Health Impact Assessment
Training

Kelly Muellman, AICP
MN Climate & Health Program Planner
Linden Weiswerda
MN Climate & Health Program Planner
July 16, 2014
1
Acknowledgements
 This HIA training is supported by a grant from
the Health Impact Project, a collaboration of
the Robert Wood Johnson Foundation and The
Pew Charitable Trusts.
 The opinions expressed are those of the
author(s) and do not necessarily reflect the
views of the Health Impact Project, Robert
Wood Johnson Foundation or The Pew
Charitable Trusts.
2
Agenda

Welcome & Introductions

Connections between health and the environment

Introduction to HIA

Step 1: Screening

Step 2: Scoping

Step 3: Assessment

Step 4: Recommendations

Step 5: Reporting

Step 6: Evaluation and Monitoring

Training Evaluation
3
Today Think . . .
Slide 1
Slide 1
Complete Street’s Photostream - Flickr
Slide 2
Slide 2
©Ann Forsyth. Used with permission.
Slide 3
Slide 3
Source: Wikipedia.org
Slide 4
Slide 4
Source: Raise the Wage MN
Learning Objectives
 The purpose of an HIA: to provide health
information to decision-makers before
important decisions are made, so they can
make a more informed decision
 Six HIA steps and HIA process
9

What is health?
Health is a state of complete physical, mental
and social well-being and not merely the
absence of disease or infirmity.
Source: World Health Organization
This definition has not been amended since
1948
Something is wrong
2010 Avg Life Expectancy and Healthcare Spending
US ranked
42nd in life
expectancy
for 2010
and 1st in
health
spending
per capita.
WHO and Global
Health Expenditure
Database
http://www.gapminder.org/
Health Determinants
Health status is determined by: 30% by genetics; only 10% by
health care; but 60% by social & environmental conditions,
and behavior
Source: N Engl J Med 2007;357:1221-8.
12
What do Minnesotans die from?
Leading causes of death in Minnesota: 2010
Cause
Deaths
1. Cancer
9,599
2. Heart Disease
7,144
3. Unintentional Injury
2,087
4. Stroke
2,154
5. Chronic Lower Respiratory Disease 2,012
Rate
166.9
118.7
36.4
35.8
35.1
Health Impact Assessment (HIA)

Definition: A systematic process that uses
an array of data sources and analytic
methods and considers input from
stakeholders to determine the potential
effects of a proposed policy, plan,
program, or project on the health of a
population and the distribution of those
effects within the population. HIA
provides recommendations on monitoring
and managing those effects.

National Research Council, Improving
Health in the United States: The Role
of Health Impact Assessment, 2011.
14
Why Conduct HIA?

Identify harms and benefits before decisions are made

Identify evidence-based strategies and recommendations to promote
health and prevent disease

Increase transparency in the policy decision-making process

Support inclusive and democratic decision-making

Support community engagement in the decision-making process

Advance equity and justice

Shift decision-making from an economic to a quality of life framework

Inform a discussion of trade-offs involved with a project or policy

Facilitate decisions and their implementation
15
Values of Health Impact Assessment
 HIA aims to advance the
values of
 democracy
 equity
 sustainable development
 the ethical use of evidence
 a comprehensive approach
Source: http://www.policylink.org/atf/cf/%7B97c6d565-bb43-406da6d5-eca3bbf35af0%7D/PROMOTINGEQUITYHIA_FINAL.PDF
to health

