Health Impact Assessment
Training

Kristin Raab, MLA, MPH
MN Climate & Health Program Director
Kelly Muellman, MURP
MN Climate & Health Program Planner
Brenda Hoppe, PhD
MN Climate & Health Program Epidemiologist
September 13, 2013
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.
2
Agenda

Welcome & Introductions

Connections between health and the environment

Introduction to HIA

Haila Maze, AICP, City of Mpls—Introduction to ATF Plan

Step 1: Screening & Exercise

Step 2: Scoping & Exercises

Step 3: Assessment

Jared Erdmann, MPH, City of Mpls—Reflections on ATF HIA

Step 4-6: Recommendations, Reporting &Monitoring and
Evaluation

Training Evaluation
3
Today . . . . .
Think “Health”
Slide 1
Complete Street’s Photostream - Flickr
Slide 2
©Ann Forsyth. Used with permission.
Slide 3
Atlantacitizen at the English language Wikipedia [GFDL (http://www.gnu.org/copyleft/fdl.html) or
CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0/)], from Wikimedia Commons.
Slide 4
© Regents of the University of Minnesota.
Used with the permission of Metropolitan
Design Center.
Slide 5
Bob Nichols / Photo courtesy of USDA Natural Resources Conservation Service
9
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
10

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
2000 Avg Life Expectancy and Healthcare Spending
http://ucatlas.ucsc.edu/spend.php
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.
13
What do Minnesotans die from?
Leading causes of death in Minnesota: 2010
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
166.9
118.7
36.4
35.8
35.1
Health & the Built Environment
Planning/Design
Issues
Health Issues
• Disconnected Land Use
Patterns
• Physical Inactivity
• Land Fragmentation
(Loss of farmland, open
space, wetlands, etc…)
• Mental Health Issues
• Low Density
• Auto Dependency
• Congestion
• Poor Diet & Nutrition
• Decreased Social
Capital
• Poor Air Quality
• Increase in Car Crashes
• Trail/Sidewalk Gaps
• Increase in Bike/Ped
Injuries
• Limited Choices
• Poor Water Quality

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.
16
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:
17
November 2010.
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
18
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
19
HIA in the U.S.
247 HIAs
(8/9/2013)
Source: Health Impact Project
20
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 (Sept, WDC)
21
HIA in Minnesota
 MN HIA Coalition
 BlueCross BlueShield
Foundation of
Minnesota
 MDH website/listserv
 Training:

MDH 1-hour online
training
22
MN HIA Coalition: Draft Goals

Educate on and promote the appropriate use of HIA.

Share information, tools, best practices and lessons learned (especially
what works and what doesn’t) from HIAs.

Collaborate on and coordinate (when applicable) HIA-related activities.

Seek and vet future projects for HIA funding opportunities.

Promote/systematize policies, legislation and funding for HIAs and Health
in All Policies.

Seek funding to support MN HIAs.

Develop a strategic plan/workplan to accomplish goals.
23
History of HIA in MN
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:
th
6 Ave
E Redesign
 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
26
Douglas County Comp Plan HIA
 Evaluated the May 2010 Douglas
County Comprehensive Plan
 Recruited Advisory Committee
 Aging population
 Social capital
 Access to places
 Safety & transportation
 Recommended specific language and
policy statements
 Recommendations adopted into plan
Divine Mercy Development HIA
 Desktop HIA
 Mixed use development, 181
acres, near Faribault
 Church campus, school, lowdensity residential, senior living,
townhomes, commercial
 10 Health Categories: Air Quality,
Land Development, Parks, Trees &
Vegetation, Transportation, Housing,
Food, Water, Noise, and Safety
 26 health indicators
 Results shared with developer
Healthy Corridor for All
 1st Comprehensive HIA in MN
 Community driven: ISAIAH, Take
Action MN, PolicyLink
 3 Areas of Assessment:
 Healthy Economy
 Healthy, Affordable Housing
 Safe and Sustainable
Transportation
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. Monitoring and evaluating - determine the affect of
the HIA on the decision process
30
Example project: Above the Falls
 Presentation on the
Above the Falls Master
Plan by Haila Maze, AICP,
City of Minneapolis
31
Step 1: Screening

32
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? 33
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
34
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
35
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?
36
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?
37
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
38
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?
39
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?
40
HIA Screening
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?
41
Screening Exercise

42
Example: Above the Falls Master Plan

Focus area includes or adjacent to diverse
neighborhoods with large health disparities

