinants that may be affected by the proposal rather than on attempting to provide a complete assessment of community health. National Research Council (US) Committee on Health Impact Assessment. Disclaimer. As discussed at the beginning of this chapter, HIAs in the United States are often conducted without a formal legal mandate and by an agency or organization that does not have decision- making authority. A number of corporations and professional associations, such as the International Committee on Mining and Metals and the International Association of Oil and Gas Producers, have guidance for HIA, but relatively few completed industry-led HIAs or environmental, social, and health impact assessments are available on the Internet or on public Web sites that catalog HIA activity. Washington (DC): National Academies Press (US); 2011. Health Impact Assessment: Main Concepts and Suggested Approaches-the Gothenburg Consensus Paper. Scoping establishes the boundaries of the HIA and identifies the health effects to be evaluated, the populations affected, the HIA team, sources of data, methods to be used, and any alternatives to be assessed. Bhatia R, Farhang L, Gaydos M, Gilhuly K, Harris-Roxas B, Heller J, Lee M, McLaughlin J, Orenstein M, Seto E, St Pierre L, Tamburrini AL, Wernham A, Wier M. Bhatia R, Branscomb J, Farhang L, Lee M, Orenstein M, Richardson M. Birley M. Health Impact Assessment in multinationals: A case study of the Royal Dutch/Shell Group. For example, in Oregon, an independent health-oriented nonprofit organization conducted an HIA of a series of proposals to reduce vehicle miles traveled in a bill intended to reduce greenhouse- gas emissions (UPH 2009). The HIA team identified the following critical issues that could affect the health of the study area population: access and social equity, physical activity, safety, social capital, and environment (including air quality, noise, and water management). The committee selected a six-step framework as a clear way to organize and describe the critical elements of an HIA. Information on costs of HIAs would be valuable in determining whether an HIA can be undertaken with the resources available and could inform the screening process as described below. Screening involves making an initial rapid judgment of whether an HIA is likely to be feasible and valuable. Since there are different models to guide assessment and planning, as well as a variety of organizations and agencies that carry out these activities, there may be confusion in choosing among approaches. . As part of the assessment phase, a set of specific indicators that can be used to describe the baseline and potential changes in health status or health determinants should be developed. Box 3-2 provides an example of scoping for the HIA of a proposed development in Atlanta. Possible Elements of a Community Team. Box 3-1 provides an example of how screening on a proposal for a residential housing program was conducted. 2006). The National Partnership for Women and Families commissioned Human Impact Partners and researchers at the San Francisco Department of Public Health to conduct an HIA of the federal Health Families Act of 2009, (more). Efforts to support health-based recommendations must be carefully distinguished from biased efforts to promote a specific outcome or measure on the basis of an incomplete or inaccurately weighted comparison of favorable and unfavorable aspects of a proposal or of a predetermined political agenda. Directive 2001/42/EC of the European Parliament and of the Council of 27 June 2001 on the assessment of the effects of certain plans and programmes on the environment. HHS Vulnerability Disclosure, Help The committee notes that public involvement is important in screening; information provided by stakeholders may provide insight into the potential effects of a proposal under consideration that contribute to the final determination of whether an HIA is warranted and likely to be useful. 1999; Roscam Abbing 2004). The report of the Healthy Families Act HIA provides a clear description of the steps in the analytic process. Johnson BL. In this approach, the aspects of a proposal that may affect health are listed and considered in major categories of health and illness. Alerting decision-makers to the more general need to focus on health in future decisions. Such information would be useful for informing future implementation. The committee notes that each approach for gathering and interpreting data may be conducted in ways that are more or less participatory, engaging stakeholders in shaping the research questions, interpreting the findings, and developing recommendations on the basis of the findings. Public Health Accreditation Board Acronyms and Glossary of Terms Version 1.0 [PDF 536KB], July 2011, as adapted from Healthy People 2010 and CDCs National Public Health Performance Standards Program. That issue is discussed at greater length in Chapter 4. Even when there is substantial uncertainty, an assessment can illuminate potential causal pathways thateven when there appear to be conflicting influences on a specific outcomecan point the way toward a flexible framework for monitoring and managing any impacts that might occur as the proposal is implemented. The most vulnerable populations were identified as people of low economic status, children, older adults, renters, and the carless. The enacted legislation is consistent with some of the recommendations of the HIA, but there were no data to evaluate whether those drafting the legislation were influenced by the recommendations; there were no interviews with legislators over the course of the legislative process (Human Impact Partners 2010). Framework for Environmental Health Risk Management Final Report. 