Pages
Reflection Pieces
Students may choose any three classes’ reading lists as the subjects for their reflection pieces. Reflections must be short (approximately 300 words) and may touch upon any aspects of the readings that students found surprising, important, lacking, or otherwise notable. Full credit will be given for all submissions that reflect meaningful engagement with the material.
Rapid HIA Pathway Presentation
With a group, develop and present a pathway diagram demonstrating the links between the proposed policy, program or project, and health. These diagrams illustrate the potential steps from the proposed decision to changes in social, economic and environmental conditions that lead to changes in health.
Learning Objectives
The goal of this assignment is to demonstrate your understanding of the possible impacts of the proposed decision on health. Drawing these diagrams will help you to consider all the exposures and outcomes, as well as prioritize those that matter most for the HIA. You will later use these pathways and data to assess these effects of the proposed decision, by providing baseline health information about health status in the area of interest, or by predicting the effects from the decision.
Expectations
These diagrams are often complex and dynamic and often involve numerous exposures and outcomes. The pathways can have multiple “steps” connecting the planned decision to health. For example, a proposed fare increase and service cut for a train system may affect transportation mode choice, which in turn may affect physical activity and air pollution levels, which are both associated with changes in cardiovascular health.
The potential links should be based on evidence from relevant literature, the stakeholder process, and professional and expert opinion. A good pathway diagram does not include all possible effects of the planned decision, but only those with evidence behind them and plausible health connections. The diagram should visually show the connections you have identified, and you should be able defend those pathways during your presentation.
The diagrams do not need to follow a specific structure; please view pathway diagram examples from Human Impact Partners(PDF).
Critique of published HIA (individual assignment 500–700 words)
Read through several published HIAs from the Pew Charitable Trust website, and choose one to critique.
Learning Objectives
The goal of this assignment is to help you familiarize yourself with the structure, content and challenges of HIA, and to deepen your understanding of how HIA is practiced. Note that there is considerable diversity in the products and practice of HIA, due to the variety of topics assesses, contexts in which decisions take place, and resources available and invested in the product. There is not a singular correct way to practice and publish, and no rigid criteria for HIA exist, but a number of available documents provide basic guidance and best practices. Many of these resources are listed in the Syllabus. Comparing your chosen HIA to the guidance documents will enhance your understanding of different approaches to conducting HIAs, and help you determine how to approach the final assignment for the course.
Expectations
Briefly describe the HIA decision topic, stakeholders involved, projected health impacts, and major recommendations. Use the remainder of the response to critique the strengths and weaknesses of the HIA. You can approach this in various manners, though some suggested questions to consider are listed below
- Was the screening process documented? Can you tell what factors went into the decision to perform the HIA and what stakeholders were involved?
- In the scoping, was there documentation and details on the overall HIA plan (i.e. research questions, rationale for selecting specific pathways, etc.)? Was the literature search transparent?
- How deep and meaningful was the assessment? Did they collect baseline data and are the data sources appropriate?
- Were the recommendations supported by the assessment? Did they seem logical and feasible?
- Is there transparent documentation of plans for reporting and communicating the results of the HIA?
- Is there a monitoring plan and or impact and outcome evaluation?
Rapid HIA
With a group, conduct a rapid HIA on a local project, proposal or policy in collaboration with a community partner. HIA topics will be provided, and students will decide which topic they would like to work on.
Learning Objective
You will produce a full rapid HIA for this assignment. Reflecting HIA practice, you will work with the other students in your group r to review research, collect and analyze secondary data, develop recommendations based on assessments of the data, and write a report of your findings. Through the process of conducting the HIA you should become comfortable identifying connections between public decisions and health outcomes, and searching, reviewing and synthesizing academic health literature. The goal of this assignment is to become proficient in identifying decisions appropriate for HIA, apply skills and concepts learned during class to produce a full report, and demonstrate understanding of HIA practice.
Expectations
Rapid HIAs are generally shorter and less resources and time intensive than typical HIAs, but deliver impactful evidence on the connections between a proposed project, policy, or program and potential changes in health outcomes.
The HIA should include the following six sections:
- Screening – determine whether an HIA is appropriate and describe the process of this determination.
- Scoping – defines priority issues, research questions and methods, and participant roles.
- Assessment – characterize the baseline rates of health conditions and create a population profile, and evaluate potential health impacts.
