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Using Peer Review to Improve HIA Quality


Kristin K. Raab
Minnesota Department of Health, Minneapolis

Arthur Wendel
Centers for Disease Control and Prevention, Atlanta

In brief

Peer review is an exciting yet challenging issue for HIA practitioners, as peer review needs to balance the need for timeliness of the HIA with the potential benefit of improved HIA practice. This session will provide an opportunity to discuss how peer review might be effective and the tools that need to be developed to improve the peer review process in HIA.

At the 2014 HIA of the Americas workshop this working group reviewed the results of a survey of HIA practitioners about peer review and the paper drafted based on these results, and discussed next steps on how to promote peer review within HIA practice.


Over the next year, the group will develop a factsheet/guidance document on best practices for using peer review to improve HIA. New members are welcome to join in developing the factsheet/guidance document. Conference calls will occur monthly or as needed until the document is complete.

Strengthening the Use of Qualitative Research Methods in HIA


Holly Avey,
Dawn Haney,
Human Impact Partners, Oakland


The newly formed Qualitative Research working group discussed challenges that HIA practitioners face when doing qualitative research, with in depth discussions about lack of funding and time, difficulty making predictions based on qualitative data, and presumptions that qualitative research is “anything not quantitative.” We brainstormed a long list of resources and tools that this working group could contribute the field that would strengthen qualitative research methods and rigor.


The Qualitative Research working group plans to meet quarterly. Our initial priority will be identifying excellent examples of qualitative research in HIA, with future projects potentially including webinars on qualitative research for HIA practitioners and developing guidelines for reporting qualitative research findings in HIA.

Stakeholder Engagement


Ame-Lia Tamburrini (preferred contact)
Habitat Health Consulting, Calgary

Kim Gilhuly
Human Impact Partners, Cleveland

Kara Blankner
Health Impact Project, Washington

In brief

The objective of the Stakeholder Engagement in HIA working group is to develop a set of tools to help HIA practitioners and their partners establish advisory committees. The tools will address the different models or structures for an advisory committee, how to leverage current partnerships and seek out additional partnerships and dealing with power dynamics within advisory committees.


The Stakeholder Engagement in HIA working group has been working together over many years and as such has compiled a fairly comprehensive list of products that aim to address current challenges in stakeholder engagement in the field of HIA.


Advisory committees are an important aspect of stakeholder engagement in HIA yet many practitioners struggle with deciding when an advisory committee is appropriate, the structure of the committee, who to invite, what the role of the advisory committee should be, and convincing new and established partners to be involved. These are the challenges that this working group hopes to address this year with the intent of improving practice by improving engagement.


The working group will continue to finalize the Stakeholder Engagement Tools/Resources for HIA Practitioners worksheet and the Stakeholder Engagement Budget Resource worksheet and distribute to the larger HIA community for feedback. At the 2014 HIA of the Americas Workshop, the Stakeholder Small Workgroup collected great ideas around advisory committees including a list of future products to create and distribute to the wider HIA community. The next 18 months will be selecting and moving forward on 1 or 2 of these products.

2014 Working Group Summary

This group spent the majority of the time at the HIA of the Americas meeting sharing experiences working with advisory committees and providing recommendations on the following areas:

  • decision-making structures
  • recognizing and dealing with power dynamics
  • recruitment and retention

Key themes that emerged from each topic area include:

A. Decision-making structures within advisory committees

  • Different decision-making strategies and tools; be intentional about choosing these
  • There are different methods and ways of facilitating ACs and decision-making in ACs
  • Make decisions concrete and pragmatic; go for the low-hanging fruit so that people can have outcomes along the way
  • Build trust right off the bat
  • Transparency
  • Acknowledge power dynamics
  • Try to be aware of/encourage cultural sensitivity (language of facilitation of the meetings; acknowledge different ways of giving input (introspective/extrovert for example)

B. Power dynamics within advisory committees

  • Be up-front about expectations and ground rules
  • Level-playing field realistic? Decision-makers ultimately have the power. TRANSPARENCY.
    • What can change vs. what can’t change? Where is there actually room for the conversation to contribute to change? Be up-front about what the power dynamics really are.
  • Working with pople with an agenda- maybe people who you know want to derail the process
    • Have different advisory subgroups
      • Having the groups decide: do you want to meet as a big group? Underpowered groups might not want to be in a separate room (feel like they don’t have power)
      • Consider how building connections/cross-sector learning could suffer from different groups
      • Efficiency-what’s your capacity for having lots of different groups?
      • Have sitting sessions/listening sessions- diffuse tension before the group gets together (awareness building)
      • Start with key stakeholder interviews- figure out who’s talking to who, where the connections are
      • Preliminary work- the origins of the HIA
    • What is the goal of having them there?
  • What about the power of the HIA team? Recognize this.
  • Approaches: do you give people something to respond to?
  • Include community in developing stakeholder engagement plan, scoping and pathway diagrams- focus the discussion on the PRODUCT rather than a person or an issue