2006). Prospective health impact assessment: Pitfalls, problems, and possible ways forward. Conversely, to have the greatest relevance as an informational and planning document and to ensure judicious use of resources, the HIA should ultimately focus on the health effects of greatest potential importance. Some decisions to conduct HIA may depend on a specific statutory requirement or mandated procedure. The wide array of evidence includes public testimony on local conditions and concerns, interviews with key informants, surveys, epidemiologic analysis (for example, observational cross-sectional surveys, longitudinal studies, and intervention or experimental studies), measurement of physical environmental conditions and modeling (for example, modeling of infectious-disease propagation or dispersion of noise and air pollutants), and expert opinion. McAuliffe M. Developers of Proposed Springfield Biomass Plant tell Public Health Council: Nothing Less Than the Best. The decision-maker must ultimately balance health considerations with the many technical, social, political, and economic concerns that bear on the proposal. Federal government websites often end in .gov or .mil. In contrast, the effect of decisions on some health outcomes (such as cancer or obesity) may take years to occur and may have multiple contributing factors. Scoping identifies appropriate data sources for the analysis and should also identify important data gaps. Observations that might indicate some influence of the HIA include discussion about HIA by legislators debating a proposal. A description of the HIAs impact on decision-making (to the extent that salient decisions have occurred by that time) as measured by an accounting of HIA recommendations that were adopted and an evaluation of available evidence that suggests whether and how the HIA played a role in decisions or contributed to changes in decision-makers knowledge, attitudes, or positions. Key elements of the model include: Disseminating surveys Conducting key informant interviews and focus groups Incorporating county-level data on health Small rural hospitals may lack the required resources to successfully address issues that may be identified as a result of a CHNA. 1. New surveys to address data gaps or questions specific to the proposal in question are also common in comprehensive HIAs. For example, the San Francisco Department of Public Health routinely screens major projects and plans to ensure adequate analysis and mitigation of environmental health impacts. L 91-190, 42 U.S.C. In other cases, it may not be possible to attribute a particular decision to the influence of an HIA (Wismar et al. Health impact assessment: A tool to help policy makers understand health beyond health care. Sources: Adapted from Cook et al. This review outlines the epidemiology of suicide and suicidal behavior in young people. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Culturally competent care means providing care within the context of a patient's culture and beliefs. In general, this approach describes effects directly related to the proposal (such as changes in air emissions) and traces them to health determinants (such as air quality) and finally to health outcomes (such as asthma). Saving Lives, Protecting People. For that reason, it is important that scoping begin with a systematic consideration of all potential effects rather than limiting consideration to a subset of issues predetermined by the teams research interests or regulatory requirements. That permits recommendations to form the basis of effective implementation and management rather than merely providing a static system without the capacity to adapt. Within several of these components, we discuss characteristics that are critical to improving community health. The committee recognizes that undue bias in an HIA may compromise its credibility and efficacy. Intermediate HIAs require more time and resources and involve more complex pathways, more stakeholder engagement, and a more detailed analysis but include little collection of new data. More structured approaches have also been used. Identifying high-priority issues has been addressed in numerous contexts outside HIA, including human-health and ecologic risk assessment (see, for example, EPA 1989, 1992; NRC 1996, 2009). The committee notes that some guides consider evaluation not as a step of HIA but rather as an independent practice that supports the development of the field (see Appendix E). However, it appears to be increasingly accepted that HIA is carried out to inform the decision rather than to evaluate the impacts after the decision is made, and there is general agreement on the procedural steps of HIA (Harris-Roxas and Harris 2011). Decision-making is rarely based solely on scientific evidence but instead takes into account an array of political, economic, technical, and practical considerations. The assessment also highlighted several potential benefits, such as funding for infrastructure and health care; increased employment and income; and continued funding of existing infrastructure (BLM 2007, p. 500). The committee considers self-evaluation and independent evaluation to be essential for