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Health Impact Assessment Toolkit

Are you planning to conduct a health impact assessment? This toolkit from New Mexico Environmental Public Health is a good starting point.

Health Impact Assessment Toolkit

Typically, a Health Impact Assessment (HIA) is a six-step process that engages people living in the communities most impacted by a proposed project (or in some cases by lack of services or a lack of projects). This toolkit sketches the process.

HIA Key Points

  • Type of study that helps policy makers identify and address the likely health impacts of decisions in fields outside of health
  • Procedures + methods + tools to identify:
    • potential, and sometimes unintended, effects of a proposed project on the health of a population
    • distribution of effects within the population and appropriate actions to influence effects


A Health Impact Assessment (HIA) is "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," according to the PEW Charitable Trust (http://www.pewtrusts.org/en/projects/health-impact-project/health-impact-assessment). Further, the "HIA provides recommendations on monitoring and managing those effects."

HIAs tend to be a voluntary research and public engagement tool used to increase the awareness of health and equity in public policy and planning decisions. The end-product is typically a report or set of products designed to communicate the implications of the proposed policy, plan, or project. Additionally, recommendations are often made to either promote positive health effects or to mitigate potential negative health effects. Most often, the primary audience for the assessment are decision makers whose choices influence the proposed projects or policies.

For a HIA to be truly effective it needs to be done before a prospective project is started. That means it needs to be done during the early planning stages of that proposed project. The HIA can be initiated by local public health professionals, community groups, affected stakeholders, the project planners. Sometimes it can be required by a local policy or legislation.


A Health Impact Assessment is important because it:

  • Looks at health from a broad perspective that considers social, economic and environmental influences.
  • Brings community members, business interests and other stakeholders together, which can help build consensus.
  • Acknowledges the trade-offs of choices under consideration and offers decision makers comprehensive information and practical recommendations to maximize health gains and minimize adverse effects.
  • Puts health concerns in the context of other important factors when deciding about a project or community change.
  • Considers whether certain impacts may affect vulnerable groups of people in different ways. (Pew Charitable Trust).


Reasons for using the HIA approach in your community could include:

  • Ensuring health, environmental health, and health disparities are considered in a decision.
  • Your community members and appropriate organizations (the stakeholders) are involved in decision-making.
  • The stakeholder's concerns can be addressed.



HIAs allow for a great deal of flexibility and can range from simple to complex depending on need, resources and timeframe. It is best to consider the complexity of the assessment before beginning the process. A simple assessment, known as rapid assessments, can be completed within a few weeks. More complex assessments with intensive data collection and advanced analysis of data can take months to complete. Other assessment options can fall anywhere on the continuum between simple and complex

NM EPHT provides many resources you can apply throughout your HIA process. First, we recommend starting with the Community Environmental Health Profiles for your county or area. (https://nmtracking.org/community/Introduction.html).

Consider using NM EPHT data to build your HIA.
  • Resources for each step of the HIA include:
    • Guidance on literature reviews.
    • Expertise on intersection of environmental exposures and health (risk analysis and toxicology).
    • Analyses to identify vulnerable populations/localities (e.g., heat stress morbidity)
    • Background information coupled with data on many health outcomes and exposures.
  • Get in contact with us at doh-eheb@state.nm.us. In the subject line state: HIA, Attn: Tracking Program.
There are many approaches to conducting a HIA. This toolkit outlines the steps typically used in the process. Whichever methods you choose, we remind you to always consider environmental health as part of your assessment. NM EPHT offer several resources to support you on that journey.

For a HIA to be truly effective it needs to be done before a prospective project is started. That means it needs to be done during the early planning stages of that proposed project. The HIA can be initiated by local public health professionals, community groups, affected stakeholders, the project planners. Sometimes it can be required by a local policy or legislation.

The key steps for a HIA are:

Health Impact Assessment Steps

Step 1 - Screening

Determine the value and need for a HIA

During the screening phase, the primary focus is on addressing the question of "Is a HIA required?" This allows the assessment partners to determine if time, energy, and resources should be given to a HIA project. During this phase consideration should be given to determining the health relevance of the policy, program, or project.

A few questions to ask to determine if a HIA should be conducted include:

  • Could the policy/program/project affect any of the determinants of health in the community?
  • Could the policy/program/project affect any of the vulnerable populations in the local area?
  • Is a similar assessment already being conducted?
  • Are there any potential sources of funding for a HIA?
Step 2 - Scoping

Clarify and prioritize issues to focus on in the HIA, methods for analysis, and workplan

The Scoping phase provides answers to the question "Who will complete the HIA and how it will be completed." The goals, objectives, and resources available to complete the project will be defined at this time.

