health impact assessment training kristin raab, mla, pha mn climate & health program director...

Health Impact Assessment Training

Kristin Raab, MLA, PHAMN Climate & Health Program Director

Brenda Hoppe, PhDMN Climate & Health Program Epidemiologist

May 20, 2014

Outline

What is HIA? Definitions, background, steps

How has HIA been used to improve health? Healthy Corridors for All HIA (St. Paul) HB 2800: Oregon Farm to School and School Garden

Policy HIA Above the Falls HIA (Mpls)

How do I determine if I should do an HIA? First HIA step: screening

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What is health?

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

Source: World Health OrganizationThis definition has not been amended since 1948

Current Health Conditions in the US2000 Avg Life Expectancy and Healthcare Spending

US ranked 51st in life expectancy for 2012

https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html

http://ucatlas.ucsc.edu/spend.php

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Health Determinants

Health status is determined by: 30% by genetics; only 10% by health care; but 60% by social & environmental conditions, and behavior

Source: N Engl J Med 2007;357:1221-8.

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What do Minnesotans die from?

Leading causes of death in Minnesota: 2010

Cause Deaths Rate1. Cancer 9,599 166.92. Heart Disease 7,144 118.73. Unintentional Injury 2,087 36.44. Stroke 2,154 35.85. Chronic Lower Respiratory Disease 2,012 35.1

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Health Impact Assessment (HIA)

A systematic process that uses an array of data sources and analytic methods and considers input from stakeholders to determine the potential effects of a proposed policy, plan, program, or project on the health of a population and the distribution of those effects within the population. HIA provides recommendations on monitoring and managing those effects.

National Research Council, Improving Health in the United States: The Role of Health Impact Assessment, 2011.

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Values of Health Impact Assessment

HIA aims to advance the values of democracy equity sustainable development the ethical use of evidence a comprehensive approach

to health North American HIA Practice Standards Working Group (Bhatia R,

Branscomb J, Farhang L, Lee M, Orenstein M, Richardson M). Minimum Elements and Practice Standards for Health Impact Assessment, Version 2. North American HIA Practice Standards Working Group. Oakland, CA: November 2010.

Source: http://www.policylink.org/atf/cf/%7B97c6d565-bb43-406d-a6d5-eca3bbf35af0%7D/PROMOTINGEQUITYHIA_FINAL.PDF

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Why Conduct an HIA?

Identify harms and benefits before decisions are made

Identify evidence-based strategies and recommendations to promote health and prevent disease

Support inclusive and democratic decision-making and increase transparency in the decision-making process

Support community engagement in the decision-making process and foster community empowerment

Advance equity and justice

Note: There are many ways to insert health into decision-making. HIA is one way.

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Types of Decisions Influenced by HIA

• Policy Decisions (bills by state legislature, city council decision, local school board on district-wide policy)

• Policy Implementation (weigh various implementation options for a policy once it is passed)

• Project Specific (siting, permitting, construction, design)

• Comprehensive Plans (neighborhood plan, regional growth plans, master planning documents)

Provided by Health Impact Projecthttp://www.healthimpactproject.org/

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What topics have HIAs addressed?

Provided by Health Impact Projecthttp://www.healthimpactproject.org/

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Completed and in progress HIAs

Provided by Health Impact Project & CDChttp://www.healthimpactproject.org/hia/us

HIA at the National Level

Two major national funders Centers for Disease Control & Prevention (CDC) (directly funds

grantees and professional organizations) Health Impact Project (PEW and RWJF)

SOPHIA (Society of Practitioners of HIA): http://www.hiasociety.org/

Two conferences: HIA of the Americas Workshop (Oakland, CA) National Health Impact Assessment Meeting (WDC)

Local Funder: Blue Cross Blue Shield of MN Foundation

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History of HIA in MN

HIAs began with Design for Health in 2006

MDH began providing technical assistance, leading or supporting many HIA-related activities in MN starting in 2009

Almost all 21 HIAs in MN relate to the built environment: comprehensive plans, land use plans, transportation, except School Integration Strategies, St. Paul Emerald Ash Borer, Safe and Supportive MN Schools Act (not listed).

