Health Impact Assessment
IntroductionMassachusetts Healthy Transportation
CompactJuly 28, 2011
Aaron Wernham, M.D., M.S.
Director | The Health Impact Project
901 E Street, NW, Washington, D.C. 20004
p: 202.540.6346
e: awernham@pewtrusts.org
www.healthimpactproject.org
Outline
1. 1.Why do we need HIA?
2. 2.Introduction to HIA: basic definitions, process, and state of
the practice
3. 3.Brief case examples
4. 4.Common concerns and challenges
The U.S. spent $2.5 trillion on
health care in 2009
My child’s asthma is out of control…
Transportation
Housing
“Eat more fruits and vegetables…”
Food Deserts
Public health: A new multidisciplinary focus
“Public health agencies alone cannot assure
the nation’s health.”
Institute of Medicine, 2002. The Future of the Public’s Health in
the 21st Century
“Non-health” policies: An emerging priority for
public health
Opportunities for prevention increase when those
working in housing, transportation, education, and
other sectors incorporate health and wellness into
their decision making.
National Prevention Council, 2011
How do we put this into practice?
• No common language:
o transportation engineers don’t understand health data
o public health professionals don’t understand the constraints and
limitations of the planning process
• Few formalized requirements
• No routine interaction between health and other sectors
• Priorities don’t necessarily match:
o Public health is one consideration of many; transportation decisions
involve many other considerations (moving people, funding, technical
limitations, local politics, etc)
HIA: Definitions
A combination of procedures, methods and tools that systematically judges the
potential effects of a policy, 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.
World Health Organization, adapted by the International Association of
Impact Assessment, 2006
Health Impact Assessment
• A practical approach to aid decisions on specific proposals—new
policies, projects, programs and plans—that have a potential for
health risks or benefits.
• Provides a decision maker with public health data and input in a
structured, organized way.
• Focuses on solutions: develops practical recommendations,
informed by both public health priorities AND the economic,
technical or political constraints on the decision.
HIA ExampleJack London Gateway rapid HIA
Topic of HIA:
proposed housing
development of 61
senior housing units
near two major
freeways and the Port
of Oakland.
Health Risks:
Source: Human Impact Partners,
http://www.humanimpact.org/component/j
downloads
Jack London Gateway rapid HIA
Outcomes:
1. 1.Air Quality – developer implemented
air filtration; changed windows facing
freeway.
2. 2.Noise – developer added a noisebuffered courtyard and entranceway
Source: http://humanimpact.org/JLG_case_study_draft.pdf
away from the highway
3. Safety
– recommendations for “traffic calming” measures (speed bumps,
wider sidewalks with narrower lanes, safe cross walks) to allow residents
walking access to nearby retail. Under consideration.
Health Impact Assessment: Origins in
International practice
Origins/approaches:
• integrated with EIA
• urban planning, HiAP
World Bank and IFC: part of evaluation
standards for large development loans
Multinational Corporations (e.g. Shell,
Chevron, large mining companies)
Business case for HIA
• Lower business costs
• Corporate social responsibility
• Healthy workforce
• Risk management
Completed and In Progress HIAs
1999–2011: 113
WA 3
MT 1
OR 16
ME 1
MN 5
NH 1
MI 1
MA 4
PA 1
NJ 1
OH 1
IL 1
CO 2
CA 46
MO 1
DC 1
KY 1
MD 2
TN 1
NM 2
SC 1
GA 7
TX 2
AK 8
Federal HIAs: 2
HI 1
Map Courtesy of A. Dannenberg, A. Wendel, CDC NCEH.
The Health Impact Project is a collaboration of the Robert Wood Johnson
Foundation and The Pew Charitable Trusts.
Topics of HIAs: A wide spectrum
• •Land use and transportation: comprehensive planning, siting,
corridor planning, road projects, transit and TOD
• •Natural resource development: oil and gas, mining
• •Energy projects: coal, biomass
• •Policies:
o
o
o
o
o
MA LIHEAP
MA rental vouchers
Paid sick days
California carbon cap & trade
New Hampshire state budget
• •Food and Agriculture: farm to school legislation, county agricultural
plan
The HIA
Processhttp://www.healthimpactproject.org/hia/process
1. 1.Screening – decide whether HIA should be done: is the HIA going to add
new information? Does it fit within the timeline?
