HEALTH IMPACT ASSESSMENT Workshop...physical, social and mental well-being, and not merely the absence of disease or infirmity.” Furthermore, health is the ability of an individual

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May 1-2, 2013

HEALTH IMPACT ASSESSMENT

Workshop



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Presented by Michelle J. M. Rushing, MPH



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WHAT IS HEALTH?

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

Furthermore, health is the ability of an individual or group “to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment.”

1948 World Health Organization Constitution and the 1986 Ottawa Charter for Health Promotion



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CONVENTIONAL HEALTH POLICY

Source: The Bipartisan Policy Center



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“GET MORE EXERCISE…”

Source: Wernham, A. Health Impact Project. http://www.healthimpactproject.org/resources#presentations_webinars



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“EAT MORE FRUITS AND VEGETABLES…”



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LET’S GO ‘UPSTREAM’

Image credit: Albuquerque - Bernalillo County Health Department



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HEALTH IN ALL POLICIES (HiAP)

A strategy that strengthens the link between health and other policies, creating a supportive environment that enables people to lead healthy lives.



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LEADING CAUSES OF DEATH: GEORGIA

1. Heart Disease 2. Cancer 3. Lung Disease 4. Traffic Injury 5. Stroke

6. Alzheimer's 7. Diabetes8. Nephritis/

Kidney9. Blood

Poisoning10. Influenza-Pneumonia

11. Suicide12.

Hypertension/ Renal

13. Liver Disease 14. Parkinson's 15. Homicide



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MODE SHAREMode Safety Access & Equity Physical Activity Environment Civic/ Social

Private passengermotor vehicle/ Motorcycle

•Some occupant protection•High injury/ fatality rate•High impact to other groups

•Unlimited schedule and route; high speed•High user cost•High congestion•High parking

•Mostly sedentary•Walk from parking

•High emissions per user mile•High noise•Moderate to high lifecycle•AFV partial offset

•Low to moderate interaction during use (some telecom & group travel)

Passenger/light rail

•Low injury/ fatality rate•Moderate impact to other groups

•Fixed schedule•Fixed guideway•Moderate to low user cost•Low congestion•No parking

•Moderate to high activity level

•Low to moderate emissions per user mile•Moderate to high noise•AFV partial offset

•Moderate to high interaction during use

Bus •Low injury/ fatality rate•Moderate impact to other groups

•Fixed schedule•Semi-fixed route•Low user cost•Moderate congestion•No parking


•Low to moderate emissions per user mile•Moderate to high noise•AFV partial offset


Bicycle •Moderate injury/ fatality rate•Low impact to other groups

•Unlimited schedule and route; moderate speed•Very low cost•Low congestion•Low parking

•High activity level •Very low emissions per user mile•Very low noise•Low lifecycle

•Moderate interaction during use

Walk •Moderate injury/ fatality rate•Low impact to other groups

•Unlimited schedule and route; low speed•No cost•Low congestion•No parking


•High emissions per user mile•High noise•AFV partial offset•No lifecycle




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WHAT IS UPSTREAM?



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HiAP & HIA

Health impact assessment (HIA) is one of the key strategies for moving toward a health in all policies perspective.


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Overview of HIA:

Health Impact Assessment


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DEFINITION OF 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.

Source: “Improving Health in the United States: The Role of Health Impact Assessments” by the National Research Council, September 2011


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DEFINITION OF HIA




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DEFINITION OF HIA




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DEFINITION OF HIA




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DEFINITION OF HIA




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• Democracy

• Equity

• Sustainable

Development

• Scientific & Robust

Practice

• Holistic Approach to

Health

KEY VALUES OF HIA


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STAGES OF HIA

Screening, to determine whether a proposal

is likely to have health effects and whether the HIA will provide useful information

Assessment, which is a two step process

that first describes the baseline health status and then assesses potential impacts

Scoping, to establish the scope of health effects

that will be included in the HIA, the populations affected, the sources of data and the methods to be used


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STAGES OF HIA

Recommendations suggest design

alternatives that could be implemented to improve health or action that could be taken to manage health effects

Monitoring and evaluation includes

monitoring the implementation of HIA recommendations. Evaluation can be of process, impact or outcomes

Reporting presents findings and

recommendations to decision makers and stakeholders


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WHAT HIA IS NOT . . . WHAT HIA IS

HIA is not used before a policy, program, or project has even been considered.

