Review of Health Impact Assessments Informing Agriculture, Food, and Nutrition Policies, Programs, and Projects in the United States

  • Krycia Cowling Johns Hopkins University
  • Ruth Lindberg The Pew Charitable Trusts
  • Andrew L. Dannenberg University of Washington
  • Roni A. Neff Johns Hopkins University
  • Keshia M. Pollack Johns Hopkins University
Keywords: Health Impact Assessment, Policy, Food, Nutrition, Agriculture


Policies, programs, and projects related to agriculture, food, and nutrition can significantly affect public health. Health impact assessment (HIA) is one tool that can be used to improve awareness of the health effects of decisions outside the health sector, and increasing the use of HIA for agriculture, food, and nutrition decisions presents an opportunity to improve public health. This study identifies and reviews all HIAs completed in the United States on agriculture, food, and nutri­tion topics. Studies were identified from HIA databases, an Internet search, and expert consulta­tion. Key characteristics were extracted from each study: type of decision assessed, location, level of jurisdic­tion, lead organization, methods of analysis, and recommendations. Twenty-five eligible HIAs that were conducted between 2007 and 2016 address topics such as regulations on land use for agricul­ture; food and beverage taxes; and devel­oping gro­cery stores in food deserts. These HIAs have predominantly supported policy, as opposed to program or project, decisions. Four case studies are presented to illustrate in detail the HIA process and the mechanisms through which HIA findings affected policy decisions. Among other influences, these four HIAs affected the language of legislation and provided guidance for federal regulations. These examples demonstrate several findings: appropriate timing is critical for findings to have an influence; diverse stakeholder involvement gener­ates support for recommendations; and the clear communication of feasible recommendations is highly important. There is substantial scope to increase the use of HIA in the agriculture, food, and nutrition sectors. Challenges include the pau­city of monitoring and evaluation of HIAs’ effects on health outcomes, and the limited funding availa­ble to conduct HIAs. Opportunities include inte­grating HIAs and community food assessments, and more widely sharing HIA findings to inform related decisions in different jurisdictions and to increase support for additional HIAs that address the food system.

Note: See the supplemental Excel file (under Article Tools>Supplementary files at left) for more details on the health impact assessments included in this systematic review.

Author Biographies

Krycia Cowling, Johns Hopkins University

PhD Candidate, Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University; 624 North Broadway, Room 496; Baltimore, Maryland 21205

Ruth Lindberg, The Pew Charitable Trusts
Senior Associate, Health Impact Project, The Pew Charitable Trusts; 901 E Street NW; Washington, DC 20004
Andrew L. Dannenberg, University of Washington
Affiliate Professor, Department of Environmental and Occupational Health Sciences, School of Public Health, and Department of Urban Design and Planning, College of Built Environments, University of Washington; Box 357234, 1959 NE Pacific Street; Seattle, Washington 98195
Roni A. Neff, Johns Hopkins University
Assistant Professor, Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University; 615 North Wolfe Street, Room W7010; Baltimore, Maryland 21205
Keshia M. Pollack, Johns Hopkins University
Associate Professor, Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University; 624 North Broadway, Room 380A; Baltimore, Maryland 21205