Health Impact Assessment: Towards Institutional Accountability to the Public’s Health

Prepared for the Grantmakers In Health February 25th, 2009 Audio Conference

Rajiv Bhatia, MD, MPHSan Francisco Department of Public Health

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Rajiv Bhatia, MD, MPHHealth Impact Assessment

Our Nations Health: Intolerable Facts

Annual health care spending $6405 per person (1st place)

Average life expectancy is a full year less than peer-countries (30th place)

The most affluent live 4.5 years longer than the least affluent

Neighborhood to neighborhood differences in life-expectancy within cities can exceed ten years of life.

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Rajiv Bhatia, MD, MPHHealth Impact Assessment

Diverse social and environmental conditions impact human health!

Employment wages and job quality predict disease and mortality from most causes

Asthma aggravated and lung development and life expectancy compromised for residents near freeways

Physical activity & mental functioning improved by access to parks and green space

Heart disease, hypertension, and sleep disturbance triggered by traffic noise exposure

Pedestrian injuries and deaths increased for people near busy roads

Crowding, displacement, infectious diseases, hunger, and exposure aggravated by unaffordable housing.

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Rajiv Bhatia, MD, MPHHealth Impact Assessment

An Institutional Vision For A Healthy Public Policy

A public health community engaged in informing policy making

The public and decision makers aware of the health impacts of public decisions

Health objectives achieved through institutional policies in all sectors

Institutions accountable to health protective rules and mandates

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Rajiv Bhatia, MD, MPHHealth Impact Assessment

Case Study: Sprawl

Public policies resulted in sprawl

Sprawl promised healthy communities!

What did we miss? Environmental

consequences Urban Disinvestment and

Blight Inequities Health Impacts

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Rajiv Bhatia, MD, MPHHealth Impact Assessment

The Case for Considering Health Impacts in Public Policy

Prevent harm Leverages public investments to

promote health Supports community engagement

in policy Stimulates cross-sector ownership

of health objectives Mobilizes political support for

social change

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Rajiv Bhatia, MD, MPHHealth Impact Assessment

Health Impact Assessment is a systematic process to make evidence-

based judgments on the health impacts of public decisions

Health Impact Assessment Definition

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Rajiv Bhatia, MD, MPHHealth Impact Assessment

HIA responds to the question: How do decisions affect our health?

Mobilizes and synthesizes evidence to forecast the health impacts of public decisions, considering health holistically

Communicates findings to inform and influence the policy process

Involves stakeholders in both assessment and communication

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Rajiv Bhatia, MD, MPHHealth Impact Assessment

The HIA Process

Screening Determine the need for and value of a HIA

Scoping Determine priority health impacts and the data and methods for analysis

Assessment Judge the magnitude and certainty of potential health impacts

Reporting Communicate the results to stakeholders and decision-makers

Monitoring Track the decision outcomes

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Rajiv Bhatia, MD, MPHHealth Impact Assessment

HIA is Different from…

Community Assessment Health Risk Assessment Systematic Reviews Health Element of the General Plan Healthy Development criteria Design and Planning Exercises

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Rajiv Bhatia, MD, MPHHealth Impact Assessment

The National Environmental Health Policy Act (NEPA) requires analysis health and safety problems caused physical changes

National and State Environmental Justice Policy mandates agencies to identify and address adverse health effects on low income and minority populations

Federal rules require cost-benefit analysis of environmental quality regulations

Several Existing Institutional Rules Promise Healthy Public Policy

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Rajiv Bhatia, MD, MPHHealth Impact Assessment

Three Common Contexts for HIA

Required by HIA policy, regulation or law

Conducted to comply with requirements of EIA regulations

Initiated by project proponent, stakeholder, responsible public agency, or policy-maker

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Rajiv Bhatia, MD, MPHHealth Impact Assessment

Policy settings appropriate to the application of HIA

Transportation - Speed policy; highways; transit

Housing - Public housing; Housing Subsidies

Labor - Minimum wage; employment benefits

Agriculture - Crop and water subsidies

Natural - Dams; oil drilling; water

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Rajiv Bhatia, MD, MPHHealth Impact Assessment

Health Impacts of a Living Wage (1999)

Quantified the following Health and Social Benefits of a Living Wage Life-expectancy Graduation rates Teenage childbearing Depression’ Sick days

HIA Outcomes Support for local living wage laws Public health could contribute

analysis to social and economic policy

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Rajiv Bhatia, MD, MPHHealth Impact Assessment

HIA of the Healthy Families, Healthy Workplaces Law (2008)

Paid Sick Day mandate proposed in California Legislature

Legislative sponsors requested HIA HIA found health benefits from

Taking leave from work to care for ill children and dependents.