North American HIA Practice Standards Working Group (Bhatia R,
Branscomb J, Farhang L, Lee M, Orenstein M, Richardson M). Minimum
Elements and Practice Standards for Health Impact Assessment, Version 2.
North American HIA Practice Standards Working Group. Oakland, CA:
16
November 2010.
Types of Decisions Influenced by HIA
•
Policy Decisions (bills by state legislature, city council
decision, local school board on district-wide policy)
•
Policy Implementation (weigh various implementation
options for a policy once it is passed)
•
Project Specific (siting, permitting, construction, design)
•
Comprehensive Plans (neighborhood plan, regional growth
plans, master planning documents)
Provided by Health Impact Project
http://www.healthimpactproject.org/
17
What topics have HIAs addressed?
Provided by Health Impact Project
http://www.healthimpactproject.org/
18
HIA in the U.S.
314 HIAs
(5/28/2014)
Source: Health Impact Project
http://www.healthimpactproject.org/
19
HIA at the National Level
 Two major national funders
 Centers for Disease Control & Prevention (CDC) (directly funds
grantees; ASTHO-HIAs, training, TA)
 Health Impact Project (PEW and RWJF)
 SOPHIA (Society of Practitioners of HIA):
http://www.hiasociety.org/
 Two conferences:
 HIA of the Americas Workshop (Oakland, CA)
 National Health Impact Assessment Meeting (Washington DC)
20
HIA Minimum Elements & Practice
Standards
 Minimum elements to
include in every HIA
 Guidance for each step of
HIA
 Also, guidance and
training available at
Human Impact Partners
(HIP)
www.humanimpact.org/
21
HIA in Minnesota
 2006-2014: 21 HIAs
completed or in-progress
 MN HIA Coalition
 Training
 Technical Assistance
 MDH website/listserv
 Funding (BCBS Foundation
of Minnesota)
http://www.health.state.mn.us/divs/hia/
22
Duluth’s HIA:
th
6 Ave
E Redesign
•
Schematic Redesign Study on the
former MN Trunk Hwy 194
completed in January 2011
•
Straight, four-lane, high speeds,
main arterial
•
Barrier for all non-motorized
transportation/school access
•
Local HIA Team: PH educator,
engineer, city planner, GIS specialist
•
MDH technical assistance
Duluth’s HIA: 6th Ave E Redesign (cont.)
 Built off of existing partnerships
 Used public meetings for input
 Duluth’s HIA:
 Accessibility & Safety
 Physical Activity
 Livability
 Pollution
 Food Access
 HIA becomes an addendum to the
Sixth Avenue East Schematic
Redesign Study
24
Gary/New Duluth Small Area Plan
 Small Area Plan
components:




Commercial & Residential
development
Natural Environment
Transportation
Parks
 HIA focus areas:



Social cohesion
Physical activity
Access to healthy food
25
Gary/New Duluth: Stakeholder Engagement
 Technical Advisory Committee
 Community survey
 Paper (distributed widely)
 Online (Survey Monkey)
 Public meetings
26
Lincoln Park Small Area Plan
 Kicked-off in May 2014
 Integrated process
 “Health in all policies”
 Building upon existing
studies & initiatives:





OneRoof
2012 NRP
Duluth-LISC
Ecolibrium3
On the Move Lincoln Park
27
Six Steps of HIA
1. Screening - to determine if an HIA is useful for a
specific project or policy
2. Scoping - identify which health effects to consider
3. Assessment - determine which people may be
affected and how they may be affected
4. Recommendations - suggest changes to proposal to
promote positive or mitigate adverse health effects
5. Reporting - present the results to decision-makers
6. Evaluation and Monitoring - determine the affect of
the HIA on the decision process
28
Step 1: Screening

29
Step 1: Screening: What is HIA Screening?
The Screening process helps determine if:

… the HIA is feasible
 Is there sufficient information about the decision?
 Is there available resources to conduct the HIA?

… the HIA can be done in a timely manner
 Can the HIA fit within the decision-making time frame?

