key elements of a community health assessment
Screening involves making an initial rapid judgment of whether an HIA is likely to be feasible and valuable. Health Impact Assessment: International Best Practice Principles. Good Practice Guidance on Health Impact Assessment. 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 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. Any logic models or scoping tables that were completed should also be included. Example of a Table for Rating Importance of Health Effects. Reporting: Legislation on Paid Sick Days. Cancer risk associated with exposure to hazardous chemicals. Second, recommendations are effective only if they are adopted and implemented. 2010). The use of the information by the decision-maker is discussed at greater length in Chapter 4 in the section Managing Expectations.. Saving Lives, Protecting People. It is also highly likely to lead to improved compliance with public-health guidance regarding seasonal influenza and community mitigation strategies for pandemic influenza. In contrast, effects that are likely but less well supported include increased ambulatory or preventive primary care, fewer emergency-room visits by workers who are insured, and greater compliance with infection-control policies. Quigley RJ, Taylor LC. Qualitative approaches can more easily present the causal pathways in terms used by participants; this ensures that different voices are presented in the HIA and can increase the legitimacy and stakeholders ownership of the process and results. 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. government site. Human Health Evaluation Manual Part A. EPA/540/1-89/002. Potential health effects have been estimated by using established approaches for quantitative analysis, such as the calculation of the fraction of disease rates in a population that can be attributed to the risk being analyzed and the application of available exposure-response functions to quantify cancer risk associated with incremental changes in exposure to carcinogens. Decisions are often based on incomplete information and must often be made within a specified time rather than waiting for more complete information. The quality of the report can be a criterion by which the quality of the process is judged; that is, How clearly does the final document present the results of the analysis? 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. Leventhal T, Brooks-Gunn J. Impact evaluation attempts to judge whether the HIA influenced the decision- making process, that is, whether and to what degree the recommendations were adopted and implemented and how the HIA influenced the decision-making process. In addition, federal and state policy and accreditation requirements may be revised or implemented to better facilitate assessment and planning collaboration between health departments, hospitals, and others for the purpose of improving community health. Remember, although this example uses boxes and arrows, you and your partners in change can use any format or imagery that communicates more effectively with your stakeholders. Variations were found in race, age, employment status, poverty, car ownership, and mortality. A clear explanation should be provided with the characterization of effects that indicates the evidence used to develop the matrix and any limitations, data gaps, and uncertainties. The Association for Community Health ImprovementsCommunity Health Assessment Toolkitoffers a nine-step pathway for conducting a CHA and developing implementation strategies. Use of health impact assessment in incorporating health considerations in decision making. Source: Adapted from BLM 2007 and Wernham 2007. Third, it informs government agencies and officials of potential changes in demand for services, such as health care, emergency response, and public safety; this can facilitate an appropriate response. For example, in Oregon, an independent health-oriented nonprofit organization conducted an HIA of a series of proposals to reduce vehicle miles traveled in a bill intended to reduce greenhouse- gas emissions (UPH 2009). The goal was to incorporate health considerations into the decision-making process by predicting health consequences, informing decision makers and the public about health impacts, and providing realistic recommendations to prevent or mitigate negative health outcomes (p. 9). 4321-4347 [1970]; EC 2001). Open communication is necessary to build trust and ensure mutual objectives. Mechanisms to limit bias in decision-relevant analyses further are discussed in Chapter 4. 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. You will be subject to the destination website's privacy policy when you follow the link. Various sources of population-health statistics at the national, state, and local levels are available. Other groups have developed standard approaches to promote and evaluate practice quality, including the quality of analysis (see, for example, Fredsgaard et al. 2009; Bhatia et al. Possible Elements of a Community Team. 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. Therefore, scoping should be thought of as a two-part process that starts with a systematic effort to identify all potentially important effects and that continues with selection of the most important and well-substantiated effects for further analysis at later stages. That permits recommendations to form the basis of effective implementation and management rather than merely providing a static system without the capacity to adapt. Commonly, a core team is responsible for the bulk of writing and analysis. Additional modeling approaches, such as system-dynamic modeling and agent-based models, are also promising and emerging tools that could have applications to health. The decision to initiate an HIA is often made ad hoc when public-health advocates recognize that the proposal may have important health implications that would not otherwise be recognized or addressed. 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. 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. The committee emphasizes that the effectiveness of recommendations depends not only on the scientific validity of the interventions identified but on their relevance to the affected communitys concerns and their applicability within the regulatory or legislative framework of the proposal being considered. 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 key findings are provided in the opening section of the report, and they are categorized according to the strength of the evidence as highly likely, likely but less well-supported by the available evidence, and plausible, but not well-supported. For example, according to the report, a requirement for paid sick days is highly likely to lead to more workers taking leave to recuperate from an illness, to receive preventive care, or to care for ill children and dependents. 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. The final HIA report describes each factor (see below) and presents the results of the scoping. Science and Decisions: Advancing Risk Assessment. 1999; Roscam Abbing 2004). The final draft responds to public comments and incorporates necessary changes or new information. 