Using this generic model as a template, let's fill in the details with another example of a logic model, one that describes a community health effort to prevent tuberculosis. SFCC (Federation of Swedish County Councils). Source: Adapted from BLM 2007 and Wernham 2007. Northeast National Petroleum Reserve-Alaska (NPR-A) Draft Supplemental Integrated Activity Plan/Environmental Impact Statement (IAP/EIS). Affected populations: As the TAD constituted only a portion of the city that would be directly affected, the HIA team created the HIA study area by placing a 0.5-mile buffer around the BeltLine TAD. On the basis of the findings, the HIA recommended a series of public-health mitigation measures that were selected to maximize any favorable impacts and to minimize harms. Special thanks to the Community Guide Branch, CDC, the Community Preventive Services Task Force, and the Public Health Foundation for their support. Ibid. 2005 and Bhatia and Seto 2011. The committee notes that each approach for gathering and interpreting data may be conducted in ways that are more or less participatory, engaging stakeholders in shaping the research questions, interpreting the findings, and developing recommendations on the basis of the findings. Drafting measures that address identified public-health risks and that fulfill the requirements of the legal framework governing a decision will increase the chances that HIA recommendations are implemented. A decision-making bodysuch as a department of planning or transportation can conduct an HIA to inform its own decision. Because HIAs can address decisions that range from small, localized programs or projects to national policies, screening ensures that HIA is used judiciously and when it is most likely to be valuable. The HIA conclusions and recommendations should be presented in a manner that is clear and easily understood. They expressed interest in developing The Crossings in a way that will address local community needs for affordable housing and for other community assets that are safe, healthy, and supportive (p. Intro-1). 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. Source: SFDPH 2011. National Public Health Performance Standards Program, National Center for State, Tribal, Local, and Territorial Public Health Infrastructure and Workforce, SDOH Research by CDC Authors: Frequently Asked Questions, Examples of How the SDOH Can Be Addressed Through the 10 Essential Public Health Services, Performance Management & Quality Improvement, National Public Health Improvement Initiative, National Public Health Performance Standards, Public Health Finance and Infrastructure Support, Competencies for Public Health Professionals, National Leadership Academy for the Public's Health, Supporting the Performance Improvement Workforce, Alerts About Current & Projected Funding Opportunities, Cooperative Agreements, Grants & Partnerships, Strengthening Public Health Systems & Services, USAPI Strengthening Public Health Systems & Services, Integrity & Accountability Review Offices, National Health Initiatives, Strategies & Action Plans, State & Territorial Health Department Websites, US Territories & Freely Associated States, Style for Referring to US Territories & Freely Associated States, About the Public Health Infrastructure Center, Implementing the Community Health Needs Assessment Process, U.S. Department of Health & Human Services, Multisector collaborations that support shared ownership of all phases of community health improvement, including assessment, planning, investment, implementation, and evaluation, Proactive, broad, and diverse community engagement to improve results, A definition of community that encompasses both a significant enough area to allow for population-wide interventions and measurable results, and includes a targeted focus to address disparities among subpopulations, Maximum transparency to improve community engagement and accountability, Use of evidence-based interventions and encouragement of innovative practices with thorough evaluation, Evaluation to inform a continuous improvement process, Use of the highest quality data pooled from, and shared among, diverse public and private sources, Improved organizational and community coordination and collaboration, Increased knowledge about public health and the interconnectedness of activities, Strengthened partnerships within state and local public health systems, Identified strengths and weaknesses to address in quality improvement efforts, Baselines on performance to use in preparing for accreditation, Benchmarks for public health practice improvements. Saving Lives, Protecting People. Washington (DC): National Academies Press (US); 2011. It is important for event staff to know exactly who has final decision-making power to eliminate potential conflicts. Elements of a Health Impact Assessment - Improving Health in the United 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. Cole BL, Wilhelm M, Long PV, Fielding JE, Kominski G, Morgenstern H. Prospects for health impact assessment in the United States: New and improved environmental impact assessment or something different? Having transparency throughout the process and clearly delineating the roles and responsibilities among various parties will help to limit real and perceived bias. Risk Assessment in the Federal Government: Managing the Process. Key Elements - Kent County, Michigan The decision-maker must ultimately balance health considerations with the many technical, social, political, and economic concerns that bear on the proposal. A related issue is incomplete disclosuresuch as disclosure of only summary information without data or analysis, disclosure only by electronic media in communities unlikely to have access, and English-only reports. 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). L 91-190, 42 U.S.C. For example, the San Francisco Department of Public Health routinely screens major projects and plans to ensure adequate analysis and mitigation of environmental health impacts. They help us to know which pages are the most and least popular and see how visitors move around the site. Developing new cross-disciplinary and interagency collaborations. 