… the HIA would add value to the decision making process
 Is health already at the table?
 Will the proposed project benefit from an HIA and promote
health and influence positive change to the community?
30
Types of HIAs
Upstream Public Health, Portland, OR
Modified from Harris et al, 2007, Health impact assessment: A practical guide, Centre for Health Equity, Training, Research and Evaluation
(CHETRE), Part of the UNSW Research Centre for Primary Health Care and Equity, UNSW
http://www.hiaconnect.edu.au/hia_a_practical_guide.htm
31
Screening: When not to do an HIA
 No added value
 Chula Vista Plan to Improve Walkability
 Plan was already considering health
 Health advocates involved in design
 Resources better focused elsewhere
 No influence on decision
 Milwaukee Zoo Interchange Project
 Time: insufficient time to complete HIA for drafts
 Stakeholders: DOT was not open to considering health
(recommendations seen as another obstacle or more red
tape)
Source: Wisconsin Department of Health Services, Health Impact Assessment: A Tool to
Increase Health Equity in Decision-Making, Great Lakes Intertribal Council, April 23, 2012
32
Concerns about HIA
Concern
Response
HIA is costly
Not as costly as treatment of health impacts in
the long run
HIA is time-consuming and
will slow decision-making
process
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
the best available evidence to make a broad
statement about impacts
Source: Wisconsin Department of Health Services, Health Impact Assessment: A Tool to
Increase Health Equity in Decision-Making, Great Lakes Intertribal Council, April 23, 2012
33
HIA Screening: Getting Started
How to start the screening process:
1. Define the decision
 What is being proposed?
 What is the timeline for the decision?
Project
Launch
Final
Decision
Draft Plan
Available
Can the HIA be
ready here?
34
HIA Screening: Engaging Stakeholders
2. Decide who will be involved in the
screening process
 Identify the stakeholders (i.e.,
residents, business owners, regional
agencies, local organizations, elected
officials)
3. Determine if potential partners are ready to
work on the HIA
 Do they have the resources available to
conduct an HIA?
35
HIA Screening
4. Evaluate the program, plan, or policy
based on screening criteria (including will the
program have a significant impact on health)
Utilize a Screening Worksheet or a Checklist
 There are a number of worksheets to
choose from
 Use the worksheet that best meets your
needs
36
Screening Criteria
 Has a project, plan or policy been proposed?
 Is there time to conduct HIA before decision is made?
 Will the project, plan or policy affect health?
 Would health inequities be impacts? How?
 Are health impacts likely to be significant in terms of
number of people impacted (magnitude), severity of
impact, or immediacy or permanence of impacts?
 Is there expertise, evidence and/or research methods
available to analyze health impacts?
37
Screening Criteria (cont.)
 Is health already being considered?
 Are there clear links between the proposal and
health?
 Are decision-makers open to considering HIA
findings?
 Will the HIA process have potential health impacts?
 Do stakeholders have the interest and
capacity/resources to participate in the HIA?
38
HIA Screening: Notify Stakeholders
The Final & Essential Screening Task
1.
Define the decision and its alternatives
2.
Decide who will be involved in the screening process
3.
Determine if potential partners area ready to work on the HIA
4.
Evaluate the project plan, or policy based on screening criteria
5. Notify stakeholders of your decision
 Will you be conducting an HIA?
39
5 Minute Brainstorm
 Project, Plan or Policy that might benefit from
an HIA
40
Step 2: Scoping

41
Step 2: Scoping: Two Main Goals
Two Main Goals:
1. Create the plan for the HIA
2. Determine health
indicators to be assessed
Health issues that
will be assessed
42
Scoping: Determine Responsibility
Determine:
 Team responsible for
conducting the HIA
 Group who will oversee
the HIA process
 Stakeholder engagement
43
Scoping: Stakeholder Engagement

