using law, policy, and research to improve the public’s health • spring 2011 27 Introduction The concept of Health in All Policies aims to improve the health outcomes associated with policies in an attempt to mitigate health disparities and provide optimal environments for healthier living. This mul- tidisciplinary framework seeks to improve health through effective assessment and reformation of policy for organizations of any level and stature. The importance of integrating health in policy assessment and decision making is a key concept in the growing field of Health Impact Assessment. 1 The World Health Organization defines Health Impact Assessment (HIA) as “a combination of proce- dures, methods, and tools by which a policy, program, or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population.” 2 HIA provides a mechanism for collaboration between various sectors and disciplines bridging the gap between research, policymaking, and implementation of policies, pro- grams, and projects affecting health outcomes. 3 In the United States, while some HIA efforts have focused on proposed public policies, HIA has been used primarily to analyze the health effects of proposed development projects and plans related to community design and transportation. However promising as an emerging practice in the U.S., HIA has yet to achieve broad integration and consideration within U.S. public policy. 4 A fundamen- tal and expanded understanding of HIA’s legal basis may help facilitate the integration of health impact considerations into a broad range of public policies, actions, and institutions. 5 This article introduces a statutory and regulatory framework for HIA under the National Environmental Policy Act of 1969 (NEPA), and provides additional examples of HIA conducted within and outside the context of NEPA. The HIA examples set the stage for the broader question of how HIA might function within existing laws, policies, and processes, such as, What are the legal bases for HIA in existing federal law, state statutes, public regula- tions, and legal provisions? Answers to such questions may facilitate a broader understanding and approach toward health in all policies. National Environmental Policy Act: Historical Foundations in Health There is emerging agreement that a primary legal basis for HIA is articulated within NEPA. 6 NEPA epit- omizes the comprehensive and meaningful aspirations of the modern environmental era without neglecting the human element. Its concepts have been replicated in some form into the environmental laws of many states 7 and multiple countries. 8 As demonstrated by its basic statutory framework, and its more detailed regulatory structure, NEPA is concerned with both the ideals of the natural resources conservation move- ment preceding it, and the pollution and public health concerns substantively embodied in the air and water pollution laws enacted during the same period. NEPA is intended to create “a national policy which will encourage productive and enjoyable harmony Benjamin R. Rajotte, J.D., LL.M., is an Assistant Professor of Law, Florida Coastal School of Law. Catherine L. Ross, Ph.D., is the Harry West Professor, Advance Professor, and Director of the Center for Quality Growth and Regional De- velopment in the School of City and Regional Planning at Georgia Institute of Technology in Atlanta, Georgia. Chinyere O. Ekechi, J.D., is a Public Health Analyst at the Centers for Disease Control and Prevention, National Center for Envi- ronmental Health/Agency for Toxic Substances and Disease Registry. Vladimir N. Cadet is an M.D./M.P.H. Candidate at Morehouse School of Medicine in Atlanta, Georgia. Health in All Policies: Addressing the Legal and Policy Foundations of Health Impact Assessment Benjamin R. Rajotte, Catherine L. Ross, Chinyere O. Ekechi, and Vladimir N. Cadet