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 final HIA report describes each factor (see below) and presents the results of the scoping. The American Hospital Associations review of the IRSs final rules for CHNAs and implementation strategies can be foundhere. In practice, not all HIAs have conducted systematic literature reviews or documented review methods. Vol. Petticrew M, Cummins S, Sparks L, Findlay A. Validating health impact assessment: Prediction is difficult (especially about the future). Another issue that should be addressed in scoping is identifying alternatives to the proposed action. In contrast, the effect of decisions on some health outcomes (such as cancer or obesity) may take years to occur and may have multiple contributing factors. Observing and documenting the HIA processsuch as methods of engaging stakeholders and interacting with decision-makers and approaches to addressing analytic challenges and interviewing participants and stakeholders are the main methods of process evaluation. Chapter 2. Other Models for Promoting Community Health and Development The committee considers self-evaluation and independent evaluation to be essential for moving the field ahead. Scoping identifies those likely to be affected by the proposed policy, project, program, or plan. Health impact assessment: A tool for healthy public policy. Thomson H. HIA forecast: Cloudy with sunny spells later? Seven Steps for Conducting a Successful Needs Assessment - NICHQ Criteria for use in the evaluation of health impact assessments. HIAs in the private sector are increasingly common, pursuant to internal corporate guidelines or requirements of lending banks, such as the International Finance Corporation and World Bank (see Appendix A for further discussion) (Birley 2005; IPIECA/OGP 2005; McHugh et al 2006; ICMM 2010; IFC 2007, 2010).3 Few, however, are made public. Acknowledgments 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. That permits recommendations to form the basis of effective implementation and management rather than merely providing a static system without the capacity to adapt. Iteration during scoping and between scoping and assessment often results in additional changes in the final list of issues included in the HIA. I and III, Breaking the Cycle, East London and the City Health Action Zone and Queen Mary. The committee recognizes that undue bias in an HIA may compromise its credibility and efficacy. Scholars point to a remarkable consistency in the basic elements that are generally included in descriptions of HIA (Mindell et al. 54873. The HIAs also changed the debate in such a way that providing paid sick days for employees began to be presented as a public-health issue rather than a labor issue. Before discussing the various elements of HIA, it is important to understand the context in which HIA is undertaken in the United States. An HIA would identify health assets, health liabilities, and health-promoting mitigations related to the proposed development project. 2017 Jul/Aug;23 Suppl 4 Suppl, Community Health Status Assessment:S14-S21. The development of recommendations should be guided by a consideration of any available evidence regarding effectiveness. The use of various types of evidence and approaches used to make predictions are discussed below. The information generated by the HIA process needs to be organized and presented in such a way that it can be readily understood by the intended audiences and present a compelling case for recommended actions. Mindell JS, Boltong A, Forde I. Such information would be useful for informing future implementation. Health Impact Assessment for Regeneration Projects. There are, however, no current examples of HIAs in the United States that include outcome evaluation as described here. A Guide to Health Impact Assessments in the Oil and Gas Industry. The wide array of evidence includes public testimony on local conditions and concerns, interviews with key informants, surveys, epidemiologic analysis (for example, observational cross-sectional surveys, longitudinal studies, and intervention or experimental studies), measurement of physical environmental conditions and modeling (for example, modeling of infectious-disease propagation or dispersion of noise and air pollutants), and expert opinion. However, where practical, the HIA team should aim to evaluate a variety of alternatives or, minimally, to identify the characteristics of proposed actions that would be health-protective or detrimental to health. As discussed above, additional benefits may include, for example (Wismar et al. The available data, however, may not be sufficient, and the HIA team may make a decision to dedicate resources to collection of new data. 2006; Bhatia 2010; ICMM 2010). Evaluating health impact assessment. It can also include information from social-science and epidemiologic studies regarding the strength of associations between the social and physical environment (such as air and water quality and economic impacts) and health outcomesinformation essential in the quantitative prediction of health effects. Regardless of whether effects are quantified, the assessment stage should include a characterization of each effect to the greatest extent. However, it is important to note that the use of qualitative approaches in HIA should not be interpreted as implying a need for less analytic rigor. 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. HIAs are also differentiated according to whether they are integrated into an environmental impact assessment or done independently. A number of corporations and professional associations, such as the International Committee on Mining and Metals and the International Association of Oil and Gas Producers, have guidance for HIA, but relatively few completed industry-led HIAs or environmental, social, and health impact assessments are available on the Internet or on public Web sites that catalog HIA activity. Box 3-3 provides an example of an assessment step that was based on interviews with people who were likely to be affected by a decision and that considered their impressions of the effects that industrial activities were having and were likely to continue to have on individual, family, and community life. FOIA A smaller set of related indicators was endorsed for use in monitoring key elements of community health status (CDC, 1991). To provide this care as a community health nurse, you need to continually acquire knowledge, refine skills, and assess yourself. The process of describing pre-existing health issues, health disparities, and influences on health may also begin during scoping, although the full characterization of baseline health status generally takes place during assessment. Assessing the baseline health status of the affected population provides a reference point with which the predicted changes in health status may be compared; it identifies any groups that could be more vulnerable than the general population to the impacts of the proposal; and it provides an understanding of the factors that are responsible for determining health in the affected communities, and this, in turn, allows for a better understanding of how any changes in those factors may affect health. Atlanta BeltLine Redevelopment Plan. Accessibility 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 identified which areas and villages were most likely to be affected and when. Public and stakeholder participation during scoping can serve several important purposes, such as providing local knowledge regarding existing conditions and potential impacts, introducing alternatives or mitigation measures that stakeholders would endorse as effective ways to address key concerns, and allowing representative participation in shaping the terms of the HIA by groups affected by the proposal. Community Health Assessment Toolkit. 