C. Recruitment and retention for advisory committees

  • Recruitment
    • Do not reinvent the wheel – use pre-existing groups/committees
    • Answer the question “what’s in it for me?” for each stakeholder group you want to include
    • Anticipate barriers to participation and address them (e.g. financial, child care, transportation)
    • Be transparent in: the time commitment; the goals of the HIA; the impact that the AC may have or that the HIA may have
    • Be flexible with your plan for engagement with the AC
    • Provide compensation when possible and appropriate
  • Retention
    • Provide compensation when possible and appropriate
    • Provide encouragement along the way. Remind people why they are involved and what their involvement means
    • Be effective and transparent in communicating with AC members
    • Ensure that there is a feedback loop established. How is information from the AC being used, or not being used
    • Be clear about the schedule and be upfront for the need for flexibility. Schedules’ change.
    • Be respectful of people’s time (# of meetings, # of communications, etc.).

Possible next steps:

  1. Fact sheet – about decision making tools/structures (like majority votes, consensus –building decision making, democracy, etc.)
  2. Fact sheet – on stipends, what is the going rate for compensation of community participation or stakeholder participation, strategies for how to compensate people if you’re a state or federal or public agency.
  3. Templates for MOUs/Partnership Agreements – build on and improve the HIP “Principles of Collaboration”
  4. Finish/revise “What’s In It For Me?” info sheet – build as a template
  5. Different ways of communicating during decision-making (visual, reflective, prospective)
  6. Check to see what tools OPHI, NNPHI, and GHPR have created already – E.g. sample agendas

Health in All Policies (HIAP) Screening Tool Workgroup


Mandy Green,
Green Health Consulting,

Tia Henderson,
Upstream Public Health,


The purpose of this Society of Practitioners of HIA (SOPHIA) workgroup is to develop a screening tool that provides guidance on selecting alternative tools to incorporate a broad health perspective when an HIA does not fit, based on HIA principles and practice elements.

At the local level, HIA practitioners are in need of tools that incorporate health into decision-making processes, and that are still centered on HIA core practice elements and core values such as sustainability, equity, democracy and ethical use of evidence. This work began at the HIA of the Americas Conference in 2013, and continued at the 2014 Conference. It builds off of previous workgroups that have discussed the intersection of HIA and health in all policies/sectors and various methods for health in all policies/sectors. It moves the field forward by using existing HIA practice as a foundation for building stronger tools for HIAP/health in all sectors practice which is currently loosely defined.

Working Group Objectives

  1. Review “when an HIA is not appropriate” rationale from Screening 2.0 Ecosystem discussion from HIA of Americas session as a basis for developing an HIAP screening tool
  2. Identify, discuss and refine a grouping of HIA “alternative tools” based on the Screening 2.0 Ecosystem discussion from the HIA of the Americas session in 2013
  3. Identify, discuss and refine a set of draft core questions that can be part of a screening tool, similar to core questions asked to screen a project for an HIA.
  4. Develop a draft structure of a screening tool, such as a guide and decision tree for use by practitioners.

Workgroup Process and Product

We would like for HIA practitioners who are willing to contribute to the development of the screening tool and finalize it for publication as either a white paper or in a peer reviewed document to join the SOPHIA workgroup (by emailing Tia or Mandy) and participate in conference calls. We will also request that HIA practitioners pilot test the tool, and the workgroup will collect information from this pilot process to refine the tool.

Practice Standards/ Pricing & Resourcing HIAs


Jonathan Heller,
Human Impact Partners, Oakland

Marla Orenstein,
Habitat Health Consulting, Calgary

Murray Lee,
Habitat Health Consulting, Calgary

Max Richardson,
Public Health Institute

Rajiv Bhatia,
The Civic Engine/U.C. Berkeley
San Francisco Bay Area,

In brief

New practitioners, topics, and perspectives are contributing to a diverse and rapidly evolving North American HIA field. This session will support high-quality, effective HIA practice by presenting a consensus-based document that incorporates lessons learned from applying the 2010 MEs/PEs in practice. The topic of pricing/ resourcing HIAs has not been broached before at HIA of the Americas even though it is of interest to a wide range of attendees.

