Health-Impact Assessments

What Is a Health-Impact Assessment (HIA)?

How are existing or planned land use, community design, and transportation policies, projects, or programs affecting, or likely to affect, public health?

Simply put, the Health-Impact Assessment (HIA) methodology seeks to evaluate public-policy decisions on their likely human outcomes. It is a process and a tool. According to the National Research Council of the National Academies Improving Health in the United States: The Role of Health Impact Assessment, HIA is a systematic process that uses an array of data sources and analytic methods and considers input from stakeholders to determine the potential effects of a proposed policy, plan, program, or project on the health of a population and the distribution of those effects within the population. HIA provides recommendations on monitoring and managing those effects.

Health-impact assessments (HIAs):

  • Look at health from a broad perspective that considers social, economic and environmental influences
  • Bring community members, business interests and other stakeholders together, which can help build consensus
  • Acknowledge the trade-offs of choices under consideration and offers decision makers comprehensive information and practical recommendations to maximize health gains and minimize adverse effects
  • Put health concerns in the context of other important factors when making a decision
  • Consider whether certain impacts may affect vulnerable groups of people in different ways

Healthy People 2020 describes five defining characteristics of HIAs:

  1. A focus on a specific policy, program, or project proposal
  2. A comprehensive consideration of potential health impacts, positive and negative
  3. A population-based perspective incorporating multiple determinants and dimensions of health.
  4. A multidisciplinary systems-based approach
  5. A transparent approach that is highly structured but sufficiently flexible to confront a wide range of proposals.

HIA and the Planning Process


This chart outlines the planning process for an HIA. It begins with an assessment, leading into a proposal once it is decided an HIA would be beneficial. Suggestion, implementation, evaluation, and monitoring complete the process.

A Health-Impact Assessment (HIA) offers a more comprehensive decision-making model that better balances all community concerns.

For example, deciding where to place a playground may seem irrelevant, but the realization that children must cross a busy highway to get there could lead to plan revisions that make access more practical and lead to greater use and physical activity. Decisions made regarding community design, development, and policy implementation have the potential to impact the health of surrounding populations safely when they have the perception of a “neighborhood expressway.”

Consider the chart below, which outlines a Health-Impact Assessment in Colorado. Derby-area Redevelopment in the historic Commerce City demonstrates how a project seemingly outside of the health sector has the potential to have lasting health impacts on a population:

This flowchart provides a visual breakdown of the economic and health benefits of redevelopment in the town of Derby, such as how changes in traffic patterns can eventually improve overall pedestrian safety.

The potential health impacts of land redevelopment, an adaptation based on an HIA performed for a Derby-area redevelopment project in Colorado.

An HIA does not only impact community-health determinants, but quality of life at the individual level. HIAs are designed to integrate both promotion of health and protection of the community. In short, they are beneficial and worthwhile to perform.

“To have true control of your health is not just about what you can do as an individual, but what can be done at the community level.”


Where and When are HIAs Necessary?

Geography: Where or when an HIA can be conducted is not geographically constrained; wherever policymakers, legislators, governments, or other entities are engaged in a decision-making process, an HIA is possible and recommended.

Timing: There is often little reason to conduct an HIA after a decision has been reached, or so late in the process that any resultant conclusions cannot be fully debated, presented to the public, stakeholders, and decision-makers.

Scale: In deciding whether or not to conduct an HIA, it is important to determine whether the project, plan, or policy in question is of the appropriate scale.

  • Are there likely health-related outcomes?
  • Are those outcomes already so obvious that an analysis would be redundant?
  • Finally, and most importantly, is there even a decision to be made?

It is essential to remember that each HIA is unique.


Major Steps of an HIA

The graph above simply provides a visual flowchart and guide for the steps outlined in the following text.


  • Could the policy affect any of the determinants of health in the community?
  • Could the policy affect any of the vulnerable populations in the area?
  • Is a similar assessment already being conducted?
  • Are there any potential sources of funding for an HIA?

Visit our checklist for more important questions to consider.



