Sec. 1003. Health impact assessments
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Congress makes the following findings: Health Impact Assessment is a tool to help planners, health officials, decisionmakers, and the public make more informed decisions about the potential health effects of proposed plans, policies, programs, and projects in order to maximize health benefits and minimize harms. Health Impact Assessments can be done at a fraction of the cost and time typically required for other planning and permitting reviews. Health Impact Assessments can build community support and reduce opposition to a project or policy, thereby facilitating economic growth by aiding the development of consensus regarding new development proposals.
Health Impact Assessments facilitate collaboration across sectors. It is the purpose of this section to— provide more information about the potential human health effects of policy decisions and the distribution of those effects; improve how health is considered in planning and decisionmaking processes; and build stronger, healthier communities through the use of Health Impact Assessment. Part P of title III of the Public Health Service Act ( 42 U.S.C. 280g et seq.), as amended, is further amended by adding at the end the following:
In this section and section 399V–13: The term Administrator means the Administrator of the Environmental Protection Agency. The term built environment means the components of the environment, and the location of these components in a geographically defined space, that are created or modified by individuals to form the physical and social characteristics of a community or enhance quality of human life, including— homes, schools, and places of work and worship; parks, recreation areas, and greenways; transportation systems; business, industry, and agriculture; and land-use plans, projects, and policies that impact the physical or social characteristics of a community, including access to services and amenities.
The term Director means the Director of the Centers for Disease Control and Prevention. The term eligible entity means a unit of State or Tribal government the jurisdiction of which includes individuals or populations the health of which are, or will be, affected by an activity or a proposed activity. The term eligible institution means a public agency or private nonprofit institution that submits to the Secretary, in consultation with the Administrator, an application for a grant authorized under such section at such time, in such manner, and containing such agreements, assurances, and information as the Secretary and Administrator may require.
The term Health Impact Assessment means a systematic process that uses an array of data sources and analytic methods and considers input from stakeholders to determine the potential effects of a proposed policy, plan, program, or project on the health of a population and the distribution of those effects within the population. Such term includes identifying and recommending appropriate actions on monitoring and maximizing potential benefits and minimizing the potential harms.
The term health disparities are a particular type of health differences that are closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.
The term proposed activity means a proposed policy, program, plan, or project currently under consideration by a local, State, Tribal, or Federal agency or government. The Secretary, acting through the Director and in collaboration with the Administrator, shall carry out the following: Establish a program at the National Center for Environmental Health at the Centers for Disease Control and Prevention focused on advancing the field of Health Impact Assessment. In developing and implementing the program, the Director of the National Center for Environmental Health shall consult with the Director of the National Center for Chronic Disease Prevention and Health Promotion as well as relevant offices within the Department of Housing and Urban Development, the Department of Transportation, and the Department of Agriculture.
The program shall include— collecting and disseminating best practices; administering capacity building grants to States to support grantees in initiating Health Impact Assessments, in accordance with subsection (d); providing technical assistance; developing training tools and providing training on conducting Health Impact Assessment and the implementation of built environment and health indicators; making information available, as appropriate, regarding the existence of other community healthy living tools, checklists, and indices that help connect public health to other sectors, and tools to help examine the effect of the indoor built environment and building codes on population health; conducting research and evaluations of Health Impact Assessments; and awarding competitive extramural research grants.
In accordance with subsection (c), develop guidance and guidelines to conduct Health Impact Assessments. In accordance with subsection (d), establish a grant program to allow States to fund eligible entities to conduct Health Impact Assessments. The Director, in consultation with the Director of the National Center for Environmental Health and, the Director of the National Center for Chronic Disease Prevention and Health Promotion, and relevant offices within the Department of Housing and Urban Development, the Department of Transportation, and the Department of Agriculture, shall— develop guidance for conducting Health Impact Assessment, including— background on national and international efforts to bridge urban planning and public health institutions and disciplines, including a review of Health Impact Assessment best practices internationally; evidence-based direct and indirect pathways that link land-use planning, transportation, and housing policy and objectives to human health outcomes; data resources and quantitative and qualitative forecasting methods to evaluate both the status of health determinants and health effects, including identification of existing programs that can disseminate these resources; best practices for inclusive public involvement in conducting Health Impact Assessments; and technical assistance for other agencies seeking to develop their own guidelines and procedures for Health Impact Assessment; in developing the guidance, consider available international Health Impact Assessment guidance, North American Health Impact Assessment Practice Standards, and recommendations from the National Academy of Science; and not later than 1 year after the date of enactment of this section, publish the guidance.
