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Sandra Whitehead, MPA, PhD; Emily Bever, BS INTA;
Ruth Lindberg, BA CH, MPH, MUP; James E. Dills, BS, MUP, MPH

UPDATING THE MINIMUM ELEMENTS AND PRACTICE 
STANDARDS FOR HIA TO REFLECT EVOLUTION IN THE FIELD 

OF PRACTICE: OPPORTUNITY FOR INPUT

Abstract:

The Minimum Elements and Practice Standards for Health Impact Assessment (MEPS) is 
undergoing its first update in six years. This document was first created to standardize health 
impact assessments (HIA) through specific guidance and benchmarks and describe best practices 
for how an HIA should be conducted. A group of leading HIA practitioners created the MEPS in 
2009. Since then, it has been updated twice to reflect the evolution of HIA as a practice and the 
expanded use of HIA as a tool to implement health in all policies. This commentary describes 
current efforts to revise the MEPS in the context of continued learnings in the field.



Updating the Minimum Elements and Practice Standards for HIA Whitehead; Bever; Lindberg; Dills

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Introduction
HIA is one important strategy to advance health 
in all policies (HiAP), defined by the World 
Health Organization as “an approach to public 
policies across sectors that systematically 
takes into account the health implications of 
decisions, seeks synergies, and avoids harmful 
health impacts in order to improve population 
health and health equity” (World Health 
Organization, 2014). 

The Society of Practitioners of Health Impact 
Assessment (SOPHIA) is an international 
association of individuals and organizations 
that develops high-quality resources to help HIA 
practitioners build capacity, supports member 
networking and peer mentoring opportunities, 
and communicates timely information on 
resources, training, and technical assistance 
opportunities. Data from SOPHIA’s routine 
membership survey suggests that its guidance 
documents and publications, including the 
MEPS, are among the most used and valued 
resources. The MEPS outline the minimum 
criteria that an HIA should address, as well 
as best practices for conducting an HIA. This 
commentary describes current SOPHIA efforts 
to revise the MEPS for the first time in six years.

Evolution of HIA Practice and the Need 
for Revised Standards
HIA was first used in the U.S. in 1999. 
Practitioners adapted European models of 
practice, including the use of HIAs within 
environmental assessment frameworks, and, 
by 2009, there was a wide variety of documents 
labeled HIAs in the U.S. However, these 

assessments followed different methodologies 
and provided a range of evidence levels and 
research quality. A working group of experienced 
HIA practitioners identified the need for 
practice standards during the September 2008 
North American Conference on Health Impact 
Assessment and published a formal document 
in 2009 (North American HIA Practice 
Standards Working Group, 2009). In 2010, the 
working group updated the practice standards 
and added minimum elements (North American 
HIA Practice Standards Working Group, 2010). 
The goals were to offer high-level guidance 
for distinguishing HIA from other assessment 
methods and provide benchmarks for 
standardizing North American HIA practice. At 
this early point, the working group determined 
it was advantageous to establish common HIA 
characteristics and activities to guide practice. 
The working group completed the most recent 
MEPS update in 2014 (Bhatia et al., 2014); since 
then, the HIA field has experienced several 
changes. 

According to the cross-sector toolkit for health1  
maintained by the Health Impact Project, when 
U.S. HIA practice was still emerging in the early 
2000s, over 70% of HIAs focused on decisions 
related to the built environment, including 
transportation, land use planning, and housing. 
This was due in part to funders prioritizing these 
topics and to the rapidly expanding evidence 
base connecting built environment interventions 
to health outcomes (Jackson, Dannenberg, & 
Frumkin, 2013). Since 2014, HIAs have been 
applied to decisions in a wider range of topics 

1  The Health Impact Project’s cross-sector toolkit for health (www.pewtrusts.org/healthimpactproject/toolkit) catalogs 
U.S. HIAs for which there is a publicly available product. It relies on self-reported information from practitioners. 
While it is updated quarterly, the toolkit may not include every HIA conducted in the U.S. To suggest new resources, 
please complete this form and submit it to healthimpactproject@pewtrusts.org. Frequently asked questions and 
more information about the toolkit are also available. The Health Impact Project is a collaboration of the Robert Wood 
Johnson Foundation and The Pew Charitable Trusts. 

http://www.pewtrusts.org/healthimpactproject/toolkit
https://www.pewtrusts.org/-/media/assets/2019/04/toolkit-content-submission-form.pdf
mailto:healthimpactproject%40pewtrusts.org?subject=
https://www.pewtrusts.org/en/research-and-analysis/articles/2019/04/03/frequently-asked-questions-about-the-cross-sector-toolkit-for-health
https://www.pewtrusts.org/en/research-and-analysis/articles/2019/04/03/frequently-asked-questions-about-the-cross-sector-toolkit-for-health


Updating the Minimum Elements and Practice Standards for HIA Whitehead; Bever; Lindberg; Dills

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such as climate change/extreme weather 
events, criminal justice, education, employment, 
and economic development. 

