ULI Houston News

Is a Healthy Development a Better Investment? Using HIAs to Quantify Health Benefits

Co-Authors: Adele Houghton, Biositu, LLC; Ellen Schwaller, SOPHIA


Photo Source: Eschipul

The Value of Quantifying Health

Health, wellness, and quality of life have become recognized buzzwords in the real estate industry over the past few years, often paired with environmental sustainability.

The benefits of incorporating health and wellness amenities into a development’s story are many and clear. For example, workplaces with healthy indoor air can increase productivity and reduce absenteeism. Providing opportunities for active living and recreation can increase marketability and sale/rental prices in residential and mixed-use developments. Similarly, establishing a relationship with providers of fresh, healthy food can increase a development’s marketability and property value.

ULI’s Building Healthy Places Initiative launched in 2013 in response to the unique needs of developers interested in capitalizing on these trends. In addition to publishing an online toolkit laying out best practices for healthy developments, the Initiative has also published a report outlining the business case for Building for Wellness.

But, with so many design strategies available (the toolkit outlines 21 potential strategies), it can be difficult to decide which aspects of health to address on a particular project.

That’s where Health Impact Assessments can help.

Health Impact Assessment, or HIA, is a methodology assessing the potential health impacts of a project where health was not an initial consideration. HIAs work to establish which elements of health are most relevant to a specific project, plan, or policy. They are designed to be impartial, using evidence to identify the highest priority health needs associated with a development during the draft/design phase, and providing recommendations on ways to maximize benefits to health while minimizing potential harms. Ideally, these recommendations would be considered for integration prior to final design and construction. While there are different types of HIAs (from comprehensive to rapid or desktop), all of them work to incorporate stakeholder and community input into the findings and recommendations.

Beyond helping to identify opportunities to integrate health into the design decision process, HIA can be a useful tool to work with stakeholders interested in understanding the ways a new development may benefit or potentially compromise the health of vulnerable populations or the surrounding community as a whole.

Caption: Key Health Issues Identified by East Aldine District Stakeholders. Source: East Aldine District HIA, 2017.

Caption: Key Health Issues Identified by East Aldine District Stakeholders. Source: East Aldine District HIA, 2017.

HIA in Houston

Houston has participated in a national trend over the past five years to increase consideration of human health during policymaking, community planning, and land use development initiatives. For example, in 2012, an assessment of ways that an upcoming expansion of the city’s lightrail system into a predominantly low-income Latino neighborhood north of downtown (since completed) would spur transit-oriented development identified opportunities for the project to reduce neighborhood residents’ risk of obesity and heart disease, while simultaneously increasing their access to area health care services and economic and educational opportunities.

Another local HIA assessed the relative resilience of a downtown office building, an urban infill multi-family development, and an urban university to the negative health effects of climate change. This HIA developed design recommendations after looking at resilience from four perspectives: 1) the urban infrastructure, 2) the building design, 3) the inherent resilience of the building’s occupants, and 4) the resilience of the surrounding community.

In both cases, the HIA’s recommendations highlighted opportunities for leveraging activity in allied sectors in the interest of improving community health. These initiatives included LEED certification, reducing greenhouse gas emissions, increasing access to healthy food, planning for parks and green space, and preventing traffic-related injuries.

Since 2015, Harris County Public Health’s Built Environment Unit (BE Unit) has spearheaded an initiative to tailor the use of HIAs to the unique needs of the real estate market in the Greater Houston Area, including releasing a locally-focused toolkit. The BE Unit also recently published an HIA examining East Aldine District’s new town center development plans and providing recommendations for the design and programming of spaces in and around the development. The HIA was conducted by an interdisciplinary group representing both the county (represented by the BE Unit) and local community groups. The resulting HIA discusses the implications of developing the 61-acre vacant land, specifically as it relates to pedestrian safety, physical activity, access to healthy food, and access to health care. While many positive health (and economic) outcomes were identified, there were a number of potential negative outcomes related to pedestrian safety which the BE Unit is working to address alongside local leaders.

Completing an HIA may not always be feasible, particularly for smaller and fast-tracked development projects. With this in mind, the BE Unit is working towards a rapid review process for developers who are interested in making a positive impact on the health of the community. If you are interested in learning more about HIA or the rapid review process, see the list of resources below or consider joining the ULI Houston Building Healthy Places Committee.



  • For additional information about the history of HIAs and how they add value to the development process, read this article from Urban Land Magazine.
  • The Society of Practitioners of Health Impact Assessment provides resources for learning about and performing HIAs.
  • The Health Impact Project has a library of national HIA examples. Harris County Public Health’s HIA Toolkit is aimed at regional audiences.
  • The American Planning Association released a report in 2016 highlighting best practices for performing HIAs on land use development projects.
  • Learn more about ways that HIAs and health assessments in general are being integrated into green building tools such as LEED and Enterprise Green Communities.
  • View an example demonstrating how the HIA process can be used to develop design recommendations tailored to the unique needs of a specific development project.
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