- Recommendations – developed to improve the project, plan, or policy and / or to mitigate any negative health impacts.
- Reporting and Communication – create a plan to share the results with stakeholders and decision makers.
- Monitoring and Evaluation – create a plan to track the impacts of the HIA on the decision, and impact of the decision on health.
For the assignment, students are expected to use publically available datasets, but can enhance quantitative assessments with qualitative data including interviews and focus groups with stakeholders and / or those affected by the proposed decision. Students should meaningfully engage with the community partner throughout the process of developing the HIA, and this should be collaboration should be reflected in the final product.
CLASS # | TOPICS |
---|---|
1 |
Class Introduction Course description, social determinants of health, rapid HIA client introduction. |
2 |
Major Health Challenges from a Public Health Perspective Synopsis of mortality and morbidity domestically and abroad; contrasting perspectives on health and disease. |
3 |
Rapid HIA, Training Guest lecturer: Barry Keppard, MAPC |
4 |
Health Disparities Measurement, definition, monitoring and tracking; inequity versus inequality; arguments for and against a focus on narrowing gaps in health status. |
5 |
Socioeconomic Status Income: What aspects of health can buy money? Material factors, relative position, psychosocial factors, stress, bandwidth, risk aversion. Employment: Job demand and control, job insecurity, occupational health and safety, prestige. Education: Contemporaneous and life course effects, links to other social factors. |
6 | HIA: Assessment Introduction |
7 |
Discrimination, Race / Ethnicity Scientific and social views on race, Latino health paradox, immigration and assimilation, discrimination, unequal returns on investment. |
8 | Criminal Justice System |
9 |
Neighborhoods: Built and Natural Environment Guest lecturer: Peter James, Harvard School of Public Health Air quality, water, green space, home-based hazards, heat, extreme weather/storms, climate change. Sprawl, food environment, neighborhood amenities, safety, identity and attachment. |
10 |
Neighborhoods: Social Environment What is a “neighborhood effect?” Community change, displacement, social capital. |
11 |
Embodiment Physiological effects of stress, immune function, life course perspective, intergenerational transmission. |
12 |
Policy and Policymaking Guest lecturer: Lauren Smith, FSG (former Commissioner, Massachusetts Department of Public Health) Costs and benefits of bringing a health lens to non-health policies; planning and the Patient Protection and Affordable Care Act. |
13 | Pathway presentations |
14 |
HIA: Applications Reviewing examples of HIAs, HIA process, scoping working session. |
15 |
HIA: Screening and Scoping Guest lecturer: Barry Keppard, MAPC Picking a policy, program, budget, plan for assessment; prioritizing health risks and health outcomes to examine. |
16 | HIA Assessment Workshop: Record Expungement |
17 | HIA Assessment Workshop: Just Cause for Eviction |
18 |
HIA: Designing Recommendations Using evidence effectively. HIA Critique Due |
19 |
Working Session Informal class presentations, time to workshop in teams. |
20 |
HIA: Successes and Failures HIA pitfalls and triumphs, with examples. |
21 |
State of the Practice Guest lecturer: Bethany Rogerson, Health Impact Project The breadth, scope, and growth of HIA practice. Comparison to other impact assessment. |
22 |
Alternatives to HIA Guest lecturer: Barry Keppard, MAPC Health in all policies, health lens analysis, other tools. |
23 |
HIA: Communications Framing, organizing, advocacy. |
24 | Final HIA presentations with clients |
25 | Final HIA presentations with clients (Cont.) |
26 |
Future of HIA Where do we go from here? Will HIA continue to spread? Should it? |

Image by Geoff Maddock on Flickr. CC BY-NC.
Below are selected lecture notes from class.
