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Transcript of Health Impact Assessment: Towards Institutional Accountability to the Public’s Health Prepared for...
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
HIA OverviewPage 2
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.
HIA OverviewPage 3
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.
HIA OverviewPage 4
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
HIA OverviewPage 5
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
HIA OverviewPage 6
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
HIA OverviewPage 7
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
HIA OverviewPage 8
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
HIA OverviewPage 9
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
HIA OverviewPage 10
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
HIA OverviewPage 11
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
HIA OverviewPage 12
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
HIA OverviewPage 13
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
HIA OverviewPage 14
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
HIA OverviewPage 15
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
HIA OverviewPage 16
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
HIA OverviewPage 17
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)
HIA OverviewPage 18
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)
HIA OverviewPage 19
Rajiv Bhatia, MD, MPHHealth Impact Assessment
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.
HIA OverviewPage 20
Rajiv Bhatia, MD, MPHHealth Impact Assessment
Modeling Vehicle PM2.5 for a Residential Development using CAL3QHCR—Harrison and Beale Streets, San Francisco
HIA OverviewPage 21
Rajiv Bhatia, MD, MPHHealth Impact Assessment
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
HIA OverviewPage 22
Rajiv Bhatia, MD, MPHHealth Impact Assessment
Freight Routes and Truck-related collisions in West Oakland
Port of Oakland Case StudyPage 22
San Francisco Department of Public HeathHealth Impact Assessment Mini-Course – July 2008
HIA OverviewPage 23
Rajiv Bhatia, MD, MPHHealth Impact Assessment
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
HIA OverviewPage 24
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
HIA OverviewPage 25
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
HIA OverviewPage 26
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
HIA OverviewPage 27
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
HIA OverviewPage 28
Rajiv Bhatia, MD, MPHHealth Impact Assessment
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
HIA OverviewPage 29
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