Convincing local governments to invest in nature can often be a hard sell. With a finite amount of resources and growing demands, prioritizing nature in cities can be difficult. One strategy for obtaining funding or buy in for your urban nature project is to conduct an assessment of its potential health impacts. Human health benefits of nature can often be a compelling argument when local governments, businesses, and organizations are burdened with rising healthcare costs.

What tools are available to help determine the health impacts of urban nature projects? One tool that cities may find useful is the Health Impact Assessment process.

The Process

Health Impact Assessments (HIAs) grew out of Environmental Impact Assessments (EIAs). Rather than being mandated or measuring the impact on the environment, HIAs are voluntary and measure the impact of programs, policies, or projects on human health. HIAs are a broad tool that can be used to show the negative health impacts of a project, but often are undertaken to show the positive impacts. The HIA Process includes six steps, including

  • Screening: Will an HIA be needed and useful?
  • Scoping: What is the plan for the HIA? What are the potential health risks and benefits? Who will be affected?
  • Assessment: What is the baseline of health in your community? What are the potential impacts of the decision?
  • Recommendations:  What are some practical solutions that can be implemented within the limitations of the project, policy, or program being assessed?
  • Reporting: Whom should the results be disseminated to? Who are the affected communities and other stakeholders that should be aware of the findings?
  • Monitoring and Evaluation:  How should project, policy, or program be evaluated to measure the health impacts and process?

The process is flexible and fluid. Many of the steps overlap with other parts of the process.  In addition to the six steps, there are various types of HIAs that you can use, including desktop, rapid, intermediate, and comprehensive.

The desktop HIA is the shortest assessment and typically only takes a few weeks to complete. Due to the short amount of time, it is nearly impossible to engage the community. The rapid HIA is slightly more thorough and provides more detail. An intermediate HIA may combine some community engagement and then uses the desktop HIA process. A comprehensive HIA is rarely undertaken due to the amount of time required to fully conduct a comprehensive HIA.

Case Study

BeltLine, Atlanta

The Beltline in Atlanta, Georgia, U.S.A. is a trails, park, and transit project that reuses a loop of abandoned rail line near the city center (HIA Guide).  The Beltline adds additional greenspace and parks to the Atlanta area. This project affects over 6,500 acres of the city (HIA Guide).

The team used the Atlanta Development Authority’s BeltLine Redevelopment Plan as the foundation for the HIA (HIA Guide).  Current health status of the affected communities was determined by various indicators, including cancer, diabetes, homicide, HIV, etc (HIA Guide).  The team then looked into they key issues for the BeltLine and ways that that it could affect public health (HIA Guide).  The HIA team used a variety of resources including newspapers, surveys, professional knowledge, and a survey.

Not surprisingly, the BeltLine was determined to have a positive affect on the health of residents through increasing physical activity, access to green space, greater transit use, and social equity (HIA Guide). The HIA team recommended accelerating the project, including a health professional on board, and ensuring that affordable housing is included.

The HIA conducted on the Atlanta BeltLine is a good example of how an HIA can be applied to green space projects.


There are many tools that can be used to help cities across the world complete HIAs on prospective urban nature projects.

Health Impact Assessment of greenspace: A Guide

A guide that has been created to assist those interested in conducting HIAs of greenspace. It has been produced by greenspace scotland and partners. It gives case studies and advice on conducting an HIA on this particular topic. See attached.

The Design for Health website is a collaborative resource created by Ann Forsyth and Joanne Richardson and includes numerous resources on successful conducting HIAS. It includes examples and ready-to-use checklists. More tools available at

World Health Organization (WHO)

The WHO has several resources on their website for HIAs that have been completed worldwide and resources for helping new practitioners get started.  For more resources, please see

Health Impact Project

The Health Impact Project is a great resource for easily understanding the HIA process and seeing successful case studies in the U.S.A. In addition, they offer trainings for organizations on HIA.


Health Impact Assessments are a great tool for measuring the health impacts of urban nature projects. While a wealth of case studies is not available, there are several tools for helping cities get started with HIA. HIAs can be resource intensive, but there is funding available for initiating HIA projects. Engaging in the Health Impact Assessment process can help those who may not believe in the inherent benefits of nature, but are interested in improving public health. There are many pervasive public health issues that can be addressed through increasing access to nature, so there could not be a better time to incorporate nature into cities across the world.


HIA Guide. (n.d.). Atlanta Beltline. HIA Guide. Retrieved March 3, 2014, from

 By Carla Jones