1

Health Impact Assessment:Bringing Health into “non-health” discussions

2

Why Health?

Augmenting current decision-making processes

Externalities

Disparities

Money is not the same as happiness

A health frame can be persuasive

People understand health personally

Health is an indicator of quality of life and well-being

Health is a shared value

People are morally outraged by health inequities

3

HIA Definition

Health Impact Assessment

A combination of procedures, methods and tools

that systematically judges the potential, and

sometimes unintended, effects of a policy, plan,

program or project on the health of a population

and the distribution of those effects within the

population. HIA identifies appropriate actions to

manage those effects.

International Association for Impact Assessment, 2006

4

HIA Addresses Determinants of Health

How does the proposed project, plan, policy affect

and lead to health outcomes

5

119 HIAs Completed or In Progress (2010)

AK 7

CA 47

CO 4

FL 1

MA 4

NJ 1

MN 6

GA 8

WA 8

OR 12

OH 1PA 2

MD 2

MT 3

Map Courtesy of A. Dannenberg, A. Wendel, CDC NCEH

NM 1

TN 1

HI 1

IL 1

KY 1 MO 1

NH 2

TX 1

ME 1

WI 1

Steps of HIA

Screening Determines the need and value of a HIA

Scoping Determines which health impacts to evaluate, methods for analysis, and a workplan

Assessment Provides:

1) a profile of existing health conditions2) evaluation of potential health impacts

Recommendations Provide strategies to manage identified adverse health impacts

Reporting Includes: 1) development of the HIA report 2) communication of findings & recommendations

Monitoring Tracks: 1) impacts on decision-making processes and the decision2) impacts of the decision on health determinants

6

7

When is a HIA carried out?

The purpose of HIA is to inform decision-makers before they make decisions.

A HIA is most often carried out prospectively - before the decision is made or the policy is implemented.

HIA is used to assess a defined project, plan or policy

8

Components of an HIA Scope

Identify health determinants that proposal will impact

Identify vulnerable populations

Develop pathway diagrams

Generate research questions

Identify preliminary data sources and methods

Determine goals

Identify stakeholders and roles

Create a workplan

Develop a project timeline

Long Beach DTP HIA

Increase capacity of community groups to use HIA

Highlight the impacts of City Planning on Housing and Employment

Demonstrate the value of HIA to stakeholders and agencies in Long Beach

Ensure that environmental analysis considers mitigations for impacts to housing and employment

Paid Sick Days HIA

Conduct a policy-level HIA

Highlight health evidence as part of the debate

Draw public health practitioners into a new policy arena

Setting HIA Goals

Common HIA Goals:Improve decision to account for health impacts

Include health in the decision-making process

Involve diverse stakeholders, including community members

Build the capacity of stakeholders to use HIA

9

10

Health Determinant:

Existing Conditions Research Question

Impact Research Question

Indicators

Scoping Example: Housing

Housing Affordability

How affordable is the current housing stock for the existing population?

What will be the impact of the proposed plan on housing affordability?

Proportion of renter and owner occupied housing

Housing purchasing capacity

Proportion of households paying greater than 30% of their incomes on housing

Proportion of housing production to housing need by income category

11

The HIA Process

Screening

Scoping

Assessment

Reporting

Monitoring

Recommendations

12

Step 3: Assessment

ObjectiveTo provide a profile of existing conditions data, and an evaluation of potential health impacts.

Tasks

Key points

Tools

Resources

HIA Assessment Steps

Profile existing conditions Research baseline conditions, including health outcomes and

determinants of health disaggregated by income, race, gender, age and place when possible.

Can you use existing data or do you need to collect data?

What methods will you use to collect data?

Evaluate potential health impactsUse theory, baseline conditions, and population concerns; consider

evidence that supports and refutes health impacts; assess affects by income, race, gender, age, and place; include assessments of the certainty, significance, and equity of impacts; justify the selection or exclusion of data/methods; identify data gaps, uncertainties, and limitations; allow stakeholders to critique findings

What methods will you use to predict impacts?13

HIA Data Collection

Gather existing data and collect primary data when necessary

empirical literature

community expertise

available social, economic, environmental, and health measures and surveys data

regulatory criteria, standards, checklists and benchmarks

focus groups and community surveys

neighborhood assessment tools

14

15

Predicting Health Impacts

Predicting impacts with absolute certainty is not possible. However, using the best available evidence, an HIA should present reasoned predictions of health impacts.