From 2010-2014, an average of almost 48 HIAs 
were conducted each year in the U.S. Several 
national-level organizations, such as the U.S. 
Centers for Disease Control and Prevention 
and the Health Impact Project, funded multi-
year, comprehensive HIAs2 during this time. 
As the total number of HIAs grew, the number 
using rapid HIA methods (Human Impact 
Partners, 2020) also increased. For example, 
from 1999-2009, practitioners completed 7 
rapid HIAs in the U.S., compared with 42 from 
2010-2020. Since 2014, overall HIA grant 
funding has decreased, along with the number 
of HIAs conducted yearly. In addition, current 
public health and decision-making contexts 
have led practitioners to adapt HIA principles 
and standards into new approaches like Public 
Health 3.0 and Health in All Policies using 
tools such as health impact reviews (Harris 
County Public Health; Washington State Board 
of Health) and health notes (Health Impact 
Project, 2019) to inform proposed legislative 
and budgetary decisions. Rapid HIAs and 
similar approaches provide a streamlined 
process to inform decisions on a short time 
frame with less time and staffing investments. 
The resulting products are often one-page 
summaries, brief reports, fact sheets, or video 
clips that are accessible to decision makers 
and stakeholders at various levels. The original 
working group wrote the MEPS with a focus 
on comprehensive HIAs and at a time when 
the primary dissemination product for most 
assessments was a lengthy report. This MEPS 
update acknowledges the evolution of the 
practice to include rapid and adapted methods 

and streamlined products, while maintaining 
applicability to intermediate and comprehensive 
HIAs and longer reports that document the full 
process and findings from the assessments. 
The update further acknowledges that even 
comprehensive HIAs can result in condensed 
communication tools such as those listed above. 

Lead HIA organizations have also changed 
over time. Largely due to the funding structure, 
almost 40% of HIAs conducted before 2014 
were led by state or local health departments 
(Health Impact Project, 2018). In recent years, 
a wider variety of organization types are leading 
HIAs. Since 2014, about 35% of lead HIA 
organizations have been nonprofits, compared 
to about 30% state or local health departments 
(Health Impact Project, 2018). As more 
community-based organizations and resident 
groups perform HIAs, practitioners and their 
partners are more commonly using findings 
from these assessments to advocate for policy 
changes that advance health and equity. As the 
HIA field increasingly recognizes the value and 
opportunity of these assessments to support 
advocacy efforts, the MEPS play a critical role 
in ensuring that all HIAs use the best available 
evidence, examine a range of potential health 
impacts, and present all relevant findings, not 
just those that support a specific policy position. 
HIAs continue to be undertaken for a variety of 
reasons beyond advocacy, including mandated 
projects and decision-support scenarios, and 
practitioners should ensure their HIA approach 
is appropriate and responsive to their specific 
HIA context and stakeholders. 

HIA has always embraced equity as one of 
several core values (World Health Organization, 
2014). SOPHIA has a history of creating tools 

2  HIAs can be completed quickly, using a “rapid” or “desktop” model over a few weeks or months, or take longer, 
using either an “intermediate” approach using available data or a “comprehensive” approach involving primary data 
collection, both of which take several months to more than a year to complete.



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and resources to advance equity through HIA 
practice and has a standing equity committee. 
This committee developed the Equity Metrics 
for HIA Practice, a tool that enables practitioners 
to plan for and evaluate the inclusion of equity 
considerations and actions in an HIA.
 
In recent years, HIA practice has evolved and 
is now commonly used as a tool to support an 
overall HiAP approach. Using a HiAP framework 
encourages the routine inclusion of health 
and equity in decision making, bringing equity 
considerations to the forefront. Over time, the 
MEPS authors have been revising the document 
to reflect this increasing need to address equity, 
and the current update working group continues 
this effort. 

Process for Updating the Minimum 
Elements and Practice Standards
SOPHIA solicited interest to participate in the 
MEPS update workgroup at its Practitioner 
Workshop in April 2019. Volunteers participated 
in biweekly meetings from fall 2019 through 
spring 2020. The workgroup consists of four 
members representing a total of 40 years of 
HIA experience. Workgroup members bring 
experience from the non-profit, federal, state 
and academic sectors. 

