Environmental Factor

October 2011


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NRC report offers lawmakers new approach for health impact assessment

By Ian Thomas
October 2011

John Balbus, M.D.

Balbus is the NIEHS lead on a number of global and domestic public health initiatives. (Photo courtesy of Steve McCaw)

In a new report, co-sponsored by NIEHS, the National Research Council (NRC) introduced a comprehensive, six-step framework for assessing the potential health impact of new policies, plans, and projects. While other incarnations of such a process have been utilized in the past, the one proposed in the NRC report(http://www.nap.edu/openbook.php?record_id=13229&page=1) Exit NIEHS, titled “Improving Health in the United States: The Role of Health Impact Assessment,” provides guidance that is unique for its flexibility of application, integration of multiple risk factors, and applicability in both the public and private sectors.

“Health impact assessment is an important addition to the public health toolbox,” said John Balbus, M.D.(http://www.niehs.nih.gov/about/od/advisor/balbus/), senior advisor for public health at NIEHS. “By taking into account a variety of diverse factors, such as environmental exposures, pollutants, nutrition, physical activity, and mental health, among others, this assessment model offers public health officials a holistic approach that identifies both the risks and rewards associated with a given policy, law or project.” 

Comprised of six key steps, a health impact assessment begins by screening a policy to determine the scope and overall necessity of its application. Next, it identifies what populations would be affected and how. From there, the assessment evaluates the beneficial and adverse health effects of the policy, and compiles recommendations for dealing with both.  Finally, these recommendations are reported to lawmakers and the public, and policy effectiveness is monitored after implementation. Still, as much potential as this model has for enhancing public health, Balbus admits that it's not without its detractors.

“Conducting health impact assessment does require some investment of time, personnel, and financial resources,” he explained. “In the setting of local infrastructure projects, the perception is that this type of in-depth, methodical process only leads to more delays and increased costs. Changing such a perception will require greater education on the part of decision-makers and stakeholders, plus additional training for experts to ensure that these assessments are performed correctly and with maximum results.”

While the framework proposed in this report is merely the first step in promoting such a concept to government and community officials, Balbus agrees that factoring health and related costs into major decisions must always be taken into account.

“The NRC report provides a number of recommendations for additional research and education on this subject, many of which NIEHS will have a strong role in addressing,” Balbus concluded. “Finding new ways to get communities, stakeholders, and individuals engaged in the decision-making process is crucial in addressing issues of public health and social justice. Ultimately, health impact assessment provides a more accessible means by which everyone involved can do just that.”

(Ian Thomas is a public affairs specialist in the NIEHS Office of Communications and Public Liaison.)



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