key elements of a community health assessment

Because the biologists on the EIS team were uncertain of the degree to which subsistence harvests might be favorably or adversely affected, the HIA did not attempt to make quantitative estimates of the probability or intensity of the impact. That issue will probably continue to challenge the credibility of HIA practice in the eyes of some audiences and highlights the need for continued research and refinement of methods to improve its value to decision- makers (Petticrew et al. Or, in some cases, there may be unpublished evaluations of measures that have been implemented in similar scenarios. For example, there may be concerns about risks to a proponents reputation or to the viability and public acceptance of a proposed project if a report discloses important unmitigated adverse impacts or potential impacts that are uncertain or for which strong evidence does not exist. 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. Articles in Google Scholar by Kaye Bender, PhD, RN, FAAN Association for Community Health Improvement. Health impact assessment. 2003; ICMM 2010). Here are 7 common components of a successful Community Health Needs Assessment (CHNA): Information, Research, and Data Collection Stage A review of health impact assessment frameworks. National Research Council (US) Committee on Health Impact Assessment. Efforts to support health-based recommendations must be carefully distinguished from biased efforts to promote a specific outcome or measure on the basis of an incomplete or inaccurately weighted comparison of favorable and unfavorable aspects of a proposal or of a predetermined political agenda. Screening involves making an initial rapid judgment of whether an HIA is likely to be feasible and valuable. The Collective Impact Framework has five key elements: Participants have a common agenda with a joint approach for solving an agreed-upon problem. Cookies used to make website functionality more relevant to you. 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). A Guide to Health Impact Assessment: A Policy Tool for New Zealand. 2006). EC (European Communities). sharing sensitive information, make sure youre on a federal CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Human Impact Partners then worked with groups in other states to extrapolate the findings of the national report to local jurisdictions to analyze the health effects of paid sick days. Evaluation of whether a decision has changed specific health outcomes may often be difficult or impossible because of the complex and multifactorial causal pathways involved in many health outcomes, the length of time from implementation of a decision to observable changes in health indicators, and the lack of suitable comparison groups (Quigley and Taylor 2004; Parry and Kemm 2005). The development of recommendations should be guided by a consideration of any available evidence regarding effectiveness. Similarly, HIAs sponsored by private nonprofit organizations may not have requirements for disclosure inasmuch as most U.S. HIAs are not done under a legal mandate that requires disclosure. Alternative to a proposal. It is not reasonable to expect decision-makers to adopt HIA widely in the absence of evidence of its effectiveness and value. Neidell M. Information, avoidance behavior, and health: The effect of ozone on asthma hospitalizations. Decisions are often based on incomplete information and must often be made within a specified time rather than waiting for more complete information. The committee notes that a variety of qualitative and quantitative approaches are often used to generate predictions, but regardless of the methods used, most available guidance emphasizes the importance of considering diverse forms of evidence, a consistent and unbiased approach to selecting and interpreting evidence, and a clear and transparent description of the analytic approach (WHO 1999; Mindell et al. Indicators may be health outcomes in some cases, whereas health determinants may be more appropriate in others. The programs and policies, however, may not provide any guidance on how health should be considered (see, for example, Pub. Adopting a position for or against a proposal (for example, support for or opposition to a legislative proposal). HIA practice is often defined in terms of several categories. Elliott E, Francis S. Making effective links to decision-making: Key challenges for health impact assessment. A smaller set of related indicators was endorsed for use in monitoring key elements of community health status (CDC, 1991). The HIA conclusions and recommendations should be presented in a manner that is clear and easily understood. For that reason, it is important that scoping begin with a systematic consideration of all potential effects rather than limiting consideration to a subset of issues predetermined by the teams research interests or regulatory requirements. Community Health Assessment (CHA) archived training Identifying and selecting indicators for the CHA Data Collection, Analysis and Synthesis Presenting the CHA Findings Community Health Improvement Plan (CHIP) archived training Prioritizing Issues Choosing Strategies Developing a CHIP and Implementation Plan Gruber JB, Wang W, Quittner A, Salyakina D, McCafferty-Fernandez J. Popul Health Manag. About the Annie E. Casey Foundation, Baltimore, Maryland. Although completed HIA reports are readily available, peer-reviewed or gray literature that discusses the impacts of specific HIAs is still rare. Review of literature and a consideration of the social, economic, and political context of the eventual decision are also important. The committee concludes that the following are the most important factors to consider in determining whether to do an HIA: Ultimately, the HIA report should provide a rational and consistent explanation of how proposals are selected for screening. Well-executed scoping saves time, work, and resources in the later stages of the HIA (Harris et al. The reliability and validity of predictions made in HIAs have often been questioned (Thomson 2008). A comprehensive profile will include many indicators; those related to selected priorities The enacted legislation is consistent with some of the recommendations of the HIA, but there were no data to evaluate whether those drafting the legislation were influenced by the recommendations; there were no interviews with legislators over the course of the legislative process (Human Impact Partners 2010). 