key elements of a community health assessment

The core issues that are commonly addressed are as follows: Some HIA guides recommend using a matrix, such as those shown in Tables 3-2 and 3-3, to characterize effects (Harris et al. As for any other research method, qualitative analysis in HIA should use appropriate methods and a clear, rigorous research design. 2006). Environmental, Social and Health Impact Assessment (ESHIA) Process. Screening should result in a simple statement that includes the following: Screening is essential for high-quality HIA. Reprinted with permission; copyright 2010, International Council on Mining and Metals. A review of health impact assessment frameworks. 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. In some cases, the timeline and available resources will prevent collection of new data to address gaps that are identified. Ibid. Screening: HIA of a Residential Housing Program, Example of a logic framework that maps out the possible causal pathways by which health effects might occur, Example of a Table Used for Systematic Scoping, Example of a Matrix for Analyzing Health Effects, Example of a Table for Rating Importance of Health Effects, Assessment: Northeast National Petroleum Reserve-Alaska, Examples of Health and Behavioral Effects That Have Been Addressed Quantitatively in HIA, Presidential/Congressional Commission on Risk Assessment and Risk Management (1997). A major alternative to a proposal (for example, routing a proposed highway away from a vulnerable population or building a light-rail line rather than widening a road). Adopting a position for or against a proposal (for example, support for or opposition to a legislative proposal). For those reasons, the committee concludes that HIAs including, to the extent practical, the data used for the analysis, analytic methods, assumptions, findings, uncertainties, data gaps, and recommendations should be made public. It is common for mitigation measures and design alternatives to be considered during scoping, to be refined as the assessment phase further characterizes the impacts and identifies their importance, and to be made final during the recommendations phase. CDC twenty four seven. The https:// ensures that you are connecting to the Focusing on Health: How Can the Health Impact of Policy Decisions be Assessed? Community health assessment and community health improvement planning are continuous, systematic processes for assessing and addressing health needs in a community. On the basis of its review of available literature, HIA guides, and practice standards, the committee has synthesized the key criteria that define HIA and that set it apart from related approaches to public-health practice and policy. Any approach to determining which proposals will be screened should demonstrate a consistent rationale; should document the rationale in the HIA report; and should take account of public input. The available data, however, may not be sufficient, and the HIA team may make a decision to dedicate resources to collection of new data. These common components included preplanning; developing partnerships; developing vision and scope; collecting, analyzing, and interpreting data; identifying community assets; identifying priorities; developing and implementing an intervention plan; developing and implementing an evaluation plan; communicating and receiving feedback on the 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. Cole BL, Wilhelm M, Long PV, Fielding JE, Kominski G, Morgenstern H. Prospects for health impact assessment in the United States: New and improved environmental impact assessment or something different? 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. Citation for Toolkit Quigley RJ, Taylor LC. Ensuring that the public has accurate and complete information on adverse and beneficial effects. Disclosure requirements and practices vary considerably among development lenders and private-sector proponents. 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, (more). Because the degree to which the proposed action affects public health or safety is one factor considered, this process could be considered the equivalent of the screening step of an HIA. Across the field, there is little uniformity in the content of written HIA reports. A matrix can be a useful way to organize a qualitative analysis and to convey results in a manner that is easy to understand, but a matrix may also be misinterpreted as being more objective than a simple description. The HIA team identified the following critical issues that could affect the health of the study area population: access and social equity, physical activity, safety, social capital, and environment (including air quality, noise, and water management). Past Projects: Vehicle Miles Traveled Legislation. 98224-MS. SPE International Health, Safety & Environment Conference; 24 April 2006; Abu Dhabi, UAE. A preliminary opinion regarding the potential importance of the proposal for health. Human Impact Partners. The Public Health Accreditation Board defines a community health improvement plan as a long-term, systematic effort to address public health problems on the basis of the results of community health assessment activities and the community health improvement process. This list can then be used to set priorities. Lifetime Effects: The High/Scope Perry Preschool Study through Age 40. Accessed at www.healthycommunities.org/assesstoolkit. Disclaimer. Public Health: What It Is and How It Works. 2003; ICMM 2010). That definition reflects the committees finding that the involvement of stakeholdersalthough the approaches used vary from little or no involvement to robust engagement and participation at every stephas consistently been described as a core element of HIA practice and should be considered essential to it. For each step, the committee describes the basic purpose, objectives, and practice elements; summarizes the main outputs; and presents conclusions regarding pertinent issues raised. In 2009, an HIA was conducted to ensure that health impacts were considered in the design and development of The Crossings and in the broader policies that affected redevelopment in the area. HIA recommendations take various forms, and some examples are provided below. Turnock B. Utilizing Community Health Needs Assessments (CHNAs) in Nonprofit Hospitals to Guide Population-Centered Outcomes Research for Pediatric Patients: New Recommendations for CHNA Reporting. The approaches can provide useful information on how people view the proposal, that is, how it is expected to affect them and potentially improve or harm their quality of life. A variety of planning and zoning, funding, and environmental regulatory