Health impact assessments

Part P of title III of the Public Health Service Act (42 U.S.C. 280g et seq.), as amended by section 7901C–1(a), is further amended by adding at the end the following: 399V–15. Health impact assessments (a) Definitions In this section: (1) Administrator The term Administrator means the Administrator of the Environmental Protection Agency. (2) Director The term Director means the Director of the Centers for Disease Control and Prevention. (3) Health impact assessment The term health impact assessment means 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. Such term includes identifying and recommending appropriate actions on monitoring and maximizing potential benefits and minimizing potential harms. (4) Health inequity The term health inequity means a particular type of health difference that is closely linked with social, economic, or environmental disadvantage and that adversely affects groups of people who have systematically experienced greater obstacles to health based on their— (A) racial or ethnic group; (B) religion; (C) socioeconomic status; (D) gender; (E) age; (F) mental health; (G) cognitive, sensory, or physical disability; (H) sexual orientation or gender identity; (I) geographic location; (J) citizenship status; or (K) other characteristics historically linked to discrimination or exclusion. (b) Establishment The Secretary, acting through the Director and in collaboration with the Administrator, shall— (1) in consultation with the Director of the National Center for Chronic Disease Prevention and Health Promotion and the heads of relevant offices within the Department of Housing and Urban Development, the Department of Transportation, and the Department of Agriculture, establish a program at the National Center for Environmental Health of the Centers for Disease Control and Prevention focused on advancing the field of health impact assessment that includes— (A) collecting and disseminating best practices; (B) administering capacity building grants to States, Indian Tribes, and Tribal organizations to support subgrantees in initiating health impact assessments, in accordance with subsection (d); (C) providing technical assistance; (D) developing training tools and providing training on conducting a health impact assessment and the implementation of built environment and health indicators; (E) making information available, as appropriate, regarding the existence of other community healthy living tools, checklists, and indices that help connect public health to other sectors, and tools to help examine the effect of the indoor built environment and building codes on population health; (F) conducting research and evaluations of health impact assessments; and (G) awarding competitive extramural research grants; (2) develop guidance and guidelines to conduct health impact assessments in accordance with subsection (c); and (3) establish a grant program to allow States, Indian Tribes, and Tribal organizations to award subgrants to eligible entities to conduct health impact assessments. (c) Guidance (1) In general Not later than 1 year after the date of enactment of the Health Equity and Accountability Act of 2026, the Secretary, acting through the Director, shall issue final guidance for conducting health impact assessments. In developing such guidance, the Secretary shall— (A) consult with the Director of the National Center for Environmental Health, the Director of the National Center for Chronic Disease Prevention and Health Promotion, and the heads of relevant offices within the Department of Housing and Urban Development, the Department of Transportation, and the Department of Agriculture; and (B) consider available international health impact assessment guidance, North American health impact assessment practice standards, and recommendations from the National Academy of Sciences. (2) Content The guidance under this subsection shall include— (A) background on national and international efforts to bridge urban planning, climate forecasting, and public health institutions and disciplines, including a review of health impact assessment best practices internationally; (B) evidence-based direct and indirect pathways that link land-use planning, transportation, and housing policy and objectives to human health outcomes; (C) data resources and quantitative and qualitative forecasting methods to evaluate both the status of health determinants and health effects, including identification of existing programs that can disseminate these resources; (D) best practices for inclusive public involvement in conducting health impact assessments; and (E) technical assistance for other agencies seeking to develop their own guidelines and procedures for health impact assessment. (d) Grant program (1) In general The Secretary, acting through the Director and in collaboration with the Administrator, shall— (A) award grants to States, Indian Tribes, and Tribal organizations to award subgrants to eligible entities for capacity building or to prepare health impact assessments; and (B) ensure that States, Indian Tribes, and Tribal organizations receiving a grant under this subsection further support training and technical assistance for subgrantees under subparagraph (A) by funding and overseeing appropriate experts on health impact assessments from local, State, and Tribal governments, the Federal Government, institutions of higher education, and nonprofit organizations to provide such training and technical assistance. (2) Applications for subgrants (A) In general To be eligible to receive a subgrant under this subsection, an eligible entity shall— (i) be a community-based organization serving individuals or populations, the health of which are, or will be, affected by an activity or a proposed activity; and (ii) submit to the grantee an application in accordance with this subsection, at such time, in such manner, and containing such additional information as the Secretary (acting through the Director and in collaboration with the Administrator) and the grantee may require. (B) Inclusion An application for a subgrant under this subsection shall include— (i) a list of proposed activities that require or would benefit from conducting a health impact assessment by not later than 180 days after receiving the subgrant; (ii) supporting documentation, including letters of support, from potential conductors of health impact assessments for the listed proposed activities; (iii) an assessment by the applicant of the health of the population to be served through the subgrant; and (iv) a description of potential adverse or positive