Imagine this scenario: Together with key leaders in the community, you want to increase physical-activity levels in your city’s parks and walking and biking trails. Discussions take place, and a preliminary plan is developed to connect the city’s trails as part of an alternative transportation system. But how do you get the community to support this plan? How will you know if your plan will help the local economy? How do you convince decisionmakers that this plan will result in positive health outcomes for all of the people affected?

A Health Impact Assessment (HIA) is an evidence-driven tool that helps evaluate the potential health effects of a program, plan or policy, such as building a new roadway or expanding parks, trails and green space. By thinking about the health effects of a plan or program before it is set in place, community leaders and policymakers become more aware of hidden opportunities to improve health, save on health-related costs and use limited resources more wisely.

The City of Greenville, South Carolina, is currently conducting a three-year comprehensive planning process to connect its west-side neighborhoods to jobs and open space. In 2012, the South Carolina Institute of Medicine and Public Health worked in partnership with the City of Greenville to integrate an HIA into the piece of their comprehensive planning process that focused on parks, trails and green space. The Advisory Committee included community members and representatives from academic institutions, senior housing, advocacy groups, city officials, urban planners, the County of Greenville, medical institutions, nonprofit groups and the South Carolina Department of Health and Environmental Control. The goal of the HIA was to examine the potential positive and negative health impacts of the development of parks, trails and green space in Greenville’s west side. In addition, the HIA would help increase the understanding among participants and community residents of the relationship between health and the built environment, bring health to the forefront for policies that fall outside traditional public health arenas, and ultimately, promote continued use of HIAs in Greenville and in South Carolina. 

As a result of the HIA, the Advisory Committee concluded that development of green space in the west side has the potential to increase physical activity and combat high obesity and chronic disease rates in the community, which would also lead to improvements in mental and physical well-being. The proposed park would increase social cohesion among residents by providing a place for residents to gather. There is also potential for changes in community and family economic stability and an opportunity to increase access to healthy food through community gardens and farmers’ markets.

The Atlanta BeltLine HIA in Georgia involved more than a year of research and analysis on the potential health benefits of the Atlanta BeltLine, a transit, trails, parks and redevelopment project that uses a 22-mile loop of abandoned rail line. The HIA identified five areas of potential health impacts, which included access to health-promoting amenities and goods and opportunities for physical activity.

An interesting finding came from the assessment of parks, which revealed that 187,000 of the 213,000 residents in the study area have park access. The BeltLine would create new access to parks for approximately 11,000 people, but an estimated 15,000 residents would still be without. The HIA also discovered that although the BeltLine would improve Atlanta’s ratio of park acres to residents, the addition of new park acres would be offset by an increase in the population. The city would therefore have to ensure that additional park space is created in order to prevent the ratio of park acres to residents from decreasing. 

The assessment also shed light on areas that have higher mortality rates for chronic diseases linked to a lack of physical activity. It was concluded that parks, trails and transit must be accessible to these populations for the BeltLine to make an impact.

Some of the more critical recommendations made as a result of the HIA include: 

• Create additional park acres throughout Atlanta to meet the city’s target of 10 acres per 1,000 people;

• Where feasible, provide trail access points every quarter mile; 

• Implement educational campaigns in the parks, along the trails and in the broader Atlanta community to encourage physical activity; and

• Create a variety of park types, including passive and active parks.

An HIA is an excellent tool for providing community leaders with the information they need to make better decisions. Not only does an HIA draw attention to the health implications of a policy, plan or program, it also helps policymakers make budgetary decisions. However, it can be costly and time-consuming, and it is not always necessary for some proposed policies or projects.

To learn more, visit the Health Impact Project website or the Centers for Disease Control and Prevention's HIA page. Also, the American Planning Association and the National Association of County and City Health Officials developed a “how-to” guide for conducting HIAs.

Zarnaaz Bashir is NRPA’s Director of Strategic Health Initiatives.