Risk Assessment in the Federal Government: Managing the Process. Community health assessment and community health improvement planning are continuous, systematic processes for assessing and addressing health needs in a community. 2007; Bhatia 2010). The committee notes three considerations that may be particularly important for producing effective, actionable recommendations. Thus, HIA teams may include not only health experts but professionals in other related disciplines, such as air or water quality or traffic modeling. A description of the proposed policy, program, plan, or project that will be the focus of the HIA, including the timeline for the decision and intervention points at which HIA information will be used. Experimental evidence of welfare reform impact on clinical anxiety and depression levels among poor women. Knowing Your Community: Community Health Assessment as a Pow - LWW 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. The committee recognizes that undue bias in an HIA may compromise its credibility and efficacy. 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. Centers for Disease Control and Prevention. To provide this care as a community health nurse, you need to continually acquire knowledge, refine skills, and assess yourself. The .gov means its official. The nature of the proposal being assessed, including alternatives that were included in the analysis. In 1998, the Bureau of Land Management (BLM) completed a Northeast National Petroleum Reserve-Alaska Integrated Activity Plan/Environmental Impact Statement (EIS). 1. Thus, the assessment phase is separated from the management phase, as recommended elsewhere (NRC 1983). Vol. Health impact assessment: A tool to help policy makers understand health beyond health care. Practice implications include better understanding of different models and requirements by health departments, hospitals, and others involved in assessment and planning to improve cross-sector collaboration, collective impact, and community health. Such a plan is often referred to as a public-health management plan or a health-action plan (Quigley et al. Source: ICMM 2010. A Review Package for Health Impact Assessment Reports of Development Projects. HIA practice is often defined in terms of several categories. Several approaches for scoping are available. Community input during the development of recommendations can ensure that they address specific aspects of living conditions and community design that may not be obvious to an outside researcher, and it provides an opportunity to ensure that the recommendations address high-priority issues in a manner that is acceptable to the affected community. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. Seventh, disclosure allows people to take voluntary actions to avoid risk (Neidell 2009). International Finance Corporation Performance Standard 4 Rev -0.1, Community Health, Safety, and Security. Self-evaluation should be considered a valuable step of the HIA process. Use of health impact assessment in incorporating health considerations in decision making. For example, if a traffic-calming infrastructure was installed on a street that had a high rate of pedestrian injury, it may be appropriate to monitor injury rates directly because changes would be expected as soon as the installation was complete. Furthermore, impact assessments, including HIAs, may rely on proprietary business information whose disclosure is legally barred or could damage a proponents business edge or competitiveness. For example, in the context of NEPA, the lead federal agency must consider the degree to which the proposed action affects public health or safety to determine whether a proposal is likely to have significant effects and therefore require an environmental impact statement (40 CFR 1508.27). Some provide a checklist of factors to consider and often focus on health determinants that might be affected by the proposal. Rapid HIAs may be completed in a short time (weeks to months), are often focused on smaller and less complex proposals, and generally involve primarily literature review and descriptive or qualitative analysis. The quality of the report can be a criterion by which the quality of the process is judged; that is, How clearly does the final document present the results of the analysis? The Importance of Common Metrics for Community, Social - Health Leads Community Health Assessment and Improvement Planning - NACCHO 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). HIA recommendations take various forms, and some examples are provided below. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services. The process is analogous to the approach in the new risk-based decision- making framework proposed in Science and Decisions (NRC 2009), in which the primary objective of risk assessment is to help decision-makers choose among risk-management options by providing information on health risks that can be considered in the context of economic, social, and other factors. The variability also reflects a lack of clear criteria that define HIA as a distinct field. Scoping considers input from many sources, including preliminary literature searches, public input, and professional or expert opinion in fields relevant to the proposal. The committee finds that an HIA report should at least describe the proposal and alternatives that are the subject of the HIA, the data sources and analytic methods used, the groups and individuals that were consulted in the course of the HIA, the process and findings of each step of the HIA, and the overall conclusions and recommendations. During scoping, the HIA team may produce an initial list, refine it on the basis of stakeholder input, and then make it final through research and analysis in the assessment phase. A review of health impact assessment frameworks. It discusses intersectionality as an emerging framework to guide research on prevention of suicide in young people and highlights several clinical and community settings that . 