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Health Impact Assessments: Underutilized Tool for Nutrition and Agriculture Programs

Researchers Say HIAs Can Improve Stakeholder Engagement, Project Outcomes

Aug 25, 2017


Health impact assessments (HIAs) can offer local and national policymakers a useful framework for engaging and responding to the needs of communities affected by agriculture, food, and nutrition decisions, according to a new study by researchers at the Johns Hopkins Center for a Livable Future (CLF) in the Bloomberg School of Public Health’s Department of Environmental Health and Engineering.

HIAs use interdisciplinary and participatory techniques to evaluate the potential health impacts of policies, plans and projects, and can help stakeholders make judgment calls on how to promote health or avoid harm. The study is the first of its kind to analyze the use of this National Academy of Science-endorsed tool in projects related to the food system.

“Over the past twenty years, health impact assessments have helped to support decision-making in an array of sectors including housing, planning, education, and criminal justice, but we found that they’re not often used in projects related to food,” said Krycia Cowling, MPH, lead author of the study and a CLF-Lerner Fellow. “By not using these assessments, policymakers may be missing out on opportunities to hear community perspectives and better understand the potential effects of an initiative on the diet and health of the communities they are trying to serve.”

The study identified all HIAs completed in the United States before June 2016 and found only 25 of the total 400 (or around 6%) focused on agriculture, food, and nutrition topics. Of the 25 HIAs, 40% focused on agriculture, 44% on food access and availability, and 16% on nutrition. The HIAs predominantly supported policy as opposed to program or project decisions. Two HIAs were conducted on decisions at the federal level, seven at the state level, and 16 at the local level. The geographic areas addressed by these HIAs fell within 14 different states across the country – five in California; two each in Florida, Hawaii, New Mexico, Tennessee, and Illinois; and one each in Ohio, North Carolina, Oregon, Wisconsin, Kansas, Virginia, Indiana, and New Jersey.

Non-profit organizations led the majority of these HIAs, with government agencies and academic institutions leading far fewer. Researchers say this breakdown by institutional type suggests that most of these HIAs were privately rather than publicly funded, which raises concerns about the sustainability of HIA funding.

The report also details the substantial scope to increase the use of HIAs in the agriculture, food, and nutrition sectors. While dietary impacts may be anticipated by decisions in these sectors, HIAs have the potential to identify unexpected health impacts through a wide range of additional pathways, such as changes in employment or tax revenue. The authors advocate sharing HIA findings more widely to inform related decisions in different jurisdictions and to increase support for additional HIAs that address the food system.

Review of Health Impact Assessments Informing Agriculture, Food, and Nutrition Policies, Programs, and Projects in the United States” was written by Krycia Cowling, Ruth Lindberg, Andrew L. Dannenberg, Roni A. Neff, and Keshia M. Pollack, and published in the Journal of Agriculture, Food Systems and Community Development.