Health impact assessment as community participation

Health impact assessment (HIA) is a tool by which prospective policies and plans are evaluated for their potential impact on human health outcomes. This interdisciplinary practice uses community-based approaches to examine social determinants of health. This paper critically examines the prevailing belief that HIA practice in the US context increases community democracy, equity, and social justice through evaluations of three HIAs: Clark County (Washington) Bicycle and Pedestrian HIA, Lake Merritt BART Station Area Plan HIA (Oakland, CA), and the I-710 Corridor HIA (Southern California). By tracing community interests, I demonstrate HIA's potential as a community development tool. HIAs with a robust advisory committee; attention to social determinants of health and healthy equity; and adequate time for scoping health issues are likely protective of community. However, political pressures and limited resources easily compromise this potential, suggesting that practitioners should explicitly create community engagement plans and release the HIA in a timely manner.