Lecture 2: Life Expectancy (PDF - 2.9MB)
Lecture 4: Reflections on HIA (PDF - 1.1MB)
Lecture 5: Socioeconomic Status (PDF)
Lecture 8: Criminal Justice (PDF)
Lecture 10: Neighborhoods, Social Environment (PDF - 1.4MB)
Lecture 14: HIA Applications (PDF - 1.3MB)
CLASS # | READINGS |
---|---|
1 |
National Research Council, and Committee on Health Impact Assessment. “Why We Need Health-Informed Policies and Decision-Making.” In Improving Health in the United States: The Role of Health Impact Assessment. National Academies Press, 2011. ISBN: 9780309218832. [Preview with Google Books] Beauchamp, Dan E. “Public Health as Social Justice.” Inquiry 13, no. 1 (1976): 3–14. |
2 |
Murray, Christopher J. L., Ryan M. Barber, et al. “Global, Regional, and National Disability-Adjusted Life Years (DALYs) for 306 Diseases and Injuries and Healthy Life Expectancy (HALE) for 188 countries, 1990–2013: Quantifying the Epidemiological Transition.” The Lancet 386, no. 10009 (2015): 2145–91. Pearce, Neil. “Traditional Epidemiology, Modern Epidemiology, and Public Health.” American Journal of Public Health 86, no. 5 (1996): 678–83. Link, Bruce G., and Jo Phelan. “Social Conditions as Fundamental Causes of Disease.” Journal of Health and Social Behavior (1995): 80–94. Krieger, Nancy. “Theories for Social Epidemiology in the 21st century: An Ecosocial Perspective.” International Journal of Epidemiology 30, no. 4 (2001): 668–77. |
3 |
Gottlieb, Laura, Paula K. Braverman, et al. "Health Impact Assessment: A Tool for Promoting Health in All Policies." (PDF) Robert Wood Johnson Foundation, 2011. [You may need to open this file manually in Adobe Acrobat] Kemm, John. Chapter 1 in Health Impact Assessment: Past Achievement, Current Understanding, and Future Progress. Oxford University Press, 2013. ISBN: 9780199656011. "Findings and Recommendations of the Rapid Health Impact Assessment of the Proposed Farmers Field Development." (PDF - 17.1MB) Human Impact Partners, July 2012. |
4 |
Sen, Amartya. “Why Health Equity?” Health Economics 11, no. 8 (2002): 659–66. Arcaya, Mariana C., Alyssa L. Arcaya, et al. “Inequalities in Health: Definitions, Concepts, and Theories.” Global Health Action 8, no. 4 (2015): 261–71. Marmot, Michael, Sharon Friel, et al. “Closing the Gap in A Generation: Health Equity Through Action on the Social Determinants of Health.” The Lancet 372, no. 9650 (2008): 1661–9. |
5 |
Berkman, Lisa F., and Ichiro Kawachi, eds. Chapters 2, 5, and 6 in Social Epidemiology. Oxford University Press, 2000. ISBN: 9780195083316. [Preview with Google Books] White, Gillian. “A Small Boost in Family Income Makes A Big Difference for Kids.” The Atlantic, 27 September, 2015. Marmot, Sir Michael. “Edited Transcript of Interview.” (PDF) for Unnatural Causes: Is Inequality Making Us Sick? Public Broadcasting Service, 2008. Muennig, Peter, Lawrence Schweinhart, et al. “Effects of a Prekindergarten Educational Intervention on Adult Health: 37-year Follow-Up Results of a Randomized Controlled Trial.” American Journal of Public Health 99, no. 8 (2009): 1431–7. [Read Introduction, Discussion to end] |
6 |
Kemm, John. Chapters 3 and 4 in Health Impact Assessment: Past Achievement, Current Understanding, and Future Progress. Oxford University Press, 2013, pp. 9–15. ISBN: 9780199656011. Bhatia, Rajiv. "Health Impact Assessment: A Guide for Practice." (PDF - 6.5MB) Human Impact Partners, 2011. National Research Council, and Committee on Health Impact Assessment. Improving Health in the United States: The Role of Health Impact Assessment. National Academies Press, 2011, pp. 95–106. ISBN: 9780309218832. [Preview with Google Books] Revisited from class 3: "Findings and Recommendations of the Rapid Health Impact Assessment of the Proposed Farmers Field Development. Human Impact Partners." (PDF - 17.1MB) Human Impact Partners, July 2012. |
7 |
Berkman, Lisa F., and Ichiro Kawachi, eds. Chapter 3 in Social Epidemiology. Oxford University Press, 2000, pp. 67–76. ISBN: 9780195083316. [Preview with Google Books] Williams, David R. “Miles to Go Before We Sleep: Racial Inequities in Health.” Journal of Health and Social Behavior 53, no. 3 (2012): 279–95. Lara, Marielena, Cristina Gamboa, et al. “Acculturation and Latino Health in the United States: A Review of the Literature and Its Sociopolitical Context.” Annual Review of Public Health 26 (2005): 367–97. |
