Health Impact Assessment Tools for Influencing the Determinants of Health

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Health Impact AssessmentTools for Influencing
the Determinants of Health

• Washington State Public Health Association
• Joint Conference on Health
• October 7, 2008

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Presentation Objectives

• Introduce Health Impact Assessment (HIA) basic
  considerations
• Share process and learning from a recent HIA in
  Clark County WA
• Incite HIA among those attending this session,
  including hands on experience
• Build an increasing network of HIA collaborators
  and colleagues

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What is HIA?

• Definition

A combination of procedures, methods and tools by
which a policy, program or project may be judged
as to its potential effects on the health of a
population, and the distribution of those effects
within the population. European Centre for
Health Policy, WHO Regional Office for Europe.
(1999) Gothenburg Consensus Paper. Health impact
assessment main concepts and suggested approach.
Brussels WHO.
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The Value of HIA

• Expands theoretical base across sectors
• Health is more than health care
• Social determinants drive health
• Health behaviors occur in context
• The causes of the causes
• Social, economic and other public policy
  decisions shape health outcomes

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The Value of HIA

• Promotes equity
• Participatory community engagement
• Legitimize unheard community voices
• Builds new relationships and partnerships
• Is not deficiency- or client- based

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Value of HIA

• Operationalizes evidence base
• Real decisions, real actions
• Pragmatic assessment using a range of tools
• A specific project, plan or policy
• Cross fertilizes a variety of disciplines
• Forces choice from among alternatives
  maximize health, minimize risk
• Provides for forecasting

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Determinants of Health

• Determinants of health as planning issues
• Democratic process - Housing
• Air Quality - Noise
• Safety - Social Networks
• Nutrition - Parks and Natural Space
• Private Goods/ Services - Public Services
• Transportation - Social Equity
• Livelihood - Water Quality
• Education

Source Human Impact Partners
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Scenario

• What are the health issues?
• What are the possible causes?
• What are the causes of the causes? i.e.
• What social factors might be causes of these
  health issues?
• What built environment factors?
• What personal behavior choices?

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Health Issues and Causes for HIA
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Where to Use HIA?

• Residential and commercial redevelopment
• Land use planning
• Farm policy
• Transportation policy/plans
• Parks and trail plans
• Power plant location
• Wage policies
• Walk to school programs
• Land leasing for oil/gas/mining
• Public subsidies for housing and home heating

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Screening

• Identify projects where HIA may be of benefit.
• Identify feasibility of assessing projects or
  policies that may have a substantial health
  impact.
• Determine suitability of HIA as a tool.
• Skip this step if youre asked to do HIA.

Outcome Decide whether HIA is suitable.
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HIA Screening Checklist
Source Human Impact Partners
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HIA Screening Checklist
Source Human Impact Partners
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Scoping

• Identify key issues to be considered.
• Create assessment parameters, objectives, and
  tools.
• Assess partners.
• Develop a workplan for the project.
• Proceed with an action plan.

Outcome Know WHO will measure WHAT, HOW, to
understand WHICH issues?
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Appraising

• Establish baseline of existing conditions.
• Analyze and map data, literature
• Make prediction(s) for proposed project.
• Determine whether impacts are significant.
• How to mitigate adverse impacts.
• How to maximize health benefits.

Outcome Make the determination on the program or
policy. Does it effect health? How?
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Reporting

• Develop recommendations based on the appraisal.
• Can take many forms
• Letter or Memo to Agency, Decision-Maker,
  Developer, Community Group or Neighborhood
  Association
• Technical report or appendix to EIS or other
  report
• A plan incorporating health interventions
• New codes and/or enforcement of existing codes
• Presentations to Planning Commissions and others

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Highway 99 Sub-area Plan
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Starting Point

• Anecdotal info about neighborhood
• Technical Reports
• Demographic Data
• Neighborhood Visioning Document
• Maps

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Technical Reports

• 1 Draft Hwy 99 Land Use Demographics  
• 2 Visual Preference Survey Synopsis of
  Community Comments   
• 3 Transportation
• 4 Sidewalk System Inventory 
• 5 Bike System Inventory
• 6 Parks, Trails Open Spaces
• 7 Cultural Historic Opportunities
• 8 Market Assessment
• 9 Health Impact Assessment 
•   Health Impact Assessment- Attachments
• 10 Analysis of Form Based Zoning Potential
  Applicability
• 11 Economic Development Toolbox
• 12 Analysis of Housing Development Tools
• 13 Stormwater
• 14 Sustainable Development
• 15 Community Safety
• Community process and input