In addition to promoting inclusive, healthy, and equitable
communities, stakeholder participation can improve the efficacy
of an HIA by helping to:
 identify important stakeholder concerns
 bring important reflections of experience, knowledge, and
expertise
 ground truth findings and recommendations by ensuring
that the lived reality matches priorities, data, and analysis
 support the value of equity and democracy within the HIA
 create more support for the implementation of HIA
recommendations
 shape communication and dissemination methods
44
Who Are the Stakeholders?
Who are the stakeholders?
 Public health agencies
 Community residents/
organizations
 Public agencies
 Policy makers
 Businesses
Populations likely to be impacted by a decision should be
involved and have an oversight role in the HIA process
45
Stakeholder Analysis
Stakeholder
Group
(Description
/Key
Contact)
Interest in
HIA or
related
decision?
Power to
How and
influence the when (what
decision
stage) to
(high/
engage?
medium/
low)
Potential
Barriers/
role in/
challenges to
contribution engagement
to HIA
46
How to Involve Stakeholders
How should stakeholders and the
affected communities be
involved?
 Advisory Committee
 Public meetings
 Small group discussions/ Focus
groups
 Comment forms
 Project website
 Workshops/ Design charrettes
 Surveys
47
Lincoln Park Small Area Plan/HIA
 Kick-off at Our Lincoln Park community event
 Community survey
 Monthly meetings with 30+ organizations
 Public meetings
48
Stakeholder Engagement: Challenges
 Developing and maintaining relationships
 Establishing common goals, expectations, ground rules
 Managing conflicting interests and
perspectives Ensuring meaningful involvement
that leads to empowerment
Start-up is important!
Scoping: Create the Plan for the HIA
First meeting(s):
 Discuss HIA plan, timeline and
the decision and alternatives
 Ground rules
 Goals of HIA & screening
 Communications plan
 Geographic area
 Population(s) and
subpopulations to be studied
50
Scoping: Identifying Health Issues
All possible health issues
Scoping next meetings:
 Examine the range of possible
health issues
 Come to agreement on priority
health issues
 Discuss pathways
 Determine research questions,
data sources & methods
Health issues that
will be assessed
51
Examine Range of Health Issues
 Concerns identified during stakeholder engagement
 Start baseline data investigation
52
Examine Range of Health Issues (cont.)
 Start baseline data investigation
Census Tract 38
Duluth
Minnesota
Population below
poverty level
Population under
18 below poverty
level
12.2%
21.4%
11.0%
7.3%
25.2%
14.0%
Population 65
years and over
below poverty
level
14.4%
8.5%
8.3%
53
Scoping: Determine Health Indicators
 Come to agreement on priority health issues
 Prioritization Criteria
 Health impacts with the greatest potential significance,
magnitude, severity, certainty, permanence
 Stakeholder/community priorities
 Equity
 Available resources: time, existing data/research,
ability to collect new data for gaps in data/research
54
Gary/New Duluth
Scoping meeting:
 Discussed existing conditions in
neighborhood
 Discussed input from
community survey
 Voted
 Scoped 3 Health Determinants:
1. Social Capital
2. Physical Activity
3. Access to Healthy Food
Health Determinant Votes
social capital
5
physical activity
3
access to healthy food
3
stress or mental health
2
crime
2
jobs
2
community livability/
living conditions
2
gentrification/
displacement
quality of life
1
1
55
Scoping: Pathways & Research Questions
All possible health issues
Scoping next meetings:
 Examine the range of possible
health issues
 Come to agreement on priority
health issues
 Discuss pathways
 Determine research questions,
data sources & methods
Health issues that
will be assessed
56
Scoping - Pathways
 Pathways can be direct:
 Traffic and
vehicle speeds
 Motor vehicle
accidents
 Injuries and
deaths
 Or indirect:
New business
 Employment
opportunities
 Ability to
meet basic
needs
 Food security
 and can be fairly complicated…
57
Scoping – Pathways (example 1)
Source: Oregon Farm to School and School Garden
Policy, HB 2800 Health Impact Assessment
58
Scoping – Pathways (example 2)
Source: Healthy Corridors for All HIA
59
Pathway Exercise
Proposed
Changes
Short Term
Outcomes
Intermediate
Outcomes
Health
Outcomes
Proposed
change
60
Pathway Diagrams: Summary

A visual tool for explaining what the HIA will study

Help generate research questions

Help stakeholders and decision-makers understand
potential effects of decision making, and their relative
importance

Can show how changes to a proposal or other conditions
may lead to changes in health outcomes

Identify where there is uncertainty about causes andeffects or magnitude of impacts

Help guide the selection of recommendations
Developing Research Questions
Create a plan for the Assessment:
Focus your research
 Create research questions
 Baseline questions versus
Impact questions
Too generic: Is pedestrian
safety an issue? Ho will the
proposed plan affect pedestrian
safety?
Better: How many pedestrian,
bicyclist, and motor-vehicle
accidents are there today and
at what locations? How will the
proposed changes to policy,
programming, and projects
affect the number and/or rate
and location of accidents?
62
HIA Scoping Worksheet
Project:
Health
Determinant:
Geographic
Scope:
Existing
Conditions
Research
Questions
How many
pedestrian, bicyclist,
and motor-vehicle
accidents are there
today?
How does Winona
County compare to
the state?
Are there “problem
areas” with higher
number or rates of
accidents?
Winona County Active Living Plan HIA
Traffic & pedestrian safety
County
Impact
Research
Questions
How will the proposed
changes to policy,
programming, and projects
affect the number and/or
rate of accidents?
How will the proposed
changes to policy,
programming, and
projects affect the
location, number and/or
rate of accidents?
Indicators
Methods Priority Notes
Data
Source
Motor vehicle, pedestrian
and bicyclist crashes (by
date, location, and cause
– Do they also have
age?)
Injuries (ED visits and
hospitalizations) and
mortality from accidents
Motor vehicle, pedestrian
and bicyclist crashes (by
date, location, and cause
– Do they also have
age?)
63
HIA Scoping Exercise
Project:
Health
Determinant:
Geographic
Scope:
Existing
Impact
Conditions
Research
Research
Questions
Questions
Indicators
Data
Sources
Methods
Priority
Notes
64
Purpose and Use of Scoping Worksheet
 Scoping Worksheet
Identify research questions, data sources,
and analytic methods for analysis
Help identify where secondary data may exist
and primary data collection is needed
Identify participant roles and responsibilities for
data collections
Help guide discussion of prioritization for
research questions and indicators
65
Scoping Outputs