effects on health that the proposed activities may create. (C) Preference In awarding subgrants under this subsection, a State may give preference to eligible entities that demonstrate the potential to significantly improve population health or lower health care costs as a result of potential health impact assessment work. (3) Use of funds (A) In general A State, Indian Tribe, or Tribal organization receiving a grant under this subsection shall use such grant to conduct health impact assessment capacity building in support of a subgrantee conducting a health impact assessment for a proposed activity in accordance with this subsection. (B) Purposes The purposes of a health impact assessment under this subsection are— (i) to facilitate the involvement of Tribal, State, and local public health officials in community planning, transportation, housing, and land use decisions and other decisions affecting the built environment to identify any potential health concern or health benefit relating to an activity or proposed activity; (ii) to provide for an investigation of any health-related issue of concern raised in a planning process, an environmental impact assessment process, or policy appraisal relating to a proposed activity; (iii) to describe and compare alternatives (including no-action alternatives) to a proposed activity to provide clarification with respect to the potential health outcomes associated with the proposed activity and, where appropriate, to the related benefit-cost or cost-effectiveness of the proposed activity and alternatives; (iv) to contribute, when applicable, to the findings of a planning process, policy appraisal, or an environmental impact statement with respect to the terms and conditions of implementing a proposed activity or related mitigation recommendations, as necessary; (v) to ensure that the disproportionate distribution of negative impacts among vulnerable populations is minimized as much as possible; (vi) to engage affected community members and ensure adequate opportunity for public comment on all stages of the health impact assessment; (vii) where appropriate, to consult with local and county health departments and appropriate organizations, including planning, transportation, and housing organizations, and provide them information and tools regarding how to conduct and integrate health impact assessment into their work; and (viii) to inspect homes, water systems, and other elements that pose risks to lead exposure, with an emphasis on areas that pose a higher risk to children. (4) Assessments Health impact assessments carried out using funds under this section shall— (A) take appropriate health factors into consideration as early as practicable during the planning, review, or decision-making processes; (B) assess the effect on the health of individuals and populations of proposed policies, projects, or plans that result in modifications to the built environment; and (C) assess the distribution of health effects across various factors, such as race, income, ethnicity, age, disability status, gender, and geography. (5) Eligible activities (A) In general A State, Indian Tribe, or Tribal organization receiving a grant under this section shall conduct an evaluation of any activity proposed to be funded through the grant, including through a subgrant, to determine whether such activity will have a significant adverse or positive effect on the health of the affected population to be served, based on the criteria described in subparagraph (B). (B) Criteria The criteria described in this subparagraph include, as applicable to the proposed activity, the following: (i) Any substantial adverse effect or significant health benefit on health outcomes or factors known to influence health, including the following: (I) Physical activity. (II) Injury. (III) Mental health. (IV) Accessibility to health-promoting goods and services. (V) Respiratory health. (VI) Chronic disease. (VII) Nutrition. (VIII) Land use changes that promote local, sustainable food sources. (IX) Infectious disease. (X) Health inequities. (XI) Existing air quality, ground or surface water quality or quantity, or noise levels. (XII) Lead exposure. (XIII) Drinking water quality and accessibility. (ii) Other factors that may be considered, including— (I) the potential for a proposed activity to result in systems failure that leads to a public health emergency; (II) the probability that the proposed activity will result in a significant increase in tourism, economic development, or employment in the population to be served; (III) any other significant potential hazard or enhancement to human health, as determined by the grantee; or (IV) whether the evaluation of a proposed activity would duplicate another analysis or study being undertaken in conjunction with the proposed activity. (C) Factors for consideration In evaluating a proposed activity under subparagraph (A), a grantee may take into consideration any reasonable, direct, indirect, or cumulative effect that can be clearly related to potential health effects and that is related to the proposed activity, including the effect of any action that is— (i) included in the long-range plan relating to the proposed activity; (ii) likely to be carried out in coordination with the proposed activity; (iii) dependent on the occurrence of the proposed activity; or (iv) likely to have a disproportionate impact on high-risk or vulnerable populations. (6) Requirements A health impact assessment prepared with funds awarded under this subsection shall incorporate the following, after conducting the screening phase (identifying projects or policies for which a health impact assessment would be valuable and feasible) through the application process: (A) Scoping Identifying which health effects to consider and the research methods to be utilized. (B) Assessing risks and benefits Assessing the baseline health status and factors known to influence the health status in the affected community, which may include aggregating and synthesizing existing health assessment evidence and data from the community. (C) Developing recommendations Suggesting changes to proposals to promote positive or mitigate adverse health effects. (D) Reporting Synthesizing the assessment and recommendations and communicating the results to decision makers. (E) Monitoring and evaluating Tracking the decision and implementation effect on health determinants and health status. (7) Plan A subgrantee under this subsection shall develop and implement a plan, to be approved by the Secretary (acting through the Director and in collaboration with the