This session began by introducing version 3.0 of the North American Minimum Elements and Practice Standards for HIA (MEs/PEs), and shifted into a discussion of appropriately pricing and resourcing HIAs.


The practice standards were first drafted in 2008 at the inaugural HIA of the Americas meeting, with the hope that they would support high-quality, consistent HIA practice that aligned with the 1999 Gothenburg Consensus Paper. The first revision was conducted in conjunction with the 2010 HIA of the Americas meeting. In an effort to maintain the rigor and applicability of the MEs/PSs to the burgeoning HIA practice in North America, the MEs/PEs Working Group invited comments during an open comment period in spring 2014 and produced Version 3.0 accordingly.


Follow-up activities may include dissemination of the updated MEs/PEs, ideas for tracking the use of/adherence to the MEs/PEs, determining whether any follow-up activities are needed at the next HIA of the Americas.



Jonathan Heller,
Human Impact Partners, Oakland

Marjory Givens
Health Impact Project, Washington

Tina Yuen
NACCHO, Washington

In brief

Given the values of equity and democracy that HIA was founded upon, growth in the field holds promise for addressing health inequities. To achieve this, practitioners of and participants in HIAs must be vigilant and competent in ensuring that equity is central to the process of and the analysis in HIA. While most completed HIAs have addressed some elements of equity, many have room for improving the incorporation of equity in the HIA process.

The main objective of the Equity Working Group is to advance equity through HIA practice by identifying: a) barriers to incorporating equity considerations into HIA practice and ways to overcome those barriers; and b) opportunities for ensuring that equity considerations are a fundamental component of HIA. An additional objective of the working group is to disseminate the metrics the group developed over the last 18 months. Link to Equity Metrics for HIA Practice:


At the March 2013 HIA of the Americas Workshop, the working group identified several potential joint projects and prioritized one: developing a set of metrics to evaluate how equity was incorporated into an HIA. Working group members have had monthly phone calls to carry this out and the metrics will be released at the September 2014 HIA of the Americas Workshop.


Some of the potential joint work that was identified in the past includes:

  • Guidance of framing around equity in HIA practice: When do you lead with equity? When do you call it something else? Etc.
  • Discussions with funders about how to further support equity in HIA
  • New tools for data collection with populations facing inequities
  • Tools and opportunities to address power imbalances through HIA practice
  • Develop training and TA tools related to equity in HIA for use by others

Notes from the 2014 Working Group Meeting

After discussing the newly released Equity Metrics, participants discussed barriers to addressing equity through HIA practice. Some of the barriers discussed include:

  • Unclear definition of inequity
  • Lack of resources to address equity
  • Tokenism
  • Communicating with decision makers around promoting equity
  • Lack of agreement on what are the inequities (inequity is not just one thing)
  • Framing equity so that communications result in action
  • Difficulty in code-switching when talking about equity with different audiences so that people buy in
  • The need of public health to appear “objective”
  • The need to reframe what data is and what evidence is; what evidence is valid?
  • Tensions between different goals of HIA: policy win vs addressing equity
  • Lack of skills sets among practitioners to achieve the goal of addressing equity in HIA
  • Timidity within public health
  • Apathy within public health
  • Lack of (robust) community organizing
  • Narrative around equity

We next discussed potential opportunities we might take advantage of to better address equity through HIA. Some of those opportunities include:

  • HIA as a strategy in the Environmental Justice process, including new guidance docs around EJ from the EPA
  • Interest in HIA from the EPA
  • Example of how HIA was used as an advocacy tool
  • Infusing equity into the steps of HIA more rigorously
  • Inserting equity more into the practice standards revision
  • Interest in the SDOH among funders
  • The newly formed National Collaborative for Health Equity
  • CDC’s minority health program
  • Dispelling the idea that there isn’t a public health movement around equity
  • The National Prevention Council’s work
  • The National HIA Conference
  • Interest in HIA among community organizers

Participants then prioritized several of the barriers and opportunities as being the most important/interesting for future work together by voting. We then discussed activities to undertake to address these prioritized barriers and opportunities.