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. 3, Elements of a Health Impact Assessment. The first step in the framework is typically a determinant of health, such as air pollution, traffic, employment, or noise. 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. Others have proposed categorizing HIAs as participatory (emphasizing shared governance, public participation, and a focus on socioeconomic and environmental determinants), quantitative or analytic (concentrating on the methods and rigor of the analysis), or procedural (drawing on elements of the other two approaches but emphasizing the procedural steps required and often undertaken within a specified administrative or regulatory context) (Cole and Fielding 2007). Jagannathan R, Camasso MJ, Sambamoorthi U. Characterization of health effects in HIA relies on qualitative and quantitative evidence. Major issues and challenges for HIA development and practice are considered in Chapter 4. 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 Thomson H. HIA forecast: Cloudy with sunny spells later? Bhatia R, Wernham A. We identified 11 common assessment and planning components across 18 models and requirements, with a particular focus on health department, health system, and hospital models and requirements. It includes the production and dissemination of written materials that document the HIA process, methods, findings, recommendations, and limitations of the analysis; and it includes the public dissemination of results through other channels, such as meetings with the public, decision-makers, and other stakeholders. 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. 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. Poorly selected proposals may result in HIAs that add little new information and consume considerable time and resources of the HIA team to complete and of recipients to review. Disclaimer. Alerting decision-makers to the more general need to focus on health in future decisions. Since there are different models to guide assessment and planning, as well as a variety of organizations and agencies that carry out these activities, there may be confusion in choosing among approaches. 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. For example, in Alaska, one of the adverse impacts of a proposed mine expansion was the feared contamination of water and wildlife, and evidence suggested that a fear of contamination might lead communities to shy away from eating a traditional diet. They can take longer than a year to complete. Developing new cross-disciplinary and interagency collaborations. Steinemann A. 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). There could also be concerns that disclosure of such information would lead to litigation. The committee recommends that HIAs be publicly released and disseminated. Although there are many potential benefits of undertaking an HIA, one common objective is to inform decisions to promote changes that support improvements in health determinants or health outcomes. Kemm J. 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. In many cases, the first course of action is to gather information from published literature, unpublished reports, administrative data gathered for routine monitoring purposes, and other available documents. In other cases, a draft may be submitted to an internal body, such as a steering group, whose comments are incorporated into a final public version. As noted above, the iterative process is known as adaptive management in the field of environmental management. Describes data sources and analytic methods and methods used to engage stakeholders. 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. 2006). In this report, HIA practitioner refers to the person (or people) involved in conducting an HIA. 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. Examples of Health and Behavioral Effects That Have Been Addressed Quantitatively in HIA. Key elements of community health include: Identifying top public health concerns within the specific geographic area, such as environmental and social factors that affect healthy life choices. 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. 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. The Collective Impact Framework has five key elements: Participants have a common agenda with a joint approach for solving an agreed-upon problem. Integrates stakeholder input into the analysis of effects. This site needs JavaScript to work properly. In: Kemm J, Parry J, Palmer S, editors. 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. 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. Not all HIAs will meet all proposed criteria, but the criteria are intended to describe typical practice. IPIECA/OGP (International Petroleum Industry Environmental Conservation Association and International Association of Oil and Gas Producers). The committee notes three considerations that may be particularly important for producing effective, actionable recommendations. For private corporations undertaking an HIA, the decision of whether to make an HIA public and what to disclose may be governed by internal corporate policies, by the standards of lenders supporting the project, or by a government that has jurisdiction over the project (McHugh et al. HIAs are also differentiated according to whether they are integrated into an environmental impact assessment or done independently. 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. The dissemination strategy should be developed in a systematic manner, should consider what groups need or will rely on the information (including stakeholders and decision-makers), and should determine the most effective ways to present the information to these groups, taking into account any barriers or challenges. In other cases, it may not be possible to attribute a particular decision to the influence of an HIA (Wismar et al. Scoping should therefore entail a deliberative process that involves engagement of stakeholders. It should define the vision for the health of the community through a collaborative process and should address the gamut of strengths, weaknesses, challenges, and opportunities that exist in the community to improve the health status of that community. Parry J, Stevens A. The phrase desktop HIA has also been used to refer to a rapid HIA that entails little or no public engagement. Review of literature and a consideration of the social, economic, and political context of the eventual decision are also important. Monitoring focuses on measures that are likely to be sensitive and early indicators of change. During scoping, the HIA team may produce an initial list, refine it on the basis of stakeholder input, and then make it final through research and analysis in the assessment phase. 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. Another categorization is based on the breadth of the HIA and distinguishes HIAs that have a tight focussuch as ones that use a narrow definition of health and emphasize quantification from HIAs that have a broader, holistic focus shaped by the social determinants of health (Kemm 2001). 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.