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). 2008). 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. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. 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. The health-management plan suggests which stakeholder agency or entity could take responsibility for implementing each recommendation. 2010). While CHNAs are a recent requirement, community health assessments (CHAs) have long been used as a tool by hospitals, public health departments and other social service agencies to identify key community health concerns. 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. Observing and documenting the HIA processsuch as methods of engaging stakeholders and interacting with decision-makers and approaches to addressing analytic challenges and interviewing participants and stakeholders are the main methods of process evaluation. Failing to undertake a systematic review may mean overlooking evidence that would lead an assessor to a different conclusion. HIA guidance often points out the need for monitoring and continuing management and verification that mitigation measures are being implemented. All information these cookies collect is aggregated and therefore anonymous. 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, which would guarantee workers access to paid sick leave. Frank DA, Neault NB, Skalicky A, Cook JT, Wilson JD, Levenson S, Meyers AF, Heeren T, Cutts DB, Casey PH, Black MM, Berkowitz C. Heat or eat: The Low Income Home Energy Assistance Program and nutritional and health risks among children less than 3 years of age. Discuss what entity has the authority or ability to implement each measure and document any commitments to do so. 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). Decisions are often based on incomplete information and must often be made within a specified time rather than waiting for more complete information. Scoping also establishes a plan for the analytic methods that will be used during the assessment phase. Citation for Toolkit Key health effects: Issues were identified through analysis of newspaper coverage; outreach to such groups as local officials, members of the public, and businesses; development of a logic framework; and a survey of people living, working, or attending school near the BeltLine. 2004). From Principles to Consider for the Implementation of a Community Health Needs Assessment Process [PDF 457KB] (June 2013), Sara Rosenbaum, JD, The George Washington University School of Public Health and Health Services, Department of Health Policy. MAPP brings four assessments together to drive the development of a community strategic plan MAPP Framework Organizing Visioning Assessments Strategic Issues Goals/Strategies Action Cycle Organize for Success Organizing the planning process and developing partnerships Organize for Success Determine the necessity of undertaking the MAPP process. 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. The potential for irreversible or catastrophic effects (including effects of low likelihood). Therefore, scoping should be thought of as a two-part process that starts with a systematic effort to identify all potentially important effects and that continues with selection of the most important and well-substantiated effects for further analysis at later stages. Different HIA guides vary somewhat as to the specific descriptors that should be used, and practice is highly variable. It is important to note that a matrix does not explain how evidence was used to reach conclusions. The role of adaptive management as an operational approach for resource management agencies. It characterizes health effects according to their nature, direction, intensity, magnitude, distribution, timing and duration, and likelihood. Although less common to date, HIAs are also sometimes conducted by a decision-making agency, such as a metropolitan planning organization or a federal agency complying with NEPA. A preliminary opinion regarding the potential importance of the proposal for health. Northeast National Petroleum Reserve-Alaska (NPR-A) Draft Supplemental Integrated Activity Plan/Environmental Impact Statement (IAP/EIS). A community health assessment gives organizations comprehensive information about the community's current health status, needs, and issues. The baseline profile also generally draws on data that describe the social, economic, and environmental conditions important to health, such as labor or housing reports, environmental impact assessments, and gray or unpublished data specific to the decision context. 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. Leventhal T, Brooks-Gunn J. Bethesda, MD 20894, Web Policies Some lawssuch as NEPA, state environmental-policy acts, and various local zoning ordinancesmay establish protection of health as a requirement or priority. The first step in the framework is typically a determinant of health, such as air pollution, traffic, employment, or noise. It follows a systematic process that includes screening, scoping, assessment, recommendations, reporting, and monitoring and evaluation. The committee proposes on the basis of its review the following adaptation of the current working definition of the International Association of Impact Assessment (Quigley et al. The HIA team was assisted by an advisory committee, but it appears that the committee was not involved in the scoping. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. 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. The local North Slope Borough governmentan agency that participated in preparing the EISconducted an HIA, which was integrated into the EIS report. 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. Because HIA in the United States is often undertaken outside a formal legal mandate, it has not consistently included alternatives assessment. Additional modeling approaches, such as system-dynamic modeling and agent-based models, are also promising and emerging tools that could have applications to health. Scholars point to a remarkable consistency in the basic elements that are generally included in descriptions of HIA (Mindell et al. 