New HIAs: Winona Co Active Living Plan & Lincoln Park SAP

Leading/performing HIAs: (7) Douglas County Comprehensive Plan; St. Louis Park Comprehensive Plan; Duluth 6th Ave Redesign Plan; Divine Mercy HIA; Gary/New Duluth Small Area Plan HIA; Winona County Active Living Plan HIA; Lincoln Park Small Area Plan HIA

Providing technical assistance: (6) Healthy Corridor for All HIA; Bottineau Transitway HIA; HIA on the Fort DuPont Redevelopment Project DE; Second Street Redevelopment Plan GA; Emerald Ash Borer HIA; MN School Location & Design HIA

Providing HIA training: (10+) (250+ people)

MDH’s Role in Promoting HIA

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http://www.health.state.mn.us/divs/hia/duluth.html



http://delawaregreenways.org/hia.html

http://delawaregreenways.org/hia.html

MDH’s Role in Promoting HIA (II)

Promoting Health in All Policies EAW & Comprehensive

Plans Tool Development (EAW,

comp planning, brownfields, climate change)

Sharing information on HIA: website & listserv (500+)

Promoting HIA through Collaboration

(http://www.health.state.mn.us/divs/hia/)

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Collaboration HIA Interagency Workgroup: (12 agencies)

MN HIA Coalition: (70+ members) (http://www.health.state.mn.us/divs/hia/coalition.html)

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HIA Methodology

Six steps Stakeholder engagement

in all steps Equity considered

throughout the steps Scalable

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Six Steps of HIA

1. Screening - to determine if an HIA is useful for a specific project or policy

2. Scoping - identify which health effects to consider

3. Assessment - determine which people may be affected and how they may be affected

4. Recommendations - suggest changes to proposal to promote positive or mitigate adverse health effects

5. Reporting - present the results to decision-makers

6. Monitoring and evaluating - determine the affect of the HIA on the decision process

Types of HIAsType Desk Based Rapid Intermediate Comprehensive

Duration Up to 6 weeks 6-12 weeks 12 weeks – 6 months 6 months – 1 year or more

Effort 1 full time person 1 full time person 1 full time person, and supporting help

1 full time person, and supporting help

Complexity Provides a broad overview of potential health impacts

Provides a more detailed overview of potential health impacts

Provides a thorough assessment of potential health impacts & more detail on specific predicted impacts

Provides a comprehensive assessment of potential & predicted health impacts

Methods Involves collecting & analyzing existing data

Involves collecting & analyzing existing data with limited input from experts & key stakeholders

Involves collecting & analyzing existing data, gathering some new qualitative data from stakeholders & key informants

Involves collecting & analyzing data from qualitative & quantitative sources

LESS COMPLEXITY MORE COMPLEXITY

Modified from Harris et al. 2007. Health impact assessment: A practical guide, Centre for Health Equity, Training, Research and Evaluation (CHETRE), Part of the UNSW Research Centre for Primary Health Care and Equity, UNSW: (http://www.hiaconnect.edu.au/hia_a_practical_guide.htm)

Evaluation of HIA

Reviewed 23 HIAs completed in the U.S. between 2005 and 2013 11 HIAs directly contributed to decision outcomes—the way

projects, plans, and policies were developed or implemented 14 HIAs influenced changes beyond the decision under

consideration 16 HIAs showed key stakeholders the health effects of non-health

policies and programs. 17 HIAs built consensus HIAs amplified community member voices in the decision-making

process

Bourcier, E., Charbonneau, D., Cahill, C., & Dannenberg, A. (2014). Do health impact assessments make a difference? A national evaluation of HIAs in the United States. Seattle: Center for Community Health and Evaluation.

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Case StudiesHealthy Corridor For All (MN)

http://sapcc.org/node/600

Healthy Corridor for All

1st Comprehensive HIA in MN: funded by Health Impact Project

Rezoning ordinance Lead by three organizations:

ISAIAH, Take Action MN, PolicyLink

Community driven: The HIA Steering Committee

(20+) was made up of community leaders and residents http://www.policylink.org/atf/cf/{97c6d565-bb43-406d-a6d5-eca3bbf35af0}/

HEALTHYCORRIDOR_SUMMARY_FINAL_20120111.PDF

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Community Concerns

Transit-oriented development can be very beneficial for communities by providing opportunities for people to live, work, and play without having to get into a car, potentially reducing congestion, air pollution, and increasing access to opportunity for transit-dependent households. Yet, as TOD has been constructed in many cities, it has often been associated with displacement of low-income people and communities of color.

This HIA helped support equitable development— ensuring that low-income households and communities of color benefit from TOD without being displaced.