The prioritized activities that the workgroup is planning to undertake are:

  • Low Hanging Fruit
  • Develop abstracts and communicate with National HIA Meeting Planning Committee re sessions about equity in HIA, including another plenary
  • Talk to the Qualitative Working Group about their activities related to dispelling the belief that qualitative data (which is often used to describe inequity) is inferior to quantitative data. Integrating equity in those activities if possible.
  • Map existing work around equity in public health – National Collaborative for Health Equity, government agencies, non-profits, etc. – and identify holes in the network which we may be able to fill as well as opportunities for collaboration.
  • Big activity for the next year
  • Because we all have trouble communicating about equity to decision makers and others, develop a toolkit of best practices about framing and messaging about equity for various audiences (disaggregated by audience – red vs blue, decision maker vs community member, etc.), taking advantage of what has worked elsewhere
  • Write a project description
  • Try to find funding
  • Scan for what already exists (e.g., BMSG webinar), analyze gaps, and make it specific to HIA
  • Research & writing

Communicate findings:

  • Toolkit
  • Video
  • Panel discussion at future conferences
  • Webinar

After that, to build the skills of HIA practitioners, develop a webinar about incorporating equity into HIA practice broadly. This would include the findings about messaging/framing as well as other ways to incorporate equity (based on past workgroup products). Also develop associated training materials for those who do HIA trainings and work with them to incorporate this into their trainings.

Addressing Impacts to Mental Health in HIA


Holly Avey

Human Impact Partners, Oakland

Tiffany McDowell

Adler School of Professional Psychology, Chicago

In brief

This workgroup continued discussions about the importance of integrating mental health considerations into HIA and explored content for the remaining resource sheets identified in the 2013 session aimed to build capacity of HIA practitioners to incorporate mental health considerations. These resource sheets may eventually be consolidated into a white paper. Additional resource sheet topics the group envisions include: 1) identifying resources for assessment, including indicators to use and available data sources, 2) providing sample recommendations that could be offered to address mental health impacts and determinants, 3) reporting and communications guidance on how to translate mental health data into accessible information for engaging decision-makers, and 4) providing a review of the current status of mental health in HIAs. Ongoing work will include developing the remaining documents.


The SOPHIA Mental Health Workgroup was established in March 2013 and consists of 18 members from diverse backgrounds and geographic areas. Their common goal is to integrate mental health considerations into HIAs. Two resource sheets have already been drafted: 1) creating a set of common definitions HIA practitioners can utilize when incorporating mental health into their HIAs, and 2) providing sample pathways explaining positive and negative connections between potential decisions and mental health.

Highlights from the 2014 HIA of the Americas meeting

The Mental Health working group met for its second session at an HIA of the Americas meeting. Of the 9 attendees, 7 were new to the group. Facilitators provided a brief overview of the history of the working group and reviewed the draft materials that have been created to date. Participants then split into two groups. Using current HIA projects as examples, participants discussed how to utilize the draft materials to guide them in better incorporating mental health considerations into their HIAs, then reflected on this process, concluding that the materials were helpful. Facilitators then discussed plans for remaining materials to be created and next steps.

Future Plans

The Mental Health working group plans to meet quarterly. We will revise existing resource sheets and continue work on drafting new resource sheets on: 1) identifying resources for assessment, including indicators to use and available data sources, 2) providing sample recommendations that could be offered to address mental health impacts and determinants, and 3) reporting and communications guidance on how to translate mental health data into accessible information for engaging decision-makers.

Improving the Practice of Monitoring and Evaluation


Florence Fulk

U.S. Environmental Protection Agency, Cincinnati

Justicia Rhodus

CSS-Dynamac, Cincinnati

Andrew Dannenberg

University of Washington School of Public Health, Seattle


The purpose of this working group is to identify ways to improve monitoring and evaluation in health impact assessment (HIA), recognizing essential elements for planning and implementation and capitalizing on best practices.


While recent HIA publications have highlighted the importance of monitoring and evaluation in advancing the practice of HIA, the field has seen limited use of evaluation of the effectiveness of HIA in informing decisions and of monitoring to document the changes in health and health determinants post implementation of a decision. The increased development of indicators in the health, social, environment and economic sectors provides an opportunity to link the HIA assessment with a post-decision monitoring plan. Engaging stakeholders in development of a monitoring and evaluation plan, including the best indicators for monitoring and training in the collection of data to support indicators (both in assessment and follow-up monitoring) can: 1) increase their knowledge of health and health determinants in their community; 2) increase awareness of the links between the built and natural environment and public health and 3) empower the stakeholders to advocate for better decisions that impact their community.

Initial Working Group Participation * *Continued participation in the working group is optional

Eighteen (18) individuals from state and federal agencies, state and county health departments/organizations, universities, private industry, non-profits, and community based organizations participated in this working group at the 2014 HIA of the Americas meeting.