2. 2.Scoping – develop framework for HIA: the important health effects,
affected populations, available evidence
3. 3.Assessment – A)analyze baseline conditions; B) predict potential effects
4. 7.Recommendations – develop health-based recommendations and a
feasible plan for implementing them
5. 8.Reporting – produce a report; disseminate the results (interim and final)
to decision makers, public, other stakeholders
6. 9.Monitoring and Evaluation – HIA process; impact of doing HIA;
outcomes of implementing HIA/decision
“HIA 2.0” – beyond project-specific applications
• •Should a new HIA be done for each new project or program?
• •Can HIA be a formative learning tool that results in adoption
of new “healthy by design” principles that obviate the need for
HIA on every projects?
“HIA 2.0” – beyond project-specific applications
Ingram County, MI (Lansing):
Local health dept now using “HIA Checklist”
This website has case study and link to the checklist:
http://www.cacvoices.org/healthylifestyles/environmental/HIA/
“HIA 2.0” – making health-based planning more routine
Ingram County, MI
(Lansing):
Local health dept now
using “HIA Checklist”
This website has case
study and link to the
checklist:
http://www.cacvoices.org/h
ealthylifestyles/environme
ntal/HIA/
Health Impact Assessment: Common
questions
1. 1.Is HIA going to lead to a longer planning and permitting
process, greater costs and increase the potential for litigation?
2. We already address air quality, traffic flow, connectivity and other
factors that influence health. What will HIA add?
Health Impact Assessment: Common
questions
1. 1.Is HIA going to lead to a longer planning and permitting process,
greater costs and increase the potential for litigation?
• Most HIAs are done for ~$10,000-$150,000.
• HIAs should be done within the timeframe for the decision—we have not
seen any examples of delay
• Delays often come from opposition and litigation: proactively addressing
concerns is a way to build support and prevent litigation
• Duty to warn: failing to disclose potential risks generally creates a greater
risk.
Health Impact AssessmentCommon
questions
2. We already address air quality, traffic flow, connectivity and other
factors that influence health. What will HIA add?
• Baseline health data: where are the vulnerable populations and needs: e.g.
high asthma or obesity rates, traffic injury hotspots, food deserts.
• Differentiating alternatives
• Addressing community concerns, adding a trusted voice
• Building support for a well-planned project
• New partnerships for future decisions
• If it doesn’t add anything, don’t do it! (remember screening)
Thank you
Aaron Wernham
Director, Health Impact Project
The Pew Charitable Trusts
202-540-6346
awernham@pewtrusts.org
Massachusetts Low Income Energy
Assistance Program
Policy Question: energy prices spiked after Katrina, increasing the financial
burden for families. Should LIHEAP funds be increased?
Health Effects:
• Pneumonia
• Burns
implications for Medicaid expenditures
• CO poisoning
• Hunger and poor nutrition
Recommendations and Outcomes:
• Increased funding for LIHEAP
• New evaluation parameters to ensure adequate data on outcomes of
program
“HIA 2.0” – beyond project-specific applicationsThe
Healthy Development Measurement Tool
Example: Pittsburg Railroad Avenue TOD HIA
Proposed action:
• New BART (light rail) station
• 1600 new housing units
• 446,000 sq. ft. retail
• Parking
• Pedestrian and biking
improvements
HIA Findings: Baseline health status
Health Baseline: Pittsburg (CA in parentheses)
•
•
•
•
•
•Heart disease mortality 220/100,000: (180/100,000)
•Adult obesity + overweight: 60% (57%)
•Child Obesity + overweight: 44% (27.5%)
•Depression: 23% (21%)
•Injury deaths: 28.7/100,000 (26.4/100,000)
Health risks (“health determinants”)
Air pollution in residences near highway 4; less walkable
neighborhoods; less access to full-service grocery stores;
neighborhood safety
HIA Findings: Potential health risks and benefits
1. 1.Improved walking access to retail
services and transit (grocery stores,
etc.)
o decreased risk of crime, obesity
2. 2.Increased vehicle trips AND walking
trips in surrounding neighborhood:
o injury risk
3. 5.Noise: new buildings near highvolume freeway
o risk of sleep disturbance
o high blood pressure
HIA Recommendations and Outcomes:
1. 1.Access to retail services:
needs assessment; incentive for
supermarket; zoning to prevent fast
food and liquor outlets.
2. 2.Transportation:
o Traffic calming
o Improve sidewalks; bike lanes;
bus service
3. 3.Noise: interior courtyards,
acoustic shielding, sound barrier on
HWY 4.