This case study of a St. Louis-area Health Impact Assessment—a tool still uncommon in the U.S.—reveals the value and challenges of involving a large interdisciplinary team, engaging community stakeholders and working with key decision-makers.

A health impact assessment (HIA), common in Europe but just introduced to the U.S., is a process to evaluate the impact on community health of a project or program. This HIA was conducted prospectively on a proposed redevelopment of a major thoroughfare in Pagedale, Missouri., a close-in suburb of St. Louis. The neighborhood is predominantly poor and Black.

The purpose of the HIA, conducted between April 2009 and September 2010, was to influence the project to improve neighborhood walkability, safety, and access to recreation and healthy food. The large, multidisciplinary core team of this HIA consisted of university-affiliated experts, plus a representative from the nonprofit developer. Members were familiar with the area’s social, political and physical landscape but had not worked together as a team. This case study notes that the HIA team successfully delivered a comprehensive report reflecting input from a variety of disciplines, but that lessons were learned in the process.

Key Recommendations:

• Allow adequate time to educate team members on the HIA tool and to work through defining the objectives and process in an organized, flexible way.
• Plan for and prioritize community engagement and education from the outset; build on existing partnerships; and create mechanisms to sustain momentum after the HIA report is delivered.
• Team members should be politically savvy and carefully consider relationships with key decision-makers so that the team can maintain its objectivity and freedom, while also fostering key partnerships and alliances.

The authors hope this case study informs future applications of this promising evidence-based tool which can bring health considerations “to the table” in large complex projects.