Land use barriers to accessing the river

Proposal to transition predominantly industrial ->
parks and residential land uses

Health concerns: water, noise and air pollution

Master Plan update – incorporate findings from:
 ATF Policy Review & Implementation study
 Park Board’s RiverFirst visionary design
 HIA recommendations
43
HIA Screening
 Example screening
worksheet
44
ATF Screening
 ATF Screening Criteria
 the strength of the connection between the land use





alternative and health;
the extent of potential impact (i.e. reach) among the
resident populations;
timing of implementation of the land use alternative
such that it could be informed by the HIA;
stakeholder support for the alternative;
potential health effects on current health status of
priority populations; and
effect on the local economy.
45
HIA Screening
The worksheet should have helped you 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
 Will the proposed project benefit from an HIA and
promote health and support positive change in the
community?
46
Step 2: Scoping
Two Main Goals:
1. Create the plan for the HIA
2. Determine health
indicators to be assessed
Health issues that
will be assessed
47
Scoping: Create the Plan for the HIA
Determine:
 Team responsible for
conducting the HIA
 Group who will oversee
the HIA process
48
Scoping: Create the Plan for the HIA
How should stakeholders
and the affected
communities be involved?
 Advisory Committee
 Steering Committee
 Technical Committee
 Public meetings
 Small group discussions
49
Scoping: Healthy Corridor for All
 Established three groups to implement the HIA:
 HIA Team, HIA Steering Committee & HIA Technical
Advisory Committee
50
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—is
everyone at the table?
 Geographic area
 Population(s) and
subpopulations to be studied
51
ATF HIA

The HIA study area included ten
Minneapolis neighborhoods: Hawthorne, Near
North, McKinley, Webber-Camden, and Lind-Bohanon, St.
Anthony West, Sheridan, Bottineau, Marshall Terrace, and
Columbia Park.
Goals of the HIA:
1. Elevate health considerations during the
ATF plan revision process;
2. Maximize potential health benefits and
mitigate identified risks of proposed
changes;
3. Receive input from diverse stakeholders
including groups not reached previously;
and
4. Serve as a catalyst for accelerated
redevelopment efforts along the Upper
Mississippi Riverfront in Minneapolis.
52
Scoping continued . . .
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
*scoping flows into assessment
+data
sources & methods-discussed in assessment
53
Healthy Corridor for All HIA
First meetings:
 Discussed vision for the
community
 Discuss range of possible issues
 Voted
 3 Areas of Assessment:
1. Healthy Economy
2. Healthy, Affordable Housing
3. Safe and Sustainable
Transportation
54
Farm to School and School Garden Policy
 Bill 2800 (HB 2800), the Farm to School and School Garden
legislation, as introduced in January of 2011:
 (1) allocate $19.6 million in state funds, equivalent to 15 cents per
lunch and 7 cents per breakfast, to reimburse schools for
purchasing Oregon food products, and
 (2) provide $3 million in competitive education grants to support
food, garden and agriculture activities, up to 150 school teaching
gardens each fiscal year.

Source: Henderson, T., Rader, M., Sorte, B., Ratcliffe, M. M., Lawrence, A., Lucky, J., and Harris, C. (2011)
Health Impact Assessment: Farm to School and School Garden Policy, HB 2800, Upstream Public Health and
the Health Impact Project. http://www.upstreampublichealth.org/sites/default/files/F2SHIA_FINAL.pdf
Scoping: Health Determinants
1.
Employment
2.
Diet & Nutrition
3.
Farm to School & School
Garden Education
4.
Environmental Health
5.
Social Capital
All pictures and text from:
http://www.upstreampublichealth.org/sites/default/files/F2SHIA_FINAL.pdf
Above the Falls HIA: Exercise
57
ATF HIA
 Determined land-use
decisions to evaluate
 Health issues:
 Obesity
 Mental Health
 Environmental Quality (air,




noise and water quality)
Safety and Security
Neighborhood Cohesion
Neighborhood Livability
Employment
58
Scoping II: Pathway Diagrams