The Secretary, acting through the Director and in collaboration with the Administrator, shall establish a program under which the Secretary shall award grants to States to fund eligible entities for capacity building or to prepare Health Impact Assessments, and shall ensure that States receiving a grant under this subsection further support training and technical assistance for grantees under the program by funding and overseeing appropriate local, State, Tribal, Federal, university, or nonprofit Health Impact Assessment experts to provide technical assistance.
Such assessments shall— ensure that appropriate health factors are taken into consideration as early as practicable during the planning, review, or decisionmaking processes; assess the effect on the health of individuals and populations of proposed policies, projects, or plans that result in modifications to the built environment; and assess the distribution of health effects across various factors, such as race, income, ethnicity, age, disability status, gender, and geography.
To be eligible to receive a grant under this section, an eligible entity shall submit to the Secretary an application in accordance with this subsection, at such time, in such manner, and containing such additional information as the Secretary may require. An application under this subsection shall include a list of proposed activities that require or would benefit from conducting a Health Impact Assessment within six months of awarding funds. The list should be accompanied by supporting documentation, including letters of support, from potential conductors of Health Impact Assessments for the listed proposed activities.
Each application should also include an assessment by the eligible entity of the health of the population of its jurisdiction and describe potential adverse or positive effects on health that the proposed activities may create. Preference in awarding funds under this section may be given to eligible entities that demonstrate the potential to significantly improve population health or lower health care costs as a result of potential Health Impact Assessment work. An eligible entity shall use amounts provided under a grant under this section to conduct Health Impact Assessment capacity building or to conduct or fund subgrantees to conduct a Health Impact Assessment for a proposed activity in accordance with this subsection.
The purposes of a Health Impact Assessment under this subsection are— to facilitate the involvement of Tribal, State, and local public health officials in community planning, transportation, housing, and land use decisions and other decisions affecting the built environment to identify any potential health concern or health benefit relating to an activity or proposed activity; to provide for an investigation of any health-related issue of concern raised in a planning process, an environmental impact assessment process, or policy appraisal relating to a proposed activity; to describe and compare alternatives (including no-action alternatives) to a proposed activity to provide clarification with respect to the potential health outcomes associated with the proposed activity and, where appropriate, to the related benefit-cost or cost-effectiveness of the proposed activity and alternatives; to contribute, when applicable, to the findings of a planning process, policy appraisal, or an environmental impact statement with respect to the terms and conditions of implementing a proposed activity or related mitigation recommendations, as necessary; to ensure that the disproportionate distribution of negative impacts among vulnerable populations is minimized as much as possible; to engage affected community members and ensure adequate opportunity for public comment on all stages of the Health Impact Assessment; where appropriate, to consult with local and county health departments and appropriate organizations, including planning, transportation, and housing organizations and providing them with information and tools regarding how to conduct and integrate Health Impact Assessment into their work; and to inspect homes, water systems, and other elements that pose risks to lead exposure, with an emphasis on areas that pose a higher risk to children.
Eligible entities funded under this subsection shall conduct an evaluation of any proposed activity to determine whether it will have a significant adverse or positive effect on the health of the affected population in the jurisdiction of the eligible entity, based on the criteria described in subparagraph (B). The criteria described in this subparagraph include, as applicable to the proposed activity, the following: Any substantial adverse effect or significant health benefit on health outcomes or factors known to influence health, including the following:
Physical activity. Injury. Mental health. Accessibility to health-promoting goods and services. Respiratory health. Chronic disease. Nutrition. Land use changes that promote local, sustainable food sources. Infectious disease. Health disparities. Existing air quality, ground or surface water quality or quantity, or noise levels. Lead exposure. Other factors that may be considered, including— the potential for a proposed activity to result in systems failure that leads to a public health emergency; the probability that the proposed activity will result in a significant increase in tourism, economic development, or employment in the jurisdiction of the eligible entity; any other significant potential hazard or enhancement to human health, as determined by the eligible entity; or whether the evaluation of a proposed activity would duplicate another analysis or study being undertaken in conjunction with the proposed activity.
In evaluating a proposed activity under subparagraph (A), an eligible entity may take into consideration any reasonable, direct, indirect, or cumulative effect that can be clearly related to potential health effects and that is related to the proposed activity, including the effect of any action that is— included in the long-range plan relating to the proposed activity; likely to be carried out in coordination with the proposed activity; dependent on the occurrence of the proposed activity; or likely to have a disproportionate impact on high-risk or vulnerable populations.
