

Health impact assessments (HIA) are increasingly common in the U.S., although rarely required and still underutilized to assess the health effects of decisions made in non-health sectors, even when an evaluation of the health impact is required.

HIAs use a specific systematic approach, which includes stakeholder input, to assess the health impacts of non-health sector actions, such as, building a highway or waste-disposal facility. An HIA is designed to help decision-makers weigh, during their deliberations, the effects of actions on population health, which is notably and broadly defined to include physical, psychological and general well-being. This report reviewed laws and policies in 36 diverse jurisdictions, including 20 states, 10 localities, five tribal nations and the federal government.

Key Findings:

  • Few jurisdictions require HIAs but many have laws open to their use.
  • Even when no explicit authority exists to conduct HIAs, governments are increasingly doing them or relying on information developed through HIAs done by other organizations.
  • Environmental and energy laws are most likely to require or “facilitate” the use of HIAs, as they did in 22 jurisdictions (61% of the sample).
  • In transportation, seven jurisdictions (19%) require or facilitate HIAs. Washington State and Massachusetts specifically require HIAs, while the federal government, through the U.S. Department of Highways, facilitates their broader use.
  • Seven jurisdictions (19%) facilitate the use of HIAs in agricultural projects, and 11 jurisdictions (31%) facilitate their use in Waste Disposal and Recycling.
  • Several key legal themes were identified, including that laws requiring assessments of health risks, usually due to potential exposure to toxins or other hazards, may support use of a broader HIA review.

The report does not recommend HIAs be legally required if already being used voluntarily. But it does identify laws that can be used to advocate for the increased use of HIAs.