MEMBERSHIP FORM
Minnesota Health Impact Assessment Coalition (MN HIA Coalition)
MN HIA Coalition Purpose
The National Research Council defines Health Impact Assessment (HIA)
as “a structured process that uses scientific data, professional expertise,
and stakeholder input to identify and evaluate public-health
consequences of proposals and suggests actions that could be taken to
minimize adverse health impacts and optimize beneficial ones.” The
main purpose of the MN HIA Coalition is to champion HIA in Minnesota.
Principles of Collaboration
By signing below, members commit to work towards the MN HIA Coalition
goals and to demonstrate HIA core values (see side bar). Members
promote, champion and improve the practice of HIA in accordance with
these goals and values whenever possible. Specifically, participants
commit to:
• Provide constructive and proactive input (rather than obstructive
and reactive input);
• Practice “both/and” rather than “either/or” thinking as much as
possible;
• Be inclusive by respecting different priorities and concerns;
• Try on new ideas and perspectives;
• Attend meetings; and
• Perform tasks as determined during and outside of meetings.
Your Commitment
I have reviewed the Goals, Values and Principles of Collaboration.
I agree to serve as a member of the MN HIA Coalition.
Name: _________________________________________________
Email:__________________________________________________
Name of Organization/Affiliation (if representing an organization):
________________________________________________________
________________________________________________________
Signature
Date
________________________________________________________
Supervisor Signature (if needed).
Date
MN HIA Coalition
Goals:
1. Educate on and promote the
appropriate* use of HIA.
2. Share information, tools, best
practices and lessons learned
(especially what works and what
doesn’t) from HIAs.
3. Collaborate on and
coordinate (when applicable)
HIA-related activities.
4. Seek funding and act as a
sounding board for future HIA
projects.
5. Support efforts to evaluate
and document the processes and
outcomes of HIA.
6. Promote/institutionalize
policies for HIAs and Health in
All Policies.
Values:
+Democracy
+Equity
+Sustainable development
+Ethical use of evidence
+Defined by World Health Organization
(www.who.int/hia/about/why/en/index.ht
ml)
*HIA, as articulated by the National Research
Council, uses a distinct methodology and is one tool
for promoting health in policies and plans. The MN
HIA Coalition acknowledges that sometimes other
tools are more appropriate and useful in achieving
better health for a population.