Defence Health Leadership Institute (DHLI) Panel Discussions
1 Health Impact Assessment: Bringing Health into “non-health” discussions.
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Transcript of 1 Health Impact Assessment: Bringing Health into “non-health” discussions.
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Health Impact Assessment:Bringing Health into “non-health” discussions
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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
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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
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HIA Addresses Determinants of Health
How does the proposed project, plan, policy affect
and lead to health outcomes
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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
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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
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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
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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
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The HIA Process
Screening
Scoping
Assessment
Reporting
Monitoring
Recommendations
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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
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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
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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
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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
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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?
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What the Critics Say
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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
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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
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The HIA Process
Screening
Scoping
Assessment
Reporting
Monitoring
Recommendations
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Step 4: Reporting
Objective To develop the HIA report and communicate findings and recommendations.
Tasks
Key points
Tools
Resources
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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
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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
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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