A Brief History of Health Impact Assessment in the United States

  • Andrew L. Dannenberg, MD, MPH School of Public Health and College of Built Environments University of Washington, Seattle


In recent decades, several factors have contributed to the increasing use of health impact assessment (HIA) in the United States. Initially in California and subsequently in other states, communities that have been traditionally disenfranchised began seeing HIA as an opportunity to address the issues impacting their lives and to increase their ability to participate in decision-making processes about those issues. Second, public health professionals began to better understand the links between health and the natural and built environments, and to use HIA as a tool to improve cross-disciplinary communication. Third, public health professionals recognized that HIA could be valuable to address economic and social issues, such as educational and wage policies, in addition to built environment issues, such as land use and transportation.