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. Section 1508.27). The decision to initiate an HIA is often made ad hoc when public-health advocates recognize that the proposal may have important health implications that would not otherwise be recognized or addressed. 2004; Bhatia and Wernham 2008). Parry JM, Kemm JR. PDF Community Health Resource Centers: A Toolkit - Episcopal Health Foundation This chapter has described HIA categories, defined HIA, discussed current HIA practice, noted variations in practice, and provided the committees conclusions regarding each step of the HIA process. Similarly, HIA recommendations concern measures that can be taken to protect or improve health, but ultimately the decision-makers must weigh those recommendations with the political, economic, social, and technical factors that are relevant to the decision. 2005; Bhatia and Seto 2011). Monitoring focuses on measures that are likely to be sensitive and early indicators of change. 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. First, disclosure informs affected communities and individuals and possibly other stakeholders, such as government agencies and officials, of possible effects on their health and well-being, a core objective of HIA. 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. HIAs conducted as part of a formal government process are generally subject to disclosure and freedom-of-information requirements. The entire decision-making process is appropriately not described in the final report; however, the reader is not told whether the HIA team prepared a scoping report or whether it presented the findings of the scoping stage. Health and impact assessment: Are we seeing closer integration. 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. The potential for the HIA to be completed in the time allotted and with the resources available. HIA provides recommendations on monitoring and managing those effects. 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. 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. A CHA is a systematic process involving the community to identify and analyze community health needs and assets, prioritize those needs and then implement a plan to address significant unmet needs.1Upon completing the assessment, hospitals develop implementation strategies to address the significant community health needs identified in the CHA.2A community health assessment process can focus your organizations efforts around community health improvement and provide structure for addressing the determinants of health and illness in your community. One Step Forward, One Step Back: An Analysis of the IFCs Sustainability Policy, Performance Standards and Disclosure. The committee notes that in any assessment, it (more), Assessment should result in a report that. Health-supportive measures that would generally support health but are not tied directly to a specific impact (for example, building a clinic in an underserved neighborhood that would be adversely affected by emissions from a new freeway). Some HIAs rely on proxy measures when rates of specific diseases are not available or are too small to calculate. Review of literature and a consideration of the social, economic, and political context of the eventual decision are also important. Community Health Assessment Toolkit | ACHI National Public Health Performance Standards Program, National Center for State, Tribal, Local, and Territorial Public Health Infrastructure and Workforce, SDOH Research by CDC Authors: Frequently Asked Questions, Examples of How the SDOH Can Be Addressed Through the 10 Essential Public Health Services, Performance Management & Quality Improvement, National Public Health Improvement Initiative, National Public Health Performance Standards, Public Health Finance and Infrastructure Support, Competencies for Public Health Professionals, National Leadership Academy for the Public's Health, Supporting the Performance Improvement Workforce, Alerts About Current & Projected Funding Opportunities, Cooperative Agreements, Grants & Partnerships, Strengthening Public Health Systems & Services, USAPI Strengthening Public Health Systems & Services, Integrity & Accountability Review Offices, National Health Initiatives, Strategies & Action Plans, State & Territorial Health Department Websites, US Territories & Freely Associated States, Style for Referring to US Territories & Freely Associated States, About the Public Health Infrastructure Center, Implementing the Community Health Needs Assessment Process, U.S. Department of Health & Human Services, Multisector collaborations that support shared ownership of all phases of community health improvement, including assessment, planning, investment, implementation, and evaluation, Proactive, broad, and diverse community engagement to improve results, A definition of community that encompasses both a significant enough area to allow for population-wide interventions and measurable results, and includes a targeted focus to address disparities among subpopulations, Maximum transparency to improve community engagement and accountability, Use of evidence-based interventions and encouragement of innovative practices with thorough evaluation, Evaluation to inform a continuous improvement process, Use of the highest quality data pooled from, and shared among, diverse public and private sources, Improved organizational and community coordination and collaboration, Increased knowledge about public health and the interconnectedness of activities, Strengthened partnerships within state and local public health systems, Identified strengths and weaknesses to address in quality improvement efforts, Baselines on performance to use in preparing for accreditation, Benchmarks for public health practice improvements.