Scoping should result in a project plan for the HIA that
includes:
 Pathways demonstrating how health could be affected by
the proposed decision, and a summary of how issues
were selected for inclusion
 Identification of the population and vulnerable groups that
could be affected by the proposed decision
 Description of research questions, data sources, methods
to be used, and any alternatives to be assessed

Identification of data gaps
 Summary of how stakeholders were engaged in scoping,
and how issues raised will be addressed in the HIA, or
rationale for why not
66
Step 3: Assessment

67
Case Study 1
Healthy Corridor For All (MN)
http://sapcc.org/node/600
68
Case Study 2
HB 2800: Farm to School and School Garden Policy (OR)
Photos from: http://www.upstreampublichealth.org/sites/default/files/F2SHIA_FINAL.pdf
69
Six Steps of HIA: Step 3
1.
Screening - determine if HIA is useful for specific project or policy
2.
Scoping - identify health effects to consider
3. Assessment – perform research,
determine populations affected & how
4.
Recommendations - suggest changes to proposal to promote positive
or mitigate adverse health effects
5.
Reporting - present results to decision-makers
6.
Monitoring and evaluating - determine effect of HIA on decision
process
70
Step 3: Assessment: Main Goals
Main goals:
1. Profile baseline conditions, characteristics of target
populations
2. Analyze potential health effects of decisions
71
Build Off of Pathway Diagrams
Policy
Direct Impacts
Rate of car
ownership in
population?
Light Rail
Construction
↓ car use
Intermediate Impact Health Outcomes
Measures of air
pollutants in
area of concern?
↓ GHG
Emissions
Rates of
asthma?
↓ Asthma
Baseline Profile
 U.S. Census
 Hospital-discharge
records
 Disease registries
 Behavioral Risk
Factor Surveillance
Survey
Traffic with 73 solo drivers vs. traffic with 73
commuters using bus, carpool and vanpool.
73
Baseline Profile: Data limitations
Scale discrepancies
Proxy measures
74
Ex: Healthy Corridor for All - Topics
Healthy Corridor For All
 Health Economy
 Affordable, Healthy Housing
 Safe & Sustainable
Transportation
75
Ex: Healthy Corridor for All – Data
Selection
Healthy Corridor For All
 Measurability
 Availability
 Time & Resources
 Ability to answer research
questions, objectives
 Relevance
76
Ex: Healthy Corridor for All - Indicators
Indicator
Data Source
Methodology
Distribution of
population by
race/ethnicity
US Census 1990,
2000, 2010
Aggregated total residents by race & ethnicity
by block group for CC, St Paul, and Ramsey
County (1990,2000); aggregated total residents
by race & ethnicity by block for CC (2010)
Number of
US Census 2010;
persons living
Metro Transit
within ¼ mile of
transit lines
Selected all high-frequency bus routes. Using
ArcGIS, selected all blocks within ¼ mile.
Aggregated total population residing in those
blocks in SPSS for all blocks within the CC
Location of bike St Paul, Dept of
& ped collisions Public Works,‘03-07
Summed total number of bike and ped
collisions in CC
Small, minority- U-PLAN survey
owned
businesses
Selected all businesses located in St Paul only;
summed institutions identified as “small” and
as “minority-owned”
77
Ex: Healthy Corridor for All – Students by
Race
78
Ex: Healthy Corridor for All – Transit
Dependence
79
Ex: Healthy Corridor for All – Community
Assets
80
Ex: Farm to School – Research Questions
HB 2800 Farm to School
http://www.healthimpactproject.org/resources/document/Upstream-HIA-Oregon-Farm-to-School-policy.pdf
81
Ex: Farm to School – Statewide maps
HB 2800 Farm to School
Percent of Oregon population in poverty, 2009
http://www.healthimpactproject.org/resources/document/Upstream-HIA-Oregon-Farm-to-School-policy.pdf
82
Step 3: Assessment – Analyze potential
health impacts
Main goals:
1. Profile baseline conditions, characteristics of target
populations
2. Analyze potential health effects of decisions
83
Analysis – Literature Review
Literature Review
84
Analysis: Qualitative & Quantitative Data
Qualitative
Quantitative
 Behaviors, beliefs
 Statistics, models
 Focus groups, interviews,
surveys, transcripts
 Census data,
epidemiological studies,
direct sampling, modeling
85
Analysis – Example methodology
86
Analysis: Healthy Corridor for All
Healthy Corridor For All
 Mixed methods
 Qualitative: literature
review, public meetings
 Quantitative: extensive use
of existing data for
summary statistics and
predicting impacts
87
Analysis: Healthy Corridor for All (cont.)
Healthy Corridor For All
Increased pedestrian injury and/or fatalities due to unsafe intersections are likely
UNSAFE INTERSECTIONS FOR PEDESTRIANS RELATIVE TO PROJECTED INCREASES
IN HOUSING BY STATION AREA
88
Analysis: Farm to School
HB 2800 Farm to School
 Mixed methods
 Qualitative: literature review,
interviews, community forums
 Quantitative: secondary data
analysis, economic
procurement analysis (IMPLAN)
Photos from: http://www.upstreampublichealth.org/sites/default/files/F2SHIA_FINAL.pdf
89
Analysis: Farm to School (cont.)
HB 2800 Farm to School
90
Assessment
In THEORY:
In PRACTICE:
 Identify determinants
 Multiple interacting factors
 Complete baseline profile
 Assess potential impacts
 Estimate change in
population health
that could affect health
 Lack of data or empirical
evidence
 Lack of consensus amongst
stakeholders
91
Assessment - Summary
 You don’t have to predict everything with absolute
certainty
 Look at all the evidence available and make an informed
judgment based on
 analysis of data
 expertise
 experience
 Validity = Transparency
92
Exercise
 If you were going to do an HIA on ….
 What information or analysis would you need?
 Talk amongst your group.
93
HIA Scoping Worksheet (Part 2)
Project:
Health
Determinant:
Geographic
Scope:
Existing
Impact
Conditions
Research
Research
Questions
Questions
Indicators
Data
Sources
Methods
Priority
Notes
94
Step 4: Recommendations

