Health Impact Assessments

EPA is evaluating Health Impact Assessment (HIA) as a decision-support tool for promoting sustainable and healthy communities. The foundation of a healthy community is strongest when built upon a decision-making process that balances environmental, social, and economic factors to promote the health and well-being of its members. HIA is a tool designed to investigate how a proposed program, project, policy, or plan may impact health and well-being and inform decision-makers of these potential outcomes before the decision is made.


  • determine the potential effects of a proposed decision on the health of a population and the distribution of those effects within the population;
  • consider input from stakeholders, including those impacted by the decision;
  • use different types of evidence and analytical methods;
  • are flexible based on available time and resources; and
  • provide evidence and recommendations to decision-makers in a timely manner.

HIAs consider the full range of potential impacts of the proposed decision‒ both positive and negative‒ on health and those factors known to directly and indirectly affect human health. HIAs provide recommendations for maximizing the potential positive health impacts and minimizing and/or avoiding the potential negative health impacts of the decision.  In addition to promoting human health considerations, HIAs also encourage democracy, health equity, and sustainability in decision-making.

  • A Review of Health Impact Assessments in the U.S.

    EPA performed a review of 81 Health Impact Assessments (HIAs) from the U.S. to obtain a clear picture of how HIAs are being implemented nationally and to identify potential areas for improving the HIA community of practice. The review was focused on HIAs from four sectors that the EPA’s Sustainable and Healthy Communities Research Program has identified as target areas for empowering communities to move toward more sustainable states. These four sectors are Transportation, Housing/Buildings/Infrastructure, Land Use, and Waste Management/Site Revitalization.

    The Minimum Elements and Practice Standards for Health Impact Assessment was chosen from the broad body of HIA guidance documents as the benchmark against which to review the HIAs. The HIA Review systematically documented organizations involved in conducting the HIAs; funding sources; the types of community-level decisions being made; data, tools, and models used; self-identified data needs/gaps; methods of stakeholder engagement; pathways and endpoints; characterization and prioritization of impacts; decision-making outcomes/recommendations; monitoring and follow-up measures; HIA defensibility and effectiveness; attainment of the Minimum Elements of HIA; areas for improvement; and identification of best practices.

    The results of the HIA review were synthesized to identify the current state of the HIA practice in the U.S., best practices in HIA, and areas for improvement.

    Related Resources

  • EPA's Health Impact Assessments (HIA) Case Studies

    EPA is undertaking several HIA case studies to learn how its science can be used in the HIA process and how HIA can be incorporated into its decision-support tools, actions, and mission.

    Gerena School HIA (Springfield, MA)

    Gerena Community School, located in Springfield, MA, is undergoing renovations to improve the environmental conditions for its users. The facility functions as an elementary school and community center, serving students and residents of the North End Community. EPA is collaborating with stakeholders, including departments within the City of Springfield and community-based groups, to perform the HIA. The purpose of this HIA is to provide valuable health-focused information to help the City of Springfield narrow down and prioritize those renovation actions that best address the existing environmental conditions and reduce the potential negative health impacts to students, faculty, staff, and community members who use the facility. The HIA also provides an avenue for the community and other stakeholders to be engaged in the decision-making process. Community stakeholders have raised concerns related to Gerena School, which include indoor air quality issues related to motor vehicle emissions, flooding, moisture, mold, and other indoor environment conditions; negative perceptions of the school facilities among the community; differing priorities between school and city administrators; absenteeism; and classroom noise. The HIA utilizes on-site observations, reviewed evidence, and professional expertise to judge each of the proposed renovation options for potential impacts to respiratory health, classroom acoustics, and community perception. Based on the predicted impacts to health, the HIA provides recommendations for renovation actions that aim to maximize potential benefits to health and mitigate and/or avoid potential adverse impacts to health.

