R
Research
h IInforming
f
i
Policy:
P li
the Potential of Health Impact Assessments
Academy Health
June, 2010
Aaron Wernham, M.D., M.S.
Director | The Health Impact Project
901 E St
Street,
t NW
NW, W
Washington,
hi t
D
D.C.
C 2004
p: 202.540.6346
e: awernham@pewtrusts.org
www.healthimpactproject.org
1
By RWJF and University of
Wisconsin Madison, County
Health Rankings program:
www.countyhealthrankings.or
g/about-project/background
“Health in all Policies…”
"(The)
(The) toxic combination of bad policies
policies, economics
economics, and
politics is, in large measure, responsible for the fact that a
majority
j y of p
people
p in the world do not enjoy
j y the g
good health that
is biologically possible.” WHO Commission on Social Determinants of
Health, 2009
Health in all policies. APHA supports
requiring all new federal policies and
programs to take into consideration all
Impacts, both positive and negative, on
th public’s
the
bli ’ h
health.
lth
Health in all policies, but…
 No common language:
 transportation engineers don’t understand health data.
public health p
professionals don’t understand the constraints
p
and limitations of the planning process
 Few routine/formalized requirements
 No standard forums where health works with other
sectors
 No funding for new public health activities
 “Going out on a limb:”
Public health is science-driven, and policy and planning are
governed by many other considerations: economics, politics,
technology deadines,
technology,
deadines etc …
7
Definitions
IAIA
A combination of procedures
procedures, methods and tools that
systematically judges the potential effects of a policy,
programme or project on the health of a population
and the distribution of those effects within the
population HIA identifies appropriate actions to
population.
manage those effects.
(IAIA 2006)
(IAIA,
Analytical Framework
Proposed policy,
project, program
Determinants of
health
Health outcomes
• Broad framework: considers multiple determinants and
dimensions of health
• Considers direct, indirect, and cumulative pathways
• Both qualitative and quantitative methods used,
used as is
expert opinion
• Focus: predicting outcomes or pathways/linkages,
pathways/linkages in order
to manage effects
The HIA Process
1.Screening
1
Screening –is
is HIA feasible and likely to add value?
2.Scoping – determine the important health effects,
affected populations
populations, available evidence
evidence, etc
3.Assessment – analyze baseline conditions and likely
health effects
4.Recommendations – develop health-based recs and a
f
feasible
ibl plan
l for
f implementing
i l
ti them
th
5.Reporting – disseminate the report to the public,
stakeholders,
t k h ld
solicit
li it iinputt
6.Monitoring and Evaluation
9
Examples of Housing HIAs
Jack London Gateway (JLG) Senior Housing Project
Authors:
A
th
H
Human
IImpactt Partners
P t
and
d
SFDPH
Decision: Plan for 61 new senior housing
units close to 2 freeways & Port of
Oakland.
Outcomes:
Impacts: indoor & outdoor air quality,
• Many recommendations
noise, safety, retail planning
adopted.
• Additional HIA projects
Recommendations: AQ monitoring;
installation of ventilation systems; noise- were funded.
g windows; p
pedestrian p
protection • Healthy Development
insulating
checklist adopted by the
medians; traffic calming measures; and
Development Committee.
many others.
8
Integrating HIA into the environmental
i
impact
t statement
t t
t process:
Decision: Bush energy plan
proposed expanded oil leasing
in Alaska’s North Slope,
p
necessitating an EIS
•Local
L
l governmentt
became a “cooperating
agency”
g
y – a role through
g
which local governments
can formally participate
in an EIS
• The community health
agency drafted an HIA
through this role
• The lead federal
agency incorporated
the HIA into the EIS
Oil and gas leasing on Alaska’s Arctic
Slope
A smallll IInupiat
i t community
it 7 miles
il ffrom llarge oilil d
development
l
t
Community testimony:
Benefits: revenues pay
for services,
infrastructure
Risks: social change,
drugs and alcohol, STIs,
contaminants, cancer,
and breathing problems,
interference with
hunting and fishing
Result of the NPR-A HIA?
Health Concern
Mitigation
Dietary change from
interference with hunting
and fishing (exacerbating
risk of diabetes, obesity,
etc)
“S
“Social
ills”:
” alcohol,
STIs,
Ai pollution
Air
ll ti
BLM withheld critical hunting areas
from leasing in part because of
health and broader cultural impacts
Contamination
C
t i ti off llocall
food sources
Expand cultural orientation for
f
workers
Additi
Additional
lb
baseline,
li
modeling,
d li
and
d
monitoring above CAA requirements.
