Recommendations for Local Health Departments (LHDs)
on the Use of Health Impact Assessment (HIA)
for Documentation of Public Health Accreditation Board (PHAB) Standards and Measures 1.5
(October 2015)
This document describeshowHealth Impact Assessment (HIA)can be used as a tool to promote community health while simultaneously fulfilling certain documentation that demonstrates conformity to the established standards and measures for public health accreditation.
Background:HIA is a systematic, structured process that brings together scientific data, public health expertise, and stakeholder input (1) to assess the potential health consequences of a proposed policy, project, plan, or program that does not have health as its primary objective and (2) to craft recommendations for modifications that promote health, equity, and security. It is often seen as one component of an overall Health in All Policies (HiAP), approach towards decision-making that emphasizes collaborations and partnerships across sectors. HIA is also growing rapidly in the U.S.In April 2015, The PEW Charitable Trusts documented 345 HIAs that are either completed or in progress in the U.S (up from 54 in 2009). NACCHO reports that LHDs led or contributed to approximately 1/3 of all HIAs from 1999-2014.
For more information about HiAP click here, for more information about HIA click here.
This Tool:As HIA is becomes a more widespread practice for assessing policies, programs, plans, and projects within communities, an opportunity arises to better document HIA activities to achieve or maintain PHAB accreditation. However, oftentimes, the LHD member conducting the HIA is either involved in a limited manner within the accreditation process or not involved at all. Siloing within a health department can prevent LHDs from maximizing the research conducted and community engagement activities held during the HIA. Therefore, this tool helps HIA practitioners better understand the ways an HIA can overlap with certain standards and measures of accreditation. Moreover, this tool can helpaccreditation coordinators with a limited understanding of HIA become aware of the potential multiple purposes for an HIA. Lastly, many LHDs consider HIA a large investment of time and resources for a single project in the community. While HIA often requires a substantial commitment of staff time and resources, this tool helps highlight that theprocess of completing an HIA can also generate a range of documentation that demonstrates conformity to the established standards and measures for public health accreditation (see table below). For example, HIA might produce health data summaries, survey data summaries, data analyses, audit results, meeting agendas, committee minutes and packets, after-action reports, work plans, email, memoranda, letters, dated distribution lists, attendance logs, brochures, flyers, website screen prints, news releases, newsletters, posters, and policies.
This following table is useful to a variety of audiences interested in the best way to promote community health and equity, and become an accredited local health department. The following are the target audiences for this document: HIA practitioners, accreditation coordinators, and LHDs that are new to or unfamiliar with HIA.
Note: HIA cannot take the place of a Community Health Assessment (CHA) or a Community Health Improvement Plan (CHIP).
Through support from The Pew Charitable Trusts, NACCHO has convened a HIA Community of Practice to promote the field of HIA and tools for HIA practitioner use. This document is the product of a HIA Community of Practice Working Group.
Crosswalk Between PHAB Accreditation and HIA ProjectsDomain Number
Domain 1
Standards / Measures / Example Documentation: documentation from the HIA that was accepted by PHAB / Phase of HIA
1.2: Collect and Maintain Reliable, Comparable, and Valid Data that Provide Information on Conditions of Public Health Importance and On the Health Status of the Population / 1.2.3 A Primary data: Collection of primary quantitative health data. Collection of primary qualitative health data.The use of data collection instruments. / Example 1: Quantitative primary data collected via community survey,
Qualitative primary data collected via stakeholder interviews
Example 2: Communication Health Assessment Report (created as a result of a Mobilizing for Action through Planning and Partnerships (MAPP) process. Documentation of online vital statistics data
Example 4: Uploaded an agenda/meeting notes from an transit-related HIA Community Advisory Board meeting. Agenda shows that the HIA’s recently developed community survey would be implemented as of the meeting date. Names of health department staff in attendance were highlighted on the agenda. The first page of the community survey was also uploaded which shows that the health department worked in conjunction with a contracted evaluation agency to develop it. / Scoping and Assessment Phases
1.3: Analyze Public Health Data to Identify Trends in Health Problems, Environmental Public Health Hazards, and Social and Economic Factors that Affect the Public’s Health / 1.3.1 A Data analyzed and public health conclusions drawn / Quantitative primary data collected via community survey of transit riders and
regression analysis used to draw conclusions from data
Documentation of data analysis from HIAs, Focus group/survey data (County-wide), Qualitative/Quantitative data analysis reports from strategic planning efforts that have taken place
RD 1 – our HIA is looking at 4 primary indicators (jobs, housing, connectedness and safety). The analysis of data related to these 4 indicators could be used to meet this particular measure. The final HIA report would serve to meet the requirements.
