An official website of the United States government.

This is not the current EPA website. To navigate to the current EPA website, please go to This website is historical material reflecting the EPA website as it existed on January 19, 2021. This website is no longer updated and links to external websites and some internal pages may not work. More information »

EPA Health Impact Assessment Case Studies

EPA has undertaken several Health Impact Assessments (HIA) case studies to learn how its science can be used in the HIA process and how HIA can be incorporated into its decision-support tools, actions, and mission.

Gerena School HIA (Springfield, MA)

Gerena Community School, located in Springfield, MA, is undergoing renovations to improve the environmental conditions for its users. The facility functions as an elementary school and community center, serving students and residents of the North End Community. EPA collaborated with stakeholders, including departments within the City of Springfield and community-based groups, to perform an HIA. The purpose of this HIA is to provide valuable health-focused information to help the City of Springfield narrow down and prioritize those renovation actions that best address the existing environmental conditions and reduce the potential negative health impacts to students, faculty, staff, and community members who use the facility. The HIA also provided an avenue for the community and other stakeholders to be engaged in the decision-making process. Community stakeholders have raised concerns related to Gerena School, which include indoor air quality issues related to motor vehicle emissions, flooding, moisture, mold, and other indoor environment conditions; negative perceptions of the school facilities among the community; differing priorities between school and city administrators; absenteeism; and classroom noise. The HIA utilized on-site observations, reviewed evidence, and professional expertise to judge each of the proposed renovation options for potential impacts to respiratory health, classroom acoustics, and community perception. Based on the predicted impacts to health, the HIA provided recommendations for renovation actions that aim to maximize potential benefits to health and mitigate and/or avoid potential adverse impacts to health.

Top of Page

Proctor Creek Boone Boulevard Green Street Project HIA (Atlanta, GA)

Proctor Creek is one of the most impaired creeks in metro-Atlanta and has been placed on the impaired waters list because it does not meet state water quality standards for fecal coliform. The topography, prevalence of impervious surfaces in the watershed, and a strained combined sewer system have contributed to pervasive flooding in the Proctor Creek community and created environmental, public health, economic, and redevelopment issues. A green infrastructure project, aimed at supporting water quality and revitalization improvement efforts, was proposed in a headwater community of Proctor Creek. The purpose of this HIA was to help inform the City of Atlanta’s decision on whether to implement the proposed project as designed and to provide an avenue for stakeholders, including state environmental and public health agencies, city and county departments, advocacy groups, and the community, to be engaged in the decision-making process. The HIA evaluated the proposed Boone Boulevard Green Street Project for its potential to impact twelve determinants of health identified by stakeholders ‒ water quality; flood management; climate and temperature; air quality; traffic safety; exposure to greenness; urban noise; access to goods, services, greenspace, and healthcare; crime; social capital; household economics, and community economics. The results of the HIA suggested that the proposed green infrastructure project would have a positive impact on health overall and provided recommendations for implementation and expansion of green infrastructure projects throughout the watershed. The City of Atlanta is implementing the Boone Boulevard Green Street Project and has decided to expand the length of the green street to maximize its predicted health benefits.

Top of Page

HIA of Proposed Code Changes for Onsite Sewage Disposal Systems (Suffolk County, NY)

EPA conducted an HIA to evaluate potential beneficial and adverse impacts to health that may result from the proposed code changes regarding onsite sewage disposal systems (OSDS) for residential properties in Suffolk County, New York. OSDS are an alternative to centralized municipal sewage disposal systems and are the primary mode of sewage disposal for residential properties in the county. The proposed changes to the sanitary code would require existing OSDS serving single family residences to be upgraded to a conventional or innovative/alternative onsite wastewater treatment systems, if they have not already been upgraded. The Suffolk County Government proposed the code changes to address a growing issue of nutrient loading of Suffolk County soil, surface waters, and ground waters. Overloading of nutrients, particularly nitrogen, has been linked to the impairment of surface and ground waters, beach closures, shellfish population die offs, harmful algal blooms, and damage of marine coastlines. Suffolk County agreed to host an HIA, led by the EPA, to help inform the decision about the code changes. Based on input from stakeholders, community members, and scientific experts, pathways were identified through which the proposed code changes could potentially impact health. Five pathways were prioritized for inclusion in the HIA analysis: individual sewerage system performance and failure; water quality; community and household economics; vector control; and resiliency to natural disaster. This HIA helped inform the decision regarding changes to the Suffolk County sanitary code and provided recommendations to maximize potential benefits and mitigate potential adverse impacts to health that may result from the decision.

Former Chesapeake Supply Brownfield Revitalization HIA (Dover, Delaware)

From summer 2017 until early 2018, EPA conducted a rapid Health Impact Assessment (HIA) with the City of Dover and Kent County, Delaware to help the City and County make decisions concerning the redevelopment of a downtown Dover property. This property is a brownfield site – a formerly contaminated property – that has been cleaned up. The City and County are interested in using the property to produce food, including fresh produce and fish. This would help stimulate economic development and increase access to food in downtown Dover.

EPA assisted local and state officials with investigating a plan to use the site to produce food, including the use of aquaponics. Aquaponics is a farming system that grows plants and fish together in a way that benefits them both. To help with the effort, an abbreviated form of HIA (i.e., rapid HIA) was developed with EPA staff along with partners from City of Dover, Kent County, the State of Delaware, U.S. Department of Agriculture, and Delaware State University.

The HIA process involved the application of multiple methods, including the use of different types of data, geographic information, and a review of the scientific literature, to estimate what impacts the food production project might have on the health of people living in the community. The HIA report shows the analyses that were conducted, the findings of those analyses, and the recommendations for the City of Dover and Kent County to consider in making revitalization plan decisions for the property, and highlights future assessment and development opportunities.

This HIA report outlined the potential health benefits of using brownfield sites to address food access issues in urban environments. While the soil and groundwater at the property might be currently unusable for agriculture without further investigation and treatment, this HIA demonstrated that brownfield sites could still be suitable for agriculture with the use of alternative farming methods, such as hydroponics and aquaponics. Recommendations included in the report can be more broadly applied to future projects in the area and replicated in other urban environments nationwide.

Kingsbury Bay-Grassy Point Habitat Restoration HIA (Duluth, MN)

EPA conducted an HIA in the St. Louis River Areas of Concern (AOC) to examine the potential public health impacts of habitat restoration work and subsequent park improvement projects at two project sites along the St. Louis River – Kingsbury Bay and Grassy Point. The purpose of the HIA was to inform the Minnesota Department of Natural Resources (MNDNR) and City of Duluth’s decisions regarding the design and implementation of these habitat restoration and park improvement projects. Based on input from stakeholders, community members, and scientific experts, pathways were identified through which the proposed projects could potentially impact health. Seven pathways were prioritized for inclusion in the HIA analysis: water quality and habitat; equipment operation, traffic, and transport; air quality; noise and light pollution; crime and safety; recreation, aesthetics, and engagement with nature; and social/cultural aspects.

In examining these pathways, the HIA specifically evaluated the potential health impacts associated with changes in ecosystem services (i.e., benefits people obtain from these ecosystems) and other determinants of health, as a result of the planned sediment remediation, wetland and riparian habitat restoration, and construction of potential waterfront amenities, including trails, boardwalks, bird watching stations, fishing piers, kayak launches, and swimming beaches. The HIA will help inform the decisions regarding habitat restoration and park improvements at these two sites and provide recommendations to maximize potential benefits and mitigate potential adverse impacts to health that may result from the decisions.

Top of Page