2014 Working Group Meeting Highlights

  • Discussed types of monitoring and evaluation in HIA
  • Examined the current state of monitoring and evaluation in HIA and its limited application
  • Clarified the focus of the working group – impact and outcome monitoring and evaluation
  • Identified benefits and challenges of monitoring and evaluation
  • Highlighted examples of HIA monitoring and evaluation plans
  • Developed a framework for implementing monitoring and evaluation in HIA
  • Identified essential elements of a monitoring and evaluation plan
  • Identified best practices in monitoring and evaluation
  • Identified opportunities to integrate assessment and monitoring and evaluation – linking health determinants and health behaviors to health outcomes
  • Identified opportunities for stakeholder and community involvement in monitoring and evaluation
  • Established next steps


The working group will continue to refine and finalize the framework for improving monitoring and evaluation in HIA, detailing the benefits and challenges of monitoring and evaluation, essential elements of a monitoring and evaluation plan, best practices, opportunities for linking indicators in assessment with post-decision monitoring, and opportunities for stakeholder and community participation in monitoring and evaluation efforts. Working group members will produce a position paper or other publication presenting the framework. New members are welcome to join the working group and the effort to improve monitoring and evaluation in HIA!

Is Now the Time for Advancing the Practice of HIA at the State, Regional and Federal Level?


Florence Fulk

U.S. Environmental Protection Agency, Cincinnati

Justicia Rhodus

CSS-Dynamac, Cincinnati

Andrea Hamberg

Oregon Health Authority, Portland


The purpose of this working group is identify how the HIA community of practice can leverage recent events to advance the use of HIA in state, regional, and federal plans, policies, and decisions. The working group will identify and prioritize concrete actions to increase the visibility and use of HIAs at these higher levels of decision-making.


Increased attention to the links between built and natural environments and public health, coupled with the growing community of practice in HIA, provides a potential opportunity to advance the use of HIA at higher levels of decision-making. In addition the presidentially appointed Advisory Group on Prevention, Health Promotion, and Integrative Public Health recently recommended that the Surgeon General should encourage, coordinate, or conduct health impact assessments of key federal policies and projects. This recommendation was based on the Advisory Group’s recognition of the growing use of HIAs and their belief that “broader use of HIAs can dramatically improve policy decisions across the government.” Currently, twenty government agencies and departments are members of the National Prevention Council. In addition, there are a number of other initiatives at the state, regional, and federal levels that provide opportunities to incorporate the use of HIA in planning and policy, such as for NEPA, transportation plans, and Hurricane Sandy rebuilding efforts.

Initial Working Group Participation * *Continued participation in the working group is optional

Nineteen (19) individuals from state and federal agencies, state health departments/organizations, universities, private industry, non-profits, and community based organizations

2014 Working Group Meeting Highlights

  • Discussed the current state of HIA at state, regional and national levels
  • Provided an overview of state, regional, and national initiatives that include or have the potential to include HIA
  • Created a vision for the future state of HIA practice at state, regional, and national levels
  • Pinpointed potential barriers to achieving the future state
  • Identified a set of critical factors to move from the current state to the future state
  • Identified the initial focus for action – capitalizing on the demand that already exists and building new demand for HIA at state, regional, and federal levels
  • Established next steps

Vision for the Future State of HIA Practice: Consideration of health is embedded in all state, regional, and federal decision-making. Decision makers at these levels value HIA as a tool to reach mutual goals and give all communities and individuals a voice in the decision process.

  • Initial Focus for Action – Meeting and Creating Demand
    • Develop clear guidance on when an HIA is appropriate for audiences/partners at these decision-making levels.
  • Build on screening/HIA/HIAP working group efforts
  • Develop guidance on how to learn about the goals of potential partners and audiences at these decision-making levels and create an HIA pitch.
  • Develop audience-specific messages for pitching HIA to create an understanding of how HIAs can support/advance mutual goals


The working group will continue to refine and finalize the roadmap for advancing HIA at the state, regional, and federal levels, including actions to be taken to achieve critical factors and address potential barriers to this future state of practice. Working group members will produce a position paper or other publication presenting the roadmap for advancing HIA at the state, regional, and federal levels. The working group will also identify the appropriate audience(s) for this message of advancing HIA at higher levels of decision-making and will pursue and/or enlist others to support the set of actions listed above under Initial Focus for Action. New members are welcome to join the working group and the effort advance HIA at higher levels of decision-making!

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