RD2 (review of data) minutes from our HIA team, could serve to meet this requirement.
RD3 – analysis of data from multiple sources – HIA report could meet this
Any conclusion documents, or data, generated by the found effects of the proposed project on population health/safety presented to the community or stakeholders. (ie: potential project effects on housing, transportation, crime, physical activity) / Assessment Phase
1.3.2 Statewide public health data and their analysis provided to various audiences on a variety of public health issues / Documentation from meetings where HIA report and findings are shared, press related to HIA report, emailed final report. / Reporting Phase
1.4: Provide and Use the Results of Health Data Analysis to Develop Recommendations Regarding Public Health Policy, Processes, Programs, or Interventions / 1.4.1 A Data used to recommend and inform public health policy, processes, programs, and/or interventions / Example 1: Recommendation table created for HIA, Columbia City Council agenda item ordinance establishing membership of new city commission which used language from HIA recommendation
Example 2: Documentation of Quality Improvement processes (Expand)
Example 3: HIA report with recommended policy, processes, programs or interventions changes, and any policies/procedures generated and implemented as a direct result of data acquired in HIA process. / Reporting, Monitoring and Evaluation phase
1.4.2 T/L Tribal/community summaries or fact sheets of data to support public health improvement planning processes at the Tribal or local level / Example 1: Post data obtained in HIA process to website, in newspaper, flyers in community
Domain 3
3.1: Provide health education and health promotion policies, programs, processes, and interventions to support prevention and wellness / 3.1.2 Health promotion strategies to mitigate preventable health conditions ; Focusing on Point 3: Engagement of the community during the development of a health promotion strategy / Documentation from the Full Parks After Dark HIA; Chapter 7.0 Cross-sector Collaboration (page 50) / Scoping, Assessment, Recommendations
Domain 4
4.1: Engage with the Public Health System and the Community in Identifying and Addressing Health Problems through Collaborative Processes / 4.1.1 A Establishment and/ or engagement and active participation in a comprehensive community health partnership and/ or coalition; or active participation in several partnerships or coalitions to address specific public health issues or populations / Example 1:Documentation of participation in, or facilitation of, various coalitions (minutes, work plans, agenda, progress reports, etc.)
Documentation of engaging community through HIA – thought this would maybe not work for us, unless we had another HIA that was closer to when we are submitting. Our current HIA will be long over by the time we (re)apply for accreditation – PHAB is looking for current and active partnerships
A group that was brought together to work on the HIA could be referenced as one of the four required coalitions/partnerships if using specific partnerships vs. broad partnerships (ie: local extension office, community betterment teams). Submit agenda, meeting minutes, etc. The HIA would fulfill the requirement of change directly resulting from the partnerships.
4.1.2 T/L Stakeholders and partners linked to technical assistance regarding methods of engaging with the community / Website, Facebook, electronic marquee, and various information re: HIA will be at LHD.
4.2: Promote the Community’s Understanding of and Support for Policies and Strategies that will Improve the Public’s Health / 4.2.1 A Engagement with the community about policies and/or strategies that will promote the public’s health / Example 1: Documentation of community forum, coalition meetings with specific community members, commissioners, city council members, surveys, door to door outreach, etc. with local citizens directly affected by proposed project/changes.
4.2.2 A Engagement with governing entities, advisory boards, and elected officials about policies and/or strategies that will promote the public’s health / Example 1: Documentation of community forum, coalition meetings with specific community members, commissioners, city council members, etc.
Example 2: Minutes form Board of Health/Board of Supervisors meetings discussing HIA and proposed project, any presentations made.
