Health Impact Assessments:
The Massachusetts Experience
Healthy Transportation Advisory Council Meeting
June 2, 2014
Suzanne K. Condon, Associate Commissioner Margaret Round, Chief, Air Toxics
Director, Bureau of Environmental Health
Environmental Toxicology Program
Massachusetts Department of Public Health
Bureau of Environmental Health
Outline
I.
II.
Introduction: Steps of an HIA
Examples of Health Impact Assessments in Massachusetts
 Transportation Reform In Massachusetts
III.
Examples of Baseline Health Data Available for HIAs
IV.
Possible Criteria To Target Transportation Projects Where HIAs Might Be Most Useful
V.
Summary
I. Steps of HIA
Screening
Scoping
Identify and prioritize topics for HIAs
Identify health issues to be studied
Prioritize Research questions
Assessment
Conduct literature reviews
Research existing conditions data
Conduct surveys, interviews, focus groups
Conduct data analysis
Interpret and ground truth data
Recommendations Identify and prioritize recommendations
Reporting
Write, review and edit final report
Develop a communication, media and advocacy plan
to report findings on decision makers
Monitoring
Collect data on impacts
Hold decision-makers accountable for decision
agreements and mitigations
II. Examples of HIA Topics Addressed in Massachusetts
The HIA work at MDPH is a collaborative effort between the
Bureau of Environmental Health and Bureau of Community
Health and Prevention:
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Development of a Rail Trail*
Speed limits*
Rail trail development*
Development private equity fund to support transit oriented development projects *
Transportation planning study*
Multi-use development of land parcels
Implementing HIAs in Massachusetts
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Assess baseline health outcomes
o Elevated childhood obesity was identified in study area
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Compare baseline data with environmental exposure data to understand health impacts
o Disease burden expected to be reduced based on projected reduction in exposures associated with
motor vehicle emissions
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DPH/BEH maintains robust data sets available for assessing environmental exposures and health outcomes
to address health equity concerns
o Health Data: cancer, pediatric asthma data at neighborhood level
o Environmental Data: air quality and water quality
Transportation Reform in Massachusetts
Transportation Reform Law
In June 2009 Governor Deval Patrick signed the
Transportation Reform Law - M.G.L. Chapter 6C
The primary goal was to consolidate all transportation agencies in MA to reduce duplicate efforts and enhance transportation planning
Picture of Governor Deval Patrick signing the bill into law.
Healthy Transportation Compact

Under M.G.L. Chapter 6C, Section 33 the Healthy Transportation Compact is directed to:
o (v) establish methods to implement the use of health impact assessments (HIAs) to determine the effect of
transportation projects on public health and vulnerable populations; and
o (x) institute a health impact assessment for use by planners, transportation administrators, public health administrators
and developers.
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Transportation planning projects often have a range of health implications that are not uniformly considered but can be now
with EPHT data
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MDPH was awarded funds from the RWJ/Pew Health Impact Project to conduct a transportation-related HIA
Interagency Working Group
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Monthly meetings beginning in late 2009
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Discussion about:
o What is an HIA – do we need a MA definition?
o Need for cross agency framing to develop common understanding
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Inventory by agencies of interagency work related to transportation
o What worked best?
o What hurdles were met?
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Greater clarity on what is involved in existing transportation planning process
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Identification of a transportation project that could benefit from early incorporation of HIA into decision making process
III. Transportation Reform in Massachusetts
Overall Goal to Meet HIA Directives of Transportation Reform
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The goal of the proposed transportation-related HIA project is to work together with MassDOT, EEA and other community
representatives to:
Pilot an HIA
Pilot an HIA of a proposed
transportation related
project
Serve as a vehicle for training staff
responsible for implementing the HIA
directives
III. Transportation Reform in Massachusetts
Provide the framework for developing methods to determine which
types of transportation projects might benefit from an HIA and the
process to make such determinations
Background on “Grounding McGrath” Study
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Project underway by the MassDOT that the HIA will inform is “Grounding McGrath” Study in Somerville, MA
o Overall this transportation project aims to determine the future of the Route 28 corridor
o MassDOT indicated that the size of the investment necessary to restore the highway provided an opportunity to
evaluate the feasibility, benefits, impacts, and costs of removing at least a portion of the elevated structure on Route
28/McGrath Highway
o MassDOT’s existing study protocol lends uniquely to the HIA process including establishment of an Advisory Group
composed of community representatives to evaluate alternatives
The HIA will provide supplemental health data analyses to augment
the “Grounding McGrath” Study to promote decision making for optimal transportation design
III. Transportation Reform in Massachusetts
Picture of McGrath-Obrien Highway and
Aerial view of McGrath Highway, Somerville, MA by Google Maps 6/18/2010
III. Examples of Baseline Health Data For Consideration in HIA
Health Determinants
Air pollution – high gradient near
roadways and scientific evidence that
continues to emerge regarding health
impacts
Access to active transportation and
increasing physical activity (e.g., access to
sidewalks, bicycle paths)
Access to public transit mobility for
vulnerable populations (people with
disabilities, elderly)
Traffic Safety
Data Sources
Health Outcomes
Respiratory disease/illness (e.g., asthma),
cardiovascular disease (e.g., heart attack),
all-cause mortality, certain cancers
Benefits for reducing obesity, diabetes,