95
Six Steps of HIA: Recommendations
1.
Screening - determine if HIA is useful for specific project or policy
2.
Scoping - identify health effects to consider
3.
Assessment – perform research, determine populations affected &
how
4. Recommendations - suggest changes
to proposal to promote positive or
mitigate adverse health effects
5.
Reporting - present results to decision-makers
6.
Monitoring and evaluating - determine effect of HIA on decision
process
96
Recommendations
Assessment work
• Baseline profile
• Lit Review
• Impact analyses
Stakeholder input
• Decision leaders
• Affected parties
Recommendations
•
•
•
•
Mitigate negatives
Promote positives
Offer alternatives
Take a position
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What makes a good HIA
recommendation?

Specific & immediately actionable

Identifies lead organizations & roles in implementation

Best practices or evidence-based

Reflect scoping priorities and predicted impacts

Measurable

Feasible

Economical
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Recommendations: Specific &
immediately actionable
Bad: Increase commercial parking
vs
Good: Adopt regulations that would allow use of
undeveloped parcels for temporary parking lots to relieve
parking problems during light rail construction and in the
near term. Temporary lots must meet standards to control
impacts on local traffic and minimize aesthetic impacts
(HCFA)
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Recommendations: Identifies lead
organizations & roles in implementation
Bad: Increase efforts to market food products from Oregon
vs
Good: The OR State Department of Agriculture & the OR
Department of Education should collaborate with the OR
Agriculture Extension Service to help producers develop marketing
materials that communicate a product’s “produced or processed
in OR status”…& help school district buyers develop & use
language in their Request for Proposals that specify an OR product
preference (F2S)
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Recommendations: Best practices or
evidence-based
Good: …recommendation regards use of Oregon food items in
school meals. Much of Farm to School research is centered on
salad bars, and they have been shown to increase the amounts of
fruits and vegetables consumed by children…(F2S)
Good: The proposed changes to the zoning ordinance would
include…specific cross-references to adopted plans and policies to
strengthen basis for regulation (e.g., Housing Plan 2010, Central
Corridor Development Strategy, etc.). (HCFA)
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Recommendations: Reflect scoping
priorities and predicted impacts
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Recommendations: Measurable
Good: The First Source Hiring Program would require that all
applicants notify the St. Paul Human Rights & Equal Economic
Opportunities Department of available job openings. The
contractor would be required to maintain a log of referrals to
allow the program to monitor compliance. (HCFA)
Good: Schools could identify & promote the Aggregated Nutrient
Density Index (ANDI) scores for different salad bar items. ANDI
scores incorporate a food item’s nutrient to calorie ratio; foods
with higher ANDI scores are nutrient dense and calorie light. (F2S)
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What makes a good HIA
recommendation? (cont.)
 Feasible (technically & politically)
 Economical
 However…
Measurable
Feasible
Economical
Creative
Controversial
Bottom Line: Positive Health Impact &
Community Supported
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Recommendations Exercise
Good HIA Recommendations are . . .

