Health impact assessment (HIA) is a practical tool intended to inform policymakers—during the decision-making process—of potential positive and negative health effects of proposed laws, programs, policies or regulations. This is done first by asking: What about health? How will this proposal affect community health and well-being?
Then, through a series of steps (see Figure 1), evidence-based findings and recommendations are provided to maximize health benefits and mitigate health risks—typically for sectors not commonly associated with health.
HIA is used around the world and is becoming routine for many large development projects in both public and private sectors.
Within the United States, the number of HIAs has increased over the last seven years—from 27 in 2007 to 319 in 2014—according to the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts.
Most of these studies have been conducted at the local level by government agencies. However, educational and nonprofit institutions have also conducted HIAs to inform decisions at varying levels (local, county, regional, state and federal).
To date, the Kansas Health Institute has conducted five HIAs—four at the state level and one at the local level. This profile features two Kansas policymakers who share their perspectives on HIA to demonstrate the value of the tool for other policymakers and to inform HIA practitioners about how to identify and support emerging HIA champions.
Wichita’s public transit system is very underdeveloped for a city of its size because of inadequate funding over the years. This has resulted from the public transit system not being seen as a priority by past policymakers.
Wichita desperately needs an improved transit system, and perhaps even more importantly, can’t afford to lose routes and service due to increasing costs and flat funding. The health impact assessment was a way to demonstrate the value of public transit from one specific perspective (health), among others.
Having actual data on how to improve the bus service gave credibility to the outcome of city decisions. The report’s findings and recommendations helped build the case for additional funding, and the City Council decided to include funding for transit in the sales tax package that was presented to voters in November 2014. Regretfully, the sales tax initiative ultimately didn’t pass, so no new funding became available to implement the remainder of the assessment’s major recommendations related to route designs, locations and frequency.
One positive result of the health impact assessment was that it pointed out that the transit system had a limit of two shopping bags per rider. During the process of stakeholder engagement, we learned that limitation prohibited riders from doing their major weekly grocery shopping using public transit. As a result, Wichita Transit eliminated the bag limitation, which allows riders the opportunity to purchase adequate and healthy food.
Wichita Transit has also implemented “free ride” days whenever there is a high ozone alert. This strategy came from a recommendation in the HIA that encouraged the city to seek meaningful ways to move residents from car travel to public transit to improve air quality, which benefits health.
Marijuana possession is illegal under federal law—however, twenty-three states and the District of Columbia have passed laws legalizing it in some form. While there has been interest in medical marijuana for years in Kansas, it seems to have been limited to a handful of advocacy groups and elected officials. Efforts to seriously discuss medical marijuana within the Legislature have yielded little success—either because the issue has been too politically sensitive or there hasn’t been large enough demand from voters.
The political climate is beginning to change with increased awareness of types of marijuana that do not produce intoxicating effects and may help alleviate seizure disorders for certain patients—especially children. I was inspired to take action when a family in my district moved to Colorado to obtain a “hemp oil” for their son, who suffered more than 100 seizures a day.
The issue of medical marijuana has earned more mainstream supporters as state and national media have begun telling life-changing stories about its effects. It became clear that the Legislature needed something that could provide them with a comprehensive understanding about potential positive and negative outcomes of any medical marijuana legislation—and from an organization that knows Kansas.
Because there hasn’t been much real opportunity for thoughtful debate on the issue in the Legislature, having an unbiased, evidence-based health impact assessment adds legitimacy to an issue that has been easily dismissed. Furthermore, having an independent, non-partisan organization conduct the research means stakeholders on all sides of the issue can feel more comfortable providing input without doing so publicly in a legislative committee hearing.
Profile of an HIA champion
Champions for health impact assessment facilitate the utilization of this tool for informing decisions and improving the health of communities. These policymakers share common characteristics (see Figure 2) and tend to be influential leaders who are passionate about serving their community.