Table 2. Findings and Impacts of 5 Major Health Impact Assessment (HIA) Impact Evaluation Reports, United States, Europe, Australia, and New Zealand, 2006–2015.

Author and Year of Publication	Findings and Impacts
Davenport et al 2006 (32)	Important to monitor decisions to determine if impact occurred Engaging decision makers is important but may compromise independence and impartiality HIAs need to fit into the political and administrative environment in which they are being conducted; this fit may be as important as the technical methods used to conduct the HIA
Wismar et al, 2007 (35)	Described wide range of HIA methods used in 19 European countries Reported that some complex projects entail a large number of discrete decisions, so effectiveness may vary with different decisions Reported that none of the HIAs reviewed led to complete cancellation of a project Frameworks Defined 4-cell framework for overall effectiveness as direct, general, opportunistic, and none Identified dimensions of effectiveness as health effectiveness, equity effectiveness, and community effectiveness
Rhodus et al, 2013 (34)	Raised awareness of health and related issues Introduced health into discussions where health was typically absent (ie, informing decision making) Engaged community members and stakeholders in decisions that affect them Facilitated interdepartmental, interagency, and intersectoral collaborations Built relationships and capacity within the community For 50 of 81 HIAs for which impacts could be ascertained, effectiveness (28) was categorized as direct (60%), general (32%), opportunistic (2%), or none (6%) Only 13 of 81 HIAs (16%) met all the minimum elements as defined by Bhatia et al (37)
Haigh et al, 2015 (33); Haigh et al, 2013 (36)	91% of survey respondents reported that the HIA affected decision making 83% of those with HIA impacts reported that HIA recommendations were easily incorporated into planning process No respondent indicated that the HIA led to proposal postponement or cancellation Some HIAs influenced implementation of proposal after a decision was made Some HIAs helped legitimize involvement of the health sector in nonhealth sector decisions Many HIA participants reported technical, conceptual, and social learning from the HIA process Frameworks Findings generally supported Harris-Roxas and Harris (67) conceptual framework for HIA effectiveness The authors found Wismar’s 4-cell effectiveness framework (35) difficult to use Concepts Introduced concept of “proactive positioning” to recognize or create opportunities for conducting HIAs
Bourcier et al, 2015 (31)	48% of decision makers reported HIA shaped their decision making Made direct and concrete contributions from the recommendations to the decision-making process Facilitated incorporation of health objectives into plans, policies, and programs of nonhealth-related agencies Contributed to longer-term outcomes beyond initial decision targets Institutionalized or strengthened existing relationships between individuals and organizations, or created new and enduring relationships between public health and other agencies such as transportation or planning departments Helped decision makers and stakeholders see how health is connected to seemingly unconnected issues Built consensus around controversial topics Amplified community member voices in the decision-making process