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How has Health Impact Assessment been used? Findings from a new study

Health is impacted by multiple factors outside the direct control of the public health and health care system, such as education, income, and the conditions in which people live, work, and play. Health impact assessment (HIA), provides a structured process for examining the potential health impacts of proposed policies, plans, programs, and projects. Conducting a HIA involves using an array of data sources and analytic methods, gathering input from stakeholders, and providing recommendations on monitoring and managing potential health impacts.

A new study, published this month in the Journal of School Health, systematically identified 20 HIAs conducted in the United States between 2003 and 2015 on issues related to prekindergarten, primary, and secondary education. The HIAs were conducted to examine (1) school structure and funding, (2) transportation to and from school, (3) physical modifications to school facilities, (4) in-school physical activity and nutrition, and (5) school discipline and climate. Assessments employed a range of methods to characterize the nature, magnitude, and severity of potential health impacts. Assessments fostered stakeholder engagement and provided health-promoting recommendations, some of which were subsequently incorporated into school policies.

Results suggest that HIA can serve as a promising tool that education, health, and other stakeholders can use to maximize the health and well-being of students, families, and communities. Health impact assessments should be used when: (1) there is a decision that has the potential to affect environmental or social determinants of health, but the potential health impacts are not being considered; (2) there is sufficient time to conduct an analysis before the final decision is made; (3) the assessment can add value to the decision-making process; and (4) there are stakeholders, data, and resources to support the process.

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Using Learning To Do Good, Even Better

One of the best parts of my job is helping organizations use learning to do good, even better. Recently, we worked with Project Health Colorado, a strategy funded by The Colorado Trust with support from The Colorado Health Foundation, focused on building public will to achieve access to health for all Coloradans by fostering a statewide discussion about health care and how it can be improved. The strategy included fourteen grantees and a communications campaign working independently and together to build public will. It also combined an impact evaluation with coaching on engaging in real-time, data-driven strategic learning to help grantees and The Trust test and adapt their strategies to improve outcomes.

Lessons learned about strategic learning:

So, how can organizations use real time learning to tackle a complex strategy in a complex environment – building will around a highly politicized issue? Our strategic learning model built the capacity of The Trust and grantees to engage in systematic data collection, along with collective interpretation and use of information to improve strategies. As a result, grantees shifted strategies in real time, increasing their ability to influence audience awareness of access to health issues and willingness to take action.

As a result of the learning, The Trust made major changes to the overarching strategy including shifting from asking grantees to use a prepackaged message to using the “intent” of the message with training on how to adapt it. This was particularly important for grantees working with predominately minority communities, who reported the original message did not resonate in their communities.

The real-time learning was effective because it allowed grantees and the Trust to practice interpreting and using the results of systematic data collection, applying what they learned to improve their strategies. The evaluation also supported adaptation over accountability to pre-defined plans, creating a culture of adaptation and helping participants strategize how to be effective at building will.

Lessons learned about evaluation:

The evaluation focused learning at the portfolio level, looking at the collective impact on public will across all grantee strategies. As the evaluator charged with figuring out the impact of this strategy, where everyone was encouraged to constantly adapt and improve, we learned that having multiple in-depth data collection methods, tailored to the ways different audiences engaged in the strategy, and explicitly planning for how to capture emergent outcomes allowed the evaluation to stay relevant even as the strategy shifted.

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This post originally appeared September 14, 2015 on AEA365, the American Evaluation Association blog. The American Evaluation Association is an international professional association of evaluators devoted to the application and exploration of program evaluation, personnel evaluation, technology, and many other forms of evaluation. The American Evaluation Association is celebrating Nonprofits and Foundations Topical Interest Group (NPFTIG) Week. The contributions all this week to aea365 come from our NPFTIG members.