moving the field ahead. A logic framework was produced to guide the assessment. Identifies limitations and uncertainties clearly. In: Kemm J, Parry J, Palmer S, editors. A plan is typically updated every three to five years. Any logic models or scoping tables that were completed should also be included. Because the degree to which the proposed action affects public health or safety is one factor considered, this process could be considered the equivalent of the screening step of an HIA. Example of a Table for Rating Importance of Health Effects. Commonly, a core team is responsible for the bulk of writing and analysis. Or, in some cases, there may be unpublished evaluations of measures that have been implemented in similar scenarios. Outcome evaluation requires a suitable research design, ideally an appropriate comparison group, and data from the monitoring of health outcomes or of changes in health determinants as described above. The .gov means its official. The HIA conclusions and recommendations should be presented in a manner that is clear and easily understood. It would then fall to the decision-makers to determine routes that met those criteria. Scoping considers input from many sources, including preliminary literature searches, public input, and professional or expert opinion in fields relevant to the proposal. In this report, HIA practitioner refers to the person (or people) involved in conducting an HIA. Fourth, disclosure of potential impacts may benefit industry by reducing the risk of litigation and by reducing tort liability by fulfilling requirements to warn those potentially responsible and potentially affected before the effects occur. Box 3-4 provides several examples of topics that have been addressed in HIA by using quantitative methods. The baseline profile characterizes the health status of affected populations and includes trends and factors (social, economic, and environmental) known to affect health. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. A variety of planning and zoning, funding, and environmental regulatory decisions were required for the BeltLines various components to be developed. [online] Available: ICMM (International Council on Mining and Metals). To address that concern, monitoring of concentrations of selected contaminants in local fish was proposed as a mitigation measure. Presidential/Congressional Commission on Risk Assessment and Risk Management. It can also assess whether the HIA had other important effects, such as building new collaborations among agencies, ensuring that stakeholder perspectives were considered, and increasing awareness of previously unrecognized health considerations. Scoping identifies those likely to be affected by the proposed policy, project, program, or plan. Cookies used to make website functionality more relevant to you. For example, desktop HIAs may consider indirect stakeholder input through review of public comments submitted outside the HIA process, comprehensive HIAs may have relatively little stakeholder engagement, and rapid-appraisal HIAs of smaller-scale proposals may involve collection of some new data to inform the analysis. It outlines a set of principles that inform an ensuing discussion of key elements of community assessment. Collaboration with decision-makers or consultation with experts familiar with the legal or regulatory context may be the most effective way to ensure that recommendations are pragmatic and can be practically incorporated into the decision-making process. It should also identify the points at which there is an opportunity for information from the HIA to influence decisions. Box 3-3 provides an example of an assessment step that was based on interviews with people who were likely to be affected by a decision and that considered their impressions of the effects that industrial activities were having and were likely to continue to have on individual, family, and community life. Human Impact Partners. In practice, some HIAs have focused on a specific health end point, such as obesity, or health concerns related to a single impact of the proposal, such as the health effects of air pollutants, most likely without using a systematic approach that considered and eliminated other impacts (see, for example, Kuo et al. Leventhal T, Brooks-Gunn J. The tasks or elements that are described as part of an HIA are fairly consistent in the peer-reviewed literature and guides reviewed by the committee. Jagannathan R, Camasso MJ, Sambamoorthi U. The characteristics and approaches of evaluation should be chosen to fit the time, resources, and data available to the HIA team. The available data, however, may not be sufficient, and the HIA team may make a decision to dedicate resources to collection of new data. Examples of Health and Behavioral Effects That Have Been Addressed Quantitatively in HIA. It is also useful to assess the political context of the proposal to be assessed and consider, for example, the major political drivers of the proposal, the arguments made by political supporters and those opposed to the proposal, and any economic or technical constraints that limit the alternatives that can be considered. Chapter 4 discusses the extent to which an HIA can ensure the implementation of recommendations. Characteristics unique to the affected community may not be obvious to HIA practitioners who are outside the community. A complete nursing health assessment requires a health professional to examine a patient in a