Public health sector influence in transportation decision-making: The case of health impact assessment

Key takeaways:

  • Health impact assessment (HIA) has been an entry point for the public health profession to be influential in transportation decisions. The future of HIA practice in transportation could build on HIA’s adaptability to local decision-making contexts and embrace its ways to informally influence policy.


  • One major barrier for the public health sector’s engagement with transportation is that changing public health outcomes would require changing transportation investments and a herculean task of altering much larger economic, social, material, and spatial relationships associated with transportation technologies and infrastructure.
  • HIA practitioners recommend a six-step process:
  1. Screening: Assessing the potential value of doing an HIA to evaluate a proposed policy or project.
  2. Scoping: Outlining the potential pathways through which a policy or project decision may influence health outcomes and health equity.
  3. Assessment: Applying evidence to the proposed pathways and evaluating the quality of the evidence.
  4. Recommendation: Developing recommendations for both hazard mitigation and health promotion.
  5. Communication: Disseminating findings to relevant decision-makers and affected communities.
  6. Monitoring: Monitoring the outcomes of the project, policy or plan.
  • The majority of HIAs in transportation have assessed local transportation strategies that center on prevention and health-promoting behavior (i.e., increasing transit or active travel) as opposed to mitigating sources of pollution or hazard (i.e., highways).
  • Most HIAs focused on public transit infrastructure and service, pedestrian and bicycle plans, and the implementation of healthy community design for highways. These are local-level projects, not state-wide policies or programs, that are led and funded by public health organizations.
  • Although the HIA and health equity literature promotes HIA as a method for increasing grassroots participation in public decision-making, this study showed that 69% of transportation HIAs involved experts only (i.e., professionals working in local government or non-profit organizations) without involvement of community members.
  • 95% of transportation HIAs relied on advisory groups of professionals only (i.e., County Department of Land Use and Participation, Parks & Recreation District, County Sheriff’s Office).
  • The authors claim that the most important finding of their study is that HIAs exhibit a range of potential purposes, including a number of nuanced advocacy purposes that could influence policy decisions in informal and indirect ways.
  • The authors envision two possible futures for HIA:
  1. Future practice of HIA in transportation remains with the public health profession. HIAs continue to serve as information documents and advocacy platforms.
  2. HIA becomes institutionalized in transportation practice through legislative or regulatory change mandating partnerships or formal use of HIA.



  • The authors used the Health Impact Project (HIP) archive to analyze 59 HIAs on transportation issues conducted between 2005 and 2016 in the United States. They critically reviewed each HIA and categorized HIAs according to the types of transportation decisions they sought to influence, the partnerships it created, and the types of participation it used.


McAndrews, C. & Deakin, E. (2018). Public health sector influence in transportation decision-making: The case of health impact assessment. Case Studies on Transport Policy, Article in press.

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