By Stephen Horan, PhD
What will happen to our community under health care reform? This is an important question for anyone concerned about the health of their community. The answer is not simple to produce, but we can start by taking a systematic approach
Health impact assessment (HIA) is a systematic approach for evaluating the potential health effects of a policy or project. It has been defined as "a flexible, data-driven approach that identifies the health consequences of new policies, and develops practical strategies to enhance their health benefits and minimize adverse effects." (The Health Impact Project). HIA may involve a variety of research methods including demography, public health research, health services research, health policy research, economic impact analysis, and more. HIA typically follows a six-step process:
- Screening - Identify the projects or policies for which an HIA would be useful
- Scoping - Identify which health effects to consider
- Assessing Risks and Benefits - Identify which people may be affected, and how
- Developing Recommendations - Suggest changes to proposals to promote positive impacts and mitigate negative impacts
- Reporting - Present the results to decision makers
- Evaluating- Determine the influence of the HIA on the decision process.
At its best, HIA is designed to produce practical answers to important questions posed by people with a stake in the policy or project under study. If a community were to apply HIA to the health care reform legislation, the study could be designed to answer questions like:
- Who in our community will be covered under health reform? Who will remain uninsured?
- How might the health reform legislation affect the health status of our community population?
- How might the health reform legislation affect peoples' access to health services?
- How might the health reform legislation affect our local employers and employment?
- What steps should we be taking at the community level to promote the positive impacts of health care reform, and mitigate any negative impacts?
- What recommendations should we make to federal and state government to optimize the legislation and regulation?
Questions like these could be generated and refined by a single entity or by a coalition of community stakeholders. The results could be used to inform policy and practice at the federal, state, and local level. To learn more about the potential of health impact assessment, visit:
