









































October 2017 Volume  2

INSIGHTS INTO HOW HIAs ARE CHARACTERIZED IN THE 
PRESS: FINDINGS FROM A MEDIA ANALYSIS OF WIDELY

CIRCULATED UNITED STATES NEWSPAPERS

Maxim Gakh, JD, MPH; Courtney Coughenour, PhD; Jennifer Pharr, PhD; Aaliyah Goodie, MPH candidate;
Samantha To, MPH candidate

Abstract: 

Background: Health impact assessments (HIAs) are burgeoning tools in the policy arena, where media plays an important role 
by focusing attention on issues, informing the public, and influencing positions. Examining how media portrays HIAs is critical 
to understanding HIAs in the policy context. 

Methods:  This study considered how widely circulated, U.S. newspapers represent HIAs. After searching newspaper databases, 
we used a qualitative document analysis method consisting of  open and axial coding to examine specific phrases of  HIA depic-
tions.

Results:  In coding over 1,000 unique phrases from the 62 documents generated in our search, we found an uptick in HIA-re-
lated publications since 2010. Coding these documents identified 46 distinct codes across 10 different themes. The two most 
prominent HIA-centered themes focused on HIA engagement and the HIA setting. While themes of  policy and science, health 
determinants, and explanations of  HIAs were also frequently featured, specific mentions of  projected impacts, HIA processes, 
HIA values, and health outcomes were less prevalent.

Conclusion: HIA media portrayals warrant further inquiry by researchers and practitioners. Focusing on how media portrays 
HIAs is consistent with several HIA steps. It is also important for a broader strategy to educate stakeholders about HIAs and 
to understand HIAs’ utility. HIA practitioners should develop and implement guidelines for media interaction and tracking that 
encourage practitioners to seek additional media attention and to focus such attention on health impacts and outcomes, HIA 
recommendations, and HIA values. Building on our work, researchers should examine HIA media portrayals beyond the context 
of  this study.

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Introduction

The use of health impact assessments (HIAs) in the 
United States is on the rise. To date, over 400 HIAs 
have been completed across the country (Pew Charita-
ble Trust, 2015). According to the National Research 
Council (NRC)(2011), an HIA is a “systematic pro-
cess...to determine the potential effects of a proposed 
policy, plan, program, or project on the health of a 
population and the distribution of those effects” (p. 
46). HIAs rely on a six-step process -- consisting of 
screening, scoping, assessment, recommendations, 
reporting, and monitoring and evaluation -- and utilize 
assorted data, methods, and stakeholder inputs to draw 
meaningful conclusions (NRC, 2011).   

HIAs are especially useful for bringing health con-
cerns to decisions and issues that originate outside 
of the health sector, enhancing relationships across 
sectors, and empowering communities (Bourcier, 
Charbonneau, Cahill, & Dannenberg, 2015; Dannen-
berg, 2016). In particular, HIAs can be instruments 
to address the social determinants of health, defined 
by the World Health Organization (2017) as “condi-
tions in which people are born, grow, live, work and 
age [which] are shaped by the distribution of money, 
power and resources at global, national and local 
levels [and] are mostly responsible for health ineq-
uities - the unfair and avoidable differences in health 
status.” Addressing these social determinants is critical 
to tackling health inequalities across groups (CDC, 
2014). However, Gottlieb, Fielding, and Bravemen 
(2012) argue that, in isolation, HIAs do not constitute 
“healthy public policy.” They define “healthy public 
policy” as “a comprehensive approach to achieving 
more health-informed decision-making in other sec-
tors, [that] generally requires multiple components,” 
including HIAs and also other strategies (p.158). In 
other words, HIAs can be an important component of 
a multifaceted Health in All Policies approach (Ru-
dolph, Caplan, Ben-Moshe & Dillon, 2013; Gase, 
Pennotti, & Smith, 2013). 

Challenging questions about the effectiveness of HIAs 
-- and how to measure this effectiveness -- remain  
critical for the field to resolve (Quigley & Taylor, 
2004; Ali, O’Callaghan, Middleton, & Little, 2009). 
Studies demonstrate that HIAs can be useful in em-
phasizing the connections between health outcomes 
and some of their causes, both for policymakers and 
communities (Bourcier et al., 2015). Proponents 
frequently point to the ability of HIAs to raise aware-
ness about health and public policy connections across 
sectors and communities (Winkler et. al, 2013; Gottli-
eb et al., 2012; Harris-Roxas & Harris, 2013). Since 
HIAs appear to impact how health-related issues are 
perceived, it is important to understand how they are 
portrayed and discussed in public discourse.

Media is a powerful outreach tool to enhance 
health-promoting behaviors (Randolf, & Viswanath, 
2004). In addition -- and perhaps more salient to the 
social determinants of health and HIA work -- media 
plays an important role in public health policy. Ac-
cording to Dorfman & Krasnow (2014), media can 
blend “communications, science, politics, and advo-
cacy to advance public health goals” (p. 293). Golden 
& Moreland-Russell (2016) explain that it does so by 
focusing public attention on issues as well as “raising 
awareness of a problem, stimulating coverage of is-
sues, generating support for proposed policy solutions, 
and communicating information regarding the imple-
mentation of a policy” (p. 34). Shih, Wijaya, & Bros-
sard (2008) have found that how issues are framed in 
the media impacts ways in which audiences perceive 
them and can “activate certain thoughts or feelings in 
readers’ minds that make them more likely to react in 
a somewhat predictable manner” (p. 142); media helps 
readers form heuristics to process complex issues 
(Shih, Wijaya, & Brossard, 2008). 

Thus, determining how media portrays HIAs is critical 
to understanding the relationships between HIA and 
policy. We were unable to locate any studies in the 
literature that systematically examine HIAs’ portrayal 
in U.S. media sources. Aiming to reduce this gap, our 



Insights into How HIAs are Characterized in the Press Gakh; Coughenour; Pharr; Goodie; To

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study focused on understanding how HIAs are por-
trayed in U.S. print media. 
 
Methods

Our study aimed to examine how HIAs have been 
portrayed in U.S. media sources. Specifically, our 
study asked: how have HIAs been covered and charac-
terized in the most widely circulated U.S. newspapers? 
To answer this question, we used qualitative research 
methodology to analyze newspaper documents dis-
cussing HIAs. According to Bowen (2009), this type 
of “document analysis is a systematic procedure… 
[that] requires that data be examined and interpreted 
in order to elicit meaning, gain understanding, and 
develop empirical knowledge” (p. 27). Its methodolo-
gy is especially useful to understand context, identify 
research questions, follow the development of issues, 
and enrich other research findings (Bowen, 2009). 
This type of analysis involves breaking down the con-
tent of selected documents and synthesizing and or-
ganizing data (i.e. document excerpts and quotations) 
into meaningful themes (Bowen, 2009). The process 
consists of skimming documents, followed by exam-
ining them thoroughly and then conducting content 
and thematic analyses to make meaning of the subject 
matter (Bowen, 2009). It is comprised of open coding, 
axial coding, and selective coding (Neuman, 2004). 

In our analysis, we focused on newspapers to the 
exclusion of other news sources. Research suggests 
that consumers increasingly rely on television, on-
line, and radio sources for news and that reliance on 
newspapers is declining (Pew Research Center, 2016). 
Nevertheless, many researchers continue to focus 
on newspaper texts to analyze how media portrays 
public health concerns (Rooke & Amos, 2014; Caul-
field, Clark, McCormack, Rachul, & Field, 2014). As 
Rooke & Amos (2014) explain, newspapers perform 
an important gatekeeping function; they serve as “a 
useful proxy for reporting in other media as they often 
set the agenda for other formats and are easy to access 
and search” (p. 508). We also limited our analysis to 

newspapers because, compared to other news sourc-
es, the quality of newspaper reporting is high. For 
example, an analysis of three large newspapers and 
five local TV news channels in the San Francisco Bay 
Area assigned overall “A” grades to all three newspa-
pers while the local television channels earned grades 
ranging from “D+” to “C+.” These grades were based 
on measures of context, newsworthiness, explanation, 
civic contribution, local relevance, and enterprise (Mc-
Manus, 2003).    

Using document analysis methodology, our team 
developed and implemented a research protocol start-
ing in January 2017. First, we selected the specific 
newspapers to include in our study. We chose the 50 
U.S. newspapers with the widest circulation. These 
newspapers were identified using The World Almanac 
and Book of Facts 2016, which relied on data from 
the Alliance for Audited Media (Janssen, 2016). The 
most recent circulation data available to generate 
this list dated to March 2014. We relied on these 50 
newspapers because of the readership reach. We also 
selected the time-period of 1990 to January 31, 2017 
for our analysis. We did this primarily because HIAs 
are a fairly new tool in the U.S. (Schuchter, Bhatia, 
Corburn, & Seto, 2014). Therefore, related newspaper 
documents would be unlikely to predate 1990.

Two members of our team searched for newspaper 
documents published in each of the 50 most circulated 
newspapers by using three different databases: Pro-
Quest Newspapers, LexisNexis Academic, and Access 
World News. For the selected newspapers and dates, 
we searched each database using the key term: “health 
impact assessment.” Two members of the team then 
downloaded and saved all of the documents found, 
eliminating any duplicate results uncovered through 
multiple databases or documents printed only online. 
Online-only articles were excluded because of the dif-
ferences in online presence and archiving across news-
papers and also because the circulation and readership 
for online-only documents was difficult to ascertain.  



Insights into How HIAs are Characterized in the Press Gakh; Coughenour; Pharr; Goodie; To

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We then proceeded to code the documents and iden-
tify themes. During open coding, two members of 
the research team read through all of the resulting 
documents, twice, to familiarize themselves with 
their content and the ideas discussed. Then, the two 
team-members re-read each document individually. 
For each main idea related to our research question, 
each of the two team-members selected one to three 
representative words, or codes, keeping detailed notes 
on the meaning of each code. 

After the initial codes were created, three members 
of the team met to resolve differences and compile an 
agreed-upon, final list of codes and code definitions. 
Using this final list, two members of the research team 
together re-coded each document over several ses-
sions. Sessions consisted of each researcher reading 
and coding alone and then the two researchers imme-
diately and thoroughly discussing the document codes 
to resolve any discrepancies in order to agree on all 
final codes. The team then calculated the number of 
times each code emerged in the documents. 

After each document was coded in the open coding 
phase, the research team completed axial coding 
by arranging the codes into meaningful themes. In 
this phase, the team organized the codes generated 
during open coding into larger, categorical themes 
that discussed related ideas. Once the list of themes 
was finalized, we tallied the number of times each 
theme appeared. Finally, the team engaged in selective 
coding to pick out representative quotations that could 
illustrate the character of each code and theme. We 
deemed a quotation representative when it exemplified 
the meaning of that particular code. 

Results  

The initial search generated 70 documents, eight of 
which were excluded because they were duplicative or 
online only. The database searches ultimately pro-
duced 62 documents that met inclusion criteria. The 
62 documents came from 27 newspapers (see Table 1). 

Of these 27 newspapers, six newspapers contained 28 
total documents -- or 45.2% of all documents found in 
our search; specifically, two newspapers published six 
documents each while four newspapers published four 
documents each. These six newspapers were: The Ore-
gonian (n=6), Orange County Register (n=6), Los An-
geles Daily News (n=4), Star Tribune (n=4), St. Paul 
Pioneer Press (n=4), and Buffalo News (n=4). Four 
additional newspapers contained three documents each 
(a total of 12 documents, or 19.4% of all identified 
documents); five contained two documents each (a 
total of 10 documents or 16.1% of all identified docu-
ments); and 12 newspapers printed one document each 
(a total of 12 documents or 19.4% of all documents). 
In some of these newspapers, one author produced 
most or all of the HIA-related content. 

We found no relevant documents in the remaining 23 
newspapers. Of these 23 newspapers, we were unable 
to search for complete results for five. Three of the 
five (Long Island Newsday, Phoenix Republic, and 
The Detroit Free Press) were not indexed in the da-
tabases available to us and two of the five were only 
partially indexed for our period of interest (Pittsburgh 
Tribune-Review indexed from 2001-2015 and Wood-
land Park Herald News indexed from 1998 to 2016). 
Table 1 lists the newspapers that contained documents 
relevant to our search. Newspaper document citations 
are provided in the Appendix.



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Table 1. Number of documents mentioning “health impact assessment” in the top 50 most circulated  
newspapers of 2014 published between 1990 and January 31, 2017
Rank Newspapers Results (n) Rank Newspaper Results (n)

1 USA Today 3 26 The Oregonian 6
2 Wall Street Journal 1 27 San Diego Union Tribune -
3 New York Times 1 28 Cleveland Plain Dealer 3
4 Los Angeles Times 2 29 San Francisco Chronicle -
5 New York Post 1 30 Kansas City Star -
6 San Jose Mercury News 2 31 Pittsburgh Tribune-Review^ 1
7 New York Daily News - 32 St. Paul Pioneer Press 4
8 Chicago Tribune 1 33 Detroit Free Press* -
9 Long Island Newsday* - 34 Milwaukee Journal Sentinel 1

10 Washington Post 1 35 Sacramento Bee 3
11 Chicago Sun Times - 36 Miami Herald -
12 Dallas Morning News 1 37 Tampa Tribune -
13 Los Angeles Daily News 4 38 Atlanta Journal-Constitution 2
14 Denver Post 3 39 Fort Worth Star Telegram -
15 Houston Chronicle - 40 St. Louis Post-Dispatch -
16 Orange County Register 6 41 Salt Lake City Tribune -
17 Philadelphia Inquirer - 42 Baltimore Sun 2
18 Star Tribune 4 43 Pittsburgh Post-Gazette 2
19 St. Petersburg Times [AKA 

Tampa Bay Times]
- 44 Ft. Lauderdale Sun-Sentinel -

20 Newark Star-Ledger 1 45 Indianapolis Star -
21 Honolulu Star-Advertiser - 46 Little Rock Democrat Gazette [AKA 

Arkansas Gazette]
-

22 Boston Globe 1 47 Woodland Park Herald News^ -
23 Phoenix Republic* - 48 Buffalo News 4
24 Seattle Times 1 49 Fresno Bee -
25 Las Vegas Review-Journal 1 50 Orlando Sentinel -

Notes: * = Not indexed in the databases used; ^ = Partially indexed in the databases used

While our search dated back to 1990, the first document we found was published in 1996 and the last document 
we found was published in 2015 (see Figure 1). Between the calendar years of 1997 to 2002, we found no doc-
uments that met our search criteria. Most of the documents (n=57 or 91.9%) appeared in 2010 or after, with 21 
documents (or 34.0%) appearing in 2014 alone. Of the 62 documents that met inclusion criteria, 37 were news 
articles (59.7%), 11 were editorials or commentaries (17.7%), 9 were other opinion pieces such as letters to the 
editor (14.5%), four were news briefs (6.5%), and one was a crossword puzzle (1.6%).



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Figure 1. Frequency of documents mentioning “health impact assessment” within the top 50 
mostly widely circulated U.S. newspapers of 2014 with publication dates between 1990 and 
January 31, 2017

By coding over 1,000 individual phrases from the 62 
documents using a final list of 46 codes, grouping 
the codes into 10 different themes to capture related 
codes, and selecting quotations to illustrate the essence 
of each code, we identified several important patterns 
of how newspaper documents characterized HIAs. 

These patterns -- in order of theme frequency -- are 
discussed below. Code definitions and frequencies as 
well as illustrative quotations are presented in Table 2. 
In addition, Figure 2 illustrates the relative frequency 
with which each code was observed.

Table 2. Definitions and illustrative quotations for each code, categorized by theme
Theme Code (n) Definition Quotation
General reference to HIA or other 
HIA-related work

HIA steps (4) mentions 6 HIA steps “It’s not clear how extensive the DEC’s health-specific review 
has been or will be, or whether it will follow the guidelines and 
methodology laid out for health impact assessments laid out by 
leading medical organizations” (Campbell, 2012, September 21, 
p. ARC). 
“Getting information out to the public ahead of the official 
scoping process, perhaps beginning in June, inspired creation of 
www.coaltrainfacts.org” (Dickie, p. A15). 



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HIA-related assess-
ment (40)

mention of mental health impact 
assessment; environmental 
impact assessment; other assess-
ment related and similar to HIA 
but defined differently

“The study coincides with a 20-month, $3 million draft environ-
mental impact study, which is a required part of the government 
funding process” (Mohr, p. A3). 
“The DEC has already released a draft set of regulations and 
two non-final versions of its environmental impact statement, 
which has grown to 4,000 pages” (Campbell, 2012, September 
20, p. ARC). 

HIA background (9) mentions or discusses when, 
why, and by whom HIAs are 
used or performed – not specific 
to the HIA that is the main topic 
of the newspaper piece

“Ross said that the “health impact assessment” is about improv-
ing quality of life, such as finding best practices for sound-proof-
ing homes near an airport” (Tobin, p. A11). 
“A health impact assessment is a relatively new tool in urban 
planning. It uses existing epidemiological data to project the 
likely health outcomes of a change to a community’s built envi-
ronment” (McCurdy, sec. Clark Community). 

Previous HIAs (14) mentions or discusses other 
HIAs in the US or abroad – 
mention should be of a specific 
HIA other than the one that is 
the main topic of the article

“Doctors elsewhere are starting to call for a health assessment 
along the entire corridor. The concept is not new. A study was 
done in 2008 on the Highway 520 replacement” (Dickie, p. 
A15).  
“A similar health impact assessment was completed last year 
for the Bottineau Transitway, which is slated to be a 13- mile 
extension of the Blue Line light-rail …” (Mohr, p. A3). 

General HIA defini-
tion (6)

defines in general (that is, not 
specific to the HIA that is the 
topic of the newspaper piece) 
what HIAs are

“What if proposed policies had to include a health impact 
assessment in addition to the oft-required fiscal impact analysis? 
Including information about a policy’s health impacts could shift 
the view” (Gara, sec. My town). 
“To measure how planning decisions affect health in city neigh-
borhoods, Collier said his department would use a new digital 
tool called Health Impact Assessment, which employs data to 
measure the potential effect of policy on public health” (Litt, p. 
6). 

Miscellaneous Other (64) information not related to the 
HIA

“Cities were sickly places 150 years ago. Dysentery, typhoid, 
measles, influenza and other diseases thrived in overcrowded 
and unsanitary conditions. It took heroic and creative leader-
ship by city planners, architects and health advocates to create 
healthier cities” (Kaufman, p. M6). 
“Freed, a former board member for Environmental Advocates 
of New York, ceased working for the state in March of this year. 
Both he and the Department of Health declined comment on 
why he no longer works there” (Campbell, 2012, September 21, 
p. ARC). 

Author opinion (67) opinion or conjecture of the 
author of the editorial or letter 
– not fact

“The mayor has been a stubborn disappointment since taking 
office, but he hit a high note with his June 5 speech commemo-
rating World Environment Day” (Duin, sec. Local News). 
“When is a proposed moratorium on oil and gas drilling really 
not a moratorium at all but an excuse to ban such operations for 
a couple of years?” (Loveland is the latest, 2014, p. 15A)

HIA Values Social justice (3) discusses or mentions social 
justice

“Ben Duncan, chairman of the environmental justice task force, 
said the trains tend to pass through lower-income neighbor-
hoods, whether in eastern Oregon, Portland or Eugene. That’s 
“an environmental justice issue that cannot be ignored,” he said” 
(Learn, 2012, July 20,  sec. Local News). 
“The worst part of this story is that this compressor and pipeline, 
which are slated to be built in Pendleton and Wheatfield, will get 
the toxic gases and threat of malfunctions, while Canada gets 
“clean gas” (Stanley, p. 5). 



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Vulnerable popula-
tion (21)

discusses or mentions a vulnera-
ble population

“Delaying disconnection can cause other problems for vulnera-
ble populations, allowing them to accrue more debt” (Wernau, 
p. 2.1). 
“Metro-area faith leaders say a $1.8 billion plan to widen a 
portion of Interstate 70 in northeast Denver should be scuttled 
because it is a public health threat and will break up low-income 
families…” (Whaley, p. 17A). 

Equity (9) discussion of a population that 
is at risk of inequity or harm

“Today, if Collier’s views hold sway, equity would mean a 
greater emphasis on improving public health through parks, bike 
trails and healthier food options for residents in economically 
challenged neighborhoods” (Litt, p. 6). 
“And communities have become willing to overcome earlier 
hesitation over connecting racially and economically diverse ar-
eas with bike lanes and other recreational pathways” (Litt, p. 1). 

HIA Setting Geographic setting 
(24)

mentions or discusses the geo-
graphic setting for the decision 
related to the HIA

“Metro-area faith leaders say a $1.8 billion plan to widen a 
portion of Interstate 70 in northeast Denver should be scuttled 
because it is a public health threat and will break up low-income 
families…” (Whaley, p. 17A). 
“A $100,000 grant will fund a yearlong study of potential health 
effects resulting from the development of the Gateway Corridor, 
the transit link being developed along Interstate 94 from the 
eastern end of Woodbury to downtown St. Paul” (Anderson, p. 
2N). 

HIA decision (65) mentions or discusses the pro-
posal, policy, law, program etc. 
that is the subject of the HIA

“The Eastside Greenway [project] … would bring nature and 
recreation closer, among other benefits” (Litt, p. 1)
“Placer County has proposed developing the power-generation 
facility on county-owned land off Highway 89 between Truckee 
and Squaw Valley” (Litt, p. 1). 

Problem background 
(86)

mentions or discusses the 
situation that led to the proposal 
being examined in the HIA

“Today’s cities are plagued with traffic, violence and overcrowd-
ing” (Kaufman, pg. M2).
“When Matt Pakucko and Hibino bought their four-bedroom 
home in Porter Ranch eight years ago, they say it was never 
disclosed it sat on an oil and gas field. The closest well pumps 
crude 1,200 feet from their house” (Bartholomew, p. 3)

Timeline (25) timeline for the decision related 
to the HIA

“The council unanimously agreed last month that owner Sam 
Chew must cease new shipments and clear the lot by Feb. 1, 
1997” (Central Los Angeles, 1996, p. 5). 
“City Manager Tom Bakaly said … the analysis should be final-
ized by the end of June” (Cooley, p. H). 

Legal mandates (11) mentions or discusses govern-
ment requirements related to 
the HIA

“Tuesday is the last day to comment on new proposed fracking 
regulations in California as mandated by SB 4” (Russell, p. 
11A). 
“Such measures have historically been a tough sell in Wiscon-
sin, where the Legislature passed the truth-in-sentencing law in 
1999 and last year rescinded a program that released prisoners 
early for good behavior or health reasons” (Russell, p. 11A). 

Decision-makers 
(42)

mention or discussion of those 
who are making a decision 
related to the topic of the HIA

“Coal export critics ramped up pressure on Gov. John Kitzhaber 
on Thursday to delay any Oregon projects until a comprehensive 
“health impact assessment” is completed” (Learn, 2012, July 20, 
sec. Local News). 
“Several environmental and medical groups had on Martens and 
Gov. Andrew Cuomo to tap an independent, non-governmental 
group to assess hydrofracking’s physical effects on humans” 
(Campbell, 2012, September 20, p. ARC). 



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Baseline conditions 
(33)

discusses or mentions baseline 
or existing conditions about the 
community affected by the HIA 
decision related to health or 
other factors

“Despite almost 60 years of nationwide experience proving the 
safety and tooth-saving benefits of maintaining a consistent level 
of this naturally occurring element in the water, fewer than 14 
percent of New Jerseyans receive fluoridated drinking water” 
(Harris, p. 4).
“Among other issues, Mariposa’s assessment found that more 
than 55 percent of the neighborhood’s predominantly Latino 
residents were overweight, about 75 percent had high blood 
pressure or were borderline, and nearly 40 percent had a condi-
tion that prevented them from working” (Gose, p. B8). 

Process for this particular HIA HIA authors (20) mentions or discusses authors 
of HIA

“The Health Impact Assessment that the city commissioned 
McDaniel Lambert Inc. to complete…” (Cooley, 2014, June 12, 
p. 1). 
“Research team member Courtney Coughenour, an assistant 
professor in public health courses at UNLV…” (Ortega, p. B1). 

HIA funding (12) mentions or discusses grant or 
other funds used to conduct 
the HIA that is discussed in the 
newspaper piece

“Georgia Tech’s work is being funded in part by more than 
$300,000 in grants from sources including the Ford Motor Co., 
The Pew Charitable Trusts and The Robert Wood Johnson Foun-
dation” (Tobin, p. A11). 
“A $100,000 grant will fund a yearlong study of potential health 
effects resulting from the development of the Gateway Corri-
dor…” (Anderson, p. 2N). 

Availability (11) mention or discussion of where 
completed HIA or its related 
documents are available

“Residents can read the report online at www.henn epin.us/
bottineauhia. Copies are available at Hennepin County libraries 
at Brookdale, Brooklyn Park, Golden Valley, Rockford Road 
and Sumner” (Bottineau transitway, p. 2AA).
“The report documenting the expected health impact of the 
proposed Bottineau light-rail line is now available online and at 
local libraries” (Bottineau transitway, p. 2AA). 

Community event 
(14)

mention of public forum or 
event related to the HIA where 
community members are 
present

“The prospect of Whatcom County hosting the annual export 
of 54 million tons of Power River Basin coal helped turn out 
more than 800 people for a community meeting on what the 
environmental review of the project should cover” (Bottineau 
transitway, p. 2AA).
“The gathering attracted St. Paul citizens representing a 
cross-section of ethnic and religious groups advocating for 
protection for low income people, small businesses and history 
in the heart of St. Paul” (Simons, p. 1B). 

Steering committee 
(4)

discusses or mentions a steering 
committee created to work on 
the HIA

“Coyne is helping to lead a steering committee that includes 
planners and elected officials from Shaker Heights, Cleveland 
Heights, University Heights, Euclid, South Euclid, Beachwood, 
Lyndhurst, Pepper Pike, Mayfield, Mayfield Heights, Highland 
Heights, Orange, Warrensville Heights and Bratenal” (Litt, p. 3). 
“The committee also included former mayor Miesha Headen 
of Richmond Heights.... Christel Best, director of economic 
development, represented the city at the last steering committee 
meeting” (Litt, p. 3). 

Projected impact of decision, program, 
or policy

HIA impact of deci-
sion (19)

discusses or mentions the 
decision’s expected impact on 
health or its determinants (e.g. 
projections)

“If vaccine mandates are weakened, we will see pockets of 
unvaccinated kids putting at risk infants, pregnant women and 
people whose immunity has waned or never took when first 
inoculated” (Harris, p. 4). 
“The report found several possible negative health impacts, in-
cluding a likely increase in mortality locally due to exposure to 
air pollution, increased traffic injury risks and both mental and 
physical problems associated with the project’s odors” (Cooley, 
p. K). 



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Recommendations 
(9)

Mention or discussion of the HIA’s recommendations “Because research shows that giving children information 
about nutrition early in life can have a positive effect on 
their attitudes later, the team suggested schools provide 
professional workshops to kindergarten teachers to improve 
their nutrition education strategies. It also recommended free 
universal meals for all kindergartners to ensure they receive 
proper nutrition” (Ortega, p. B1). 

“The health impact assessment recommends that the ICC 
disallow remote disconnection” (Wernau, p. 2.1).

Cost (30) Discusses or mentions projected impact of the deci-
sion that is the subject of the HIA on monetary cost 
(in dollars) to the government or private parties

“The Gateway Corridor project is expected to cost about $400 
million” (Mohr, p. A3). 

“City staff estimate that the first phase of construction for the 
project… will cost $563,000” (Cooley, p. H). 

Economics (15) Mentions or discusses projected impact of the deci-
sion that is the subject of the HIA on the economy 
and/or economic well-being of the community or 
groups or individuals in the community

“Supporters say the project can be done without long-term 
harm to the environment, providing an economic boost to the 
regional economy” (Myers, p. A8). 

“The City Council on Tuesday night asked for additional 
changes to a cost benefit analysis taking place on the pro-
posed E&B Natural Resources oil drilling project” (Cooley, 
p. H). 

Engagement Stakeholders (100) Mentions or discusses involvement and input into the 
HIA or related decision by stakeholders (i.e. persons 
or organizations invested or interested in the decision 
being discussed by the HIA)

“Healthy Corridor for All, a coalition of St. Paul community 
groups, unions and churches, organized the event to push this 
message: Decisions surrounding the Central Corridor project 
should be made in a way that improves life for the low-in-
come and minority residents that populate the neighborhoods 
along University Avenue” (Simons, p. 1B). 

“In February, a group of 19 Duluth-area physicians, nurses 
and medical school faculty sent letters to state and federal 
regulatory agencies saying the effects of copper mining on 
human health haven’t been adequately addressed” (Myers, p. 
A8). 

Collaboration (21) Mentions or discusses relationship between different 
sectors (e.g. public health and other sector)

“The Pennsylvania Department of Health is charged with en-
suring and protecting the health of all state residents. It fulfills 
this obligation by partnering with communities to monitor 
existing and emerging health problems and to establish 
programs that prevent disease and injury” (McDermott-Levy 
& Katkins, p. B1). 

“Ross said the studies are being done by several Georgia Tech 
departments, including mechanical engineering, and city and 
regional planning” (Tobin, p. A11).

Health department 
(24)

Mentions or discusses local, state, or federal health 
department (e.g. CDC, state health department)

“The groups want the Minnesota Department of Health to 
conduct the review, saying none of the human health issues 
has been vetted in the ongoing environmental impact state-
ment that has focused on how Minnesota’s first copper mine 
might affect air and water quality, wildlife and other natural 
resources” (Myers, p. A8). 

“Officials at the Centers for Disease Control say raw milk 
consumption is 150 times more likely to cause similar infec-
tions than pasteurized milk” (Harris, p. 4). 

Expert (10) Mentions or discusses opinion of an expert in the 
field related to the HIA, other than the HIA authors

“Ann Stahlheber, a county public health dietician who helped 
collect the data, said that well-used trails and parks could 
improve safety and public health” (Litt, p. 1). 

“Three outside experts assisting New York with a health 
review of hydraulic fracturing say their work was completed 
more than a month ago, which the state Health Department 
didn’t reveal during lengthy testimony before lawmakers last 
week or in a public statement” (Campbell, 2013, February 8, 
p. ARC). 



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Feedback (154) Mentions or discusses testimony or feedback about 
the HIA or related issue from someone in community 
or a stakeholder

“Ophthalmologist Andy Harris, an advisory board member 
for Oregon PSR, said coal export out of Oregon and Washing-
ton ports poses ‘a significant risk to public health’” (Learn, 
2012, July 20, sec. Local News). 

“Michael Schommer, a health department spokesman, said 
that “Commissioner Ehlinger looks forward to discussing 
the issue with the governor later this week, and to addressing 
any of his questions about the requests for a health impact 
assessment” (Marcotty, p. B1).

Policy and Science Community advo-
cacy (21)

Discusses how community members affect policy or 
policymaking process

“The records obtained by Gannett’s Albany Bureau show 
that several organizations have been privately pushing the 
Department of Environmental Conservation and Gov. Andrew 
Cuomo’s office to take a broader look at the potential health 
impacts of hydrofracking” (Campbell, 2012, September 21, 
p. ARC). 

“More than 250 doctors asked Gov. Cuomo yesterday to 
order a thorough review of potential health hazards before 
allowing hydraulic fracturing in upstate’s Marcellus Shale” 
(Kriss, p.14). 

Science advocacy 
(2)

Discusses how scientists affect policy or the policy-
making process

“Unfortunately, health professionals contribute to this 
confusion by their silence. Some who dare to speak out are 
attacked professionally and personally. Some have trouble 
communicating complex issues in understandable language. 
Many work for public institutions, such as universities and 
health agencies, with strict rules about ‘lobbying’ and can’t 
speak directly to legislators without their employer’s consent” 
(Harris, p. 4). 

“Legislators should invite academic researchers to present 
objective testimony without concerns over lobbying. The 
state’s significant data resources and newly developed health 
information networks should inform their deliberations” 
(Harris, p. 4). 

Misinformation (4) Mentions or discusses information that is not scientif-
ically accurate or groups espousing such information

“Opponents of fluoridation, citing concerns about cost, toxins 
and lack of consent, ignore the fact that 72 percent of the 
nation’s water is already fluoridated without adverse health 
effects. Every dollar spent on fluoridation saves $38 in dental 
care” (Harris, p. 4). 

“Vaccine deniers painted a somber portrait of children 
damaged by vaccines, while public health professionals cited 
detailed research studies showing that vaccinations prevent, 
rather than cause, serious disease” (Harris, p. 4). 

Lack of evidence 
(7)

Mentions or discusses lack of consensus on an issue 
related to the HIA topic

“Los Angeles City Councilman Mitch Englander and L.A. 
County Supervisor Michael Antonovich only repeat what 
SoCal Gas says: The leak is ‘non-toxic,’ ‘no health concern.’ 
Neither repeats what dozens of residents said about being sick 
from the gas” (Frazer, p. 4). 

“Instead, self-proclaimed experts citing personal anecdotes or 
cherry-picked factoids fresh off the internet are heard in the 
same forum and often given the same credence as scientific 
experts with decades of training and experience dedicated to 
advancing public health” (Harris, p. 4). 

Scientific evidence 
(27)

Mentions or discusses credible, scientific evidence 
related to an issue related to the HIA

“A separate analysis that used ComEd’s data from its pilot 
study said education will be especially important to the area’s 
most vulnerable populations: the sick, the poor and the elder-
ly, who otherwise won’t receive the benefits they’re paying 
for” (Wernau, p.2.1). 

“Research shows that fewer patients die when their caregivers 
are vaccinated against the flu, but last year, only 64 percent 
got the shot” (Harris, p. 4). 



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Failure to conduct 
HIA (12)

Refusal to conduct HIA, despite stakeholder or com-
munity interest in an HIA

“New York’s top environmental regulator on Thursday 
dismissed calls for a lengthy outside analysis of natural-gas 
drilling’s health effects, instead calling on the Department of 
Health to tap experts to assist in the state’s review” (Camp-
bell, 2012, September 20, p. ARC). 

“Since the department has failed to provide a public registry 
of fracking-related complaints, there is no way to determine 
whether it is adequately monitoring and investigating frack-
ing’s health effects” (McDermott-Levy & Katkins, p. B1). 

HIA pushback (4) Resistance by stakeholders or decision-makers to the 
findings of a completed HIA 

“Following the preliminary report’s release in February, 
E&B’s attorneys sent the city a letter demanding it “retract 
and disavow” the report, claiming it failed to address existing 
laws that regulate air, water and soil quality” (Cooley, p. E). 

“E&B asked the city to retract and disavow the report, claim-
ing that the HIA failed to address existing laws that regulate 
air, water and soil quality. The oil company also claimed that 
statements in the report were either not backed up by science 
or used untested methods for verification” (Cooley, p. K). 

HIA resistance (23) Resistance to conducting an HIA by stakeholders or 
decision-makers

“The city of Hermosa Beach has withdrawn the Health 
Impact Assessment for the proposed oil drilling project at 
the request of the consulting group that compiled the report” 
(Cooley, p. K). 

“In February 2011, a Cuomo administration official sent a 
letter to a doctor who had pressured the Department of Health 
on hydrofracking, outlining his position that an extensive 
health assessment would be redundant” (Campbell, 2012, 
September 21, p. ARC). 

Health determinants Healthy community 
(21)

Mentions or discusses attributes of a community that 
are termed or described as healthy or desirable for 
health purposes

“By redesigning the area where people live, they hope to 
change how they live, making it so simple to move and eat 
good foods that people start leading a healthier life” (Dwor-
kin, sec. Living). 

“‘We seek a solution that demonstrably improves the health 
and wellness of residents beyond conditions that exist today 
-- that is, a solution that results in measurably better health 
conditions for residents, schoolchildren, workers and visitors 
to these neighborhoods,’ the letter says” (Whaley, 17A). 

Access to health-
care (3)

Mentions or discusses a person’s or community’s ac-
cess to the healthcare system and/or clinical services 
(e.g. paying for health insurance, getting to a doctor)

“Large Hospital groups typically make these transactions to 
keep smaller, financially distressed nonprofit hospitals open 
so they can continue to serve their communities” (Maiman, 
p. 11A). 

“Do we want to hold a community’s access to critical health 
care while the litigation process resolves itself?” (Maiman, 
p. 11A). 

Community devel-
opment (31)

Mentions or discusses building projects in the com-
munity (e.g. related to housing, transportation, and/
or planning)

“So activists are working with Portland’s Bureau of Planning 
and Sustainability to map out new sidewalks and other 
changes that could turn the area around Southeast 122nd into 
a ‘20-minute neighborhood’” (Dworkin, sec. Living). 

“‘We are the test bed for the re-creation of urban spaces, 
neighborhoods and communities,’ said Catherine Ross, direc-
tor of the school’s Center for Quality Growth and Regional 
Development. ‘My hope is that we develop this reputation 
-- with Atlantic Station, the Beltline and the aerotropolis -- as 
cutting edge examples of recreating communities’” (Tobin, 
p. A11). 



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13

Environment (24) Mentions or discusses the natural environment or at-
tempts to address impacts on the natural environment 
by government or others

“The preliminary finding said air pollution, noise and 
increased traffic from the project would subject neighbor-
ing residents to numerous physical and mental problems” 
(Cooley, p. E).

“It is also clear fracking will cause environmental damage, 
especially to water. It has happened everywhere fracking is 
allowed and it can’t be stopped” (Guy, p. 17A). 

Health behavior (6) Mentions or discusses individual behaviors that can 
have positive or negative impacts on health outcomes 
(e.g. smoking, substance abuse, sexual practices, 
healthy eating, exercise) or associated risks

“In addition to encouraging convenience stores to offer 
healthier food, Mortell and other officials have been working 
to encourage county residents to walk and bike” (McCurdy, p. 
Clark Community). 

“‘For example, developments that include sidewalks and 
nearby places to walk to such as coffee shops and grocery 
stores can encourage people to exercise -- even casually -- 
and can help in the war against obesity,’ he said” (Frankston, 
p. F1). 

Health outcomes Injury (3) Mentions or discusses injury-related morbidity or 
mortality (e.g. car crash, fall, gun violence, etc.) or 
associated risks

“The data show that from 2008 to 2012, there were 330 acci-
dents involving bikes on east side roads and streets, and 596 
pedestrian accidents” (Litt, p. 1). 

“With more time spent in the car, the probability of a crash 
becomes greater. A lack of sidewalks also can lead to more 
pedestrian fatalities” (Frankston, p. F1). 

Chronic disease 
(26)

Discusses or mentions morbidity or mortality data 
related to chronic disease

“Sprawling cities that force people to drive long distances 
to work, school or shopping reduced the amount of exercise 
people got by replacing walking with increased driving. Prob-
lems linked to sprawl include heat stroke, road rage, obesity, 
asthma and diabetes” (Frankston, p. F1). 

“‘For example, developments that include sidewalks and 
nearby places to walk to such as coffee shops and grocery 
stores can encourage people to exercise -- even casually -- 
and can help in the war against obesity,’ he said” (Frankston, 
p. F1). 



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Figure 2. Number of times each code appeared in examined documents



Insights into How HIAs are Characterized in the Press Gakh; Coughenour; Pharr; Goodie; To

15

Theme 1: Engagement
The most common theme that appeared in the doc-
uments focused on HIA-related engagement. This 
theme includes codes that captured documents’ dis-
cussions of collaboration and feedback across sec-
tors, with stakeholders, and with experts. Within the 
engagement theme, which appeared 309 times in the 
documents, “feedback” was the most frequently used 
code (n=154). The “feedback” code was used when 
a phrase focused on a reaction to the HIA or related 
issues from a stakeholder or community member. The 
second most commonly used code under this theme 
was “stakeholder” (n=100). The “stakeholder” code 
was used when an article mentioned involvement in 
the HIA or a related decision by a stakeholder. Phrases 
discussing collaborations between public health and 
other sectors (e.g. city planning, academia, or engi-
neering) also appeared within this theme.

Theme 2: HIA Setting
The second most frequently appearing theme (n=286) 
consisted of codes depicting the environment in which 
the HIA was occurring. The most frequently used 
code in this theme captured language discussing the 
“problem background” (n=86), or the situation that led 
to a proposal examined by the HIA. This theme also 
included discussions of the “HIA decision” (n=65) 
-- that is, the proposal, policy, law, or program that 
was the subject of the HIA -- and “decision-makers” 
(n=42), the individuals, groups, and organizations 
involved in making decisions on a proposal exam-
ined by the HIA. This theme also included codes that 
captured the scope of the HIA, such as existing condi-
tions (n=33), HIA or decision timelines (n=25), HIA 
geographic settings (n=24), and any related mandates 
(n=11).

Theme 3: Miscellaneous
Many of the documents contained authors’ opinions 
(n=67) and other statements (n=64) that were not 
directly related to the HIAs or the issues they were 
examining. We grouped these two codes into a theme 
that we called “miscellaneous” (n=131). While not 

focused on the HIA, phrases coded under this theme 
were still prominent. The “author opinion” code in 
particular was often used in opinion pieces.

Theme 4: Policy and Science
The fourth most frequently detectable theme repre-
sented discussions of various aspects of the policy 
process and its interaction with scientific evidence 
(n=100). Within this theme, the most frequently used 
code, “scientific evidence” (n=27) captured phrases 
that connected scientific evidence to an issue exam-
ined by the HIA. Many documents mentioned ways in 
which community members affect policy or the pol-
icymaking process (n=21). They also contained lan-
guage that discussed resistance to conducting an HIA 
by stakeholders or decision-makers (n=23), refusals 
to conduct an HIA despite stakeholder or commu-
nity interest (n=12), or resistance to the findings of 
a completed HIA (n=4). Mentions of how scientists 
affect policy were infrequent (n=2). Some documents 
discussed a lack of scientific consensus on an issue 
related to an HIA topic (n=7) or discussed information 
that was not scientifically accurate (n=4). 

Theme 5: Health Determinants
The “health determinants” theme appeared in the doc-
uments 85 separate times. The most frequently used 
code under this theme was “community development” 
(n=31), which captured discussions of built environ-
ment projects related to housing, transportation, or 
planning. Codes capturing mentions of the natural en-
vironment (n=24) and attributes of healthy communi-
ties (n=21) also appeared in the newspaper documents 
with moderate frequency. In contrast, individual health 
behaviors (n=6) and access to healthcare (n=3) were 
mentioned infrequently.

Theme 6: General Reference to HIA or Other
HIA-Related Work
Many documents made general references to HIAs or 
the HIA process or discussed other HIAs previously 
completed (n=73). Within this theme, mentions of 
HIA-related assessment, such as environmental im-



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16

pact assessments or mental health impact assessments, 
were frequent (n=40). The documents also contained 
phrases intended to explain HIAs to readers. This 
included language that defined HIAs (n=6); explained 
when, why, and by whom HIAs are typically per-
formed (n=9); specifically mentioned the 6 HIA steps 
(n=4); and discussed previously completed HIAs 
(n=14).

Theme 7: Projected Impacts 
Discussions of the projected impacts of the decision, 
program, policy, or issue at the center of the HIA were 
appeared in the documents 73 times. This included 
projections of monetary costs (n=30) and broader 
economic impacts (n=15). It also included projected 
health impacts (n=19). We coded nine times when 
specific recommendations were mentioned in the doc-
uments. 

Theme 8: Process for a Particular HIA
Codes centered on the process of a particular HIA ap-
peared in the documents with some frequency (n=61). 
This theme included mentions of an HIA’s authors 
(n=20) and funding sources (n=12). It also included 
mentions of events or fora held as part of the HIA 
process at which community members were present 
and input was solicited (n=14), and any steering com-
mittees or similar groups created to work on or guide 
the HIA (n=4). Mentions of the publication of the HIA 
report or related documents were coded as “availabili-
ty” and appeared 11 times.

Theme 9: HIA Values
Discussions of HIA-related values were relatively 
infrequent (n=33). This theme manifested primarily 
through mentions of vulnerable populations (n=21) 
and equity (n=9). In a few cases, social justice was 
also specifically referenced or discussed (n=3).

Theme 10: Health Outcomes
While mentions of health outcomes did appear in the 
documents, the use of mortality and morbidity data 
was relatively infrequent (n=29). The majority of these 

references focused on chronic diseases (n=26), such 
as asthma and diabetes, and their risk factors. A few 
phrases referenced injuries (n=3). 

Discussion 

This study examined how HIAs are portrayed in 
widely circulated U.S. newspapers. While previous 
research has considered HIAs in the broader poli-
cy-making context, we were unable to locate studies 
that systematically analyzed discussions of HIAs in 
U.S. media sources. This is an important line of inqui-
ry because of media’s prominent role in policymaking, 
particularly in focusing attention. We concentrated our 
research on representations of HIAs in major news-
papers, searching newspaper databases for documents 
published in the most widely circulated newspapers 
in the U.S. between 1990 and January 31, 2017. We 
found 62 unique documents from 27 newspapers in 
our search. Approximately two-thirds of these docu-
ments were news pieces and the remaining one-third 
were opinion pieces. Almost 92% of these documents 
were published in 2010 or thereafter and 45.2% were 
published in just six sources. For the pieces found 
through our search, we used a qualitative document 
analysis method consisting of open and axial coding to 
examine more than 1,000 individual phrases. We ulti-
mately identified 46 unique codes across 10 different 
themes. The two most prominent themes focused on 
engagement around an HIA and the HIA setting. While 
policy and science, health determinants, and explana-
tions of HIAs were also frequently featured themes, 
specific mentions of projected impacts, HIA processes, 
HIA values, and health outcomes were less prevalent.

Attention to HIAs in major U.S. print media sources 
is on the rise. This is not surprising because the use 
of HIAs is steadily increasing nationwide (The Pew 
Charitable Trusts, 2015). More surprisingly, however, 
is that while over 400 HIAs have been completed in 
the U.S. (The Pew Charitable Trusts, 2015), their cov-
erage in print versions of major U.S. newspapers has 
been limited. This may be in part because many HIAs, 



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17

including the ones that were the subjects of the news-
paper documents in our analysis, considered local-lev-
el decisions about the built or natural environment and 
most of the newspapers we searched focused primarily 
on limited geographic areas where HIAs may not have 
been taking place. Another potential explanation for 
this limited coverage may be a lack of knowledge 
of or interest in HIAs and the issues they analyze by 
newspapers. A reader relying primarily on printed 
versions of USA Today, The Wall Street Journal, The 
New York Times, The Los Angeles Times, The Chica-
go Tribune, The Washington Post, or other major U.S. 
newspapers as a main source of news, therefore, will 
have only very limited exposure to HIAs from news 
media. In fact, even in the last seven years, when the 
vast majority of HIA-related documents were print-
ed in the newspapers we searched, readers might be 
exposed to only one to three stories. In many large 
newspaper markets, exposure to HIA-related newspa-
per documents may be non-existent. In large market 
newspaper media sources, it seems, HIA discussions 
are still very much a novelty. 

Our analysis indicates that HIA depictions in news-
papers center on two major themes: (1) HIA-related 
engagement and (2) setting the scene for the HIA. 
Within the engagement theme, which appeared over 
300 times in the 62 documents, the two most prevalent 
types of depictions focused on stakeholder feedback 
(n=154) and involvement in the HIA (n=100). This 
suggests that newspaper documents are primarily 
used to demonstrate how stakeholders and commu-
nity members interact with HIA processes and their 
underlying questions. Additional research is needed 
to better understand why media portrayals focus on 
engagement and setting the HIA scene. One possible 
explanation that merits study is whether focusing on 
HIA engagement and setting the scene for an HIA 
provides what news outlets would consider newswor-
thy content when compared to other important facets 
of an HIA, such as its processes, recommendations, 
and values. Newspaper documents are also consistent-
ly used to draw attention to the setting and scope of 

the HIA, emphasizing questions leading to the assess-
ment (n=86) and the specific decisions being assessed 
(n=65). This includes emphasizing decision-makers, 
timelines, settings, and conditions giving rise to the 
issues central to the HIA as well as presenting HIAs 
as tools to understand problems and address uncer-
tainty. Relatedly, newspaper and other media sources 
appear to underscore the connections between policy 
and science, explain HIAs, and discuss health determi-
nants. The prominence of these themes across news-
paper documents is consistent with previous research 
that stresses the ability of HIAs to heighten awareness 
across communities and sectors (Winkler et al., 2013; 
Gottlieb et al., 2012; Harris-Roxas & Harris, 2013). 
Our analysis supports the possibility that media de-
pictions are a mechanism through which HIAs raise 
awareness beyond the HIA team and its partners and 
may also present an important way to measure at-
tempts to heighten awareness.
        
A more surprising finding of this study is that the doc-
uments examined focused less on projected impacts 
(including impacts on health, costs, and the broader 
economy) and HIA recommendations; HIA processes; 
health data; and HIA values. Information on the HIA 
process – including its authors, steering committees, 
funding, community events, and availability – for 
example, arose only 61 times across all documents. 
Readers of these newspaper documents therefore may 
end the pieces without a sense of the HIA process or 
what happens next. Perhaps even more surprising, 
while scholars have found that HIAs can be useful in 
emphasizing the connections between health outcomes 
and some of their causes (Bourcier et al., 2015), these 
connections appeared infrequently in the documents 
we analyzed. Although there were references to costs 
(n=30) and economic impacts (n=15), we found only 
19 phrases specifically mentioning health impacts re-
lated to an HIA and 29 references to health outcomes 
data. Specific recommendations made in the HIA 
appeared only 9 times across all 62 documents. HIA 
values (i.e. social justice, vulnerable populations, and 
equity) were mentioned in the documents in aggregate 



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18

only 33 times. These findings are surprising because, 
in contrast to the portrayal we observed in the newspa-
per documents, HIAs are organized around projecting 
health impacts and recommending health-promoting 
actions around core values. An implication of this find-
ing is that in contributing to newspaper documents, 
both HIA practitioners and authors of newspaper doc-
uments should frame HIAs in terms of their scope and 
values and emphasize the health-related projections 
and recommendations that are central HIA outputs.

A concerted focus on media depictions during an 
HIA and after its completion is critical for HIA prac-
titioners (Lin, Houchen, Hartsig, & Smith, 2017). It 
is especially useful as part of reporting, stakeholder 
engagement, and monitoring and evaluation. This is 
because of media’s prominence in the public policy 
process (Golden & Moreland-Russell, 2016). HIA 
coverage in major newspaper sources is limited, 
leaving an important mechanism of dissemination 
and potential impact underutilized, especially in the 
reporting phase. Our finding that only about 14.5% of 
the documents analyzed were letters to the editor also 
suggests untapped opportunities to use HIA findings 
in media-based advocacy. A practitioner-led effort to 
use media more frequently and in ways that emphasize 
health impacts, recommendations, and HIA values – 
especially in larger markets – may be important for 
a shared strategy of informing community members 
about HIAs and the social determinants and building 
momentum in the field. Employing such a strategy 
may require that practitioners work with trained com-
munications experts or receive additional training on 
both how to work with media effectively and how to 
portray and frame their work around HIA processes, 
projected impacts, recommendations, and values. Such 
a strategy would be consistent with the major strengths 
of HIAs: inserting health concerns into non-health sec-
tor decisions and empowering communities (Bourcier 
et al., 2015; Dannenberg, 2016). 

HIA practitioners should also build on existing prac-
tices to track HIA media portrayals as part of moni-

toring and evaluation (Lin et al., 2017). In addition to 
aiding with monitoring issues and tracking impacts of 
specific HIAs, media analysis can also assist in under-
standing the aggregate impact of the HIA field, which 
remains a challenge (Quigley & Taylor, 2004; Ali et 
al., 2009). Uniform practitioner standards to track 
HIA-related media reporting are imperative for the 
success and utility of individual tracking efforts.
         
While our study presents important findings, it has 
several limitations. Our study focused on large mar-
ket (i.e. top 50), print newspapers. However, we 
were unable to comprehensively search five of the 50 
newspapers in the databases available to us. The study 
also excluded all other newspapers. In the process, it 
excluded any discussions of HIAs occurring in other 
markets or in smaller newspapers in the same markets. 
Furthermore, the study excluded other frequently con-
sumed media sources, such as television, radio, and 
the internet. These exclusions may affect the general-
izability of this study beyond the sources we consid-
ered. Nevertheless, analyzing newspaper documents 
is important, particularly because of their gatekeeping 
function and because of the relative quality of their 
content. In addition, while we analyzed newspaper 
documents, our study did not take into account wheth-
er readers actually read these documents or how they 
interpreted them. Finally, while we used an established 
method of document analysis, the phrases that trig-
gered certain codes and themes for our team may have 
triggered other codes or themes for other researchers 
or led other researchers to select alternative themes 
and taxonomies.

This study and its limitations raise vital questions for 
future research. Media can be important to the poli-
cy process and advancing public health (Dorfman & 
Krasnow, 2014). Future research in this area should 
aim to understand HIA portrayals in the media beyond 
large markets and beyond print newspapers. One strat-
egy could involve a media analysis for each completed 
HIA. Our recommendation to create and use uniform 
practitioner standards for tracking would greatly assist 



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19

in conducting this type of research. Studies should 
also examine the actual impact of media portrayals of 
HIAs on stakeholders and community members. Such 
research can help HIA practitioners understand the 
most effective ways to employ this important tool and 
contribute to new standards in the field.  

Conclusion 

A central purpose of HIAs is to contribute best-avail-
able evidence to questions of policy. As such, HIAs 
function in a larger policy landscape. A powerful 
feature of this landscape is the media, which has the 
ability to inform and shape ideas and actions of com-
munities, stakeholders, and decision-makers both 
about specific policy questions and the connections 
between the social determinants and health outcomes. 
Thus, it is critical to understand how HIAs are repre-
sented in media sources. By aiming to examine how 
widely circulated, U.S. newspapers depict HIAs, our 
study begins to build systematic evidence to answer 
this question. 

Our findings indicate that there is substantial room in 
both how much HIAs are discussed in major media 
sources and how they are discussed. While discus-
sions of HIAs in newspaper documents are on the rise, 
many readers are never confronted with HIAs in major 
newspaper sources. Those who are exposed, more 
frequently encounter depictions focused less on HIA 
projections, recommendations, and values and more 
on engagement and the HIA setting. This presents 
tremendous opportunities for HIA practitioners to in-
crease efforts to both study these portrayals in greater 
depth and enhance these portrayals through media 
interaction. In addition, HIA practitioners should 
establish and utilize uniform media engagement and 
tracking guidelines to understand and meaningful-
ly compare this aspect of HIAs. This is significant 
because the media is a powerful tool for reporting, 
monitoring and evaluation, and stakeholder engage-
ment. It is also important because of media’s potential 
to educate stakeholders about the connections between 
health outcomes and social factors and to help build an 
HIA movement. 



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20

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Appendix: Newspaper Documents Analyzed in this Study

Anderson, J. (2014, November 23). News Brief - Grant to fund health study of transit corridor. Star 
Tribune: Newspaper of the Twin Cities, p. 02N.

Bartholomew, D. (2015, August 19). Public health - Residents call for health study of proposed oil
  wells.  Los Angeles Daily News, p. 3.
Bottineau transitway health report available. (2014, January 8). Star Tribune: Newspaper of the Twin Cities,

p. 02AA.
Campbell, J. (2012, September 21). DEC's fracking announcement months in the making. USA

Today, p. ARC.
Campbell, J. (2013, February 8). Health consultants made fracking recommendations weeks ago. USA

Today, p. ARC. 
Campbell, J. (2012, September 20). Health department to assist DEC in hydrofracking review. USA 

Today, p. ARC.
Carroll, V. (2012, March 24). New front in frackingwars [Editorial]. The Denver Post, p. 9B.
Central Los Angeles; Council affirms plan to clean up dump. (1996, March 20). Los Angeles Times, p. 5. 
Cooley, R. (2014, June 12). Can Hermosa learn from Huntington?. The Orange County Register, p. 