2006). Commonly, a core team is responsible for the bulk of writing and analysis. Retrieved fromhttps://www.chausa.org/communitybenefit/assessing-and-addressing-community-health-needs Behavioral Risk Factor Surveillance System data were used for the county and the state and stratified by race. Under NEPA, a federal agency must determine whether a federal environmental decision is likely to have significant effects, and if so, the level of analysis required (40 C.F.R. and transmitted securely. A summary of how stakeholders were engaged, the main issues that the stakeholders raised, and how they will be addressed or why they will not be addressed. Shortened life expectancy associated with air pollution. . For that reason, it is important for the field to define the circumstances under which outcome evaluation may be practicable. Determining the potential health effects to include in the HIA and proposing hypothetical causal pathways are the central tasks of scoping. The final draft responds to public comments and incorporates necessary changes or new information. 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. The first step in the framework is typically a determinant of health, such as air pollution, traffic, employment, or noise. 2007; Bhatia 2010). A growing population of families that have children. 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. For example, there may be concerns about risks to a proponents reputation or to the viability and public acceptance of a proposed project if a report discloses important unmitigated adverse impacts or potential impacts that are uncertain or for which strong evidence does not exist. Health impact Assessment: Concepts, Theory, Techniques and Applications. 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. In other cases, it may not be possible to attribute a particular decision to the influence of an HIA (Wismar et al. Propose a system to verify that measures are being implemented as planned. 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. The process may include identifying communities and geographic regions; demographic, economic, racial, and ethnic groups; and vulnerable populations, such as children, elderly people, disabled people, low-income people, racial and ethnic minorities, and people who have pre-existing health conditions. The HIA report states that scoping was done by the HIA team and involved desk-based research and a web and postal survey. 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. Ultimately, regardless of the specific tool used, the decision to conduct HIA in most cases relies on the practitioners or decision-makers judgment regarding the likelihood of impacts, the time and resources available, and the likelihood that the information produced by the HIA will be a valuable aid to decision-making. Open communication is necessary to build trust and ensure mutual objectives. 3Elements of a Health Impact Assessment Chapter 2established the rationale for examining the potential effects of decisions on health and health disparities and highlighted health impact assessment (HIA) as a potential tool for assessing the health implications of various decisions. The tasks or elements that are described as part of an HIA are fairly consistent in the peer-reviewed literature and guides reviewed by the committee. National Academies Press (US), Washington (DC). For example, the planning of the Atlanta Beltline, as described later in this chapter, involved the regional planning commission, local legislative bodies, state and federal environmental regulators, and private developers. Stakeholders, however, may have insights into local conditions and potential solutions for addressing concerns raised by the proposal under consideration. Metrics are key to providing a more holistic view of a community's health, and ultimately inform and drive action. Scoping identifies appropriate data sources for the analysis and should also identify important data gaps. Outcome evaluation should be undertaken when available resources and data will allow reasonable judgments regarding the association between the implementation of decisions and observed changes in health outcomes or health determinants. 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 irreversible or catastrophic effects (including effects of low likelihood). A preliminary opinion regarding the potential importance of the proposal for health. 2006). At the center of the model are patients, families and community members, who should be engaged at every step. The HIA drew on public testimony, literature review, and accepted mechanisms of health and illness to establish the scope of health concerns that should be considered. A central tenet is that peoples experience offers an invaluable perspective on the potential effects of the proposal. sharing sensitive information, make sure youre on a federal The bulleted list below provides examples in which some health impacts or behavioral outcomes have been quantified. About the Annie E. Casey Foundation, Baltimore, Maryland. For example, the chair of the California Assembly Labor Committee referred to the HIA and asked the opposition to the bill if they condoned the spread of disease through restaurant workers.. The committee notes that any limitations, incomplete data, and uncertainty in the baseline analysis should be clearly stated. In general, the baseline profile focuses on health issues and health determinants that may be affected by the proposal rather than on attempting to provide a complete assessment of community health. The population, subgroups, vulnerable populations, and stakeholders likely to be affected and how they were involved in the HIA process.
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