decisions were required for the BeltLines various components to be developed. II, Selected Evidence Base Breaking the Cycle, East London and the City Health Action Zone and Queen Mary. However, the committee notes that no published studies in the United States have attempted to quantify the costs of undertaking an HIA across a variety of settings. What Is a Community Health Improvement Plan? Alcohol-consumption effects of alcohol taxes. Such information would be useful for informing future implementation. Thus, the assessment phase is separated from the management phase, as recommended elsewhere (NRC 1983). The diversity of practice owes partly to the fact that HIAs are undertaken for a wide array of policy-making that spans many sectors, levels of government, types of proposal (policies, plans, programs, and projects), and degrees of complexity. Red Dog Mine Extension Aqqaluk Project. Identifying data gaps and questions for future research. Depending on the nature of the proposal being assessed and the specific impacts, recommendations can take various forms (see Box 3-5), such as the following: HIA Recommendations. Identification of the population and vulnerable groupssuch as children, the elderly, racial or ethnic minorities, low-income people, and communities that are likely to be affected. Parry JM, Kemm JR. Assignment of significance rests on the characterization of an effect as described above, but judgments regarding what constitutes a significant impact are ultimately determined partly on the basis of social and political values. The bulleted list below provides examples in which some health impacts or behavioral outcomes have been quantified. 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. The process of implementing recommendations should be transparent and should include opportunities for public participation in the decision process and clear mechanisms of accountability. The committee notes that in addition to characterizing effects, HIAs may provide conclusions on the significanceor societal importanceof the effects, although this has been rare in U.S. practice. Developing a robust characterization of baseline health status and the social, economic, and environmental conditions important to health is a challenging aspect of HIA practice. Data and results are measured consistently across participants. 2010). Neidell M. Information, avoidance behavior, and health: The effect of ozone on asthma hospitalizations. Some lawssuch as NEPA, state environmental-policy acts, and various local zoning ordinancesmay establish protection of health as a requirement or priority. Another variation, rapid-appraisal HIA, has been described and in some texts includes explicit public engagement through an initial half-day workshop for stakeholders (Parry and Stevens 2001; Mindell et al. HIAs are also differentiated according to whether they are integrated into an environmental impact assessment or done independently. Although HIA may not always include or provide resources for independent evaluation, more in-depth, independent evaluation will generate more robust conclusions about HIAs effectiveness and best practices in the field and should be given high priority. This review outlines the epidemiology of suicide and suicidal behavior in young people. 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. Commonly, a core team is responsible for the bulk of writing and analysis. Community input on the proposal suggested that for the program to reassure community members effectively, the monitoring should be conducted by an independent third party, and there should be strong community oversight at each stage. Variations were found in race, age, employment status, poverty, car ownership, and mortality. A description of the HIAs impact on decision-making (to the extent that salient decisions have occurred by that time) as measured by an accounting of HIA recommendations that were adopted and an evaluation of available evidence that suggests whether and how the HIA played a role in decisions or contributed to changes in decision-makers knowledge, attitudes, or positions. and transmitted securely. Example of a Matrix for Analyzing Health Effects. Scoping establishes the boundaries of the HIA and identifies the health effects to be evaluated, the populations affected, the HIA team, sources of data, methods to be used, and any alternatives to be assessed. Because any actions taken on the basis of HIA recommendations need to be implemented within a specific legal and policy context, screening needs to establish a clear description of the decision-making process and context. They help us to know which pages are the most and least popular and see how visitors move around the site. The degree to which they are systematic varies, and some authors have suggested frameworks and guidance for conducting systematic reviews (Mindell et al. The assessment phase includes two tasks. Finally, it is appropriate to include issues that are the subject of community concern even if they seem unlikely to be substantiated by further analysis. Assessing and addressing community health needs. The potential for irreversible or catastrophic effects (including effects of low likelihood). Establishing a foundation for appropriate monitoring. In practice, the categories are rarely used consistently, and a single HIA often encompasses a blend of various approaches to stakeholder engagement and participation, analytic methods, and interactions with the formal decision-making process. Seventh, disclosure allows people to take voluntary actions to avoid risk (Neidell 2009). Moving to opportunity: An experimental study of neighborhood effects on mental health. Identification of apparent data gaps and of data collection that could be undertaken to address the gaps or a rationale for not undertaking data collection. But few data may be available on the geographic scale of some decisions addressed in an HIA, such as decisions related to projects that would affect a rural area or a single neighborhood. In selecting the analytic methods that will be used, the HIA practitioner should consider not only technical limitations but what type of information will be most useful to decision-makers. McAuliffe M. Developers of Proposed Springfield Biomass Plant tell Public Health Council: Nothing Less Than the Best. A smaller set of related indicators was endorsed for use in monitoring key elements of community health status (CDC, 1991). The local North Slope Borough governmentan agency that participated in preparing the EISconducted an HIA, which was integrated into the EIS report. 