8 |
Dumont, Dora M., Brad Brockmann, et al. “Public Health and the Epidemic of Incarceration.” Annual Review of Public Health 33 (2012): 325–39. Krieger, Nancy, Jarvis T. Chen, et al. “Police Killings and Police Deaths Are Public Health Data and Can Be Counted.” PLOS Medicine 12, no. 12 (2015): e1001915. National Research Council, Committee on Law and Justice, et al. Chapter 8 in The Growth of Incarceration in the United States: Exploring Causes and Consequences. Edited by J. Travis, B. Western, and S. Redburn. National Academies Press, 2014. ISBN: 9780309298018. Pager, Devah. “The Mark of a Criminal Record1.” American Journal of Sociology 108, no. 5 (2003): 937–75. (Read as interested) |
9 |
Harlan, Sharon L., and Darren M. Ruddell. “Climate Change and Health in Cities: Impacts of Heat and Air Pollution and Potential Co-Benefits from Mitigation and Adaptation.” Current Opinion in Environmental Sustainability 3, no. 3 (2011): 126–34. James, Peter, Rachel F. Banay, et al. “A Review of the Health Benefits of Greenness.” Current Epidemiology Reports 2, no. 2 (2015): 131–42. Sallis, James F., Myron F. Floyd, et al. “Role of Built Environments in Physical Activity, Obesity, and Cardiovascular Disease.” Circulation 125, no. 5 (2012): 729–37. Miranda, Marie Lynn, Dohyeong Kim, et al. “Environmental Contributors to the Achievement Gap.” Neurotoxicology 30, no. 6 (2009): 1019–24. “Richmond, California Struggles for Clean Air.” Unnatural Causes. Public Broadcasting Service. Accessed October 25, 2016. (Watch as interested) |
10 |
Ellen, Ingrid Gould, Tod Mijanovich, et al. “Neighborhood Effects on Health: Exploring the Links and Assessing the Evidence.” Journal of Urban Affairs 23, no. 3–4 (2001): 391–408. McLaughlin, Katie A., Arijit Nandi, et al. “Home Foreclosure and Risk of Psychiatric Morbidity During the Recent Financial Crisis.” Psychological Medicine 42, no. 7 (2012): 1441–8. Freudenberg, Nicholas, Sandro Galea, et al. “Beyond Urban Penalty and Urban Sprawl: Back to Living Conditions as the Focus of Urban Health.” Journal of Community Health 30, no. 1 (2005): 1–11. Desmond, Matthew, and Rachel Tolbert Kimbro. “Eviction’s Fallout: Housing, Hardship, and Health.” Social Forces 94, no. 1 (2015): 295–324. |
11 |
Krieger, Nancy, and George Davey Smith. “[“Bodies Count,” and Body Counts: Social Epidemiology and Embodying Inequality](https://dx.doi.org/ 10.1093/epirev/mxh009).” Epidemiologic Reviews 26, no. 1 (2004): 92–103. Boardman, Jason D., Jarron M. Saint Onge, et al. “Do Schools Moderate the Genetic Determinants of Smoking?” Behavior Genetics 38, no. 3 (2008): 234–46. Epel, Elissa S., Elizabeth H. Blackburn, et al. “Accelerated Telomere Shortening in Response to Life Stress.” Proceedings of the National Academy of Sciences of the United States of America 101, no. 49 (2004): 17312–15. Dowd, Jennifer Beam, Anna Zajacova, et al. “Early Origins of Health Disparities: Burden of Infection, Health, and Socioeconomic Status in U.S. Children.” Social Science & Medicine 68, no. 4 (2009): 699–707. |
12 |
Frieden, Thomas R. “A Framework for Public Health Action: The Health Impact Pyramid.” American Journal of Public Health 100, no. 4 (2010): 590–95. Cardenas, Vanessa, and Sarah Treuhaft. “Chapter 5.” (PDF) in All-In Nation: An American that Works for All. Center for American Progress, PolicyLink. |
13 | No readings – in-class presentations |
14 |
Botchwey, Nisha, Marla Orenstein, and Catherine L. Ross. Chapter 3 in Health Impact Assessment in the United States. Springer, 2014. ISBN: 9781461473022. Causa Justa Just Cause. “Development Without Displacement: Resisting Gentrification in the Bay Area.” (PDF - 3.5MB) April (2014). SOPHIA: Society of Practitioners of Health Impact Assessment |
15 |
Kemm, John. Chapter 2 in Health Impact Assessment: Past Achievement, Current Understanding, and Future Progress. Oxford University Press, 2013. ISBN: 9780199656011. |