Cover. 
Cooley, R. (2014, June 5). City asks for more details on oil drilling project. The Orange County  Register, p. H.
Cooley, R. (2014, April 17). City withdraws health report for oil project. The Orange County Register, p. 

K. 
Cooley, R. (2014, May 30). Hermosa Beach asks for more details on oil plan. The Orange County 

Register, p. Central_B.
Cooley, R. (2014, July 24). Report: Oil project has minimal health impact. The Orange County Register, p. E.
Cooley, R. (2014, July 16). Report: Oil project would not cause health problems. The Orange County 

Register, p. B.
Dickie, L. (2012, March 30). Huge coal-export terminal needs rigorous environmental review 

[Editorial]. The Seattle Times, p. A15.
Doctors, nurses prod Cuomo on “fracking.” (2012, October 19).  The Buffalo News, p. D3.  
Duin, S. (2013, July 2). Ending the island's misery. The Oregonian, sec. Local News. 
Dworkin, A. (2010, February 10). Health movement. The Oregonian, sec. Living.  
Dyrszka, L.M. & Gibbs, L.M. (2012, April 10). New Yorkers have a right to know the health impacts

[Editorial]. The Buffalo News, p. A8. 
Frankston, J. (2003, November 17). Health pros link sprawl with spread suburbs, obesity stir debate. The 

Atlanta Journal – Constitution, p. F1.
Frazer, G. (2015, November 20), Porter Ranch gas leak provides cause to worry [Letter to the

editor].  Los Angeles Daily News. p. 14.
Gara, M. (2014, November 24).  All measures should reveal health impacts [Letter to the editor]. San Jose

Mercury News, sec. My Town.
Gose, J. (2013, March 06). Construction that focuses on health of residents. The New York Times, p. B.8.
Guy, J. (2014, October 11). No fracking in Western Md. [Letter to the editor]. The Baltimore Sun, p. 17A.
Harris, D. (2012, February 26). Base public health policies on real science [Editorial]. The Newark Star-

Ledger, p. 004.  
Hill, P. G. (2011, February 07). Fathers' group opposed SJC pick for good reasons. Boston Globe.
Johnson, A. (2012, November 29). Study urges prison alternatives | Advocacy group says investing 

in mental health could save millions. Milwaukee Journal Sentinel, p. 03.
Kaufman, N. (2004, December 5). City Fixes; good design keeps the doctor away [Commentary]. Los 



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Angeles Times, p. M.2.
Kriss, E. (2011, October 6). Docs' frack attack. The New York Post, p. 014.
Landers, J. (2011, September 9). Projects urged to consider health. The Dallas Morning News, p. D01.
Learn, S. (2012, July 20). Critics seek delay in coal export permits. The Oregonian, sec. Local News. 
Learn, S. (2012, September 20). Stoked about coal, city leaders affirm opposition, call for study. The 

Oregonian, sec. Local News.
Litt, S. (2014, July 27). Designing with health in mind a goal of new planning director. The Cleveland 

Plain Dealer, p. 006. 
Litt, S. (2015, January 25). Opinions sought on Eastside Greenway Multiuse paths would  connect 

communities. The Cleveland Plain Dealer, p. 001.  
Litt, S. (2014, September 30). Planners seek input on East Side greenways: Many suburbs have few parks

or trails nearby. The Cleveland Plain Dealer, p. 003.
Loveland is latest front on fracking [Editorial]. (2014, June 17). The Denver Post, p. 15A.
Maiman, B. (2014, September18). Bill grants too much power to AG [Editorial]. The Sacramento Bee, p.11A. 
Marcotty, J. (2015, November 18). Dayton weighs health review of copper mine. Star Tribune:

Newspaper of the Twin Cities, p. 0B1.
McCurdy, C. (2012, August 25). Obesity a county problem. The Oregonian, sec. Clark Community.
McDermott-Levy, R. & Kaktins, N.M. (2014, July 27). Is the PA. Health Department fracko-phobic? It’s actions

don’t instill confidence that it is protecting us [Editorial]. Pittsburgh Post-Gazette, p. B-1. 
Mohr, E. (2014, November 11). Gateway Corridor study to focus on how project will affect health –

Emphasis to be on land use around bus rapid transit station. St. Paul Pioneer Press, p. A3.
Myers, J. (2014, October 22). Northern Minnesota -- More medical groups want study of proposed mine. 

St. Paul Pioneer Press, p. A8. 
Nielsen, S. On The Stump: Wheat v. coal [Editorial].  (2012, July 30). The Oregonian, sec. Editorial.
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Las Vegas Review-Journal. p. B001. 
Paweewun, O., & Murray, L. (2009, December 03). World news: Thai court keeps projects frozen on 

environmental concerns. The Wall Street Journal, p. A18.
O'Brien, M. R. (2012, November 25). Valid science must prevail on hydrofracking decision [Editorial]. The

Buffalo News, p. G4. 
Osborn, B.B. (2012, March 5). Biomass project's impact on health to be discussed. The Sacramento

Bee, p. B2.
Pakucko, M. (2015, December 4). Porter Ranch gas leak provides cause for worry [Letter to the editor]. 

Los Angeles Daily News, p. 14.
Pakucko, M. (2015, November 30). Porter Ranch gas leak provides cause for worry [Letter to the editor]. 

Los Angeles Daily News, p. 14.
Ruggles, R. The true costs of the CSX rail plan [Editorial] (2014, September 18). The Baltimore Sun, p.

19A.
Russell, C. (2014, January 14). Impose moratorium on fracking in state [Letter to the editor]. 

The San Jose Mercury News, p. 11A.
Sandel, M. Making smart meters truly smart [Letter to the editor]. (2010, August 10). The Washington 

Post, p. A.16.
Simons, A. (2011, March 6). Light-rail ralliers: 'Build it better' - Central Corridor residents' needs must be 

respected, neighborhood advocates said. Star Tribune: Newspaper of the Twin Cities, p. 01B.
Simpson, T. & Weintraub, D.M. (2010, November 14). Urban, hip and healthy - Can wellness be  a 

priority in plans for future growth?. The Sacramento Bee, p. E1. 
Stanley, A.B. (2015, December 13). Compressor, pipeline endanger communities [Letter to the editor]. 



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The Buffalo News, p. 5. 
Stassen-Berger, R. E. (2015, December 8). At the Capitol - Commissioners oppose additional PolyMet 

public health impact review - Dayton agrees after raising the issue. St. Paul Pioneer Press, p. A5.
Stassen-Berger, R. E. (2015, December 6). State agencies nix PolyMet public health impact review. St. 

Paul Pioneer Press, sec. Politics.
Thompson, K. (2009, October 25). Mon Valley Citizens Deserve an Impact Assessment [Letter to the Editor

Pittsburgh Post-Gazette, p. B-2.
Tobin, R. (2010, October 23). City a 'test bed' for urban spaces - Georgia Tech puts grant money toward 

revitalizing Atlanta. The Atlanta Journal-Constitution, p. A11. 
Wernau, J. (2012, April 24). Will smart grid save? The Chicago Tribune, p. 2.1. 
Whaley, M. (2014, November 29). Faith groups want I-70 plan curbed. The Denver Post, p. 17A. 
Zurkowski, M. Across [Crossword puzzle]. (2014, December 21). Pittsburgh Tribune-Review, sec.

Crossword.

CORRESPONDING AUTHOR
Maxim Gakh, JD, MPH
Assistant Professor
School of  Community Health Sciences
University of  Nevada, Las Vegas
Box 453064
4505 S. Maryland Parkway
Las Vegas, NV 89154
maxim.gakh@unlv.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, BA, Richard M. Fairbanks School of  Public Health, Indiana University-Purdue University 
Indianapolis

Chronicles of  Health Impact Assessment Vol. 2 (2017) DOI: 10.18060/21549
© 2017 Author(s): Gakh, M.; Coughenour, C.; Pharr, J.; Goodie, A.; To, S. 
       This work is licensed under a Creative Commons Attribution 4.0 International License