Specific & immediately actionable

Identifies lead organizations & roles in implementation

Best practices or evidence-based

Reflect scoping priorities and predicted impacts

Measurable

Feasible

Economical
105
Step 5: Reporting

106
Step 5: Reporting - Objective
 Objective
 Develop HIA report and communicate
findings and recommendations
107
Transparency in HIA Reporting
Practice Standards call for the public release of an HIA and a
transparent accounting of the process and findings
 Allows findings to be reviewed and improved
 Informs affected communities of possible health impacts
 Informs agencies of potential changes in demand for
services (emergency response, etc.)
 Warns those potentially responsible for impacts
 Allows people to take voluntary actions to avoid risk
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Reporting: Refer to Communication Plan
 Refer to HIA Communications Strategy or Plan
 Goals
 Audiences
 Objectives, Strategies, Tactics
 Key messages
 Spokespeople and messengers
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Examples of HIA Reporting
 Formal report
 Letters to proponents and
decision-makers
 Comment letters on or reports
included in draft EIS
 Public testimony
 Presentations
 Peer-reviewed publications
 Website
Source: Human Impact Partners. HIA General Training Slides. August 27, 2012.
http://www.humanimpact.org/hia-training
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Reporting: Writing the Report
 Essential Tasks:
 Determine format and
structure
 Write the report
 Offer opportunity for
meaningful feedback on report
 Update report or address
substantive criticism through a
formal written response
 Implement communications
plan
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Example: Reporting - Communications
 Bottineau HIA
 Released draft HIA report
 Published summary in 5
languages: English, Hmong,
Laotian, Somali, and
Spanish
 Advertised 2 month public
comment period (July 15 –
Sept 15)
 Incorporated feedback
from stakeholders and the
public into final HIA report
(Releases December)
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Reporting Exercise
 Who are you trying to
reach?
 How would you reach them?
(creative venues/media?)
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Step 6: Evaluation & Monitoring