Who will complete the HIA?

HIAs often involve many key individuals and groups including government stakeholders, non-profit organizations, neighborhood groups, faith-based organizations, and community members. Developing a steering committee is an important step to promoting a collaborative approach.

How will the HIA be conducted?

One of the benefits of the HIA process is that it is flexible and can range from a simple design to one more complex. It is best to determine the complexity of the assessment before starting.

Key questions at this phase are:

  • What health impacts will be considered?
  • What populations will be affected?
Step 3 - Appraisal

Research existing conditions and predict effects of policy or project on health/equity

The Appraisal or Assessment phase is where most of the work occurs. During this phase, the goal is to identity the health risks and benefits of the proposed project and compare them to key determinants of health for the community. It is during this work that the factors that impact the determinants of health are identified. To gather data, both qualitative and quantitative methods can be employed, including focus groups, interviews, and surveys. The aim is to determine the types and extents of health impacts (positive and negative) resulting from the project or policy. To ensure a holistic analysis of the findings, it is recommended to review the findings in a group setting with a range of representatives. Such settings allow for collaborations and the advancement of partnerships in the community.

Key questions during this phase are

  • What are the risks? Benefits of the proposal?
  • What changes may occur from the decision?
  • Where are the key data to understand the situation? How do we access it?
Step 4 - Recommendations

Identify actions to address any harms identified

The Recommendations phase is where practical and actionable solutions are developed. The recommendations should focus on what can be implemented with the political, economic, or technical limitations of the policy, project, or program.

Key questions during this phase are:

  • What can we do?
  • How can we do it?
  • Who should be involved in doing it?
Step 5 - Dissemination

Write a report and communicate its findings and recommendations

The Dissemination or Reporting phase entails creating a written document outlining the findings of the Health Impact Assessment and the recommendations from Step 4. The final reporting documents should be shared with key stakeholders and decision makers. These documents should be provided in a timely fashion, so they can be used in the decision-making process. In many cases, the findings are also shared with the larger community.

Key questions during this phase are:

  • Who should receive these findings?
  • How do we get the finding to key stakeholders?
Step 6 - Evaluation

Track how the HIA affected the decision.

The Monitoring and Evaluation phase provides critical information on the impact made by the Health Impact Assessment. It can answer questions regarding the impact on the decision-making process, whether the process was successful, and the possible health impacts on the population. It is also important to monitor how the plan was implemented and if important changes occurred in the plan.

Key questions during this phase are:

  • Was the evaluation implemented as planned?
  • Was the process successful?
There are many resources online in New Mexico that you could use as you conduct your health impact assessment. We encourage you to include environmental health along with your public or community health considerations.
Need ideas of how to incorporate environmental health into your health assessment? Look at these:

The Pew Charitable Trust in collaboration with the Robert Wood Johnson Foundation published a brief from the Health Impact Project entitled Health Impact Assessment Legislation in the States. Several legislative examples are highlighted in the Brief: http://www.pewtrusts.org/~/media/assets/2015/01/hia_and_legislation_issue_brief.pdf.

The World Health Organization's The Health and Environment Linkages Initiative (HELI) webpage highlights several international HIA projects. http://www.who.int/heli/impacts/hiabrief/en/.

The World Health Organization also offers a host of HIA resources at the following link: http://www.who.int/hia/tools/toolkit/en/.

The UCLA Health Impact Assessment Clearinghouse Learning and Information Center offered numerous examples of completed HIAs. http://hiaguide.org/hias.

The Centers for Disease Control and Prevention has an archived website (no longer being maintained or updated) with helpful tools and examples: https://www.cdc.gov/healthyplaces/hia.htm.

Human Impact Partners offer articles, publications, and tools/resources about the field of Health Impact Assessment at the following link: https://humanimpact.org/products-resources/issue-area/?filter=iss1-145.

The Minimum Elements and Practice Standards for Health Impact Assessment provides guidance for effective HIAs. https://sophia.wildapricot.org/resources/Documents/HIA-Practice-Standards-September-2014.pdf.
Looking for data? Want to find out what contributes, influences, or causes a health outcome? Need more information on determinants of health? The following offer information you could use in your appraisal step:

The New Mexico Environmental Public Health Tracking Program website offers information for Health Outcomes in New Mexico and information on Air Quality, Water Quality, including for Private Wells, and a Data Portal.