16 | No readings |
17 | No readings |
18 | No readings |
19 | No readings |
20 |
Quigley, Robert J., and Lorraine C. Taylor. “Evaluating Health Impact Assessment.” Public Health 118, no. 8 (2004): 544–52. Krieger, Nancy, Mary Northridge, et al. “Assessing Health Impact Assessment: Multidisciplinary and International Perspectives.” Journal of Epidemiology and Community Health 57, no. 9 (2003): 659–62. Haigh, Fiona, Fran Baum, et al. “The Effectiveness of Health Impact Assessment in Influencing Decision-Making in Australia and New Zealand 2005–2009.” BMC Public Health 13, no. 1 (2013): 1188. |
21 |
Kemm, John. Chapter 23 in Health Impact Assessment: Past Achievement, Current Understanding, and Future Progress. Oxford University Press, 2013. ISBN: 9780199656011. National Research Council, and Committee on Health Impact Assessment. Chapter 5 in Improving Health in the United States: The Role of Health Impact Assessment. National Academies Press, 2011, pp. 124 and 153–58. ISBN: 9780309218832. |
22 |
Lawless, Angela, Carmel Williams, et al. “Health in All Policies: Evaluating the South Australian Approach to Intersectoral Action for Health.” Canadian Journal of Public Health / Revue Canadienne De Sante’e Publique 103 (2012): S15–19. Corburn, Jason, Shasa Curl, et al. “A Health-In-All-Policies Approach Addresses Many of Richmond, California’s Place-Based Hazards, Stressors.” Health Affairs 33, no. 11 (2014): 1905–13. |
23 |
Bassett, Mary T. “#BlackLivesMatter—A Challenge to the Medical and Public Health Communities.” The New England Journal of Medicine 372, no. 12 (2015): 1085–7. Chapters 1–3 in “A New Way to Talk About the Social Determinants of Health.” (PDF – 3.7MB) Robert Wood Johnson Foundation, 2010. [You may need to open this file manually in Adobe Acrobat] Gollust, Sarah E., Jeff Niederdeppe, et al. “Framing the Consequences of Childhood Obesity to Increase Public Support for Obesity Prevention Policy.” American Journal of Public Health 103, no. 11 (2013): e96–102. |
24 | No reading |
25 | No reading |
26 | Corburn, Jason. “Confronting the Challenges in Reconnecting Urban Planning and Public Health.” American Journal of Public Health 94, no. 4 (2004): 541–6. |
Course Meeting Times
Lectures: 2 lectures / week, 1.5 hours / lecture
Prerequisites
There are no prerequisites for this course, but permission of the instructor is required.
Description
This course examines the built, psychosocial, economic, and natural environment factors that affect health behaviors and outcomes. It introduces tools designed to integrate public health considerations into policymaking and planning. It provides extensive hands-on training in the application of Health Impact Assessment (HIA) methodology, which brings a health lens to policy, budgeting, and planning debates, and emphasizes health equity and healthy cities. The class is designed to prepare graduate students from planning and policy fields to interface with public health organizations, agencies, or advocacy groups in professional contexts. It is also intended to accommodate advanced undergraduates, particularly pre-health undergraduates interested in behavioral and sociocultural determinants of health.
Learning Objectives
- Articulate the ways in which social, natural, built, and economic environments impact health
- Critically assess the value of examining non-health policies and projects through a health lens
- Develop the professional judgment to recognize when a health lens may add value to decision-making, and to identify concrete tools to integrate health considerations into these decisions
- Describe the purpose, benefits, and challenges of using HIAs to convey information to decision-makers and other stakeholders
- Describe the core steps used to conduct HIAs, including screening, scoping, assessment, recommendations, reporting, monitoring and evaluation
- Demonstrate competency in contributing to an HIA
Grading
ACTIVITIES | PERCENTAGES |
---|---|
Participation and professionalism | 10% |
Brief reflection pieces (choose 3 topics) | 25% |
Rapid HIA pathway presentation | 15% |
Critique of published HIA | 15% |
Rapid HIA | 35% |