key elements of a community health assessment

2009; Human Impact Partners 2009a,b; AECF 2011. The first is to create a profile of the population affected, which includes information on the demographics, baseline health status, and social, economic, and environmental conditions that are important to health. Health Impact Assessment: Main Concepts and Suggested Approaches-the Gothenburg Consensus Paper. The bulleted list below provides examples in which some health impacts or behavioral outcomes have been quantified. Some use pertinent screening questions, such as the ones noted, and apply a sequential yes-no query to each (Cole et al. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. 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. A Guide to Health Impact Assessment: A Policy Tool for New Zealand. Because it will often not be practical or possible to address all direct and indirect health effects that appear theoretically possible, it is important to select issues carefully. Atlanta BeltLine Redevelopment Plan. Human Impact Partners and San Francisco Department of Public Health. It was concluded during the screening phase that an HIA would add value to project outcomes. Health impact Assessment: Concepts, Theory, Techniques and Applications. Second, it allows findings to be reviewed and improved. Catholic Health Association, Guide to Assessing and Addressing Community Health Needs [PDF-1.5MB], June 2013. 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. II, Selected Evidence Base Breaking the Cycle, East London and the City Health Action Zone and Queen Mary. MeSH In others, scoping may identify studies that can be carried out by the HIA team or studies that can be carried out by experts involved in some other aspect of the planning, permitting, or review process (such as air-quality or traffic-safety analysis). 2005). A growing population of families that have children. Parry JM, Kemm JR. In practice, however, explicit consideration of health has been rare (Steinemann 2000; Cole et al. Data and results are measured consistently across participants. The decision-maker must ultimately balance health considerations with the many technical, social, political, and economic concerns that bear on the proposal. That explanation is particularly important when public funds are to be used for an HIA because the public may want to understand the basis for allocating sparse public resources. Recommendations form the core of a health-management plan, but the plan also determines authority for and assigns responsibility for implementing each recommendation, establishes a monitoring plan, and creates or suggests mechanisms to verify that assigned responsibilities are being met. The associations between expected disturbances and changes in health were then analyzed in more depth to look at the alternatives proposed for the expansion and at the cumulative effects of oil exploration and extraction. The facts that resources were available and that timelines were appropriate were also relevant to the decision to conduct an HIA. Health Impact Assessment on Policies Reducing Vehicle Miles Traveled in Oregon Metropolitan Areas. Accessibility An official website of the United States government. For example, rather than providing an estimate of lung-cancer rates in a small community, an HIA might identify smoking rates and important sources of airborne pollutants in the communitys airshed. 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. HIA provides recommendations on monitoring and managing those effects. 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). Harris P, Harris-Roxas B, Harris E, Kemp L. Harris-Roxas B, Harris E. Differing forms, differing purposes: A typology of health impact assessment. Morgan RK. These common components included preplanning; developing partnerships; developing vision and scope; collecting, analyzing, and interpreting data; identifying community assets; identifying priorities; developing and implementing an intervention plan; developing and implementing an evaluation plan; communicating and receiving feedback on the Disclosure requirements and practices vary considerably among development lenders and private-sector proponents. The committee notes that outcome evaluation considers the effects of the whole decision, including changes made as a result of HIA recommendations. The Affordable Care Act requires all nonprofit hospitals to complete a community health needs assessment (CHNA) process every three years. Finally, effects that are plausible but are not supported by available evidence include fewer hospitalizations because workers are able to receive the preventive primary care needed to maintain good health. For each step, the committee describes the basic purpose, objectives, and practice elements; summarizes the main outputs; and presents conclusions regarding pertinent issues raised. Influences on practice include the timeline, resources and skills available to the HIA team, the factors being considered and the data available for analysis, and the legal and regulatory context of the decision-making process. To receive email updates about this page, enter your email address: We take your privacy seriously. The source of public funding for the project was the Tax Allocation District (TAD), and only within the districts boundaries could funding be collected and bond money spent. Sources of information used in a baseline profile might include census data, hospital-discharge records, disease registries, and population and behavior surveys, such as the Behavioral Risk Factor Surveillance Survey, in which information is collected on different geographic scales. Mindell J, Biddulph J, Taylor L, Lock K, Boaz A, Joffe M, Curtis S. Improving the use of evidence in health impact assessment. National Library of Medicine The grouping of the elements in discrete stages or steps of an HIA is less consistent; some guides list as few as five steps, and others describe as many as nine (Quigley et al. 2006). 