The CDC Environmental Public Health Tracking- Info by Location provides county level information regarding environmental health issues nationwide. https://ephtracking.cdc.gov/InfoByLocation/.

NM-IBIS (New Mexico's Indicator-Based Information System), is the sister-site of NM EPHT. You can find New Mexico Public Health Data at https://ibis.health.state.nm.us. NM-IBIS is your source for data and information on New Mexico's priority public health issues. NM-IBIS provides access to the data that can help identify the health goals of New Mexico.

The Department of Health - Health Statistics. The state of New Mexico through the Department of Health and other of its state agencies use the birth and death certificate data for assessing health needs and identifying health disparities in the state. The data are used to develop, implement, and assess intervention strategies and effectiveness of programs in addressing public health issues in New Mexico. You can find data at https://nmhealth.org/about/erd/bvrhs/hsp/.

The New Mexico Environment Department. You can find information at their website under tools and maps: https://www.env.nm.gov.

EPA in New Mexico has information on environmental issues specific to the State of New Mexico. Find them at: https://www.epa.gov/nm.

The EPA's EJSCREEN (Environmental Justice Screening and Mapping tool) can be used to determine demographic and environmental information for a geographic area. https://www.epa.gov/ejscreen.

The EPA- Community-Focused Exposure and Risk Screening Tool (C-FERST) allows you to explore maps that identify sources of pollution in a community and surrounding areas. https://www.epa.gov/c-ferst.

The Agency for Toxic Substances & Disease Registry-Social Vulnerability Index identifies communities that may need support in preparing for hazards or recovering from disaster. https://svi.cdc.gov/.

The Department of Transportation's Transportation and Health Tool provides data on transportation and public health indicators. https://www.transportation.gov/transportation-health-tool.

The EPA's Envirofacts provides information on air, land, water, toxics, radiation, waste, facility and compliance by location at https://www3.epa.gov/enviro/.

TOXMAP helps you explore on-site toxic releases and hazardous waste site. https://toxmap.nlm.nih.gov/toxmap/app/.

The Behavioral Risk Factor Surveillance System (BRFSS) is a national telephone survey of adults that collects data about health-related risk behaviors, chronic health conditions, and use of preventive services. Data from the New Mexico BRFSS can be found at their website: https://nmhealth.org/about/erd/ibeb/brfss/, and also on the NM-IBIS site, https://ibis.health.state.nm.us/query/selection/brfss/_BRFSSSelection.html

The Youth Tobacco and Risk Behavior Survey (YRBS) is an on-site survey of middle and high school students, focusing on tobacco-use prevalence and other health-related behaviors. Data from the New Mexico YRBS can be found at their website: http://youthrisk.org/, and also on the NM-IBIS site, https://ibis.health.state.nm.us/query/selection/yrrs/_YRRSSelection.html

The Pregnancy Risk Assessment Monitoring System (PRAMS) collects population-based data on maternal attitudes and experiences before, during, and shortly after pregnancy. Data from the New Mexico PRAMS can be found on NM-IBIS here: https://ibis.health.state.nm.us/query/selection/prams/_PRAMSSelection.html.

The Henry J Kaiser Family Foundation provides data from multiple domains by state. You can find information about New Mexico by following this link: https://www.kff.org/statedata/?state=NM, and also at the following links on NM-IBIS: https://ibis.health.state.nm.us/report/soh/TableOfContents.html, and https://ibis.health.state.nm.us/topic/Index.html and https://ibis.health.state.nm.us/indicator/USStates.html.

The County Health Rankings and Roadmaps provides annual rankings of health issues by county nationwide. http://www.countyhealthrankings.org/. New Mexico county rankings may also be found here: https://ibis.health.state.nm.us/indicator/CHSI.html.
Are you conducting a health impact assessment in New Mexico? If so, we would like to hear from you. Tell us about your successes and lessons learned. Are you using environmental health aspects in your work? We surely would like to know. We would also like to know if NM EPHT could further assist you. Send us an e-mail at: doh-eheb@state.nm.us. In the subject line state: HIA, Attn: Tracking Program
The NM EPHT website is supported by Cooperative Agreement Number, 6 NUE1EH001354 (previously, 5 U38EH000949), funded by the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC or do not necessarily reflect the official policies of the Department of Health and Human Services, nor does the mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government. The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Fri, 15 November 2019 0:35:26 from New Mexico EPHT Tracking Public Web site: https://nmtracking.org/ ".

Content updated: Fri, 3 Aug 2018 14:54:37 MDT