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Demographic Data

• Race/Ethnicity-
• Percent White 88.0
• Percent Black 2.1
• Percent Asian 2.2
• Percent AIAN 0.7
• Percent Hawaiian/PacIslander 0.2
• Percent Other 3.4
• 2 or more races 3.3
• Percent Hispanic White 3.7

• Overall Population-
• Total Population 12,190
• Families 3,070
• Median age 35.8

• Economics-
• Median Household Income
• 49,076 17,592
• Per Capita Income
• 22,410 7,596
• Median Home Value
• 163,669 25,913

• Housing-
• Average Person per Household 2.56
• Owner Occupied Housing Units 60.4
• Renter Occupied Housing Units 33.8
• Vacant Housing Units 5.8

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• Proportion of population with grocery store
  within ½ mile of residence 42.9
• Proportion of population with a park within ¼
  mile of residence 77.1
• Proportion of population within 500 feet of
  highways 16.4
• Proportion of population within ¼ mile of
  commercial 68.1
• Proportion of population within ¼ mile of a bus
  stop 69.2

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HIA Team Brainstorm

• What are the potential health issues?
• How will we measure them?
• What population(s) may be affected by these
  issues?
• What is relevant?
• What is actionable?

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Scoping Worksheet
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Identified Health Issues

• Access to healthy food / Urban agriculture
• Urban canopy
• Community safety
• Pedestrian friendly
• Bicycle friendly
• Reduced traffic risks
• Parks and green space

• Access to public transit
• Affordable housing
• Living wage jobs
• Mixed use / Mixed income development
• Air quality
• Noise mitigation

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Process Considerations

• What are our goals?
• How should the HIA be organized?
• Who is the audience?
• What are credible and available data sources?
• Are maps feasible?
• What outcomes do we want?

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Values

• Mixed Use Mixed Income Community
• Sustainable Community
• Socially Cohesive Community
• Active Community

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Matrix Presentation
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Data Sources

• Existing literature
• Existing local data, where available
• Wide body of health research available
• Human Impact Partners - Evidence Base
• Design for Health - Research Summaries
• Healthy Development Measurement Tool

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• Almost one-third of Americans who commute to
  work via public transit meet their daily
  requirements for physical activity (30 or more
  minutes per day) by walking as part of their
  daily life, including to and from the transit
  stop.
• Besser, L.M. and Dannenberg, A.L.. Walking to
  public transit steps to help meet physical
  activity recommendations. Am J Prev Med.
  29(4)273-80 (2005).

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• Trees and green space remove air pollution
  from the air, mitigating 'heat island' effects in
  urban areas, which lower energy demands and
  associated emissions during warm periods.
  Evaporation from a single large tree can produce
  the cooling effect of ten room-size air
  conditioners operating 24 hours a day.US Dept
  of Agriculture, Forest Service pamphlet FS-363,
  cited in Benefits of Trees in Urban Areas.
  Colorado Tree Coalition. Available at HYPERLINK
  "http//www.coloradotrees.org"

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• There is a 1.0 - 8.0 increased risk of
  mortality for every 50 ug/m3 PM10. There is a 1.0
  - 3.5 increase in mortality for every 25 ug/m3
  PM2.5
• US EPA. Air Quality Criteria for Particulate
  Matter. Revised 2004.
• At http//cfpub.epa.gov/ncea/cfm/recordisplay.cfm?
  deid85763Download.

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GIS Mapping

• Most Counties have mapping capability
• Assessment or GIS offices often have mapping
  services available to Public Health
• Software licenses are expensive (ArcMap 900 per
  user) but data are widely available
• Powerful way to display Census data
• Population, demographics, SES are useful
• Overlays SES and mortality, or a specific issue
  e.g. pollution over land use

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• 500 foot buffers around major highways and
  thoroughfares model areas with high exposure to
  particulate matter and other transportation
  related air pollution.
• Link of air pollution and chronic disease.

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• ¼ mile buffers around each bus stop in the
  sub-area model areas with good access to public
  transit.

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• ½ mile buffers around each large, full-service
  grocery store in or near the sub-area model areas
  with good access to healthy foods.