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ScopingFirst meetings:Discussed vision for the communityDiscuss range of possible issuesVoted3 Areas of Assessment:

1. Healthy Economy2. Healthy, Affordable Housing3. Safe and Sustainable

Transportation

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Key research questions: how will the proposed zoning…

Healthy Economy Obj 1: change the amount and quality of jobs that will be available to

residents in the corridor neighborhoods? Obj 2: affect, small, locally and minority-owned businesses by the corridor?

Affordable, Healthy Housing Obj 3: affect the likelihood of neighborhood gentrification and the involuntary

displacement of current residents? Obj 4: impact the cost of housing in the neighborhood and the availability of

affordable housing?

Safe and Sustainable Transportation Obj 5: coordinate with and affect affordable and accessible public trans? Obj 6: coordinate with and affect access to safe and connected routs to from

and around rail and bus stops?

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Housing Pathway

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Assessment: Availability of Affordable Housing

Existing Conditions:

14% of total housing units in CC are subsidized affordable units (80% of Area Median Income or less). 65% of corridor residents make less than 80% of the AMI

59% of resident spend more than 30% of their income on housing, compared with 40% St. Paul & 37% Ramsey

68% of renters pay more than 30% of their income in rent

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Assessment: Availability of Affordable Housing (II)

Key Impact Assessment Findings: Market projections suggest nearly 7000 new residential units may

be built in station areas by 2030 of which several hundred may be affordable if projects use public funding

% of existing subsidized affordable hosing units is likely to decrease, increasing housing burdens and potentially leading to involuntary displacement

Rising rents and home values will likely decrease the amount of affordable housing

If property values near transit stations continue to rise, acquisition of land for affordable housing near transit will be more difficult due to higher land costs

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Recommendations: 5 Policies

Community Equity Program: Pilot program requiring residential and mixed use projects within ¼ mi of transit stations to make a % of units affordable or facilitate the production of affordable housing

Codify Commitment to Affordable Housing: make explicit statements in the ordinance of the intent to promote diversity and provide a range of affordable housing

Density Bonus Program: expand incentives in the ordinance to offer increased density in the form of floor area and height bonuses and/or modification of parking requirements for affordable housing

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Recommendations (II): 5 Policies

Relieving Lack of Commercial Parking: adopt regulations that would allow use of undeveloped parcels for temporary parking lots to relieve parking problems during construction

First Source Hiring: all construction contractors notify the St. Paul Human Rights and Equal Economic Opportunity Department of available job openings—a referral system shall identify targeted applications who meet contractor’s qualifications. Contractor would be required to keep a log of referrals and applicants hired to monitor the program for compliance.

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Monitoring/Evaluation

Increased relationships among SC members who never worked together in the past

Increased community capacity to understand land use policy and its impacts on health and equity

Research and data SC leaders can continue to use

City Council: resolution to create affordable housing workgroup

Commissioned a feasibility analyses on a number of affordable housing recommendations

Shifted policy debate to include more community voices and introduced health into the discussion

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Farm to School and School Garden Policy

Bill 2800 (HB 2800), the Farm to School and School Garden legislation, as introduced in January of 2011: (1) allocate $19.6 million in state funds,

equivalent to 15 cents per lunch and 7 cents per breakfast, to reimburse schools for purchasing Oregon food products, and

(2) provide $3 million in competitive education grants to support food, garden and agriculture activities, up to 150 school teaching gardens each fiscal year.

Source: Henderson, T., Rader, M., Sorte, B., Ratcliffe, M. M., Lawrence, A., Lucky, J., and Harris, C. (2011) Health Impact Assessment: Farm to School and School Garden Policy, HB 2800, Upstream Public Health and the Health Impact Project. http://www.upstreampublichealth.org/sites/default/files/F2SHIA_FINAL.pdf

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Screening/Scoping: Health Determinants

1. Employment

2. Diet & Nutrition

3. Farm to School & School Garden Education

4. Environmental Health

5. Social Capital

All pictures and text from: http://www.upstreampublichealth.org/sites/default/files/F2SHIA_FINAL.pdf

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Key Research Questions

HB 2800 Farm to School

http://www.healthimpactproject.org/resources/document/Upstream-HIA-Oregon-Farm-to-School-policy.pdf

Assessment

Literature review

Secondary data analysis (food insecurity, school meal eligibility, school nutrition services, unemployment)

Economic analysis

Interviews, committee feedback, community forums


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Assessment: Employment


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Current Conditions/Assessment

Oregon’s unemployment rate was 10.5% in December 2010, higher than the national average of 9% .

The recession hurt Oregon’s farms: almost 2/3 of farms reported net losses. Small & mid-sized farms especially are struggling to compete.