It is not always necessary to quantify health impacts

Use qualitative analysis for issues that don’t lend themselves to quantitative forecasting

When possible, use tools and methods that already exist to assess health conditions and

potential impacts

16

A 1 g/m3 change in PM2.5 predicts a 1.4% change in non-injury mortality!

Air Quality Modeling

Modeling vehicle source PM2.5 CAL3QHCR Line Source Dispersion Model

Excelsior District, San Francisco

Air Quality Model Inputs

Traffic data

Vehicle emissions rates

Traffic speed

Temperature and humidity

Surface meteorology

Number of receptors

17

The exposure threshold for increased incidence of heart disease is 65 dBA

Noise Modeling

Noise Model Inputs

Vehicle types and volumes

Temporal distribution of trafficUse traffic noise model to find

exposure as function of distanceAdd topography and building

sizes

Add stationary sources

18

Pedestrian Injury Collision Modeling

% Change in Pedestrian Injury

20%

21%

15%

24%

Injury collision rates resulting from Eastern Neighborhoods Rezoning

Developing a Collision Model

Traffic volume

Arterial streets (% without transit)

Land area

Percent car ownershipPercent commuting via walking

or transit

Number of residents

Addressing HIA “Sticking Points”

What do the critics say about HIA?

What are some of the barriers and solutions to implementing a HIA practice?

How do HIA and advocacy fit together?

19

What the Critics Say

20

Criticism Response

HIA is costly Not as costly as treatment of health impacts in the long run

HIA is time-consuming and will slow decision-making processes

Conducting the HIA early will bring issues to the front of the decision-making process, potentially speeding approval processes and preventing costly litigation that delays projects

HIA will stop economic development

The role of HIA is to identify mitigations and recommendations, not to say “don’t do that”

HIA is not scientific

Role of HIA is to pull together disparate pieces of evidence to make a broad statement about impacts

21

EIA Extension to Health

EIA Category Environmental Indicators

Extension to Health Indicators

Transportation Vehicle trips

Vehicle volume

Auto level of service

Access to retail

Traffic injuries

Physical activity

Noise exposure

Air Quality Air quality standards Air pollution exposure

Respiratory disease

Housing Need to construct new housing

Displacement

Quality of housing

Crowding/affordability

Homelessness

Social isolation

Culture and

Community

Physical division of a communityLoss of cultural and historical resources

Social support

Cultural practices

Community violence

22

The HIA Process

Screening

Scoping

Assessment

Reporting

Monitoring

Recommendations

23

Step 4: Reporting

Objective To develop the HIA report and communicate findings and recommendations.

Tasks

Key points

Tools

Resources

24

Step 5: Monitoring

Objective To track the impacts of the HIA on the decision-making process and the decision, the implementation of the decision, and the impacts of the decision on health determinants.

Tasks

Key points

Tools

Resources

25

Developing an HIA Workplan

Define the health determinants you are addressing

Define the research questions for that health determinant

State the goal for the HIA

Identify partners and their roles in each HIA step

Potential issues for the HIA scope

Data needs

Support needed to move forward

Other resources for the HIA

Project timeline

Concrete next steps

26

N. American Practice Standards

Minimum Elements

Practice Standards

http://www.humanimpact.org/component/jdownloads/finish/11/9

Health & Comprehensive Planning

• Evaluate potential health impacts of recommendations from Citywide Vision: 1) mixed-use TOD @ the Sports Complex2) Completing subway extension to TNY

• attempt to quantify impacts of alternative scenarios (no development, single-use development), (no transit, surface transit)

• Focus on key health determinants: • Job access for vulnerable populations• Air quality, VMT, congestion, traffic safety• mixed-income housing & connection to transit, goods & services, parks, etc. • walkability & pedestrian activity

Lower South District HIA

Scope

• Inform future land use plan and rezoning

• Provide City Council members and their constituents with health-based rationales for adopting a revised zoning map

• Bring new evidence in support of the subway extension, move the process along

• Introduce HIA to Philadelphia

Lower South District HIA

Goals

• Survey TNY employees/employers re: mode choice, commute times, housing location preferences, inclination and ability to shift modes in future (PIDC is partner)

• Model future zoning scenarios, estimate impact on health-related issues

• Estimate future population, quantify benefits (access, location efficiency, etc)

• traffic counts @ TNY, FDR; work with Parks and Rec on survey of current users, levels of service, etc.

Lower South District HIA

Methods

• Some case studies to learn from• Ports of LA & Long Beach• Oakland

• Screening: what decision or future action might we actually influence?

• Scoping: What research questions (and answers) most compelling to decision-makers?

HIA & Goods Movement: Considerations