摘要：Laws and regulations for an environmental impact assessment enable a health impact assessment whenever physical changes in the environment may significantly affect health. In this case study, I describe 2 instances in which a local public health agency used the procedural requirements for an environmental impact assessment to account for societal-level health determinants that are not traditionally evaluated in land-use decisions. These examples show that a public health critique can contribute both to the scope of analysis in an environmental impact assessment and to substantive changes in land-use decisions. I have evaluated this health appraisal approach as a form of a health impact assessment and will make recommendations for law, research, and practice that support its technical, cultural, and political feasibility. THE 1969 NATIONAL Environmental Policy Act requires federal agencies to identify and analyze potentially adverse environmental effects of public agency–approved policies, programs, plans, and projects. Furthermore, when indicated, federal agencies are required to prepare a “detailed statement” of effects and related mitigations, i.e., an environmental impact statement. 1 , 2 So far, US public health professionals have not used the environmental impact assessment (EIA) to provide the public and policymakers with a systematic analysis of health consequences from effects on such factors as housing quality; land use density, design, and diversity; public infrastructure; and residential segregation. 3 – 5 The health impact assessment (HIA) is an emerging practice that is closely related to the EIA and aims to inform policymakers about potential direct and indirect health effects in institutional contexts as diverse as urban planning, agriculture, energy, and economics. 6 Some countries, including Australia and Canada, integrate the HIA within an EIA; in other countries, such as the United Kingdom and Sweden, practitioners conduct the HIA as an independent appraisal. 7 – 10 With a growing understanding of the associations between social determinants, the built environment, and health in the United States, public health professionals have new opportunities for participating in land-use and transportation policymaking and planning, 11 – 16 and the EIA is a vehicle for this engagement. 17 , 18 The National Environmental Policy Act and its related federal guidelines have explicit language that requires the evaluation of both direct and indirect effects on health as well as health effects on low-income and minority populations. 19 , 20 At the state level, the California Environmental Quality Act mandates environmental impact reports whenever “the environmental effects of a project will cause substantial adverse effects on human beings, either directly or indirectly,” 21 and Hawaii requires an EIA to consider changes in economics and social welfare, impacts on public health, and effects on cultural beliefs, practices, and resources. 22 In this case study, I describe the use of EIA procedural requirements by the San Francisco Department of Public Health (SFDPH) to account for potential indirect health effects of land use development. This case study shows how the identification of potential health effects within the EIA process can influence policy decisions and legitimize needs raised by marginal stakeholders. I have evaluated this health appraisal approach as a form of an HIA and make recommendations for law, research, and practice that could enable its further development.