Unemployed are up to twice as likely to die earlier than others of the same age and sex.

The meal reimbursement program would create jobs and stimulate economic growth.


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Conclusions


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Assessment: Farm to School & School Garden Education


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Current Conditions/Assessment (II)

Current Oregon learning standards do not require children to learn where food comes from or how it is made.

Cafeterias are not connected to classroom curriculum.

1 in 4 Oregon adolescents are overweight or obese.

58% of 11th graders eat three or less servings of fruits and vegetables a day.

Research on F2S & SG programs report that children choose more fruits and vegetables - leading to potential increases in consumption.

Studies show that children who spend time in the garden learn better, get physical activity and behave better in the classroom.


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Conclusions (II)


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Recommendations Amend HB 2800 to specify that schools can only get reimbursed

for foods produced/processed in OR

Food, Agriculture and Garden education grants will be preferentially given to school districts serving: a low-income student population schools with a racially diverse student population schools in rural or urban areas with limited food access

Support schools developing multiple-component programs, having at least one element in each of the following categories: Education, Promotion, Procurement and Community Involvement


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Above the Falls Master Plan

(2000) City of MSP & MPRB adopted redevelopment plan for Upper Mississippi Riverfront Phase out heavy industry, address land use conflicts Some projects completed, but not to scale Stakeholders raised concerns over practicalities, costs

(2012) Above the Falls Policy Review and Implementation Study

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ATF: Screening

Feasible Resources (staff, money, info) Interest

Timely Fit into timeline for incorporation of Review & Implementation Study Stakeholders already mobilized

Value Opportunity to increase awareness of health impacts & disparities Research unknowns Highlight common ground & accelerate implementation

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ATF: Scoping

Identify Alternatives

Many land use alternatives to consider so developed criteria for selection

4 measurable land use decision alternatives that HIA would investigate

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ATF: Scoping (II)

Determine Study Area

Determine Goals

Elevate health considerations

Maximize benefits & mitigate risks

Collect input from diverse stakeholders, esp. untapped groups

Serve as catalyst for redevelopment efforts

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ATF: Scoping (III)

Identify pathways

Obesity

Environmental quality (air, noise, water quality)

Mental health

Safety & security

Neighborhood cohesion

Neighborhood livability

Employment

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ATF: Scoping (IV)

Scoping Results

Research questions What draws/inhibits residents to RF? Links to health? Which land uses draw the most residents to RF locally &

regionally? Links to health? Which land uses could improve/harm health of

residents?

Measurable health indicators

Proposed research methods

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ATF: Assessment

Literature review

Baseline Health Profile

Analysis of Impacts

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ATF: Assessment (II)

ATF Research Activities:

Review of literature and previous HIAs

Secondary data analysis of health indicators

Community Input Survey

Resident input from community events and forums

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ATF: Assessment (III)

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ATF: Assessment (IV)

Baseline Health Profile

Demographics

Existing land use

Pollution in the area

Evidence & existing conditions related to 4 land use alternatives: Park Access + Obesity + Mental Health Parkland + Environmental Quality Trails & River Connection + Health Employment + Health

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ATF: Recommendations

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ATF: Recommendations (II)

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ATF: Monitoring & Evaluation

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Internal Evaluation Report Collected feedback from key stakeholders Evaluated overall HIA process and various steps Focus on if goals were achieved Included Impact Evaluation

ATF: Monitoring & Evaluation (II)

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Screening helps determine if HIA…

… is feasible sufficient information about the decision? resources available to conduct the HIA?

… can be done in time fit within the decision-making time frame?

… would add value to the decision making process health already being considered? will decision benefit from an HIA, promote health, influence

positive change?

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When not to do an HIA

No added value Chula Vista Plan to Improve Walkability

Plan was already considering health Health advocates involved in design Resources better focused elsewhere

No influence on decision Milwaukee Zoo Interchange Project

Insufficient time to complete HIA for drafts Stakeholders (DOT) not open to considering health

Source: Wisconsin Department of Health Services, Health Impact Assessment: A Tool to Increase Health Equity in Decision-Making, Great Lakes Intertribal Council, April 23, 2012

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Concerns about HIAConcern 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 process

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 the best available evidence to make a broad statement about impacts

Source: Wisconsin Department of Health Services, Health Impact Assessment: A Tool to Increase Health Equity in Decision-Making, Great Lakes Intertribal Council, April 23, 2012

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Getting Started

How to start the screening process:

1. Define the decision What is being proposed? What is the timeline for the decision?

Project Launch

Draft Plan Available

Final Decision

Can the HIA be ready here?

