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National Research Council (US) Committee on Health Impact Assessment. Improving Health in the United States: The Role of Health Impact Assessment. Washington (DC): National Academies Press (US); 2011.

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Improving Health in the United States: The Role of Health Impact Assessment.

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Appendix DGlossary

Capacity building

The process by which skills and competence are built for understanding the use for and carrying out a health impact assessment. It may include “policy seminars to sensitise senior managers and advocate change; training courses to build knowledge of method and procedure; dissemination; institutionalisation to enable self-sustaining training in institutions…;[and]case studies and research to build specialist skills.”1


In the context of this report, the committee uses this term to describe “groups of people who live in the same geographical area; groups of people with a shared history, culture, language; [or] citizens for whom governments are responsible and to whom governments are accountable.”2

Comprehensive plans

“A legal document that states the goals, principles, policies, and strategies to regulate the growth and development of a particular community… The main characteristics are comprehensiveness, long-range time frame, and holistic territorial coverage. They include elements on land use, economic development, housing, circulation and transportation infrastructures, recreation and open space, community facilities, and community design, among many other possible elements.”3


“The dynamic process of dialogue between individuals or groups, based upon a genuine exchange of views, and normally with the objective of influencing decisions, policies, or programs of action.”4

Cost-benefit analysis

A method of considering the advantages and disadvantages of alternative policies or programs by converting all outcomes into monetary values.5

Cost-effectiveness analysis

An analysis that compares two or more policies or programs on at least two attributes, for example, costs and benefits. The analysis is done at the margin—that is, to determine the incremental cost effectiveness of one policy or program compared with another, the analyst determines the additional cost required to achieve an additional unit of benefit.6

Council on Environmental Quality

An agency in the Executive Office of the President that “coordinates federal environmental efforts and works closely with agencies and other White House offices in the development of environmental policies and initiatives. CEQ was established…by Congress as part of the National Environmental Policy Act of 1969 and additional responsibilities were provided by the Environmental Quality Improvement Act of 1970.”7

Determinants of health

Many factors contribute to the health of individuals or communities. “Whether people are healthy or not, is determined by their circumstances and environment. To a large extent, factors such as where we live, the state of our environment, genetics, our income and education level, and our relationships with friends and family all have considerable impacts on health, whereas the more commonly considered factors such as access and use of health care services often have less of an impact. The determinants of health include: the social and economic environment, the physical environment, and the person’s individual characteristics and behaviours.” 8

Environmental assessment (EA)

In the context of the National Environmental Policy Act, an environmental assessment is a public document that briefly discusses a proposed action and alternatives to it, including the need for the action and the direct, indirect, and cumulative ecologic, cultural, historical, social, or health impacts of the proposed action and the alternatives. It may be the basis for determining whether the proponent agency has a responsibility for preparing a more comprehensive environmental impact statement or whether it can execute a finding of “no significant impact.” It also aids in an agency’s compliance with the statute when an environmental impact statement is not necessary. 9

Environmental impact assessment (EIA)

“The process of identifying, predicting, evaluating and mitigating the biophysical, social, and other relevant effects of development proposals prior to major decisions being taken and commitments made.” 10 It is a process mandated by law in countries around the world, including the United States, and is also used by multilateral development banks.

Environmental impact statement (EIS)

The “detailed statement” required by the National Environmental Policy Act for proposed major federal actions “significantly affecting the quality of the human environment.” 11 It is prepared prior to a federal agency making a decision on the proposed action and must include an analysis of the effects of the proposed action and reasonable alternatives to it. 12

Environmental, social, and health impact assessment (ESHIA)

An integrated process by which the impacts of a project on the environment, society, and the health of individuals and the surrounding community are assessed. These assessments are currently carried out more often in the oil, gas, and mining industries.13, 14,15

European Union

In 2010, the European Union (EU) had 27 member states and four applicants for membership. The EU “is not a federation like the United States. Nor is it simply an organisation for the co-operation between governments, like the United Nations. The countries that make up the EU (its ‘Member States’) remain independent sovereign nations but they pool their sovereignty… and delegate some of their decision-making powers to shared institutions.” 16 “The EU’s decision-making process in general and the co-decision procedure in particular involve three main institutions: the European Parliament (EP), which represents the EU’s citizens and is directly elected by them; the Council of the European Union, which represents the individual member states; [and] the European Commission, which seeks to uphold interests of the Union as a whole.” 17 The commission proposes new laws, which are debated and then adopted by the European Parliament and the council of the EU. The commission and the member states then implement the laws, and the commission ensures that the laws are properly carried out.18


A set of basic elements of a process for evaluating scientific and technical information; in the context of HIA, this process is conducted to understand the potential adverse and beneficial effects of proposed policies, plans, programs, and projects on health.


