“The problem with taking an evidence-based approach to employee health,” a colleague once told me, “is that there isn’t any evidence.”
Fair enough. This is where health shifting comes in. But to fully appreciate health shifting, we first have to understand the potential role of health impact assessment.
There isn’t a lot of evidence showing us how to improve employee health, but there’s plenty showing us how to diminish it: Require too much overtime, design jobs with high demands but limited employee control, have inflexible time-off policies, and fail to balance rewards with efforts, to name a few. (Check out this site’s Evidence page for a sampling of relevant studies.) The best strategy for an employer who seeks a healthier workforce, for whatever reason, is to factor in the effect its business decisions will have on worker health and wellbeing. The public health community has developed a systematic process we can use for this purpose: health impact assessment.
The National Research Council defines health impact assessment as
a systematic process that uses an array of data sources and analytic methods and considers input from stakeholders to determine the potential effects of a proposed policy, plan, program, or project on the health of a population and the distribution of those effects within the population. HIA provides recommendations on monitoring and managing those effects.
Health impact assessment analyzes the population-health impact of decisions that, on the surface, may not appear to be health-related. It’s somewhat like an environmental impact assessment, except it predicts health rather than environmental consequences. For example, an employer can assess the impact that a potential work-from-home policy would have on employee health. Or another might assess the health consequences of hiring seasonal employees compared to requiring the existing workforce to work overtime.
The steps of health impact assessment, as described by the Centers for Disease Control and Preventi0n, include:
- Screening (identifying plans, projects or policies for which an HIA would be useful)
- Scoping (identifying which health effects to consider)
- Assessing risks and benefits (identifying which people may be affected and how they may be affected)
- Developing recommendations (suggesting changes to proposals to promote positive health effects or to minimize adverse health effects)
- Reporting (presenting the results to decision-makers)
- Monitoring and evaluating (determining the effect of the HIA on the decision).
There may be some parallels between health impact assessment and a process with which large employers are more familiar…namely, health risk assessment. The health risk assessment is supposed to reveal to the individual employee the health consequences of his or her behaviors. The health impact assessment reveals population health consequences of population-oriented actions.
Health impact assessments have most commonly been conducted by community agencies and government entities. To date, there is little or no precedent for employers conducting health impact assessments. And we may find that, unless health impact assessments are mandated in the way that environmental impact assessments sometimes are, employers will fail to embrace the process. But, even if that’s the case, the health impact assessment process — rapidly growing in acceptance by public health groups, community agencies, and government entities — will influence how employers think about health shifting and about employee health.
Rather than continually investing in how to fix employee health, growing acceptance of health impact assessment will encourage employers to think strategically about how to act in a manner that doesn’t break employee health.
If you are an employer reading this and thinking…
- I don’t believe this process is meaningful
- Health impact assessment is just a fancy way of telling us what we already know
- We don’t have time to conduct health impact assessment
- We don’t have resources to conduct health impact assessment
- We have too many obstacles that will impede us from acting upon the results of health impact assessment
…then perhaps you already are learning something, because these are the same points of resistance that employees encounter when employers prod them to complete individual health risk assessments. Consider, as an employer, whose resistance you are in the best position to overcome: A large group of employees, with diverse levels of engagement, need, motivation, and commitment to your organization? Or your own resistance?
In upcoming posts, I’ll cite examples of health impact assessments related to commuting and to paid sick days, and link to examples so you can get a clearer picture of how it all works. For now, good resources include:
- The World Health Organization page on health impact assessment.
- The CDC page on health impact assessment.
- The Pew Charitable Trust page, Health Impact Project.
- Human Impact Partners.
- National Association of County and City Health Officials health impact assessment page.