cardiovascular disease, premature
mortality, improved mental and physical
health
Access to goods/services that support
health, such as groceries, clinics
Injury to pedestrians, vehicle drivers, and
cyclists
Economic: vitality of small businesses;
property values and health care costs that
could be reduced based on HIA outcomes
Multiple indirect impacts on health
Environmental Justice
Multiple indirect impacts on health
MDPH Bureau of Environmental Health
Environmental Public Health Tracking
(EPHT) Portal
http://matracking.ehs.state.ma.us/
MDPH Bureau of Community Health and
Prevention
MassDOT
MassDOT
Economist to be hired
EEA/MDPH EPHT/MassDOT
Vulnerable Populations: Environmental Justice Areas
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Vulnerable populations
defined using EOEEA designation of an Environmental Justice community
o The median annual household income is at or below 65 percent of the statewide median income for Massachusetts; or
o 25 percent of the residents are minority; or
o 25 percent of the residents are foreign born, or
o 25 percent of the residents are lacking English language proficiency
Image of Map showing Environmental Justice Criteria met according to the
American Community Survey, 2006-2010
EJ Criteria: Income, Minority Population, foreign-born, English Proficiency
& Education
Boulevard alternative shown as a reference point.
Highlights of Findings
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Two optimal alternatives are the Boulevard Alternative and Boulevard with Inner Belt Connection Alternative because they
offer the greatest opportunities for mobility and access.
o The fact that significantly more children are currently obese compared to the statewide average indicated that alternatives
that promote healthy behaviors are paramount.
o Given that the study area is classified as an Environmental Justice community, it is critical that long-term plans that involve
current residents are developed to ensure affordability of goods and services, stabilization of the cost of rental apartments,
and employment opportunities are made available.
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Conducting an HIA in tandem with the first phase of a transportation planning study can provide good preliminary information
on health impacts at an early stage of project development. However, a more detailed and precise assessment of health impacts
and benefits of proposed alternatives would be possible at a later stage of project development, once more robust
project-specific information and transportation data become available.
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Existing, publicly available health data resources, such as the MDPH/BEH Environmental Public Health Tracking portal
(matracking.ehs.state.ma.us), are available to asses existing health conditions and potential health impacts associated with
transportation projects.
Possible Criteria for Incorporating HIA into Other Transportation Projects
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Roadway Projects
Traffic volumes significantly
increase
Transit and Train Projects
 Significant increases or decreases in
service
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Airport Projects
Significant increase in number of
flights
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Highway expansion projects
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New stations or stations to be
decommissioned
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Addition of new runways
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Projects that increase motor
vehicle emissions to residents
within 300m
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Any changes that could result in mode
shift (e.g. between train, transit,
walking, biking)
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Change in size, type of aircraft
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Change will result in additional traffic
to airport
Changes that could result in mode
shift (e.g. car to walking, biking,
transit
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New parking areas that may increase
idling/PM exposure
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Changes that will result in shorter
distances from runways or taxiways to
residents
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Significant changes that could
result in housing destruction or
displacement of residents
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Significant changes that could result in
housing destruction or displacement of
residents
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Changes in access to goods and
services
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Changes in access to goods and
services
Additional Thoughts for Targeting Transportation
Projects Where HIAs Might Be Most Useful
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In addition to the criteria by transportation mode, some projects subject to the Massachusetts Environmental Policy Act (MEPA)
might be considered:
1. Any transportation project that will exceed MEPA (301 CMR 11.00) Review Thresholds, with particular regard to those
Thresholds in the Transportation Category (301 CMR 11.03 (6))
2. An HIA for any transportation project that has the potential to impact an Environmental Justice (EJ) population. The policy
participation and enhanced analysis of impacts and mitigation under MEPA for projects that exceed thresholds for air, water,
hazardous waste (other than remediation projects) or wastewater and sewage sludge treatment and disposal
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Also proposed using HIA as a decision support tool in climate change adaptation planning at the local level in MA
Summary
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HIAs provide unique opportunity for public health officials to work collaboratively across agencies and secretariats. MDPH will
present findings and recommendations to the Healthy Transportation Compact in December 2013 along with proposed criteria for
determining which transportation projects might best benefit from an HIA
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The HIA will now go through the MEPA process. This will provide an opportunity to determine if HIAs facilitates that process
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Transportation reform in MA allows us to explore and establish optimal HIA methodologies
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Use of HIAs in transportation planning and projects subject to MEPA promotes national HIA planning efforts