“A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”19

Health disparities

“Systematic, plausibly avoidable health differences adversely affecting socially disadvantaged groups.”20

Health effect, health impact

In this report, these two terms are used interchangeably and defined as any change in the health of a population or subpopulation or any change in the physical, natural, or cultural environment that has a bearing on public health.

Health impact assessment

The most commonly cited definition of health impact assessment (HIA) is in the Gothenburg consensus paper:

  • A combination of procedures, methods and tools by which a policy, program or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population.21
Other definitions have arisen over the decades, and several examples are provided in Chapter 1, Table 1-1. As discussed in Chapter 3, the committee has chosen to adapt the International Association of Impact Assessment definition22 and define HIA as follows:
  • HIA is a systematic process that uses an array of data sources and analytic methods and considers input from stakeholders to determine the potential effects of a proposed policy, plan, program, or project on the health of a population and the distribution of those effects within the population. HIA provides recommendations on monitoring and managing those effects.
The committee has selected a six-step framework as the clearest way to organize and describe the critical elements of an HIA (see Chapter 3).
  • Screening determines whether a proposal is likely to have health effects and whether the HIA will provide information useful to the stakeholders and decision-makers.
  • Scoping establishes the scope of health effects that will be included in the HIA, the populations affected, the HIA team, sources of data, methods to be used, and alternatives to be considered.
  • Assessment involves a two-step process that first describes the baseline health status of the affected population and then assesses potential impacts.
  • Recommendations suggest design alternatives that could be implemented to improve health or actions that could be taken to manage the health effects, if any, that are identified.
  • Reporting documents and presents the findings and recommendations to stakeholders and decision-makers.
  • Monitoring and evaluation are variably grouped and described. Monitoring can include monitoring of the adoption and implementation of HIA recommendations or monitoring of changes in health or health determinants. Evaluation can address the process, impact, or outcomes of an HIA.

Health impact assessment (HIA) practitioner

One who conducts HIA as an individual or part of a team.

Health in all policies

“An approach that looks at all public- and private-sector policy making through a health lens, with the objective of promoting and protecting the health of the population by addressing the social and physical environment influences on health.”23

Human health risk assessment

A process used to incorporate the understanding of the health implications of exposures, often environmental, into the regulatory decision-making process. See the description of “risk assessment” for more information.


“An official definition of ‘indigenous’ has not been adopted by any UN-system body. Instead the system has developed a modern understanding of this term based on the following: self-identification as indigenous peoples at the individual level and accepted by the community as their member; historical continuity with pre-colonial and/or pre-settler societies; strong link to territories and surrounding natural resources; distinct social, economic or political systems; distinct language, culture and beliefs; form non-dominant groups of society; [and] resolve to maintain and reproduce their ancestral environments and systems as distinctive peoples and communities.”24

Land-use planning

Considers a “community’s vision for future development; the policies, goals, principles, and standards upon which the development of the community are based; the proposed location, extent, and intensity of future land usage; existing and anticipated future housing needs; the location and types of transportation required; the location of public and private utilities; and the location of educational, recreational, and cultural facilities including libraries, hospitals, and fire and police stations.”25

Life-cycle assessment (LCA)

“A technique to assess the environmental aspects and potential impacts associated with a product, process, or service, by: compiling an inventory of relevant energy and material inputs and environmental releases; evaluating the potential environmental impacts associated with identified inputs and releases; [and] interpreting the results to help you make a more informed decision.”26 “The major stages in [a life-cycle assessment] study are raw material acquisition, materials manufacture, production, use/reuse/maintenance, and waste management.”27

National Environmental Policy Act

A U.S. federal law that requires federal agencies in the executive branch to “integrate environmental values into their decision-making processes by considering the environmental impacts of their proposed actions and reasonable alternatives to those actions.”28 It establishes U.S. environmental policy and the Council on Environmental Quality.29


The overarching term that describes “the extent and nature of activities undertaken by those who take part in public or community involvement, [engagement, and consultation.]”30


In the context of this report, a document, often adopted by a government entity, that describes a future course of action for a community to achieve a desired vision or goal. A plan typically describes the vision and goals of a community or a problem that must be solved, includes a systematic synthesis of available information to analyze the problem, and identifies future actions that must be taken and future investments that must be made to address the stated problem and achieve the desired vision. Plans are prepared and implemented by all levels of government but are especially common at local government levels. Plans include general or comprehensive plans, land-use plans, economic-development plans, and transportation plans. Plans that are commonly subjected to health impact assessment include plans for land use, infrastructure, and natural-resource management.