Core Proposed Changes to the Minimum 
Elements and Practice Standards
In response to the evolution of and trends in the 
HIA field described above, the update workgroup 
wanted this version of the MEPS to describe 
stakeholder engagement as a more significant 
part of the practice standards in order to 
emphasize equity and build on emerging 
evidence of the value of community engagement 
in HIA practice. Research suggests that HIAs 
can increase civic agency in communities 
by strengthening community members’ 
skills to influence future decisions beyond 

the HIA, enhancing relationships between 
community residents and decision-makers and 
elevating the voices of community members 
in the decision-making process (Center for 
Community Health and Evaluation & Human 
Impact Partners, 2016). Research also suggests 
that stakeholder engagement is one of the 
factors that contributes to the success of HIAs 
(Dannenberg, 2016). To make the MEPS more 
useful to a range of organization types and new 
practitioners, this version refers to more HIA 
resources from SOPHIA and other groups, and 
revisions to the standards increase feasibility for 
diverse practitioners. While the overall update is 
still in progress, the recommended core changes 
include:

Emphasizing the iterative nature of the 
HIA process. In the 2014 MEPS, HIA was 
framed as a stepwise process. Recognizing the 
iterative nature of HIA, the update workgroup 
renamed the steps of HIA to phases and 
added prompts for practitioners to re-examine 
previous decisions. This language gives explicit 
permission for practitioners to return to prior 
phases and make updates to reflect new 
information and stakeholder insights. 

Highlighting the importance of 
stakeholder and community engagement 
in HIA practice. In each phase’s practice 
standard, the update workgroup provided 
examples of typical stakeholder and community 
member roles. For the assessment phase, the 
workgroup added language to emphasize lived 
experience as critical data that should be a part 
of both existing conditions and the predictive 
assessment. In the recommendation phase, 
the revised practice standards explicitly call 
for collaboration between the HIA practitioner 
and stakeholder groups, including decision 
makers and community members. Since HIA 
recommendations are only effective if they 



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are adopted and implemented, working with 
decision makers and potential implementers 
helps address recommendation feasibility. And 
community members can help ensure that HIA 
recommendations are responsive to needs and 
appropriately address community concerns. 

Defining key outputs for each HIA 
phase. As overall HIA practice has moved 
toward rapid methods to be more responsive 
to shifting decision-making timelines, the 
workgroup adapted each phase’s definition 
and practice standard application accordingly. 
For example, in the reporting phase the revised 
standards describe that, at a minimum, all HIAs 
should document the purpose, findings, and 
recommendations from the assessment, but 
the revisions are also explicit that the length 
and level of detail can vary based on the scale 
of the HIA. The workgroup also strengthened 
the definition of each phase by adding expected 
outputs. 

Developing standards for tracking 
HIA effectiveness that are feasible 
for a range of practitioners. The most 
significant proposed changes thus far are in 
the monitoring phase. To recognize the time 
and financial constraints of HIA practice, the 
workgroup created more realistic standards 
for this phase. As the practice has shifted to 
more rapid methods, and a greater diversity of 
organizations are conducting HIAs, the revised 
standards suggest that every HIA should 
complete a process evaluation, but recognize 
that impact and outcome evaluations may not 
be feasible for all practitioners due to available 
time, funding, expertise, or other factors.

International Applicability
The MEPS were originally developed and 
updated based on emerging U.S. HIA practice, 
though HIA has a longer global history. In 
parallel to this MEPS update, SOPHIA is 
making organizational changes to expand 
its international focus. The revisions in this 
update are still based on U.S. HIA practice but 
the update workgroup recognizes the MEPS 
may also have implications for international 
HIAs. The update workgroup will leverage 
SOPHIA’s international expertise to identify 
both intersections and potential conflicts for 
international practice within the MEPS.  One of 
the steps in this process included a presentation 
at the 2021 International Association of Impact 
Assessment annual meeting. This presentation 
was an opportunity to have conversations 
with the international field about global 
HIA standards, as well as the major issues 
and evolutions in HIA that all practitioners 
experience. 

Next Steps for the MEPS Update
The SOPHIA leadership team and steering 
committee, general membership, and the 
original authors of the MEPS will have 
the opportunity to comment on the core 
proposed changes before public release. 
SOPHIA anticipates publishing the revised 
MEPS document in 2021, to coincide with the 
organization’s 10-year anniversary. To contribute 
your HIA expertise to this update, please contact 
the corresponding author, Sandra Whitehead. 



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References
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Updating the Minimum Elements and Practice Standards for HIA Whitehead; Bever; Lindberg; Dills

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CORRESPONDING AUTHOR
Sandra Whitehead
George Washington University
950 N. Glebe Road
Arlington, Virginia 22203
Swhitehead@GWU.edu 

CHIA Staff:

Editor-in-Chief 
Cynthia Stone, DrPH, RN, Professor, Richard M. Fairbanks School of Public Health, Indiana 
University-Purdue University Indianapolis

Journal Manager 
Angela Evertsen, BS, Richard M. Fairbanks School of Public Health, Indiana University-Purdue 
University Indianapolis 

Chronicles of Health Impact Assessment Vol. 6 Issue 1 (2021) DOI: 10.18060/25082
© 2021 Author(s): Whitehead, S.; Bever, E.; Lindberg, R.; Dills, J.
       This work is licensed under a Creative Commons Attribution 4.0 International License