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Overall Recommendations

• Mixed Use Mixed Income Community
• 1. Affordable Housing
• 2. Living Wage Jobs
• 3. Mixed Income Residential
• 4. Mixed Use Commercial/ Recreational/Residential
  Nodes
• Sustainable Community
• 1. Air Quality
• 2. Noise Mitigation
• 3. Urban Agriculture Access to Healthy Foods
• 4. Urban Canopy

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• Socially Cohesive Community
• 1. Community Safety
• Active Community
• 1. Access to Transit
• 2. Bicycle-Friendly
• 3. Parks and Greenspace
• 4. Pedestrian-Friendly
• 5. Reduced Traffic Risks

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Outcomes

• Completed the HIA! see http//www.clark.wa.gov/h
  wy99/docs.html
• Developed our own capacity for HIA
• Gained credibility, laid groundwork for further
  collaboration with Planning Department and
  Planning Commission
• Publicity generating interest in HIA
• Competing for funding with other County project
• In progress..Highway 99 sub-area plan

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Where Health Appears in the Plan

• Specific health safety section
• New parks and trails
• Pedestrian improvements
• Bike lane improvements
• Traffic improvements
• Urban agriculture and farmers market
  incorporated into County property
• High capacity transit bus lines

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Learnings

• You can do this!
• Assemble the right team-draw from many
  disciplines.
• Dont be hung up on form-be creative. Not rocket
  science.
• Be sensitive to your audience(s).
• GIS and mapping can be useful to demonstrate
  needs and bridge the data language barrier.
• Know how to talk with other stakeholders, such as
  advocacy groups, the Planning Commission,
  business leaders, neighborhood associations.
• Build relationships outside health department
  leadership and coordination may come from another
  community partner.
• Prepare for a longer term effort to integrate HIA
  and Public Health involvement into community
  planning processes

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Challenges

• Ad hoc, time intensive, unfunded, extra work!
• Learning new languages.
• Learning the norms of new partners.
• Making the HIA into a resource for the public, as
  well as experts.
• Adopting new tools.
• What is the ask? should there be one from
  Public Health?
• Politically charged what is our Public Health
  mandate?.
• Reactive versus proactive HIAs building
  capacity and marketing our expertise.
• How to get commitment to implement?

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Opportunities

• Work together with community partners to attract
  new funding
• New audiences for Public Health
• An opening for upstream impacts on community
  health outcomes
• Brings diverse people together to develop
  participatory decisions and generate new
  knowledge
• Strengthens the role of Public Health in the
  community

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Other HIA Examples/Formats

• Multnomah County Health Department Columbia River
  Crossing
• San Francisco DPH Healthy Families/Healthy
  Workplaces Act of 2008 (paid sick time)

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Columbia River Crossing Proposed Bridge
Project MCHD Response Letter
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Paid sick day legislation SFDPH HIP in-depth
policy analysis HIA Detailed government report
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HIA Examplessee Dannenburg A., et. al. Use of
HIA in the U.S. 27 Case Studies 1999-2007in Am
J Prev Med 200834 no. 3, pp 241-256
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Small Group Discussions

• Discuss local opportunities for HIA
• Who should you involve?
• What are the potential health issues?
• What are the measures?
• Where will you find data?
• What are likely recommendations?
• Who is your audience?
• What problems do you anticipate?

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Resources

• Program on Health, Equity and Sustainability
  San Francisco Dept of Public Health
  http//dphwww.sfdph.org/phes/
• Healthy Development Measurement Tool
  http//www.thehdmt.org
• Human Impact Partners http//www.humanimpact.org/i
  ndex.html
• Planning for Healthy Places Public Health Law
  and Policy http//www.healthyplanning.org/toolkit_
  healthygp.html
• Design for Health Minnesota Blue Cross Blue
  Shield et al. http//www.designforhealth.net/

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LHJ Opportunities for HIA

• Your phone is going to start ringing! Prepare
  by..
• Convene a HIA team.
• Track HIA literature.
• Test-drive a HIA process.
• Develop or adapt local benchmarks.
• Build relationships with people in planning,
  housing, transportation, and sustainability.
• Look for pending projects/opportunities
• General Plan updates Code revisions
• Design standards Advisory Boards

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Thank you!

• Heather Gramp, Health Assessment Manager
• 360-397-8495 / Heather.Gramp_at_clark.wa.gov
• David Heal, HIV Services Manager
• 360-397-8086 / David.Heal_at_clark.wa.gov
• Dan Rubado, CSTE Epidemiology Fellow
• 360-397-7281 / Dan.Rubado_at_clark.wa.gov