EPA/600/R-13/354 December 2013 www.epa.gov/ord A Review of Health Impact Assessments in the U.S.: Current State-of-Science, Best Practices, and Areas for Improvement Office of Research and Development National Exposure Research Laboratory EPA/600/R-13/354 December 2013 www.epa.gov/ord A Review of Health Impact Assessments in the U.S.: Current State-of-Science, Best Practices, and Areas for Improvement Justicia Rhodus1, Florence Fulk2, Bradley Autrey2, Shannon O’Shea3, Annette Roth2 1 CSS-Dynamac c/o U.S. Environmental Protection Agency Cincinnati, OH 45268 2 U.S. Environmental Protection Agency National Exposure Research Laboratory Cincinnati, OH 45268 3 Contractor, U.S. Environmental Protection Agency National Exposure Research Laboratory Research Triangle Park, NC 27709 National Exposure Research Laboratory Office of Research and Development U.S. Environmental Protection Agency Cincinnati, OH 45268 Notice The U.S. Environmental Protection Agency through its Office of Research and Development funded and managed the research described here under contract EP-D-11-073 to Dynamac Corporation. It has been subjected to the Agency’s external and administrative reviews and has been approved for publication as an EPA document. Author Contributions and Acknowledgements J. Rhodus (HIA Review Lead) – developed and managed the HIA Review process (including review framework and database), reviewed HIAs, implemented the QA Review and corrective actions, compiled and managed the final review database, performed final quality check on review database, synthesized the results of the HIA Review, and authored this synthesis report. F. Fulk (Principal Investigator) – managed implementation of the HIA Review in the context of other related Agency research, provided input during conceptualization of the HIA Review process, reviewed HIAs, and reviewed this synthesis report. Brad Autrey (HIA Review Team) – provided input during conceptualization of the HIA Review process, reviewed HIAs, and reviewed this synthesis report. Shannon O’Shea (HIA Review Team) – reviewed HIAs and reviewed this synthesis report. Annette Roth (HIA Review Team) – reviewed HIAs and reviewed this synthesis report. The authors would also like to thank Ellen D’Amico (CSS-Dynamac) for GIS support and Bruce Mintz (EPA-NERL), Aaron Wernham (Health Impact Project), Celia Harris (Human Impact Partners), and Steve White (Oregon Public Health Institute) for providing critical review of this synthesis report. ii Executive Summary A systematic review of health impact assessments (HIAs) from the U.S. was conducted to obtain a clear picture of how HIAs are being implemented nationally and to identify potential areas for improving the HIA community of practice. The review was focused on HIAs from the four sectors that the U.S. Environmental Protection Agency’s (EPA’s) Sustainable and Healthy Communities Research Program has identified as target areas for empowering communities to move toward more sustainable states. These four sectors are Transportation, Housing/Buildings/ Infrastructure, Land Use, and Waste Management/Site Revitalization. The review systematically documented organizations involved in conducting the HIAs; funding sources; the types of community-level decisions being made; data, tools, and models used; self- identified data needs; methods of stakeholder engagement; pathways and endpoints; characterization of impacts; decision-making outcomes and recommendations; monitoring and follow-up measures; prioritization methods employed; HIA defensibility and effectiveness; attainment of the Minimum Elements of HIA; areas for improvement; and identification of best practices. The results of the HIA reviews were synthesized to identify the state of the HIA practice in the U.S., best practices in HIAs, and areas in the overall HIA process that could benefit from enhanced guidance, strategies, and methods for conducting community-based risk assessments and HIAs. While HIAs have helped to raise awareness and bring health into decisions outside traditional health-related fields, the effectiveness of HIAs in bringing health-related changes to pending decisions in the U.S. varies greatly. The review found that there are considerable disparities in the quality and rigor of HIAs being conducted. This, combined with the lack of monitoring, health impact management, and other follow-up in the HIAs could be limiting the overall utilization and effectiveness of this tool in the U.S. However, a number of best practices were identified in the review, which (if implemented) could help advance the HIA field of practice, reduce disparities in the quality and rigor of HIA, and improve the overall effectiveness of the tool. HIA is a relatively new and rapidly emerging field in the U.S. Understanding the current state and applicability of HIAs in the U.S., as well as best practices and areas for improvement, will help to advance the HIA community of practice in the U.S., improve the quality of assessments upon which stakeholder and policy decisions are based, and promote healthy and sustainable communities. iii Foreword The U.S. Environmental Protection Agency’s (EPA’s) National Exposure Research Laboratory (NERL) conducts human and ecological exposure research that provides the tools necessary for EPA to carry out its mission. Critical to the success of the NERL research program is communication and utility of its research to influence and impact decisions aimed towards protecting human health and the environment. Health impact assessments (HIAs) are becoming a more commonly used tool in the U.S. for incorporating health considerations into the decision-making process of plans, projects, programs, and policies. The review of HIAs in the Transportation, Housing/Buildings/ Infrastructure, Land Use, and Waste Management/Site Revitalization sectors was conducted to inventory the types of community-level decisions being made and to assess the data, tools, and models currently used in HIAs in these four sectors. This information will aid in promoting existing EPA tools, methods, and models that can support HIAs, identifying potential research focus areas to support and improve the HIA community of practice, and discovering what the ecological assessment community of practice could draw from HIAs and vice versa in order to promote healthy and sustainable communities. iv Table of Contents Notice ....................................................................................................................................................ii Author Contributions and Acknowledgements...................................................................................ii Executive Summary ............................................................................................................................ iii Foreword .............................................................................................................................................. iv Introduction ........................................................................................................................................... 1 Health Impact Assessment: The Tool.................................................................................................. 2 HIA Defined .................................................................................................................................. 2 HIA Steps....................................................................................................................................... 2 History of HIA............................................................................................................................... 2 HIA Standards and Guidelines for the Americas ........................................................................ 3 Health Impact Assessment Review ..................................................................................................... 4 Preliminary Literature Search....................................................................................................... 4 Pilot Review .................................................................................................................................. 6 Review Framework and Database ................................................................................................ 6 Final Literature Search .................................................................................................................. 9 Full-scale Review .......................................................................................................................... 9 Quality Assurance ....................................................................................................................... 11 Review Documentation............................................................................................................... 12 Health Impact Assessment Review Synthesis .................................................................................. 13 General HIA Characteristics ....................................................................................................... 13 Implementation and Outcomes of the HIA Process .................................................................. 14 Screening .............................................................................................................................. 15 Need for HIA to Inform Decision-making ................................................................. 15 Decisions