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Community Health Impact Assessment

Community health impact assessment is a way to bring the health concerns of a community forward in discussions of proposed policies, services, and programs.

Since our health and well-being is influenced by a wide range of factors both within and outside the health sector (the determinants of health), community health impact assessment is useful in examining any policy, program, project or service that will affect the population as a whole as well as specific groups within the community.

Community health impact assessment allows communities to:

  • Estimate the effect that a particular activity (a policy, program, project or service) will have on the health and well-being of the community.
  • Identify things to do that will maximize the benefits (the positive effects) for the community and minimize the harm (the negative effects) for the community related to that activity.

Community health impact assessment is facilitated by using a "Community Health Impact Assessment Tool" or CHIAT. The process to engage a community in developing its own unique CHIAT is called the "PATH process" named after the People Assessing Their Health (PATH) Project initiated in north eastern Nova Scotia in the mid-90s.

The Guysborough Antigonish Strait Health Authority (GASHA) has worked with several communities to develop CHIATs with the goal of enabling community members have a voice in health planning and to advocate for healthy public policy. These include Paqtnkek First Nation, Potlotek First Nation, Acadian/Francophone community and the Antigonish Town and County Community Health Board.

Community Health Impact Assessment Tools (CHIAT)

Antigonish Town and County Community Health Board CHIAT
In 2002, the Antigonish Town and County Community Health Board developed a Community Health Impact Assessment Tool (CHIAT). The CHIAT can be used by any group in Antigonish town or county that wants to assess the impact of policies, programs and services on the health of their community. In Antigonish, the CHIAT has been used to assess the need for affordable housing, the future of literacy programs, Sunday shopping, the need for women's services, eliminating the distribution of infant formula at the hospital, the impact of community school closures and the Kepic Mountain project. 

For more information about the community process and the CHIAT:
Contact: GASHA's Primary Health Care Facilitator: 1-902-863-6369.

To download the CHIAT: (click here)

Paqtnkek Mi'kmaw Nation and Potlotek First Nation CHIATs
In 2010-11, GASHA worked with Paqtnkek Mi'kmaw Nation and Potlotek First Nation to develop CHIATs for each of their communities. Each community undertook a community story-telling and dialogue process to identify what makes their community healthy, a vision for a healthy community, and their community-defined determinants of health. Out of this process a CHIAT was developed that is unique to each community. Their CHIATs are intended to be used by the community to assess the impact of policies, programs and services on the health of their community. The communities also anticipate working with other organizations or agencies such as GASHA to assess the impact of health services or other services on the health of their community and to ensure services are culturally safe and accessible to community members.

For more information about the community process and the CHIATs:
Contact: Paqtnkek Mi'kmaq Nation Health Centre: 1-902-386-2048
Contact: Potlotek First Nation Education Department: 1-902-535 ??

Acadian/Francophone CHIAT
In 2010, GASHA worked with Reseau Sante Nouvelle Ecosse to develop an Acadian/Francophone CHIAT. GASHA worked with a local francophone community facilitator who conducted a series of story-telling and dialogue sessions in several communities. The facilitator worked with an Advisory Committee who developed the CHIAT based on the community dialogue, the determinants of health and their vision of a healthy community. The facilitator distributed the CHIAT widely to organizations, municipalities, and schools. The CHIAT is bilingual and it is anticipated that Acadian/Francophone organizations and other groups will use the tool to assess the impact of policies, programs and services on the health of the community.

For more information about the community process and the CHIAT:
Contact: GASHA's Primary Health Care Facilitator: 1-902-863-6369.

What is the PATH Process?

The PATH process is a participatory process that engages community representatives in dialogue and storytelling asking, what does it take to make and keep our community healthy? The process includes:

  1. Examining the broad range of factors that determine health,
  2. Identifying what community members consider important in building a healthy community
  3. Encouraging all community members to become involved in decisions about local programmes and policies
  4. Reflecting community concerns and priorities and
  5. Providing information useful to community health boards and health authorities to guide decisions about the organization of primary health care 12

CHIATs, developed with a participatory process of deliberate dialogue, and storytelling in our local communities have provided an important resource for the development of policies and service planning.

The PATH Project

People Assessing Their Health (PATH) was first developed as a project in the mid 1990's through a partnership of the Antigonish Women's Resource Centre, Public Health Services and the Extension Department, St. Francis Xavier University. PATH was initiated as a community response to the restructuring of the health care system in Nova Scotia. The purpose is to examine the networks and resources that affect people's health and to measure the impact of the restructuring and other policies on health.

The PATH project involved three communities in northeastern Nova Scotia - St. Ann's Bay, Guysborough County Eastern Shore and Whitney Pier. Through a participatory community development process, that has become known as the "PATH Process," community members identified factors that determine their health and developed tools for assessing the impact of policies and programs on the health of their communities. These tools, which were unique to each community, were called Community Health Impact Assessment Tools (CHIATs). A project resource, "Pathways to Building Healthy Communities in Eastern Nova Scotia documents their experience and provides a guide to other communities who want to develop a CHIAT.

Since then, the Guysborough Antigonish Strait Health Authority (GASHA) has worked with several partners and within several local communities in north eastern Nova Scotia to support community health impact assessment through several PATH projects. In addition, those interested in continuing to support community health impact assessment formed the PATH Network. The PATH Network has involved organizations such as GASHA, including Public Health Services and Community Health Boards, St. Francis Xavier University, the Antigonish Women's Resource Centre, municipalities and communities at large.

To find out more about PATH click here (Antigonish Women's Resource Centre, "Reports" section).

Mittlemark M. Promoting social responsibility for health: health impact assessment and healthy public policy at the community level. Health Promotion International. Oxford Press, 2001. 2 Gillis D. People Assessing Their Health : Tools for community health impact assessment. Canadian Journal of Public Health. 1999.