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. 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. For that reason, it is important for the field to define the circumstances under which outcome evaluation may be practicable. Society of Petroleum Engineers; 2006. 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). 2004). Although a wide variety of excellent resources on community health assessment and CQI currently exist, those materials generally do not link assessment and CQI concepts and techniques in the way that is envisioned for . They expressed interest in developing The Crossings in a way that will address local community needs for affordable housing and for other community assets that are safe, healthy, and supportive (p. Intro-1). The committee recommends that HIAs be publicly released and disseminated. 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. Several types of evaluation may be conducted on an HIA, including the following: In practice, most HIAs do not include process, impact, or outcome evaluation; this has been attributed to a lack of interest, time, and resources in the case of process and impact evaluation and to the length of time (often many years) required for observing changes related to implementation. Seventh, disclosure allows people to take voluntary actions to avoid risk (Neidell 2009). Monitoring outcomes can in some cases help to test the validity of predictions and inform future analytic methods. It outlines a set of principles that inform an ensuing discussion of key elements of community assessment. 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). Bookshelf HIAs conducted as part of a formal government process are generally subject to disclosure and freedom-of-information requirements. It also shows how HIA results can be disseminated widely in different formats through a number of channels. This is the key link between a health profile and a health plan. The HIA team needed an authoritative description on which to base its assessment. 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. Atlanta Beltline: Health Impact Assessment. Program on Health Equity and Sustainability, San Francisco Department of Public Health. Given the breadth of decisions that are likely to warrant consideration, the approach taken will vary on the basis of who is initiating the HIA, the capacity and authority of the agency or entity undertaking it, and the objectives for contemplating an HIA. Morgan RK. Monitoring and evaluation are often, although variably, described as the final stage of HIA (see Appendix E). A description of the research questions, data sources, methods to be used, and any alternatives to be assessed. The final HIA report should document the following: In addition to a final report, stand-alone executive summaries or fact sheets can help to disseminate and communicate the findings and recommendations of an HIA to various key audiences. 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. In this approach, the aspects of a proposal that may affect health are listed and considered in major categories of health and illness. 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. On the basis of its review, the committee synthesized the information from guidance, practice, and literature to propose criteria that define an HIA and draw several conclusions regarding HIA practice. A plan for continuous monitoring, adaptation of mitigation measures, and verification of performancealthough not currently a uniform aspect of HIA practice helps to ensure that measures are carried out and achieving their objectives. Wernham A. Inupiat health and proposed Alaskan oil development: Results of the first Integrated Health Impact Assessment/Environmental Impact Statement of proposed oil development on Alaskas North Slope. The HIA team identified the pathways in which the expansion would affect the lives of the primarily Iupiat residents of the area. Sixth, because many established environmental risk factors are found at higher concentrations in vulnerable communities, disclosure of risks may be an important way to reduce health disparities and address concerns about environmental justice (Miranda et al. The research was funded by the Annie E. Casey Foundation as an initiative with the potential to encourage long-term strategies and partnerships to strengthen families and communities. It is important for event staff to know exactly who has final decision-making power to eliminate potential conflicts. The expected resource requirements of the HIA and the ability of the HIA team to meet them. A Review Package for Health Impact Assessment Reports of Development Projects. The approaches taken for stakeholder involvement vary widely. With clear language in mind, partners should come to agreement on the The grouping of the elements in discrete stages or steps of an HIA is less consistent; some guides list as few as five steps, and others describe as many as nine (Quigley et al. Given the broad scope of HIA practice settings, applications, and data sources, the committee chose not to develop specific standards or criteria for what constitutes adequate evidence or analysis for HIA. The first is to create a profile of the population affected, which includes information on the demographics, baseline health status, and social, economic, and environmental conditions that are important to health. 