114
Step 6: Evaluation & Monitoring:
Evaluation
Evaluate:
 The process of conducting the HIA
 Impacts on the decision-making process and
implementation of the decision
 Impacts of the decision on health outcomes
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Evaluation: Process Evaluation
 Process evaluation—seeks to understand how
the HIA was conducted
 Process evaluation of the HIA:
 What were the successes?
 What were the challenges?
 What worked?
 Who should we include next time?
 What data sources will you need in the future?
 Did the HIA meet the HIA minimum standards?
 Report on evaluation so that new HIA practitioners
can learn from your successes and challenges
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Process Evaluation from GND HIA
 Performed a self-evaluation.
 Answered key questions:
 Level of knowledge of HIA before & after project?
 What did you learn? What benefits did you gain?
 Was HIA an effective tool?
 How satisfied were you with the process and what
would you change?
 What were/are the challenges or barriers?
 How has health data been useful in the process?
 Was the process inclusive and/or transparent?
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Example Evaluation: GND HIA
 Level of knowledge of HIA (1 – 5):
 Before: 1.8
 After: 3.3
 Effectiveness of HIA as a tool:
 Overall responses were positive
 Effective depending on the implementation of SAP
 Changes:
 HIA training/instruction at the beginning of the
process
 More frequent, longer meetings
 Timing: Do HIA between planning and implementation
118
to inform implementation of specific strategies
Example Evaluation: GND HIA (cont.)
 Barriers/Challenges:
 Ensuring community participation and the difficulties
getting the right people engaged in the process
 Concerns that staff wouldn’t know how to implement
the HIA recommendations
 Ensuring that the HIA does not become “a series of
familiar platitudes that look good on paper”
 Inclusiveness/ Transparency of Process:
 Transparency good
 Process should have included more of the affected
populations
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Impact Evaluation
Impact evaluation seeks to understand the impact of
the HIA itself on the decision and the decisionmaking process
 It typically looks at:
 Impact on the decision
 Impact the decision-making process
 New collaborations
 Increasing awareness of previously unrecognized
health impacts
120
Outcome Evaluation
 Impacts of the decision on health outcomes
 Changes in exposures
 Health outcomes/determinants
 Unexpected consequences
 Difficult or impossible to evaluate
 the wide variety of factors that impact health
outcomes
 the inability to accurately track what factors may have
influenced a particular health outcome
 the length of time from implementation of a decision
to observable changes in health indicators
 the lack of suitable comparison groups
121
Monitoring
4. Adjust
Recommendations
1. Develop
Recommendations
3. Monitor
Recommendations
2. Implement
Recommendations
122
Indicator
Agency
Responsible for
Monitoring
Timing
Commercial Development - Improvement
in the business climate/cooperation and
increase in the number of businesses.
City Planning, DEDA,
GND Community Club,
Visit Duluth/Parks &
Recreation (wayfinding)
Residential Development – Process
developed to welcome new residents to
the community and a focus on people with
disabilities / senior care
Natural Environmental – Plan developed
for enhancing planting of trees,
development of the GND Recreation Area
and energy efficiency.
GND Community Club,
City Planning, DEDA
2016; Varies
dependent on
objectives noted in
the HIA to improve
the business
environment.
First quarter 2015
Social cohesion
Transportation – Completion of condition
survey of sidewalk/street/trails condition
Trigger
threshold
Health Monitoring Plan
City Planning, GND
First quarter 2015
Development Alliance,
GND Business Association
City Planning, GND
Community Club, MIC,
MnDOT
Park Planning – Starting capital
GND Development
improvements all the way to completion of Alliance, Parks &
the GND Community Center and
Recreation
Recreation Area.
2015-2017
First quarter 2015
Establishment of
GND Business
Association.
Establishment of a
“welcoming”
process.
Commencement
of capital
improvements at
the GND
Recreation Area.
Survey completed
with action plan.
Commencement
of capital
improvements at
the GND
123
Recreation Area.
Final Words about Evaluation
 Some see evaluation as a separate
process—objectivity, funding,
timeframe
 Lack of attention to evaluation is a
barrier that will need to be overcome if
HIA practice is to be advanced in the US
124
Review: HIA Steps
1. Screening - to determine if an HIA is useful for a
specific project or policy
2. Scoping - identify which health effects to consider
3. Assessment - determine which people may be
affected and how they may be affected
4. Recommendations - suggest changes to proposal to
promote positive or mitigate adverse health effects
5. Reporting - present the results to decision-makers
6. Evaluation and Monitoring - determine the affect of
the HIA on the decision process
125
HIA Reports




Improving Health in the United States: The Role of
Health Impact Assessment
(http://www.nap.edu/catalog.php?record_id=13229)
Minimum Elements and Practice Standards for Health
Impact Assessment
(http://www.humanimpact.org/doc-lib/finish/11/9)
Guidance and Best Practices for Stakeholder
Participation in Health Impact Assessments
(http://www.hiasociety.org/documents/guide-forstakeholder-participation.pdf)
Promoting Equity through the Practice of Health Impact
Assessment:
(http://www.policylink.org/atf/cf/%7B97c6d565-bb43406d-a6d5eca3bbf35af0%7D/PROMOTINGEQUITYHIA_FINAL.PDF)
126
Resources: HIA Websites

MDH HIA webpage
(http://www.health.state.mn.us/divs/hia/)

CDC Healthy Places webpage
(http://www.cdc.gov/healthyplaces/hia.htm)

World Health Organization HIA webpage
(http://www.who.int/hia/en/)

HIA Gateway – Public Health England
(http://www.apho.org.uk/default.aspx?QN=P_HIA)

UCLA – HIA Guide web
(http://www.hiaguide.org/)

Health Impact Project website
(http://www.healthimpactproject.org/)

Design for Health website
(http://www.designforhealth.net/resources/healthi
mpact.html)

Healthy Development Measurement Tool website
(http://www.thehdmt.org/)
Source: http://www.policylink.org/atf/cf/%7B97c6d565bb43-406d-a6d5eca3bbf35af0%7D/PROMOTINGEQUITYHIA_FINAL.P
DF
127
Evaluation
 Please fill out the evaluation
form!
128
Thank you!!!
Kelly Muellman
kelly.muellman@state.mn.us
651-201-5637
Linden Weiswerda
linden.weiswerda@state.mn.us
651-201-4924
http://www.health.state.mn.us/divs/hia/
http://www.health.state.mn.us/divs/climatechange/
129