Advancing efforts to achieve health equity: equity metrics for health impact assessment practice.

Equity is a core value of Health Impact Assessment (HIA). Many compelling moral, economic, and health arguments exist for prioritizing and incorporating equity considerations in HIA practice. Decision-makers, stakeholders, and HIA practitioners see the value of HIAs in uncovering the impacts of policy and planning decisions on various population subgroups, developing and prioritizing specific actions that promote or protect health equity, and using the process to empower marginalized communities. There have been several HIA frameworks developed to guide the inclusion of equity considerations. However, the field lacks clear indicators for measuring whether an HIA advanced equity. This article describes the development of a set of equity metrics that aim to guide and evaluate progress toward equity in HIA practice. These metrics also intend to further push the field to deepen its practice and commitment to equity in each phase of an HIA. Over the course of a year, the Society of Practitioners of Health Impact Assessment (SOPHIA) Equity Working Group took part in a consensus process to develop these process and outcome metrics. The metrics were piloted, reviewed, and refined based on feedback from reviewers. The Equity Metrics are comprised of 23 measures of equity organized into four outcomes: (1) the HIA process and products focused on equity; (2) the HIA process built the capacity and ability of communities facing health inequities to engage in future HIAs and in decision-making more generally; (3) the HIA resulted in a shift in power benefiting communities facing inequities; and (4) the HIA contributed to changes that reduced health inequities and inequities in the social and environmental determinants of health. The metrics are comprised of a measurement scale, examples of high scoring activities, potential data sources, and example interview questions to gather data and guide evaluators on scoring each metric.

Using health impact assessment to integrate environmental justice into federal environmental regulatory analysis.

Regulatory interventions are the first line of action used by the U.S. Environmental Protection Agency to fulfill its mission to protect the environment and health. Although the Agency has prioritized the integration of environmental justice into its activities, uncertainty remains in how these considerations will be incorporated into its regulatory decision-making processes. In this article, we examine the emerging practice of Health Impact Assessment and argue for its use within the regulatory assessment paradigm to help answer policy-relevant environmental justice questions. Through the use of a health lens, Health Impact Assessments can lead to a better characterization of the potential impacts and benefits of a rule by introducing novel assessments of potentially significant health effects that would otherwise be excluded, revealing whether the rule is likely to exacerbate inequities or create new ones. This article proposes a framework to overcome analytic barriers in achieving a more comprehensive, equity-focused regulatory analysis.

Using health impact assessment to integrate environmental justice into federal environmental regulatory analysis.

Regulatory interventions are the first line of action used by the U.S. Environmental Protection Agency to fulfill its mission to protect the environment and health. Although the agency has prioritized the integration of environmental justice into its activities, uncertainty remains in how these considerations will be incorporated into its regulatory decision-making processes. In this article, we examine the emerging practice of Health Impact Assessment and argue for its use within the regulatory assessment paradigm to help answer policy-relevant environmental justice questions. Through the use of a health lens, Health Impact Assessments can lead to a better characterization of the potential impacts and benefits of a rule by introducing novel assessments of potentially significant health effects that would otherwise be excluded, revealing whether the rule is likely to exacerbate inequities or create new ones. This article proposes a framework to overcome analytic barriers in achieving a more comprehensive, equity-focused regulatory analysis.