HIA:
HIA: A Tool to Achieve Public Health Goals
Academy Health, 2010
Academy Health, 2010
Arthur M. Wendel, MD, MPH
Arthur
M Wendel MD MPH
dvq6@cdc.gov
Disclaimer
The findings and conclusions in this
presentation are those of the author(s)
and do not necessarily represent the
views of the Centers for Disease Control
and Prevention.
Community Design’ss Impacts Community Design
Impacts
Core Components of
Community Design
Environmental and
Behavioral Impacts
Air Quality
Related Leading Causes
of Death - Children
Unintentional Injuries
Cancer
Water Quality/Quantity
Water Quality/Quantity
Transportation Systems
Access to Greenspace
Land Use
Housing
Related Leading Causes
of Death - Adults
Heart Disease
Destination and Transportation Options
Cancer
Cerebrovascular Disease (Stroke)
Zoning and Community Development
Physical Activity
Nutrition/Food Access
Unintentional Injuries
j
Diabetes
Health Impact Pyramid
Ed
Education
ti
Increasing
P
Population
l ti
Impact
Clinical
I t
Interventions
ti
Increasing
Individual
Effort Needed
Long-lasting
Long
lasting Protective
Interventions
Changing the Context to make
Individuals’ Default Decisions
y
Healthy
Socio-Economic Factors
Frieden, AJPH, 2010
HIA as a Pre-op Physical for
Communities
http://www.phoenix5.org/humo
r/CartoonOperation.html
Choices
Source: Atlanta Journal-Constitution, March 10, 2006
The 10 Essential Public Health Services
CDC’s
CDC
s Involvement with HIA
• CDC Health and Built Environment workshop,
p, 2002
• Identified HIA as promising area for research
• CDC/RWJF HIA workshop,
workshop Princeton,
Princeton 2004
• Developed agenda for HIA research and practice
p identified still relevant in 2010
• Manyy topics
• HIA activities at CDC during 2003-2010
•
•
•
•
•
•
Training
g
Tracking
Funding – NACCHO, APA, ASTHO, NNPHI, IOM
Technical assistance
Evaluation
Policy – Transportation policy recommendations
HIA Capacity Building
• Piloted in 2008-2009 in Oregon
g
•
•
•
•
Partnered with ASTHO
175 practitioners trained
3 local HIAs begun
Indicators developed for incorporation into Tracking
network
• Expanded to 4 states (OR
(OR, CA
CA, WI
WI, MN) in 2010
• Work ongoing
• All have conducted trainings and begun local HIA
Completed HIAs in the United States
1999–2009 ((N = 53))
WA 4
MT 1
MN 5
OR 2
MA 2
PA 1
OH 1
NJ 1
CO 2
CA
25
MD 1
GA 4
AK 3
FL
1
Completed HIAs in the United States
1999-2009 (n=53)
18
16
14
12
10
8
6
Number of HIAs
Number of HIAs
4
2
0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Source: CDC HIA tracking database as of May 24, 2010 (may be incomplete)
Wh t Are
What
A Best
B t Practices?
P
ti
?
