ducted HIAs for industry to determine the potential health consequences of various projects. Given the potential health benefits of HIA, the Robert Wood Johnson Foundation, the National Institute of Environmental Health Sciences, the California Endowment, and the Centers for Disease Control and Prevention asked the National Research Council (NRC) to develop a framework, terminology, and guidance for conducting HIA of proposed policies, programs, and projects at the federal, state, tribal, and local levels, including the private sector. As a result of that request, NRC convened the Committee on Health Impact Assessment, which prepared this report.


The U.S. population clearly has not reached its full health potential despite major medical advances and large expenditures on health care. Almost 50% of adults suffer from at least one chronic illness, and obesity, which contributes to many health conditions, has grown to epidemic proportions in children and adults. Poor health has implications not only for the quality and duration of life but for the economy. Health-care spending accounted for 7% of U.S. GDP in 1970, accounted for 16% of GDP in 2008, and is projected to account for almost 20% by 2019. Poor health also results in reduced participation in and productivity of the labor force. Thus, the consequences of chronic illness are huge in suffering and monetary and business costs.

Many scientists, policy-makers, and others recognize that health is determined by multiple factors, including factors that shape the conditions in which people are born, grow, live, work, and age. Policies and programs that have historically not been recognized as related to health are now known or thought to have important health consequences. For example, public health has been linked to housing policies that determine the quality and location of housing developments, to transportation policies that affect the availability of public transportation, to urban planning policies that determine land use and street connectivity, to agricultural policies that influence the availability of various types of food, and to economic-development policies that affect the location of businesses and industry. The recognition that health is shaped by a broad array of factors emphasizes the importance of understanding the possible health consequences of decision-making. In fact, it can be argued that major improvements in public health cannot be achieved without considering the root causes of ill health. Indeed, it has been argued that major health problems, such as the obesity epidemic and its associated health and monetary costs, are essentially unintended consequences of various social and policy factors related, for example, to the mass production and distribution of energy-dense foods and the engineering of physical activity out of daily life through changes in how transportation is organized and how neighborhoods are designed and built.

Accordingly, systematic assessment of the health consequences of policies, programs, plans, and projects is critically important for protecting and

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