Domain 5
5.1: Serve as a Primary and Expert Resource for Establishing and Maintaining Public Health Policies, Practices, and Capacity / 5.1.1 A The monitoring and tracking of public health issues that are being discussed by individuals and entities that set policies and practices that impact on public health / Example 1: Meeting minutes from HIA presentation at city council meeting
BOH/BOS meeting minutes, agendas, emails; Pertinent policies/research adopted at State level that effect HIA project/plans; State/Federal data that may support or argue against proposed project. / Reporting phase
5.1.2 A Engagement in activities that contribute to the development and/or modification of policy that impacts public health / Example 1: Email list of city and county commissions that HIA executive summary was sent to, Meeting minutes, etc.
Example 2: Distribution and/or presentation of HIA findings to our county board, and/or to the Gateway Commission that makes decisions on the HIA transit project, would serve to meet this measure.
Example 3: any public meetings, fact sheets, or official documents supporting the LHD advocacy of the policy change. / Reporting phase
5.1.3 A Informed governing entities, elected officials, and/or the public of potential intended or unintended public health impacts from current and/ or proposed policies / Example 1: Emails, documents, meetings, etc. to BOH, BOS, stakeholders, public, etc. that provide impacts of project found by HIA.
5.2: Conduct a comprehensive planning process resulting in a
Tribal/state/community health improvement plan. / 5.2.3 Elements and strategies of the health improvement plan implemented in partnership with others / Example 1: document the steps of the HIA process specific to the HIA/project referenced. (Expand)
5.2.4Monitor and revise as needed, the strategies in the community health improvement plan in collaboration with broad participation from stakeholders and partners / Example: CHA-CHIP would be used to identify a gap; HIA could be used to address the gap in PH services. Submit documentation as needed. (Expand)
Domain 6
6.1: Review Existing Laws and Work with Governing Entities and Elected/Appointed Officials to Update as Needed / 6.1.1 A Laws reviewed in order to determine the need for revisions / Example 1: documentation HIA on a policy- (Expand)
6.1.2 A Information provided to the governing entity and/ or elected/appointed officials concerning needed updates/ amendments to current laws and/or proposed new laws / Example 1: HIA report highlighting the HIA Partner Team, access to health care pathway, and access to health care recommendations
Example 2: Documentation of strategic planning development and implementation (minutes,reports, work plans, etc.)
If the HIA found the population health would benefit from law changes directly related to the project, could submit meeting minutes, official letters to law makers, etc. / Reporting phase
Domain 7
7.2Identify and implement strategies to improve access to health care services. / 7.2.1Process to develop strategies to improve
access to health care services / Example 1: HIA report, with reference to evidence based practice and how that can be applied through HIA recommendations / Recommendation and Reporting Phase
Domain 10
10.1: Identify and Use the Best Available Evidence for Making Informed Public Health Practice Decisions / 10.1.1 A Applicable evidence based and/or promising practices identified and used when implementing new or revised processes, programs, and/or interventions / Example 1: Meeting minutes from HIA presentation at city council meeting, documentation of various dissemination efforts, HIA report / Reporting Phase
10.2: Promote Understanding and Use of the Current Body of Research Results, Evaluations, and Evidence-based Practices with Appropriate Audiences / 10.2.3 A Communicated research findings, including public health implications / Example 1:Meeting minutes from HIA presentation at city council meeting or documentation of various efforts to disseminationHIA reportto various audiences
Example 2: HIAs findings could be made public through websites, media, flyers, etc.
Example 3: A file documenting a poster presentation at a national active living conference that highlighted portions of the HIA. A screenshot of the webpage of a local HiAP coalition where the HIA report was available to the public. / Reporting, Monitoring, and Evaluation Phases
Domain 12
12.3: Encourage the Governing Entity’s Engagement In the Public Health Department’s Overall Obligations and Responsibilities / 12.3.1 A Information provided to the governing entity about important public health issues facing the community, the health department, and/or the recent actions of the health department / Example 1: Proof of correspondence with county board (emails, board workshop or presentation) on HIA report and findings.
Contact information of the HIA Community of Practice Working Group:
Jason Wilcox, Columbia/Boone County Dept. of Public Health & Human Services,
Shannon Brownlee, Oakland County Health Division,
Stephanie Souter, Washington County Minnesota,
Roxanne Smith, Louisa County Public Health;
Ann Stahlheber, Cuyahoga County Board of Health,
Kelly Gallagher, Department of Health,
Kenneth Steel, Maricopa County Department of Public Health,
Deena Pourshaban, Los Angeles County Health Department,
Contact information for NACCHO:
Healthy Community Design Team at