key elements of a community health assessment

It can also assess whether the HIA had other important effects, such as building new collaborations among agencies, ensuring that stakeholder perspectives were considered, and increasing awareness of previously unrecognized health considerations. Schweinhart LJ, Montie J, Xiang Z, Barnett WS, Belfield CR, Nores M. Scott-Samuel A. Characteristics unique to the affected community may not be obvious to HIA practitioners who are outside the community. Scoping should therefore entail a deliberative process that involves engagement of stakeholders. The committees may be convened for several purposes, including providing technical guidance or peer review, ensuring adequate and fair representation of diverse interests and priorities among stakeholders, communicating the results of the HIA to decision-makers, and developing recommendations that address community needs and are compatible with the specific legal requirements of the decision- making process. Guidance Note 4. Selection of appropriate indicators will be discussed at greater length below in the section Monitoring and Evaluation.. Some provide a checklist of factors to consider and often focus on health determinants that might be affected by the proposal. The programs and policies, however, may not provide any guidance on how health should be considered (see, for example, Pub. Evaluation should be planned throughout the community health assessment (CHA) process to assess the impact of your strategies and progress toward your goals. 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. Chapter 4 discusses the extent to which an HIA can ensure the implementation of recommendations. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. Available studies suggest that efforts to involve and inform decision- makers throughout the HIA process and a strong relationship between the HIA team and decision-makers are often critical for the HIAs effectiveness (Veerman et al. 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). These 7 components are oftentimes divided into three stages: (1) information, research, and data collection stage, (2) a prioritization and strategy design stage, and (3) an implementation and action stage. First, community input is essential especially for proposals that will affect the local community primarily. If it is not possible to undertake complete, systematic literature reviews for an effect analyzed in an HIA, HIA practitioners must be vigilant to avoid selective searching and consideration of only studies that confirm particular conclusions (Mindell et al. 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 . Conversely, to have the greatest relevance as an informational and planning document and to ensure judicious use of resources, the HIA should ultimately focus on the health effects of greatest potential importance. The CH 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). The recommendations should be provided in the final HIA report and should document available supporting evidence, stakeholder input, and a health-management plan, which should do the following: If no recommendations are made in the HIA report, an explicit rationale should be provided for the decision not to include them. The committee notes that any limitations, incomplete data, and uncertainty in the baseline analysis should be clearly stated. The most vulnerable populations were identified as people of low economic status, children, older adults, renters, and the carless. In the absence of mandates or formal procedures, topics for screening are often chosen on the basis of the interests of a group wishing to use HIA as opposed to a structured, strategic selection process. 2017 Jul/Aug;23 Suppl 4 Suppl, Community Health Status Assessment:S14-S21. A logic framework was produced to guide the assessment. Human Impact Partners and San Francisco Department of Public Health. However, in some cases, the relationships between the implemented decision and health determinants may be more direct and measurable. 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. Screening should result in a simple statement that includes the following: Screening is essential for high-quality HIA. However the literature review is conducted, the methods should be clearly described in the report, and any studies with conflicting results acknowledged. Improving Health in the United States: The Role of Health Impact Assessment. 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. Human Impact Partners; 2010. The committee recommends that HIAs be publicly released and disseminated. 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. 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. The facts that resources were available and that timelines were appropriate were also relevant to the decision to conduct an HIA. Identifying data gaps and questions for future research. The HIA team identified the pathways in which the expansion would affect the lives of the primarily Iupiat residents of the area. 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. Roles and responsibilities for key, onsite event personnel, e.g., Event Organizer, Security Manager, Police, Fire, EMS, etc. It identified which areas and villages were most likely to be affected and when. The committee is not endorsing the HIAs or the recommendations, but simply providing examples. For example, in the Alaskan oil and gas HIA mentioned in Box 3-3, the HIA team drafted recommendations in collaboration with the decision-maker, the Bureau of Land Management, which formally adopted the recommendations as mitigation measures. This chapter describes the types, structure, and content of HIAs and summarizes the HIA process, methodologic approaches, and variations in practice. Epub 2018 Jun 19. 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. Special thanks to the Community Guide Branch, CDC, the Community Preventive Services Task Force, and the Public Health Foundation for their support. 