Health Impact Assessments Can Help the Housing Sector Promote Equity

Research shows housing is a social determinant of health and can influence a household’s ability to access basic health care needs. But health often isn’t considered in housing decisions. How can academic institutions, government agencies, and community-based organizations, such as neighborhood associations, ensure health is factored into decisionmaking?

This recent study analyzed how one equity-focused tool, health impact assessments (HIAs), can identify potential health effects of proposed policies, plans, programs, and projects. HIAs generally use a six-step process that includes screening, scoping, assessment, recommendations, reporting and monitoring/ evaluation. Most HIAs examined (81 percent) follow the six-step process. The remaining HIAs use guidance from the San Francisco Indicator Project, which offers other methods and resources to support policy.

For their analysis, the authors compile housing-relevant HIAs to describe key characteristics of housing HIAs and common methods and approaches, and they document the effects of housing HIAs on policy and decisionmaking. The study examines 54 housing-related HIAs conducted in the US between 2002 and 2016 across 20 states. They were sourced from an HIA database maintained by the Health Impact Project and other public sources. The HIAs were facilitated by nonprofits, public health agencies, and educational institutions seeking to inform housing and planning officials or elected officials. Two of the studies dealt with federal decisions, and the remaining 52 dealt with state or local decisions. Eighteen of the HIAs were housing specific, and 36 related to community development.

Some impacts from the HIA may have been long term and therefore unaccounted for, and the three examples used cannot be generalized but rather should provide reference of HIAs’ effectiveness.

Key findings

• The HIAs observed included literature reviews, existing datasets, stakeholder interviews, and focus groups, data collected through surveys, or field observations of health indicators, such as traffic and pedestrian features. 
• Ninety-four percent covered more than one of the four categories of housing-related health determinants: housing quality (39 HIAs), housing affordability (40 HIAs), housing location (37 HIAs), and social, economic, and political factors (32 HIAs).
• At least 19 HIAs (or 35 percent) led to revised decisionmaking and increased funding of health equity implementation.

Policy implications

• HIAs are an effective, flexible tool for making informed decisions about housing policies. A wide variety of organizations can use HIAs and apply them to a range of housing topics and with different assessment methods.
• The HIA process can promote health in final decisionmaking and provide better stakeholder engagement.
• Unfortunately, some critical assessment methods such as environmental sampling may be too expensive or demanding on the capacity of organizations conducting HIAs. In circumstances where HIAs become cost prohibitive or require resources beyond an organization’s capacity, academic institutions, government agencies, and community-based organizations may choose to rely on other health equity criteria or tools such as the San Francisco Indicator Project.