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Engaging Stakeholders2. Decide who will be involved in the screening process

Identify the stakeholders (i.e., residents, business owners, regional agencies, local organizations, elected officials)

3. Determine if potential partners are ready to work on the HIA

Do they have resources available to conduct an HIA?

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HIA Screening

4. Evaluate the program, plan, or policy based on screening criteria (including will the program have a significant impact on health)

Utilize a Screening Worksheet or a Checklist

There are a number to choose from

Use the one that best meets your needs

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Screening Criteria

Has a project, plan or policy been proposed? Is there time to conduct HIA before decision is made? Will decision affect health? Would health inequities be impacted? How? Are impacts likely to be significant in terms of number

of people impacted, severity, immediacy or permanence?

Is there expertise, evidence and/or research methods available to analyze health impacts?

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Screening Criteria (cont.)

Is health already being considered?

Are there clear links between the proposal and health?

Are decision-makers open to considering HIA findings?

Do stakeholders have interest, capacity/resources to participate in the HIA?

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HIA Screening: Final Task

The Final & Essential Screening Task

1. Define the decision and its alternatives

2. Decide who will be involved in the screening process

3. Determine if potential partners are ready to work on the HIA

4. Evaluate the project plan, or policy based on screening criteria

5. Notify stakeholders of your decision

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Example: Above the Falls Master Plan

Focus area includes or adjacent to diverse neighborhoods with large health disparities

Land use barriers to accessing the river

Proposal to transition predominantly industrial -> parks and residential land uses

Health concerns: water, noise and air pollution

Master Plan update – incorporate findings from: ATF Policy Review & Implementation study Park Board’s RiverFirst visionary design HIA recommendations

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Ex Screening Example screening

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ATF Screening

ATF Screening Criteria the strength of the connection between the land use

alternative and health; the extent of potential impact (i.e. reach) among the

resident populations; timing of implementation of the land use alternative

such that it could be informed by the HIA; stakeholder support for the alternative; potential health effects on current health status of

priority populations; and effect on the local economy.

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More Examples from HIP

Paid Sick Days HIA (national, state, local)

Treatment Instead of Prison HIA (WI)

School Integration Strategies HIA (MN)

Federal Farm Bill HIA (national)

HIA for proposed coal mine at Wishbone Hill (AK)

Lower Duwamish Waterway Superfund Site (WA)

HIA for open burning enforcement in La Crosse county (WI)

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HIA Reports

Improving Health in the United States: The Role of Health Impact Assessment (http://www.nap.edu/catalog.php?record_id=13229)

Minimum Elements and Practice Standards for Health Impact Assessment (http://www.humanimpact.org/doc-lib/finish/11/9)

Guidance and Best Practices for Stakeholder Participation in Health Impact Assessments (http://www.hiasociety.org/documents/guide-for-stakeholder-participation.pdf)

Promoting Equity through the Practice of Health Impact Assessment: (http://www.policylink.org/atf/cf/%7B97c6d565-bb43-406d-a6d5-eca3bbf35af0%7D/PROMOTINGEQUITYHIA_FINAL.PDF)

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Resources: HIA Websites

MDH HIA webpage (http://www.health.state.mn.us/divs/hia/)

CDC Healthy Places webpage (http://www.cdc.gov/healthyplaces/hia.htm)

World Health Organization HIA webpage (http://www.who.int/hia/en/)

HIA Gateway – Public Health England (http://www.apho.org.uk/default.aspx?QN=P_HIA)

UCLA – HIA Guide web (http://www.hiaguide.org/)

Health Impact Project website (http://www.healthimpactproject.org/)

Design for Health website (http://www.designforhealth.net/resources/healthimpact.html)

Healthy Development Measurement Tool website (http://www.thehdmt.org/) Source: http://www.policylink.org/atf/cf/%7B97c6d565-

bb43-406d-a6d5-eca3bbf35af0%7D/PROMOTINGEQUITYHIA_FINAL.PDF

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Contact Information

Kristin Raab, MPH, MLADirectorMN Climate & Health ProgramMinnesota Department of [email protected]

Brenda Hoppe, PhDSenior EpidemiologistMN Climate & Health ProgramMinnesota Department of [email protected]

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health impact assessment training kristin raab, mla, pha mn climate & health program director...

Documents

health care

hia step

current health conditions

world health organization

school garden policy

hia policy decisions

falls hia mpls

proposed policy