systematic fashion, from head to toe. 2008). Mindell JS, Boltong A, Forde I. In some cases, the lack of a recommendation may reflect a desire to avoid a perception that the HIA is a one-sided advocacy exercise, particularly when options for recommendations would involve adopting a position wholly supportive of or opposed to the proposal being assessed. Another variation, rapid-appraisal HIA, has been described and in some texts includes explicit public engagement through an initial half-day workshop for stakeholders (Parry and Stevens 2001; Mindell et al. The committee emphasizes that the effectiveness of recommendations depends not only on the scientific validity of the interventions identified but on their relevance to the affected communitys concerns and their applicability within the regulatory or legislative framework of the proposal being considered. A plan for continuous monitoring, adaptation of mitigation measures, and verification of performancealthough not currently a uniform aspect of HIA practice helps to ensure that measures are carried out and achieving their objectives. On the basis of its review, the committee synthesized the information from guidance, practice, and literature to propose criteria that define an HIA and draw several conclusions regarding HIA practice. Whereas HIA aims to predict the effects of a decision before it occurs, outcome evaluation assesses whether the implementation of a decision has actual effects on health or health determinants (Parry and Kemm 2005). An evaluation plan should have been developed early in the HIA process to guide selection of the appropriate methods for conducting evaluations. A smaller set of related indicators was endorsed for use in monitoring key elements of community health status (CDC, 1991). 2009). Simply producing and disseminating a report may not be sufficient to secure adoption and implementation of HIA recommendations. First is screening that measure the health effects of a proposal and whether the health assessment will yield useful HEALTH ASSESSMENT AND COMMUNICATION 4 information to decision makers and stakeholders. 2006) as a technical definition of HIA: HIA is a systematic process that uses an array of data sources and analytic methods and considers input from stakeholders to determine the potential effects of a proposed policy, plan, program, or project on the health of a population and the distribution of the effects within the population. Example of a logic framework that maps out the possible causal pathways by which health effects might occur. As discussed above, additional benefits may include, for example (Wismar et al. The use of the information by the decision-maker is discussed at greater length in Chapter 4 in the section Managing Expectations.. Source: ICMM 2010. Different HIA guides vary somewhat as to the specific descriptors that should be used, and practice is highly variable. Evaluating health impact assessment. A related issue is incomplete disclosuresuch as disclosure of only summary information without data or analysis, disclosure only by electronic media in communities unlikely to have access, and English-only reports. 2007; Harris-Roxas and Harris 2011). On the basis of its review of available literature, HIA guides, and practice standards, the committee has synthesized the key criteria that define HIA and that set it apart from related approaches to public-health practice and policy. Findings of each stage of the HIA and a summary of outputs at the end of each stage. The assessment phase includes two tasks. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. Quigley R, den Broeder L, Furu P, Bond A, Cave B, Bos R. Roscam Abbing EW. That issue will probably continue to challenge the credibility of HIA practice in the eyes of some audiences and highlights the need for continued research and refinement of methods to improve its value to decision- makers (Petticrew et al. Petticrew M, Cummins S, Sparks L, Findlay A. Validating health impact assessment: Prediction is difficult (especially about the future). An initial brief summary of the pathways through which health could be affected and the health effects to be addressed, including a rationale for how the effects were chosen and an account of any potential health effects that were considered but were not selected and why. For example, although an HIA may not be able to incorporate engineering or economic specifications for alternate routes for a proposed highway, it could discuss factors that would influence health outcomes, such as indicating that a desirable route would be, for example, 100 m from any school or elderly facility or would not be proximate to high-population-density areas with a number of vulnerable people. 2006; Jagannathan et al. The goal was to incorporate health considerations into the decision-making process by predicting health consequences, informing decision makers and the public about health impacts, and providing realistic recommendations to prevent or mitigate negative health outcomes (p. 9). Mapping out the timeline for the decision-making process can be helpful, and for large and complex programs and projects, identifying the agencies involved and their jurisdictions is important. Improving community health starts with knowing the factors that impact people's health, both inside and outside of the clinic. citrix workspace advanced preferences won't open, alicante to murcia by train,

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