  • Who will complete the HIA?
  • How will the HIA be conducted?
  • What are the goals and objectives of completing the HIA?
  • What personnel and tools are available?
  • How soon do planners need HIA results so that changes are able to be implemented?
Rapid, intermediate, and comprehensive approaches encompass the types of approaches to an HIA. This chart shows the benefits of each type of approach, such as how a "rapid" approach has fast results but how a "comprehensive" approach can result in more profound data but an extended investigation period.

Examples of the varying means by which the HIA process can be conducted


Analysis: This step is where the majority of the work occurs. The purpose of this step is to identify the health risks and benefits of the proposed project and compare them to key determinants of health for the community.

Reporting: The reporting step involves making recommendations regarding the proposed plan based on findings of the HIA.

Evaluation and Monitoring: The last part of conducting an HIA involves evaluating if there has been any impact on the decision making process. This step can also answer the question of whether the HIA was successful. It is also crucial to monitor the actual implementation of the plan to be sure that the changes are incorporated.


What Should Be Done with the Results of an HIA?

  • Justify the acceptance, denial, or modification of the policy or project in question.
  • Steer the development of a given policy or project during its formative stages to more fully address health and health disparities (most common with concurrent HIAs).
  • Educate and lobby key stakeholders to more fully consider health impacts and disparities in a project/policy under consideration for the future.
  • Educate and raise awareness among citizens, academics, the media, and the public at large.
  • Contribute to learning by decision-makers and policy researchers about whether particular kinds of projects are worthwhile.

Valuable evidence, engagement across disciplines, and spill-over into arenas outside of health and planning can help ensure that decision-makers see the value of HIA process and recommendations.


Delaware’s Success

Fort DuPont Health Impact Assessment Trails and Pathways

Health-Impact Assessment (HIA) was recommended as a strategy to build awareness, inform decision makers, and improve Delaware’s environments, policies, and systems to help people live healthier. The HIA of the Fort DuPont Master Plan and Feasibility Study, the first HIA in the state, was completed in 2013. The planning project was primarily initiated to address challenges and opportunities for the site, including: maintaining historic buildings in varying stages of decline; financing and managing a state park with low visitation; and addressing the needs and desires of other interested stakeholders, including community members of Fort DuPont and adjacent Delaware City.

Screening the area is a major part of the process. The Fort DuPont was selected from a group of candidates for the following reasons: Its timing fit within the time allotted for the grant that funded the HIA; it had a relatively certain schedule for decision making and clear decisions/decision makers; health was not explicitly being considered; and there seemed to be the potential for significant health impacts.

Scoping lasted nearly four months and prompted additional stakeholder input, the results of which were increased consideration for: access to physical activity opportunities, food choices, and healthcare. HIA goals were also established during this phase.

Assessment began with with the HIA training workshop, attended by members of the HIA Advisory Committee and other stakeholders.  This
phase lasted approximately 10 weeks and involved: 1) assessment of existing conditions; and 2) indicator assessment of alternative master plan scenarios, concerning selected health impacts. The primary focus was accessibility.

Recommendations were made through literature and reports, with the outcome being a decision that future planning in the area should be handled by the local, county, and state government. Recommended actions included: setting annual State budgets; major land use and transportation project decisions; review of development proposals and selection of a developer; and review of the plan under the land development process.

Reporting of the HIA was done in conjunction with the Fort DuPont project and thus aligned with those project goals and deadlines.

Evaluating strategies were developed during the process by stakeholders.

The Environment and Policy (E&P) Committee of Delaware’s Coalition for Healthy Eating and Active Living (DE HEAL) was integral in supporting HIAs in Delaware and providing a venue to share ideas, collaborate, and focus on the importance of achieving better public health. The HIA Advisory Committee, which was an outgrowth of the E&P Committee, guided and supported the HIA of the Fort DuPont Project in collaboration with many Delaware state agencies and organizations.


Learn More About HIAs

A PDF cover to the Delaware HSS report on HIA as a useful tool, featuring a smiling couple and a walkable, beautiful community.Read IPA’s Health Impact Assessments: A Useful Tool to learn more about how the HIA methodology can be used to evaluate public-policy decisions on their likely human outcomes.

Other resources include:



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