2007; ICMM 2010). UPH (Upstream Public Health). Scoping also determines who will be part of the HIA team and establishes a plan for technical oversight and review, stakeholder participation and involvement, and involvement of and interaction with decision-makers. 2009; Castro et al. HIAs are also done by private consultants who are hired by a project proponent or decision-maker or by private-industry stakeholders. The first step in the framework is typically a determinant of health, such as air pollution, traffic, employment, or noise. 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. Good Practice Guidance on Health Impact Assessment. Federal government websites often end in .gov or .mil. A community health improvement plan is critical for developing policies and defining actions to target efforts that promote health. The approaches can provide useful information on how people view the proposal, that is, how it is expected to affect them and potentially improve or harm their quality of life. Funding Acknowledgement The expected resource requirements of the HIA and the ability of the HIA team to meet them. Poorly selected proposals may result in HIAs that add little new information and consume considerable time and resources of the HIA team to complete and of recipients to review. Qualitative evidence provides a context-specific view of peoples lives. A community health assessment often yields a long list of public health needs, issues, and problems. There are six elements that make up a health assessment. Would you like email updates of new search results? Science and Decisions: Advancing Risk Assessment. In 2005, an HIA was conducted by a multidisciplinary team. Action plans have mutually reinforcing activities. 2007; Harris-Roxas and Harris 2011). The local North Slope Borough governmentan agency that participated in preparing the EISconducted an HIA, which was integrated into the EIS report. HIA recommendations take various forms, and some examples are provided below. Screening establishes the need for and value of conducting an HIA. International Finance Corporation Performance Standard 4 Rev -0.1, Community Health, Safety, and Security. Health impact assessment: A tool to help policy makers understand health beyond health care. Jones and Bartlett, 2009, as adapted in Public Health Accreditation Board Acronyms and Glossary of Terms Version 1.0 [PDF 536KB], July 2011. Prospective health impact assessment: Pitfalls, problems, and possible ways forward. Integrating human health into environmental impact assessment: An unrealized opportunity for environmental health and justice. Monitoring outcomes can in some cases help to test the validity of predictions and inform future analytic methods. Cole BL, Fielding JE. 2007). Thank you also to the ACHI Community Health Assessment Toolkit Workgroup for ongoing insight and contributions. EPA (U.S. Environmental Protection Agency). 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. Schweinhart LJ, Montie J, Xiang Z, Barnett WS, Belfield CR, Nores M. Scott-Samuel A. 2010). 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). Scholars point to a remarkable consistency in the basic elements that are generally included in descriptions of HIA (Mindell et al. Public Health: What It Is and How It Works. HIA practice is often defined in terms of several categories. The final draft responds to public comments and incorporates necessary changes or new information. The committee concludes that when alternatives to the proposal being assessed are under consideration, the HIA team should assess the impacts of each alternative. 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. 2023 by the American Hospital Association. The American Hospital Associations review of the IRSs final rules for CHNAs and implementation strategies can be foundhere. Office of Disease Prevention and Health Promotion, US Department of Health and Human Services. 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. More structured approaches have also been used. The discussion below briefly provides definitions and key features of HIA monitoring and evaluation. Different HIA guides vary somewhat as to the specific descriptors that should be used, and practice is highly variable. HIA recommendations take various forms, and some examples are provided below. The selection of analytic methods for HIA is driven by the complex pathways and the multiple, sometimes conflicting, influences on any given health outcome and is also affected by the decision-making context. Scoping should therefore entail a deliberative process that involves engagement of stakeholders. Human Health Evaluation Manual Part A. EPA/540/1-89/002. The committee notes that the diversity of approaches and decision contexts imposes challenges for determining the resources required for conducting an HIA. A large and growing body of quantitative evidence is available; where specific additional information is needed and resources are available, HIA teams may collect new quantitative data in the course of conducting an assessment. In addition, federal and state policy and accreditation requirements may be revised or implemented to better facilitate assessment and planning collaboration between health departments, hospitals, and others for the purpose of improving community health. 