2006; Jagannathan et al. 8 Steps to Guide Your Community Health Needs Assessment The characteristics and approaches of evaluation should be chosen to fit the time, resources, and data available to the HIA team. Washington (DC): National Academies Press (US); 2011. 2005; Bhatia and Seto 2011). 4 A Community Health Improvement Process - National Center for However, in some cases, the relationships between the implemented decision and health determinants may be more direct and measurable. Key Elements of Community Health Improvement Planning: From Assessment to Action Planning Key Elements of Community Health Improvement Planning: From Assessment to Action Planning CHA-CHIP Demonstration Project Improvement www.assesstoolkit.org April 23, 2012 The lines are muted. Consortia may wish to adopt consensus definitions of key terms such as population health, community health, and social needs vs. determinants of health, among others. Self-evaluation performed by the HIA teamfor example, against a set of process objectives or practice criteriaserves quality-assurance aims and can produce insights that will improve the field. For example, HIA reports can be disseminated in hard copy, in electronic format, at public meetings, to focus groups, or at different stages in the HIA process or policy cycle. The World Bank and International Finance Corporation have policies governing the disclosure of information, and although the policies differ, both provide for withholding or excluding documents that might contain proprietary information or information whose disclosure could damage a client or lenders financial, political, or legal interests (Halifax Initiative Coalition 2006; IFC 2006, 2010; McHugh et al. Assessing the Health Impacts of Road Pricing Policy Proposals. Cole BL, Fielding JE. 3, Elements of a Health Impact Assessment, Improving Health in the United States: The Role of Health Impact Assessment. Qualitative data can be gathered through, for example, focus groups, one-on-one interviews, surveys, individual meetings with stakeholder organizations, testimony in community meetings, Web-based or other written input, and running a stand or exhibition in a public place. A complete nursing health assessment requires a health professional to examine a patient in a systematic fashion, from head to toe. Mitigation measures that address a specific impact identified in the HIA and are intended to minimize a potential harm (for example, a measure to reduce benzene emissions from gas wells near residential areas) or measures to maximize a potential benefit. The committee is not endorsing the HIAs or the recommendations, but simply providing examples. In this report, HIA practitioner refers to the person (or people) involved in conducting an HIA. There are, however, no current examples of HIAs in the United States that include outcome evaluation as described here. 8600 Rockville Pike 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). Notwithstanding those considerations, the committee considers the public disclosure of HIAs to be an important ideal of practice but recognizes that it may not be realistic to expect widespread disclosure in the absence of requirements or incentives for it. 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. Action plans have mutually reinforcing activities. Industrial proponents, government decision-making agencies, local health departments, and independent organizations (such as universities and nongovernment organizations) may all be in a position to implement measures recommended in the HIA. The use of the information by the decision-maker is discussed at greater length in Chapter 4 in the section Managing Expectations.. 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. Human Impact Partners and San Francisco Department of Public Health. Criteria for use in the evaluation of health impact assessments. 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. Moreover, because there is generally no written record of HIAs that stop at screening, still less is known about the reasons that have led to decisions not to proceed with HIA. Issues surrounding uncertainty, literature review, and reliability and validity of predictions are discussed in greater depth in Chapter 4. As described by Ross (2007, p. 9), the Atlanta BeltLine is a transit, trails, parks, and redevelopment project that uses a 22-mile loop of largely abandoned freight rail line that lies between two and four miles from the city center and affects about 45 neighborhoods. Moving to opportunity: An experimental study of neighborhood effects on mental health. 7 Components of a CHNA | Community Health Needs Assessment The potential for health effects to place a disproportionate burden on or substantially benefit vulnerable populations. The wide array of evidence includes public testimony on local conditions and concerns, interviews with key informants, surveys, epidemiologic analysis (for example, observational cross-sectional surveys, longitudinal studies, and intervention or experimental studies), measurement of physical environmental conditions and modeling (for example, modeling of infectious-disease propagation or dispersion of noise and air pollutants), and expert opinion. The choice of what to evaluate will reflect the specific social, political, and policy context of the decision; the needs, interests, and questions of stakeholders and decision-makers; and the health status of the affected population.

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