Health impact assessment in the United States: Has practice followed standards?

•Our study examined reported HIAs in the U.S. against published practice standards.•Most HIAs used some screening, scoping and assessment elements from the standards.•The extent of these processes and stakeholder participation varied widely.•The average HIA considered multiple health determinants and impacts.•Evaluation or monitoring plans were generally not included in reports.

As an emerging practice, Health Impact Assessment is heterogeneous in purpose, form, and scope and applied in a wide range of decision contexts. This heterogeneity challenges efforts to evaluate the quality and impact of practice. We examined whether information in completed HIA reports reflected objectively-evaluable criteria proposed by the North American HIA Practice Standards Working Group in 2009. From publically-available reports of HIAs conducted in the U.S. and published from 2009 to 2011, we excluded those that were components of, or comment letters on, Environmental Impact Assessments (5) or were demonstration projects or student exercises (8). For the remaining 23 reports, we used practice standards as a template to abstract data on the steps of HIA, including details on the rationale, authorship, funding, decision and decision-makers, participation, pathways and methods, quality of evidence, and recommendations. Most reports described screening, scoping, and assessment processes, but there was substantial variation in the extent of these processes and the degree of stakeholder participation. Community stakeholders participated in screening or scoping in just two-thirds of the HIAs (16). On average, these HIAs analyzed 5.5 determinants related to 10.6 health impacts. Most HIA reports did not include evaluation or monitoring plans. This study identifies issues for field development and improvement. The standards might be adapted to better account for variability in resources, produce fit-for-purpose HIAs, and facilitate innovation guided by the principles.