Baseline
B
li llevels
l and
d ongoing
i
monitoring
Examples of HIAs
P id Si
Paid
Sick
kD
Days
Workers rights issue vs. Public health issue
Workers’
Disparities: income, race/ethnicity, occupation
Methods: Lit and health data review,,
statistical analyses, focus groups
g ER visits, flu spread
p
Keyy Findings:
restaurant workers, nursing homes
Outcomes: Changed discourse,
revitalized campaigns across US
What are the elements that define HIA?
1.
1
2.
3
3.
4.
Forward looking: addresses a proposed action
Forward-looking:
Seeks to inform decision-making
Follows 6 steps (5 in some texts)
Broad framework: broad def’n of health; considers social,
economic and environmental influences on health
5. Participatory process: engages the public and other
stakeholders
6. Cross-disciplinary: effective collaboration with decisionmakers other agencies
makers,
7. Focus on vulnerable populations/equity
The Health Impact Project:
A collaboration of the Robert Wood Johnson
Foundation and The Pew Charitable Trusts
Overall Objective:
To promote and support the use of HIA as a tool to
ensure that
th t decisions
d i i
iin non-health
h lth sectors,
t
whether
h th
at the local, state, tribal, or federal level, are made
with
ith health
h lth iin mind.
i d
Visit www.healthimpactproject.org
The Health Impact Project
Funded Projects
g Process: New Hampshire
p
Center for Public Policy
y
1.State Budget
will address the NH budget
2.State Cap-and-Trade regulations: CA DPH an HIA to inform the
rulemaking process for California’s carbon cap and trade rule
3. Agriculture Policy: Kohala Center, a nonprofit in HI, will do an
HIA to
t inform
i f
HI County’s
C
t ’ A non-profit
fit would
ld engage iin a
county agricultural plan that will shape the local economy, land
use patterns, and diet.
4.Wilshire Transportation Corridor, LA: LA DPH and UCLA will
do an HIA of planned transportation corridor in LA
5.Farm to School Legislation: a non-profit in OR will do an HIA to
inform deliberations on a farm to school bill.
The Health Impact Project CFP
Funded Projects
7 Transit Oriented Development:
7.
a. ISAIAH (a faith-based coalition) will use HIA to address planning
decisions on a light-rail project in the Twin Cities.
b. TSU will use HIA to look at a proposal for TOD
8. Coal Gasification Plants: Green River Health Department will
do an HIA of 3 proposed “clean
clean coal”
coal plants in KY
9. Construction waste power plant: Mass. Dept of Public Health
will do an HIA of a proposed biomass power plant in an
economically depressed area of Springfield, MA
10. Farm to School legislation: an OR non-profit public health
group will
ill undertake
d t k and
d HIA off proposed
d llegislation
i l ti tto ffund
d
farm to school programs
16
HIA and Science
HIA practitioners may be
experienced and well-versed in
public health
health, but it is a misguided
conceit to predict the nature and
extent of a health impact without
substantiating this by reference to
empirical data (…most of which is
uncertain and won’t
won t substantiate
impacts)
p
Thompson
…it is not reasonable to
suggest that uncertainty should
prevent HIA from making any
predictions. Certainty or even
high probability are luxuries
which HIA practitioners do not
enjoy it is little help to the
enjoy…it
decision-maker to be told that
they should wait 5 years for
more research
Kemm
Questions for discussion
1 A
1.
Are th
there minimum
i i
standards
t d d off evidence
id
th
thatt could
ld b
be
applied without restricting the range of potential
applications of HIA? What are they?
2 How should HIA handle predictions in which there are
2.
potentially important health effects and a high degree of
g
g the p
predictions?
uncertaintyy regarding
3. How can HIA avoid becoming
g a biased tool for advocacy
y
when it relies on subjective judgments
Discussion?
19
Northeast NPR-A Example: hunting and diabetes
Baseline:
• Type 2 diabetes prevalence low: ~2
~2.5%
5%
• Diet: ~50% “wild foods” – caribou, salmon, marine
mammals
Impact Assessment:
Pipelines
p
Displace
p
caribou
Dietary
Diabetes
farther from village
“Seismic”
Change
Risk
Fuel & equipment
for hunting
Revenue
20
Assessment
Y
Your
d
data
are incomplete,
i
l
your predictions
di i
are uncertain…
i
What to do?? …
Adaptive Management
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