Administrator) and the grantee, for meaningful and inclusive stakeholder involvement in all phases of the health impact assessment. Stakeholders may include community leaders, community-based organizations, youth-serving organizations, planners, public health experts, State and local public health departments and officials, health care experts or officials, housing experts or officials, and transportation experts or officials. (8) Submission of findings A grantee under this subsection shall submit the findings of any funded health impact assessment activities to the Secretary and make these findings publicly available. (9) Assessment of impacts A subgrantee under this subsection shall ensure the assessment of the distribution of health impacts (related to the proposed activity) across race, ethnicity, income, age, gender, disability status, and geography. (10) Conduct of assessment To the greatest extent feasible, a health impact assessment shall be conducted under this section in a manner that respects the needs and timing of the decision-making process such assessment evaluates. (11) Methodology In preparing a health impact assessment funded under this subsection, a subgrantee under this subsection shall follow the guidance published under subsection (c). (e) Health impact assessment database The Secretary, acting through the Director and in collaboration with the Administrator, shall establish, maintain, and make publicly available a health impact assessment database, including— (1) a catalog of health impact assessments received under this section; (2) an inventory of tools used by subgrantees to conduct health impact assessments; and (3) guidance for subgrantees with respect to the selection of appropriate tools described in paragraph (2). (f) Evaluation of grantee activities The Secretary shall award competitive grants to Prevention Research Centers, or nonprofit organizations or academic institutions with expertise in health impact assessments, to— (1) assist grantees and subgrantees with the provision of training and technical assistance in the conducting of health impact assessments; (2) evaluate the activities carried out with grants and subgrants under subsection (d); and (3) assist the Secretary in disseminating evidence, best practices, and lessons learned from grantees and subgrantees. (g) Report to Congress Not later than 1 year after the date of enactment of the Health Equity and Accountability Act of 2026, the Secretary shall submit to Congress a report concerning the evaluation of the programs under this section, including recommendations as to how lessons learned from such programs can be incorporated into future guidance documents developed and provided by the Secretary and other Federal agencies, as appropriate. (h) Authorization of appropriations There are authorized to be appropriated to carry out this section such sums as may be necessary. 399V–16. Implementation of research findings to improve health outcomes through the built environment (a) Research grant program The Secretary, in collaboration with the Administrator of the Environmental Protection Agency (referred to in this section as the Administrator), shall award grants to public agencies or private nonprofit institutions to implement evidence-based programming to improve human health through improvements to the built environment and subsequently human health, by addressing— (1) levels of physical activity; (2) consumption of nutritional foods; (3) rates of crime; (4) air, water, and soil quality; (5) risk or rate of injury; (6) accessibility to health-promoting goods and services; (7) chronic disease rates; (8) community design; (9) housing; (10) transportation options; and (11) other factors as the Secretary determines appropriate. (b) Applications A public agency or private nonprofit institution desiring a grant under this section shall submit to the Secretary an application at such time, in such manner, and containing such agreements, assurances, and information as the Secretary, in consultation with the Administrator, may require. (c) Research The Secretary, in consultation with the Administrator, shall support, through grants awarded under this section, research that— (1) uses evidence-based research to improve the built environment and human health; (2) examines— (A) the scope and intensity of the impacts that the built environment (including the various characteristics of the built environment) has on human health; or (B) the distribution of such impacts by— (i) location; and (ii) population subgroup; (3) is used to develop— (A) measures and indicators to address health impacts and the connection of health to the built environment; (B) efforts to link the measures to transportation, land use, and health databases; and (C) efforts to enhance the collection of built environment surveillance data; (4) distinguishes carefully between personal attitudes and choices and external influences on behavior to determine how much the association between the built environment and the health of residents, versus the lifestyle preferences of the people that choose to live in the neighborhood, reflects the physical characteristics of the neighborhood; and (5) (A) identifies or develops effective intervention strategies focusing on enhancements to the built environment that promote increased use, physical activity, access to nutritious foods, or other health-promoting activities by residents; and (B) in developing the intervention strategies under subparagraph (A), ensures that the intervention strategies will reach out to high-risk or vulnerable populations, including low-income urban and rural communities and aging populations, in addition to the general population. (d) Surveys The Secretary may allow recipients of grants under this section to use such grant funds to support the expansion of national surveys and data tracking systems to provide more detailed information about the connection between the built environment and health. (e) Priority In awarding grants under this section, the Secretary and the Administrator shall give priority to entities with programming that incorporates— (1) interdisciplinary approaches; or (2) the expertise of the public health, physical activity, urban planning, land use, and transportation research communities in the United States and abroad. (f) Authorization of appropriations There are authorized to be appropriated such sums as may be necessary to carry out this section. The Secretary may allocate not more than 20 percent of the amount so appropriated for a fiscal year for purposes of conducting research under subsection (c)..