• Selection of the HIA
• Methodology of the HIA
M th d
Methods
• Identified U.S. HIAs
– Previous work identified 27 completed HIAs
– Queried HIA practitioners
• Data sources
– Extracted from written reports
– Interviews and/or e-mail exchanges with
practitioners
Types
ypes o
of HIA Effectiveness
ect e ess
Decisions modified
due to HIA
YES
Health issues Direct effectiveness:
Changes made because of
adequately
HIA
acknowledged
YES
NO
Opportunistic
effectiveness:
Health-promoting choice
made anyway
NO
General effectiveness:
HIA acknowledged but
changes not made;
health awareness
raised
No effectiveness:
HIA ignored
Wismar M, et al. Effectiveness of HIA. WHO, 2007
R
Results
lt
• Obtained written materials on 53 HIAs
• Through interviews, reported
effectiveness on 35 HIAs
R
Results
lt
• St
Studied
di d HIAs
HIA were conducted
d t db
between
t
1999
19992009
• Unit
U it off analysis
l i (N
(N=53)
53)
– 18 project
– 22 policy
li
– 1 program
• Geographic
G
hi scale
l (N
(N=53)
53)
–
–
–
–
27 subsection of a city
16 metropolitan area or region in a state
9 state-wide
1 national
R
Results
lt
• HIA depth (N=53)
– 14 rapid
– 14 intermediate
– 24 comprehensive
– 1 other
• Conducting
C d ti organization
i ti (N
(N=53)
53)
– 24 Health Department
– 14 Consultant
– 22 Academic
– 8 Other
R
Results
lt
• HIA timing (N=35)
– 30 prior or during the decision
– 5 after the decision
• 2 not intended to be timely
• 15 HIAs had explicit decision-maker
support (N=35)
• 8 HIAs were intertwined with an EIA
(
(N=35)
)
HIA Effectiveness Rating
Changed
g Project
j
Total: 25
Educated Decisionmakers
Total: 9
Reinforced Decision No effectiveness
Total: 0
Total: 1
Characteristics of HIAs by
y
Effectiveness Type
Direct
Di
N=25
Generall
G
N=9
No Eff
N
Effect
N=1
Decision-maker(s) support
HIA
13 (52%)
2 (22%)
0%
Community involved
17 (68%)
6 (67%)
1 (100%)
Vulnerable populations
addressed
21 (84%)
7 (78%)
1 (100%)
New data collected
8 (32%)
1 (11%)
1 (100%)
Quantification
Q
tifi ti off any
health impact
8 (32%)
5 (56%)
1 (100%)
Characteristic
HIA Depth
p by
y Effectiveness
Rapid
Intermediate
Comprehensive
Direct
10
5
9
General
3
2
4
O
Opportunistic
t i ti
0
0
1
D fi i Success
Defining
S
• Multiple
p routes for success
– Directly changing the project or policy
– Influencing other projects or policies
– Create more demand or supply
– Expanding the field of HIA
• Conducting an HIA elevates health
Li it ti
Limitations
• Effectiveness based on self-report
p from
practitioners
• Few U.S. HIA practitioners
• Written reports varied in scope and content
• Established definitions of HIA characteristics
lacking
Summary
• Rapid HIAs can be effective
• Decision-maker support more common
among directly
di tl effective
ff ti HIAs
HIA
• Communityy involvement needs further
examination
• HIA likely to improve decisions
Barriers for Public Health
•
•
•
•
•
•
•
Lack of support, political and financial
Limited training and capacity
Viewed as outside subject area
Political hazards
Different geographical boundaries
Data may lack granularity
Determining where HIA fits
Future HIA Activities
Future HIA Activities
• Near‐term – Expanded capacity building
p
p y
g
– Integration with partners
– Indicator and surveillance development
Indicator and surveillance development
• Long‐term
– Finding a place for HIA‐like activities
– HIA as part of a comprehensive strategy to HIA as part of a comprehensive strategy to
improve health
– Integrating health criteria into project selection
Integrating health criteria into project selection
Moving Science Forward
• Basic research
• Research synthesis
– Community Guide to Preventive Health Services
– NYC
NYC’s
s Active Design Guidelines
– Healthy Development Measurement Tool
• Surveillance
S
ill
• Evaluation
Advocating for Health
Advocating for Health
• Need evidence‐based decisions, not decision‐
based evidence
• Standardization of practice could help
S d di i
f
i
ld h l
• Effective communication of uncertainty
• Relationships with decision
Relationships with decision‐makers
makers important
important
Conclusions
•
•
•
•
Still much to learn
State health departments can spur HIA growth
State health departments can spur HIA growth
Need to coordinate with partners
Consider the essential services
Thank you
Thank you
Questions
• How to build the market for HIAs
• What to do with other HIA
What to do with other HIA‐like
like projects
projects
• Where to focus HIA ‐ project or policy?