1 Upon completing the assessment, hospitals develop implementation strategies to address the significant community health needs identified in the CHA. Retrieved fromhttps://www.chausa.org/communitybenefit/assessing-and-addressing-community-health-needs Advisory, steering, and technical oversight committees are also commonly convened during scoping. 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 HIA conclusions and recommendations should be presented in a manner that is clear and easily understood. Developing new cross-disciplinary and interagency collaborations. All rights reserved. The baseline profile characterizes the health status of affected populations and includes trends and factors (social, economic, and environmental) known to affect health. They can take longer than a year to complete. One approach uses a logic framework that maps out the causal pathways by which health effects might occur (see Figure 3-1). The toolkit provides a foundation for meeting the relevant IRS requirements. 2001). This plan is used by health and other governmental education and human service agencies, in collaboration with community partners, to set priorities and coordinate and target resources. FOIA Source: SFDPH 2011. In those cases, the HIA team may need to rely on established principles of health promotion and disease prevention to develop approaches to minimizing or mitigating the identified effects. The second task is to analyze and characterize effects on health and its determinants for the proposal and for any alternatives under consideration relative to the baseline and to each other. Assessing alternatives in parallel with the proposal can aid decision-making by highlighting tradeoffs and actions that can be taken to achieve the desired outcome while minimizing harms. Box 3-4 provides several examples of topics that have been addressed in HIA by using quantitative methods. New surveys to address data gaps or questions specific to the proposal in question are also common in comprehensive HIAs. 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. other key elements that will be important for the work moving forward. 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. HIA is meant to assist decision-makers, so although the act of reporting is a formal step in the HIA process, it is also in the interest of decision-makers and the HIA team to keep in constant communication throughout the HIA process so that emerging results can be incorporated into the policy, plan, program, or project. Logic frameworks can be used as part of stakeholder engagement to develop a shared understanding of how a project will develop and the outcomes that can be expected (Cave and Curtis 2001a,b; Cave et al. Although a wide variety of excellent resources on community health assessment and CQI currently exist, those materials generally do not link assessment and CQI concepts and techniques in the way that is envisioned for . The variation partly reflects the wide array of applications of HIA; for example, it is not necessary or feasible to use the same approaches to involve stakeholders for a local project and for a high-level state or national policy. It can also include information from social-science and epidemiologic studies regarding the strength of associations between the social and physical environment (such as air and water quality and economic impacts) and health outcomesinformation essential in the quantitative prediction of health effects. National Research Council (US) Committee on Health Impact Assessment. Mindell JS, Boltong A, Forde I. Adopting a position for or against a proposal (for example, support for or opposition to a legislative proposal). However, the committee notes that no published studies in the United States have attempted to quantify the costs of undertaking an HIA across a variety of settings. The Association for Community Health ImprovementsCommunity Health Assessment Toolkitoffers a nine-step pathway for conducting a CHA and developing implementation strategies. Key Elements of Community Health Improvement Planning: From Assessment to Action Planning Key Elements of Community Health Improvement Planning: From Assessment to Action Planning CHA-CHIP Demonstration Project Improvement www.assesstoolkit.org April 23, 2012 The lines are muted. 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. Identification of apparent data gaps and of data collection that could be undertaken to address the gaps or a rationale for not undertaking data collection. o Who is ultimate decision maker if the event needs to be cancelled, postponed or similar? 2004; Bhatia and Wernham 2008). Screening: HIA of a Residential Housing Program. IPIECA/OGP (International Petroleum Industry Environmental Conservation Association and International Association of Oil and Gas Producers). All information these cookies collect is aggregated and therefore anonymous. Before Process evaluation can range from a simple self-assessment that is undertaken at the end of an HIA and focuses on a few variables that are relatively simple to describe, track, or measuresuch as the methods used, degree of certainty of predictions, and approach to stakeholder engagementto a more comprehensive case study that seeks to evaluate the HIA process holistically. 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. This toolkit was partially supported by funding from the Centers for Disease Control and Prevention through Cooperative Agreement Number 5U38OT000211-03 with the Public Health Foundation.

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