Generally, “an agreement or consensus on a range of issues, goals and objectives which need to be addressed….For example, ‘Saving Lives: Our Healthier Nation’ can be seen as a national health policy aimed at improving the health of the population of England, reducing health inequalities and setting objectives and targets which can be used to monitor progress towards the policy’s overall goal or aims.”31 In the committee’s report, the use of the term is extended to refer to anything other than land-use plans or development and infrastructure projects. In this context, policy includes formal and informal social rules, including legislation, regulation, budgets, guidelines, and practices.


“Usually refers to a group of activities which are designed to be implemented in order to reach policy objectives…. For example, many Single Regeneration Budget programmes and New Deal for Communities initiatives have a range of themes within their programmes—often including health, community safety (crime), education, employment and housing—and within these themes are a number of specific projects which, together, make up the overall programme.” 32


“Usually a discrete piece of work addressing a single population group or health determinant, usually with a pre-set time limit.” 33 “Usually (but not always), the term refers to ‘bricks and mortar’ projects involving construction of a discrete structure or group of structures, such as a power plant, highway, or housing development.”34

Public (or community) engagement

Action taken to begin to “establish effective relationships with individuals or groups so that more specific interactions can then take place.”35

Public health

The Institute of Medicine has defined public health as “what we, as a society, do collectively to assure the conditions in which people can be healthy.”36 However, the term used in the present report refers more generally to the health of the public. This use is synonymous with the emerging term population health. 37 Implicit in both terms is the notion that health is affected by a wide array of factors that range from the societal to the biologic.

Public (or community) involvement

“Effective interactions between planners, decision-makers, individual and representative stakeholders to identify issues and to exchange views on a continuous basis.”38

Risk assessment

Traditionally, risk assessment is defined as “the characterization of the potential adverse health effects of human exposures to environmental hazards.” Risk assessment can be divided into four major steps: hazard identification (“the process of determining whether exposure to an agent can cause an increase in the incidence of a health condition”), dose-response assessment (“the process of characterizing the relation between the dose of an agent administered or received and the incidence of an adverse health effect in exposed populations and estimating the incidence of effect as a function of human exposure to the agent”), exposure assessment (“the process of measuring or estimating the intensity, frequency, and duration of human exposures to an agent”), and risk characterization (“the process of estimating the incidence of a health effect under the various conditions of human exposure described in exposure assessment”).39


Any individual or group that will be affected by the outcome of a decision. Stakeholders may include the affected community or specific interest groups, individuals, or organizations that have an economic stake in the outcome and the proponents of a project.40

State environmental policy act

Legislation that “provides a way to identify possible environmental impacts that may result from governmental decisions [at the state-level]. These decisions may be related to issuing permits for private projects, constructing public facilities, or adopting regulations, policies or plans.”41 Several states have state environmental policy acts, including California, Connecticut, North Carolina, Washington, and Wisconsin.

Strategic environmental assessment (SEA)

“A systematic and anticipatory process, undertaken to analyze the environmental effects of proposed government plans, programmes and other strategies, and to integrate the findings into decision-making. It involves the public and environmental and health authorities, giving them a say in government planning: the responsible authority has to arrange for informing the public and consulting the public concerned, and the decision-maker has to take due account of comments received from the public and from the environmental and health authorities. Such assessments are most commonly carried out for land-use planning at various levels of government, but are also applied to other sectoral plans, such as for energy, water, waste, transport, agriculture and industry.”42

Tribal environmental policy act

A model act that would establish an environmental impact assessment for actions proposed by tribal governments in the United States.43

Zoning ordinance (or bylaws)

“Legislative regulations by which a municipal government seeks to control the use of buildings and land within the municipality. It has become, in the United States, a widespread method of controlling urban and suburban construction and removing congestion and other defects of existing plans.”44



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Copyright © 2011, National Academy of Sciences.
Bookshelf ID: NBK83537


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