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. Parry JM, Kemm JR. Ensuring that the public has accurate and complete information on adverse and beneficial effects. Propose appropriate indicators for monitoring. 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. 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. Articles in Google Scholar by Kaye Bender, PhD, RN, FAAN The decision-maker must ultimately balance health considerations with the many technical, social, political, and economic concerns that bear on the proposal. A local community-based organization worked (more). Some lawssuch as NEPA, state environmental-policy acts, and various local zoning ordinancesmay establish protection of health as a requirement or priority. 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. A Guide to Health Impact Assessments in the Oil and Gas Industry. 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. Use of health impact assessment in incorporating health considerations in decision making. It is important for event staff to know exactly who has final decision-making power to eliminate potential conflicts. Thus, it is generally not possible to attribute outcomes specifically to HIA recommendations because they are implemented with the decision. Review of literature and a consideration of the social, economic, and political context of the eventual decision are also important. In: Kemm J, Parry J, Palmer S, editors. It is important for nonprofit hospitals to be knowledgeable about the Internal Revenue Services regulations for CHNAs. L 91-190, 42 U.S.C. Before A description of the political and policy context of the decision and an analysis of the opportunities to influence decision-making or otherwise make health-oriented changes. The potential for substantial adverse or beneficial health effects and the potential to make changes in the proposal that could result in an improved health risk-benefit profile. Indicators may be health outcomes in some cases, whereas health determinants may be more appropriate in others. Section 1508.27). 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). Reprinted with permission; copyright 2010, International Council on Mining and Metals. Thomson H. HIA forecast: Cloudy with sunny spells later? A Review Package for Health Impact Assessment Reports of Development Projects. Because HIA in the United States is often undertaken outside a formal legal mandate, it has not consistently included alternatives assessment. 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. Bhatia R, Seto E. Quantitative estimation in Health Impact Assessment: Opportunities and challenges. 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. 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. Cook WK, Heller J, Bhatia R, Farhang L. A Health Impact Assessment of the Healthy Families Act of 2009. As noted above, the iterative process is known as adaptive management in the field of environmental management. Monitoring should provide information that allows one to conduct the evaluations noted above. Participatory approaches that actively engage stakeholders in the process can yield rich information and provide opportunities for stakeholdersincluding community membersto influence the questions asked and to participate in the interpretation of findings. 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. 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. 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. Integrating human health into environmental impact assessment: An unrealized opportunity for environmental health and justice. Assessment: Northeast National Petroleum Reserve-Alaska. 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. 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. 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. ADA (Atlanta Development Authority). Health Impact Assessment on Policies Reducing Vehicle Miles Traveled in Oregon Metropolitan Areas. Crossings at 29th St./San Pedro St. Area Health Impact Assessment. 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. Or, in some cases, there may be unpublished evaluations of measures that have been implemented in similar scenarios. About the Annie E. Casey Foundation, Baltimore, Maryland. Funding Acknowledgement Jagannathan R, Camasso MJ, Sambamoorthi U. Screening involves making an initial rapid judgment of whether an HIA is likely to be feasible and valuable. A central tenet is that peoples experience offers an invaluable perspective on the potential effects of the proposal. 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. Other groups have developed standard approaches to promote and evaluate practice quality, including the quality of analysis (see, for example, Fredsgaard et al. Example of a logic framework that maps out the possible causal pathways by which health effects might occur. Sources: Adapted from Cook et al. The specific methods used in assessment are discussed in depth in the next section. Source: Adapted from BLM 2007 and Wernham 2007. In this report, HIA practitioner refers to the person (or people) involved in conducting an HIA. Thank you for taking the time to confirm your preferences. Nurses rely on self-reported symptoms, visual observation, reported health histories, and a physical medical examination to make a health assessment. 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. 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. 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. Adoption of recommendations depends partly on the involvement of decision-makers in the HIA process (Elliot and Francis 2005; Davenport et al. Focusing on Health: How Can the Health Impact of Policy Decisions be Assessed? 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 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). Having transparency throughout the process and clearly delineating the roles and responsibilities among various parties will help to limit real and perceived bias. National Academies Press (US), Washington (DC). Careers. The effectiveness of Health Impact Assessment: Scope and Limitations of Supporting Decision-Making in Europe. For example, U.S. priorities for improving public health are expressed in the Healthy People 2020 Program of the U.S. Department of Health and Human Services (DHHS 2010). 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. In practice, therefore, the HIA team will be asking a decision-maker to consider the findings and recommendations. In some cases, the team may draw on outside consultants who have expertise in a specific health issue or method. EC (European Communities). The Catholic Health Association defines a community health needs assessment as a systematic process involving the community to identify and analyze community health needs and assets in order to prioritize these needs, and to plan and act upon unmet community health needs. The final draft responds to public comments and incorporates necessary changes or new information. The potential for irreversible or catastrophic effects (including effects of low likelihood). In general, this approach describes effects directly related to the proposal (such as changes in air emissions) and traces them to health determinants (such as air quality) and finally to health outcomes (such as asthma). Although rapid or desktop HIAs may not involve stakeholders or consider their input, this often (although not uniformly) reflects a pragmatic response to limitations, such as the timeframe for the decision or resources available to the HIA team, rather than an optimal practice. Those pathways and others were evaluated by using public-health data, literature on analogous populations, knowledge about accepted mechanisms of health and disease, witness testimony, and the effects analysis of other resources. As discussed later in this section, recommendations can also establish a foundation for monitoring, and the results of the monitoring may indicate that the management strategies need to be adapted to respond to the observed outcomesa process known as adaptive management (Johnson 1999). Assessing the Health Impacts of Road Pricing Policy Proposals. Lester C, Hayes S, Griffiths S, Lowe G, Hopkins S. Implementing a strategy to address health inequalities: A health authority approach. Citation for Toolkit New surveys to address data gaps or questions specific to the proposal in question are also common in comprehensive HIAs. 2005; Morgan 2011). Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. As a final note, it is important to remember the context in which HIAs are conducted when considering the recommendations phase. That issue is addressed again in Chapter 4. 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. It would then fall to the decision-makers to determine routes that met those criteria. McHugh S, Maruca S, Lilien J, Manning A. The committee considers self-evaluation and independent evaluation to be essential for moving the field ahead. The development of recommendations should be guided by a consideration of any available evidence regarding effectiveness. AHA does not claim ownership of any content, including content incorporated by permission into AHA produced materials, created by any third party and cannot grant permission to use, distribute or otherwise reproduce such third party content. 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. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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. A variety of screening tools and algorithms are commonly used (Cole et al. HIA practice is often defined in terms of several categories. Public-health professionals reviewed the results of the analysis. The variability in the practice has evolved in the absence of widely accepted practice standards or formal regulatory or procedural requirements for HIA outside NEPA and related state laws (see Appendix A). According to effort, complexity, and duration, HIAs are often described as rapid, intermediate, or comprehensive. 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 (more). 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. The committee notes that outcome evaluation of policy experiments is a field independent of HIA, and many large-scale social interventionssuch as Head Start and Moving to Opportunityhave been subject to outcome evaluation that has included consideration of health or health determinants (Leventhal and Brooks-Gunn 2003; Schweinhart et al. Finally, effects that are plausible but are not supported by available evidence include fewer hospitalizations because workers are able to receive the preventive primary care needed to maintain good health. official website and that any information you provide is encrypted Reporting is the communication of the findings and recommendations of an HIA to decision-makers, the public, and other stakeholders. 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. 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. Before discussing the various elements of HIA, it is important to understand the context in which HIA is undertaken in the United States. Public concerns are a common trigger for a decision to screen, and the degree of concern or controversy about a proposal may be one of the factors weighed in the decision to undertake an HIA. The various categories of HIAs, although useful for describing distinct themes in the field, do not necessarily represent consistently distinct strains of practice. Evaluating health impact assessment. Fehr R. Environmental health impact assessment: Evaluation of a 10 step model. 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. 2007). 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. Suicide is the fourth leading cause of death among young people worldwide and the third leading cause of death among those in the US. Health and impact assessment: Are we seeing closer integration. 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.

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