2008; Fredsgaard et al. Chapter 4 discusses the extent to which an HIA can ensure the implementation of recommendations. However, Science and Decisions (NRC 2009) emphasizes that a detailed understanding of the decision context is necessary for analyses to be scoped appropriately and that the conceptual distinction between assessment and management should not be interpreted as a firewall that prevents communication between parties. 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 HIA team identified the pathways in which the expansion would affect the lives of the primarily Iupiat residents of the area. A variety of information was used to inform the process, Scoping: Atlanta BeltLine HIA. 2006). As previously described in the section on Recommendations, monitoring can refer to tracking changes in health indicators as a new project or policy is implemented and has been defined as outcome monitoring. Lester C, Hayes S, Griffiths S, Lowe G, Hopkins S. Implementing a strategy to address health inequalities: A health authority approach. 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. As noted above, the iterative process is known as adaptive management in the field of environmental management. Good Practice Guidance on Health Impact Assessment. It solicits and responds to input from stakeholders throughout all stages of the process and includes publicly available and accessible documentation of processes, products, and sponsors. In contrast, independent evaluation can yield unbiased insights about an HIA from the perspectives of stakeholders and decision-makers, can contribute to a more robust external peer review, and can provide rich information regarding the strengths, weaknesses, and most effective methods and approaches in the field. Action plans have mutually reinforcing activities. Information on costs of HIAs would be valuable in determining whether an HIA can be undertaken with the resources available and could inform the screening process as described below. A local community-based organization worked (more). The health-management plan suggests which stakeholder agency or entity could take responsibility for implementing each recommendation. Health Impact Assessment: Main Concepts and Suggested Approaches-the Gothenburg Consensus Paper. Catholic Healthcare West Guidelines for Community Health Assessment This document is meant to help CHW hospitals identify and evaluate community health issues, and capacities for dealing with them. Improving relationships and collaboration between stakeholders. It is not reasonable to expect decision-makers to adopt HIA widely in the absence of evidence of its effectiveness and value. It is important for nonprofit hospitals to be knowledgeable about the Internal Revenue Services regulations for CHNAs. World Bank. A logic framework was produced to guide the assessment. 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). The committee recommends that HIAs be publicly released and disseminated. In 1998, the Bureau of Land Management (BLM) completed a Northeast National Petroleum Reserve-Alaska Integrated Activity Plan/Environmental Impact Statement (EIS). Having transparency throughout the process and clearly delineating the roles and responsibilities among various parties will help to limit real and perceived bias. Box 3-3 provides an example of an assessment step that was based on interviews with people who were likely to be affected by a decision and that considered their impressions of the effects that industrial activities were having and were likely to continue to have on individual, family, and community life. Benefits include Building evaluation into the plans for an HIA early in the process may support and reinforce a more deliberate and careful approach to designing and implementing the HIA itself. Program on Health Equity and Sustainability, San Francisco Department of Public Health. Propose a system to verify that measures are being implemented as planned. Mindell J, Boaz A, Joffe M, Curtis S, Birley M. Enhancing the evidence base for health impact assessment. DHHS (U.S. Department of Health and Human Services). An HIA, however, might not provide any recommendations; this could occur if the HIA failed to reveal any important health effects. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. Throughout the document recommendations and thoughts from community members' . 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. HIA should not be assumed to be the best approach to every health-policy question but should instead be seen as part of a spectrum of public-health and policy-oriented approaches, some of which will be more appropriate than others, depending on the specific application. The committee concludes that when alternatives to the proposal being assessed are under consideration, the HIA team should assess the impacts of each alternative. Wernham A. Bethesda, MD 20894, Web Policies The World Bank Policy on Access to Information. Robust and continuing efforts to inform decision-makers of the findings and recommendations of the HIA and efforts by HIA practitioners and other stakeholders to champion choices that will benefit health can be an essential part of an effective HIA. There are, however, no current examples of HIAs in the United States that include outcome evaluation as described here. Well-executed scoping saves time, work, and resources in the later stages of the HIA (Harris et al. In Alaska, all large natural-resources development proposals are now screened for the need for HIA in a new program begun by the state health department. 2019 Feb;22(1):25-31. doi: 10.1089/pop.2018.0049. 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. Would you like email updates of new search results? However, it is important to note that the use of qualitative approaches in HIA should not be interpreted as implying a need for less analytic rigor. MeSH Knowing Your Community: Community Health Assessment as a Powerful Tool Bender, Kaye PhD, RN, FAAN Author Information Journal of Public Health Management and Practice: doi: 10.1097/PHH.0000000000000599 2017 Wolters Kluwer Health, Inc. All rights reserved. The development of recommendations should be guided by a consideration of any available evidence regarding effectiveness. Shortened life expectancy associated with air pollution. In other cases, it may not be possible to attribute a particular decision to the influence of an HIA (Wismar et al. 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. Analyzes beneficial and adverse health effects and characterizes the changes in the indicators selected, to the extent possible, in terms of nature, direction, intensity, magnitude, distribution in the population, timing and duration, and likelihood. 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).

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