Guest Post: Using Health Impact Assessments to Transform Health in America

Note: the following post is from Robin Mockenhaupt, Chief of Staff for the Robert Wood Johnson Foundation.

To build a healthier America we will have to look beyond traditional medical care.

We will have to build health into the design of our towns and neighborhoods and make it easier for people to live a life filled with healthy choices.

The Robert Wood Johnson Foundation Commission to Build a Healthier America has been advocating for this since it released, “Beyond Health Care: New Directions to a Healthier America,” in April.

But how can we bring about such a revolution?

One promising way to make the changes we need can be seen in last week’s Journal of the American Medical Association. It is a commentary on Health Impact Assessments (registration required), or HIAs, written by Janet Collins of the Centers for Disease Control and Prevention and Jeffrey Koplan of Emory University.

The authors say that HIAs can be used to examine the effects that a policy or program might have on the health of a population. They’re similar to environmental impact assessments that have been used for many years to evaluate a policy’s effect on air or water quality.

Can they be used to help transform the health of America?

Absolutely.

Here’s how they work:  An HIA is a combination of tools or methods used to judge a policy or program’s impact on health outcomes like obesity, physical activity or social equity. Used effectively, they can increase the likelihood of a healthy outcome and bring health issues to the attention of transportation planners, zoning officials or others who might not be familiar with public health.

HIAs are already being used in Europe and Canada to evaluate policies designed to promote good health. Here in the United States, however, the field of HIAs has just started to gain momentum, building on 20 years of evidence and recognition of the impact that physical activity, air quality and injury can have on people’s health.

Collins and Koplan point out that HIAs could be used to examine the health effects of zoning policies that lead to a high density of fast food outlets. Policymakers could use the HIA to change zoning and other policies in a way that encourages a healthier mix of food stores.

That observation, as many of you who are familiar with the Commission know, fits with a critical lesson that the Commission learned during its journey: not everyone in America has the same opportunities to make healthy choices.

For example, people living in disadvantaged neighborhoods (places where fast-food outlets are on every corner) will have more trouble eating healthy foods. Those same people often are afraid to take a daily walk and some must travel miles just to get to a full service grocery store that sells fresh produce.

HIAs could also be used to examine educational policies that have pushed some school districts to cut out physical education classes or recess in order to fit in more classroom time. An HIA would reveal the troubling health outcome of such a policy: Kids in a school that cuts out recess are at risk of not getting daily exercise, which we know is crucial to good health – and also a significant tool in the fight against childhood obesity.

The Commission’s report found that for many Americans, kids included, there are barriers to living a life filled with fresh, nutritious food and lots of opportunity for exercise in a community that promotes safety and wellness.

At the Robert Wood Johnson Foundation, we believe that everyone must take responsibility for his or her health. But not everyone has the opportunity to make the choices that promote vitality and fitness.  We must overcome obstacles and improve opportunities for all Americans to make healthier choices.

HIAs are a powerful way to remove the barriers that make it hard – if not impossible – for some Americans to live longer, healthier lives.