    Proctor Creek Boone Boulevard Green Street Project HIA (Atlanta, GA)

    Proctor Creek is one of the most impaired creeks in metro-Atlanta and has been placed on the impaired waters list because it does not meet state water quality standards for fecal coliform. The topography, prevalence of impervious surfaces in the watershed, and a strained combined sewer system have contributed to pervasive flooding in the Proctor Creek community and created environmental, public health, economic, and redevelopment issues. A green infrastructure project, aimed at supporting water quality and revitalization improvement efforts, has been proposed in a headwater community of Proctor Creek. The purpose of this HIA is to help inform the City of Atlanta’s decision on whether to implement the proposed project as designed and to provide an avenue for stakeholders, including state environmental and public health agencies, city and county departments, advocacy groups, and the community, to be engaged in the decision-making process. The HIA evaluates the proposed Boone Boulevard Green Street Project for its potential to impact twelve determinants of health identified by stakeholders ‒ water quality; flood management; climate and temperature; air quality; traffic safety; exposure to greenness; urban noise; access to goods, services, greenspace, and healthcare; crime; social capital; household economics, and community economics. The results of the HIA suggest that the proposed green infrastructure project will have a positive impact on health overall and provides recommendations for implementation and expansion of green infrastructure projects throughout the watershed.

    Expanded Proctor Creek Watershed HIA (Atlanta, GA)

    EPA is conducting a second HIA in the Proctor Creek Watershed communities of Atlanta, Georgia to evaluate a proposed environmental district plan, under consideration by the City of Atlanta, that includes the use of green infrastructure and other low-impact development (LID) techniques throughout the Proctor Creek communities to address environmental, social, and economic concerns. The primary objective of this HIA is to ensure that the expansion of green infrastructure and LID projects throughout the watershed is planned such that the potentially harmful impacts of urban development are mitigated and the benefits to public health are maximized. The HIA also provides an avenue for continued community and stakeholder engagement in decisions affecting this community.

    HIA of Proposed Code Changes for Onsite Sewage Disposal Systems (Suffolk County, NY)

    EPA is conducting an HIA to evaluate potential beneficial and adverse impacts to health that may result from the proposed code changes regarding onsite sewage disposal systems (OSDS) for residential properties in Suffolk County, New York. OSDS are an alternative to centralized municipal sewage disposal systems and are the primary mode of sewage disposal for residential properties in the county. The proposed changes to the sanitary code would require existing OSDS to be upgraded to a conventional or innovative/alternative OSDS, if they have not already been upgraded. The Suffolk County Government is considering the proposed changes to address a growing issue of nutrient loading of Suffolk County soil, surface waters, and ground waters. Overloading of nutrients, particularly nitrogen, has been linked to the impairment of surface and ground waters, beach closures, shellfish population die offs, harmful algal blooms, and damage of marine coastlines. The HIA will inform the decision regarding changes to the Suffolk County sanitary code and provide recommendations to maximize potential benefits and mitigate potential adverse impacts to health that may result from the decision.

    Technical Contact

    Florence Fulk (

  • HIA Resource and Tool Compilation

    The Health Impact Assessment (HIA) Resource and Tool Compilation is a free, publicly-accessible compilation of tools and resources being developed by EPA that can be utilized by HIA practitioners at all levels of experience to guide them through the HIA process.

    The HIA resources and tools contained in the Compilation were identified through:

    • the “HIA Information Toolkit: Data, Methods, and Models from the HIA Community of Practice” Working Group at the Inaugural National Health Impact Assessment Meeting in Washington D.C. in 2012;
    • a review of EPA tools, databases, and other resources relevant to HIA;
    • data sources, tools, and models identified in the EPA report, A Review of Health Impact Assessments in the U.S.: Current State-of-Science, Best Practices, and Areas for Improvement;
    • a general online search;
    • and an extensive, although not comprehensive, review of tools used in completed HIAs.

    The HIA Resource and Tool Compilation is designed to provide an extensive list of resources that apply to the HIA process itself and the themes present throughout the process, such as equity and community participation, as well as tools that can be used to collect and analyze data, establish a baseline profile, assess potential health impacts, and establish benchmarks and indicators for recommendations and monitoring. The Compilation is divided into several primary categories based on the resource or tool type (e.g., HIA Process Resources, Databases, Guidance Documents, Analysis Tools, Models, Mapping Tools, and Data Collection Tools). The resources and tools are further categorized by the topic (or in some cases, the HIA step) to which that resource or tool pertains (e.g., Monitoring and Evaluation, Demographics, Housing, Transportation, etc.).

    The HIA Resource and Tool Compilation will initially exist as a standalone tool, but will eventually be integrated into an HIA Roadmap – a component of EPA’s Community-Focused Exposure and Risk Screening Tool (C-FERST) currently under development. C-FERST is an online community mapping, information access, and assessment tool designed to help assess risk and assist in decision-making within communities.  More information on C-FERST can be found on EPA's C-FERST webpage.