• It’s not used to make the case for why a policy, program or project should be proposed.

HIA is not used after a policy, program, or project has been completed.

• It’s not an assessment to understand the impacts of a program or policy once it has been implemented.

HIA is used during a time when a proposed policy, program, or project is under active consideration.

• It’s the sweet spot – it’s proactive!


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NATIONAL TRENDS IN HIA

The field of HIA is growing exponentially • In 2008 there were 27 completed

HIAs

• In 2016 there were over 400 completed or in-progress HIAs

HIA can, and has been, applied to a wide range of topics


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WHAT SECTORS HAVE HIAs

ADDRESSED?


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WHAT LEVELS OF DECISION-MAKING

HAVE HIAs INFORMED?



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HIA STEP BY STEP



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SCREENINGSCOPING

ASSESSMENT

RECOMMENDATIONS

REPORTING

MONITORING &

EVALUATION



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1. Is there a decision regarding a policy, plan, or project, currently under consideration by a decision-making body--such as a local, state, regional or tribal agency or legislature?

2. Could the decision impact health or health determinants?

3. Is health being considered? Would an HIA bring new information to the decision-making process?

4. Does the decision-making process allow for input from an HIA?

5. Can the HIA be completed within the timeline for the decision, and with the resources available?

6. What is the likelihood that the HIA findings and recommendations will receive consideration by decision-makers?

7. Are stakeholders concerned about the health impacts of the decision?

8. Is there the potential for some groups within the community to be more adversely affected than others? Are they populations less able to cope with their environment?

9. Does this HIA have the potential to build new partnerships or change the way decisions are made in the future?

SCREENING QUESTIONS



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SCREENING

SCOPINGASSESSMENT

RECOMMENDATION

S

REPORTING

MONITORING &

EVALUATION



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Establish boundaries for the HIA:

Geographical

Temporal

Population

Define the assessment questions

Identify needed resources

Staff/expertise

Budget

Data

Identify additional partners and stakeholders

DEFINE THE HIA



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SCOPING EXAMPLE: Affordable Housing HIA – Three Sites in Georgia



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Preliminary Report

Advisory Committee

GreenprintActions

SCOPING EXAMPLE: Mid-South Regional Greenprint HIA



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Action 1.2.3: Create, fund and execute a pilot project to address maintenance and safety issues in one or more underused parks

Perception of safety

Park use

Physical activity

Social benefits

General health status

Improve maintenance and safety

Physical safety Injury Risk

Chronic diseases:ObesityDiabetesCardiovascularStrokeCancer

Decision Proximal Effects

Health Determinants

Health Outcomes

InjuryDisabilityDeath

SCOPING EXAMPLE: Mid-South Regional Greenprint HIA



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DISCUSSION

• What are some decision points that can affect walkability?

• How far ‘upstream’ can you go?



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SCREENING

SCOPING

ASSESSMENTRECOMMENDATIONS

REPORTING

MONITORING &

EVALUATION



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1. Baseline data of affected populations

2. Characterization of the anticipated health effects of alternative decisions

3. An evaluation of the level of confidence or certainty in the effects prediction

THREE OUTPUTS OF ASSESSMENT



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ASSESSMENT EXAMPLE: Atlanta Regional Plan 2040 HIA



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Chronic diseases:ObesityDiabetesCardiovascularStrokeCancer

