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)
WA 8
ME 1
MT 3
MN 6
OR 12
NH 2
WI 1
MA 4
PA 2
OH 1
NJ 1
IL 1
CO 4
CA
47
MO 1
MD 2
KY 1
TN 1
NM
1
GA 8
TX 1
FL
1
AK 7
HI 1
Map Courtesy of A. Dannenberg, A. Wendel, CDC NCEH
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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 conditions
2) 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 decision
2) 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
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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
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
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Scoping Example: Housing
Health Determinant: Housing Affordability
Existing Conditions
Research Question
How affordable is the
current housing stock
for the existing
population?
Impact Research
Question
What will be the impact
of the proposed plan on
housing affordability?
Indicators
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
Recommendations
Reporting
Monitoring
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Step 3: Assessment
Objective
To provide a profile of existing conditions data,
and an evaluation of potential health impacts.
Tasks
Key points
Tools
Resources
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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 impacts
Use 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?
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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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Air Quality Modeling
Modeling vehicle source PM2.5
CAL3QHCR Line Source Dispersion Model
A 1 g/m3 change in PM2.5 predicts a
1.4% change in non-injury mortality!
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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Noise Modeling
Noise Model Inputs
Vehicle types and volumes
The exposure threshold for increased
incidence of heart disease is 65 dBA
Temporal distribution of traffic
Use traffic noise model to find
exposure as function of distance
Add topography and building
sizes
Add stationary sources
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Pedestrian Injury Collision Modeling
% Change in
Pedestrian Injury
20%
21%
15%
24%
Developing a Collision Model
Traffic volume
Arterial streets (% without transit)
Land area
Injury collision rates resulting from
Eastern Neighborhoods Rezoning
Percent car ownership
Percent commuting via walking
or transit
Number of residents
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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
Criticism
Response
HIA is costly
Not as costly as treatment of health impacts in the long
run
HIA is timeconsuming and
will slow decisionmaking 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
community
Loss of cultural and
historical resources
Social support
Cultural practices
Community violence
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The HIA Process
Screening
Scoping
Assessment
Recommendations
Reporting
Monitoring
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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 decisionmaking 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
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Health & Comprehensive Planning
Lower South District HIA
Scope
• Evaluate potential health impacts of
recommendations from Citywide Vision:
1) mixed-use TOD @ the Sports Complex
2) 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
Goals
• 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
Methods
• 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.
HIA & Goods Movement: Considerations
• 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 decisionmakers?