Reduced community and workplace transmission of communicable disease

Protection of household budget Sponsors used HIA to develop a public

health communication frame for the legislation

Requests for replication nationwide

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Rajiv Bhatia, MD, MPHHealth Impact Assessment

When EIA is required, Public Agency’s must:

Analyze the decision’s environmental effectsincluding direct and indirect health effects

Identify mitigations for adverse effects; Consider alternatives; Document analysis; Respond to public comment.

Environmental Impact Assessment:Key Requirements

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Rajiv Bhatia, MD, MPHHealth Impact Assessment

Organized tenants challenged the demolition and redevelopment of 360 rent-controlled apartments citing human impacts

SFDPH provided an HIA as a comment on the scope of an EIA documented adverse health effects of on stress, social cohesion, and housing

Outcomes: City required study through EIA or mitigations Project redesigned to provide replacement

housing at current rents City level planning policy changes for

replacement housing

Infill Development & Residential Displacement Trinity Plaza Case Study, San Francisco (2003)

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Rajiv Bhatia, MD, MPHHealth Impact Assessment

City proposed rezoning of historically industrial lands;

Potential environmental impacts on residents from noise, air pollutants, traffic hazards, and limited infrastructure

SFDPH contributed analysis and mitigations to EIR as “cooperating agency”

EIA required new mitigations to protect respiratory health, reduce noise exposure and added “improvement measures” to reduce pedestrian injuries

Integrating HIA / EIA for the Eastern Neighborhoods Rezoning, San Francisco (2007)

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Vehicle-Pedestrian Collision Analysis for the Eastern Neighborhoods EIR

20%

21%

15%

24%

Predicted % change in pedestrian injury collisions based on estimated changes inresident population and traffic volume.

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Modeling Vehicle PM2.5 for a Residential Development using CAL3QHCR—Harrison and Beale Streets, San Francisco

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West Oakland Port Expansion HIA (2009)

Growth of goods movements Expansion plans subject to EIA Health impacts on neighborhoods

Air Pollution Noise Vehicle collisions Retail Environment Employment Opportunities

Available analytic methods Port of Oakland HIA case study

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Freight Routes and Truck-related collisions in West Oakland

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San Francisco Department of Public HeathHealth Impact Assessment Mini-Course – July 2008

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Health Impacts of Congestion Pricing (2009)

San Francisco is considering a fee to drive A transportation study will addresses impacts on

traffic, transit, and business Strong and vocal public pushback already

emerging In progress HIA evaluating impacts on

Air Pollution exposure Environmental noise Pedestrian and Vehicle Injuries Walking environments Household budgets

Expected Outcomes of HIA More fair and balanced discussion of costs and

benefits Potential public support for proposal

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Rajiv Bhatia, MD, MPHHealth Impact Assessment

HIA resonates with community needs and concerns Not every Public Decision Requires a HIA - need to pick

issues, plans, policies strategically A scientific approach along with practical solutions in HIA

can successfully change decisions outcomes Stakeholder involvement is critical to HIA outcomes EIA is underutilized to protect public health Need to conduct objective analysis

HIA in the Bay Area: Key Lessons

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Rajiv Bhatia, MD, MPHHealth Impact Assessment

EIA is an established regulatory tool A broad scope of policies, plans, programs, and

projects trigger EIA EIA requires health effects analysis Costs of EIA analysis internalized Integrated analysis builds on existing data, creates a

setting for inter-disciplinary research, and fosters cross-sector ownership of public health objectives

EIA analysis catalyzes both new regulations and subsequent policy design

Value of integrating Health Into EIA

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Rajiv Bhatia, MD, MPHHealth Impact Assessment

HIA is One of Several Tools for Healthy Public Policy

1. Assess and monitor of health-relevant environmental conditions

2. Contribute to policy design3. Develop and enforce needed health-protective

laws & regulations4. Conduct health impact assessments of policies,

plans, and projects5. Monitor institutional accountability to existing

health protective laws and institutions6. Use authoritative power to advocate for

healthy policy

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Rajiv Bhatia, MD, MPHHealth Impact Assessment

Public and policy-maker awareness of the value of HIA Guidelines and standards to ensure HIA practice

quality Resources for HIA practice HIA practice evaluation Research and technical tools

development to fill gaps in evidence to assess policies Engagement in the EIA process

HIA: Practice and Research Needs

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San Francisco Bay Area HIA Collaborative

Includes: San Francisco Department of Public Health, UC Berkeley, & Human Impact Partners

Conducts: HIA practice Academic instruction & professional training Facilitation and mentorship Technical tools, guidelines, and standards HIA policy development

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Rajiv Bhatia, MD, MPHHealth Impact Assessment

SF Department of Public Health www.sfdph.org/phes/

UC Berkeley HIA Group http://sites.google.com/site/ucbhia/

Human Impact Partners www.humanimpact.org

Healthy Development Measurement Tool www.TheHDMT.org

SF HIA Collaborative Resources