Mental health

General health status

Health Outcomes

0%

2%

4%

6%

8%

10%

12%

14%

Mid-South ShelbyCounty

Tennessee UnitedStates

DavidsonCounty

ComparisonCities

Per

cen

t P

op

ula

tio

n w

ith

Dia

gno

sed

Dia

bet

es

Diabetes Prevalence

Diabetes Hospitalization Rate by Zip

ASSESSMENT EXAMPLEMid-South Regional Greenprint HIA



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ASSESSMENT EXAMPLEEau Claire Cannery District HIA



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SCREENING

SCOPING

ASSESSMENT

RECOMMENDATIONSREPORTING

MONITORING & EVALUATION



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GOOD RECOMMENDATIONS ARE…

1. Responsive to predicted impacts

2. Specific and actionable

3. Experience-based and effective

4. Enforceable

5. Able to be monitored

6. Technically feasible

7. Politically feasible

8. Cost-effective

9. Unaccompanied by additional negative consequences

10. Implementable within the regulatory, administrative, or legislative framework of the proposal being considered



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PRIORITIZING RECOMMENDATIONSA

nti

cip

ate

d H

ea

lth

Im

pa

ct

Feasibility/Cost



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A public involvement plan for the Greenprint should be created to ensure that equity remains a focus throughout implementation. As recommended in other HIAs, having a specific public involvement plan would ensure that communities’ voices are heard and incorporated into the long-term actions that the Greenprint Plan sets out. Some Actions under Strategic Directions 2 and 8 address issues of sustained involvement of communities, but there is no suggestion of a specific plan for public involvement.

Who would be involved in making this happen: Member organizations of the GreenprintConsortium (especially those involved with Strategic Direction 2), neighborhood and community-based groups, and Planning Departments.

RECOMMENDATION EXAMPLEMid-South Regional Greenprint HIA



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RECOMMENDATION EXAMPLELake Oswego Light Rail HIA

BEFORE

Metro (the planning agency) should encourage contractors to use better equipment.

AFTER

TriMet (the contracting agency) should work with the State DEQ Clean Diesel program to develop more stringent emissions-based equipment fleet requirements or incentives for contractors and sub-contractors working on the project.



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DISCUSSION

• If you were doing one of the screening ideas…

– What data do you need and how do you get it?

– Who could provide the evidence?

– Who are the stakeholders?



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SCREENING

SCOPING

ASSESSMENT

RECOMMENDATIONS

REPORTINGMONITORING &

EVALUATION



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What Makes a Good Report?

Documents the process for each step

Provides succinct summary

Discusses evidence, data sources and methods used for each health issue analyzed

Provides specific recommendations for decision alternatives, policy recommendations, mitigations

Includes input from stakeholders

Is accessible to multiple audiences



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SCREENING

SCOPING

ASSESSMENT

RECOMMENDATIONS

REPORTING

MONITORING

& EVALUATION



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TIMELINE: EVALUATION &

MONITORING

During and Immediately Following the HIA After HIA Completion and ongoing

HIA Process Evaluation

HIA Impact Evaluation

Monitoring: Health Outcomes,

Policy Changes

Evaluation & Monitoring

Plan



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EVALUATION EXAMPLE

Grocery store

Athletic fields

Main street shifted

from here

to here

Better connectivity

Interim use of existing

buildings for community

meeting space

Zoned for community

gardens, farmer’s

markets, urban farming

Fort McPherson BRAC HIA



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RESOURCES

hiasociety.org



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DISCUSSION

• How do you think your work has been affecting community health?

• How do you think your work has been affecting health disparities?

• How can you find out?

• What can you do now to be more intentional about your work?


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THANK YOU

Michelle J. Marcus Rushing, MPHPolicy Impact SpecialistGeorgia Health Policy Center | Andrew Young School of Policy Studies | Georgia State University55 Park Place NE, 8th Floor | Atlanta, GA 30303404.413.0282 direct | 404.512.3542 mobile404.413.0314 main | 404.413.0316 fax http://ghpc.gsu.edu / Twitter: @health_impact

The Georgia Health Policy Center offers training, technical assistance, and consulting in all types of health in all policies and health impact assessment.