In an era of growing interest in transdisciplinary collaboration, evidence-based decision-making, open government, and social impact strategies responding to political and economic challenges, Health Impact Assessment (HIA) is increasingly relevant. HIA sits at the juncture of a number of paradigms for democratic processes for dealing with uncertainty and adding value in decision-making. It draws from a rich history of impact assessment that has accounted for multiple bottom lines. While HIA has gained attention as a specific tool, it is also recognized as part of a suite of more ecological and equitable approaches to health. HIA developers are asking both how to make it work better, so that ultimately government will work better.
This research examines the state of HIA in the United States. It examines the earliest efforts to train a variety practitioners across the country, acknowledging multiple opportunities for capacity-building and many influences on effective HIA practice. More importantly, it identifies a broad definition of effectiveness. Research on HIA practice builds on this, finding that practice is not fully aligned with standards but not necessarily deficient. While objectives should guide HIA processes, the research on training and practice highlights resources as a key driver. The third component of this research considers the resource constraints of public health in general and the opportunities to leverage outside resources using the paradigm of HIA.
In moving the field forward, frameworks for community-based prevention and transdisciplinary education can inform HIA capacity-building. Evaluation of both processes and outcomes will be useful. While methodological challenges remain, the institutionalization of partnerships, processes, and indicators will support public health goals. The definition and standardization of HIA practice must be balanced with efforts to expand its utility in new areas such as community development. In such cases the HIA process and paradigm can leverage investments by estimating returns in health and social denominations. HIA also helps solve the "wrong pocket" problem by accounting for outcomes across sectors and institutions. If used wisely, HIA will be a critical component of health in all policy, sustainability agendas, and social impact strategies.