A Health Impact Assessment prepared with funds awarded under this subsection shall incorporate the following, after conducting the screening phase (identifying projects or policies for which a Health Impact Assessment would be valuable and feasible) through the application process: Identifying which health effects to consider and the research methods to be utilized. Assessing the baseline health status and factors known to influence the health status in the affected community, which may include aggregating and synthesizing existing health assessment evidence and data from the community.
Suggesting changes to proposals to promote positive or mitigate adverse health effects. Synthesizing the assessment and recommendations and communicating the results to decisionmakers. Tracking the decision and implementation effect on health determinants and health status. An eligible entity that is awarded a grant under this section shall develop and implement a plan, to be approved by the Director, for meaningful and inclusive stakeholder involvement in all phases of the Health Impact Assessment.
Stakeholders may include community-based organizations, youth-serving organizations, planners, public health experts, State and local public health departments and officials, health care experts or officials, housing experts or officials, and transportation experts or officials. An eligible entity that is awarded a grant under this section shall submit the findings of any funded Health Impact Assessment activities to the Secretary and make these findings publicly available. An eligible entity that is awarded a grant under this section shall ensure the assessment of the distribution of health impacts (related to the proposed activity) across race, ethnicity, income, age, gender, disability status, and geography.
To the greatest extent feasible, a Health Impact Assessment shall be conducted under this section in a manner that respects the needs and timing of the decisionmaking process it evaluates. In preparing a Health Impact Assessment under this subsection, an eligible entity or partner shall follow the guidance published under subsection (c). The Secretary, acting through the Director and in collaboration with the Administrator, shall establish, maintain, and make publicly available a Health Impact Assessment database, including— a catalog of Health Impact Assessments received under this section; an inventory of tools used by eligible entities to conduct Health Impact Assessments; and guidance for eligible entities with respect to the selection of appropriate tools described in paragraph (2).
The Secretary shall award competitive grants to Prevention Research Centers, or nonprofit organizations or academic institutions with expertise in Health Impact Assessments to— assist grantees with the provision of training and technical assistance in the conducting of Health Impact Assessments; evaluate the activities carried out with grants under subsection (d); and assist the Secretary in disseminating evidence, best practices, and lessons learned from grantees. Not later than 1 year after the date of enactment of this section, the Secretary shall submit to Congress a report concerning the evaluation of the programs under this section, including recommendations as to how lessons learned from such programs can be incorporated into future guidance documents developed and provided by the Secretary and other Federal agencies, as appropriate.
There are authorized to be appropriated to carry out this section such sums as may be necessary. The Secretary, in collaboration with the Administrator, shall award grants to eligible institutions to implement evidence-based programming to improve the built environment and subsequently human health. Factors that influence health that may be considered include— levels of physical activity; consumption of nutritional foods; rates of crime; air, water, and soil quality; risk or rate of injury; accessibility to health-promoting goods and services; chronic disease rates; community design; housing; and other indicators as determined appropriate by the Secretary.
The Secretary, in consultation with the Administrator, shall support research under this section that— uses evidence-based research to improve the built environment and human health; examines— the scope and intensity of the impact that the built environment (including the various characteristics of the built environment) has on the human health; or the distribution of such impacts by— location; and population subgroup; is used to develop— measures and indicators to address health impacts and the connection of health to the built environment; efforts to link the measures to transportation, land use, and health databases; and efforts to enhance the collection of built environment surveillance data; distinguishes carefully between personal attitudes and choices and external influences on behavior to determine how much the association between the built environment and the health of residents, versus the lifestyle preferences of the people that choose to live in the neighborhood, reflects the physical characteristics of the neighborhood; and identifies or develops effective intervention strategies focusing on enhancements to the built environment that promote increased use physical activity, access to nutritious foods, or other health-promoting activities by residents; and in developing the intervention strategies under clause (i), ensures that the intervention strategies will reach out to high-risk or vulnerable populations, including low-income urban and rural communities and aging populations, in addition to the general population.
The Secretary may use funds appropriated under this section to support the expansion of national surveys and data tracking systems to provide more detailed information about the connection between the built environment and health. In providing assistance under the grant program under this section, the Secretary and the Administrator shall give priority to programming that incorporates— interdisciplinary approaches; or the expertise of the public health, physical activity, urban planning, land use, and transportation research communities in the United States and abroad.
There are authorized to be appropriated such sums as may be necessary to carry out this section. Not to exceed 20 percent of amounts appropriated for each fiscal year under this subsection may be used for the research component of the program under this section. .
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Sec. 1003
Health impact assessments
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