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…
60
Scoping - Pathways
Source: Oregon Farm to School and School Garden
Policy, HB 2800 Health Impact Assessment
61
Scoping - Pathways
Source: Healthy Corridors for All HIA
62
ATF Land Use Alternatives
 HIA land use decision alternatives to be investigated:
1. To add 108 acres of parkland;
2. To extend existing Riverfront biking and walking trails
by 4.2 miles.
3. To add over the long term 3000 jobs; and
4. To add over the long term 1000 new housing units.
63
Pathway Exercise
Proposed
Changes
Short Term
Outcomes
Intermediate
Outcomes
Health
Outcomes
Proposed
change
64
Scoping – Pathways: Access to Parks
Source: ATF
Draft HIA
Scoping: Access to Parks
Determining research questions/health indicators and
data sources
Ex: Access to Parks
 Research question:
 What impact would more parkland have on the health
of residents in the ATF and surrounding area?
 Health indicators:
 Percentage of adults who get the recommended levels
of physical activity
 Percentage of adults who are overweight or obese
 Percentage of adults who have ever had depression
66
Scoping – Pathways: Redevelopment
Scoping: Redevelopment
Determining research questions/health indicators and data
sources
Ex: Residential and Commercial Redevelopment
 Research question:
 What changes related to housing and economic
development could most impact the health of residents?
Positively? Negatively?
 Health indicators:
 Percentage of unemployment?
 Percentage of adults who agree their neighborhood is a
good place to raise children?
 Foreclosures
68
Potential impacts of proposed revisions to the ATF Plan on parks:
Page 1
Potential impacts of proposed ATF Plan revisions on trails and river connections:
Page 2
Potential impacts of proposed ATF Plan revisions on business and residential development:
Page 3
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
 Determine research questions, data sources &
methods
72
Step 3: Assessment

73
Case Studies
Healthy Corridor For All (MN)
http://sapcc.org/node/600
74
Case Studies
HB 2800: Farm to School and School Garden Policy (OR)
Photos from: http://www.upstreampublichealth.org/sites/default/files/F2SHIA_FINAL.pdf
75
Six Steps of HIA
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
76
Step 3: Assessment
Main goals:
1. Profile baseline conditions, characteristics of target
populations
2. Analyze potential health effects of decisions
77
Step 3: Assessment
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.
79
Baseline Profile
Scale discrepancies
Proxy measures
80
Baseline Profile
Healthy Corridor For All
 Health Economy
 Affordable, Healthy Housing
 Safe & Sustainable
Transportation
81
Baseline Profile
Healthy Corridor For All
 Measurability
 Availability
 Time & Resources
 Ability to answer research
questions, objectives
 Relevance
82
Baseline Profile
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”
83
Baseline Profile
84
Baseline Profile
85
Baseline Profile
86
Baseline Profile
HB 2800 Farm to School
http://www.healthimpactproject.org/resources/document/Upstream-HIA-Oregon-Farm-to-School-policy.pdf
87
Baseline Profile
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
88
Analysis
Literature Review
89
Analysis
Qualitative
Quantitative
 Behaviors, beliefs
 Statistics, models
 Focus groups, interviews,
surveys, transcripts
 Census data,
epidemiological studies,
direct sampling, modeling
90
Analysis
Healthy Corridor For All
 Mixed methods
 Qualitative: literature
review, public meetings
 Quantitative: extensive use
of existing data for
summary statistics and
predicting impacts
91
Analysis
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
92
Analysis
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
93
Analysis
94
Analysis
HB 2800 Farm to School
95
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
96
Assessment
 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
97
Step 4: Recommendations

98
Step 4: Recommendations
 Use results from assessment to develop
recommendations and mitigations to address
any negative health impacts and maximize
health benefits

Recommendations -- alternative ways to design a project, plan,
or policy including its location or timing to benefit health

Mitigations -- management strategies to lessen anticipated
adverse health effects of a decision
99
Recommendations
 Recommendations can focus on Process and/or
Outcomes
To improve the process of
decision making to be more
inclusive of health
considerations
Recommendations
To lessen identified adverse
health impacts or promote
health benefits
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
100
Recommendations
 Recommendations and mitigations should be:
 Responsive to predicted impacts
 Specific and actionable
 Best practices or evidence-based
 Experience-based and effective
 Technically feasible
 Politically feasible
 Economically efficient
101
ATF HIA Recommendation
 Work with existing
businesses; they will likely
continue to be located in
the ATF area. Explore ways
of effectively engaging
businesses to assist in
achieving the ATF plan
objectives, for example by
promoting environmentally
safe or greener practices
and increasing job density.
102
ATF HIA Recommendation
 Focus on improving already
existing residential areas and
housing along Riverway
streets that may have been
hit hard by the recession and
the housing and foreclosure
crisis to help mitigate crime
and safety concerns and
promote health through
well-maintained
neighborhoods.
103
ATF HIA Recommendation
 Explore alternatives for
youth, elderly, people with
disabilities and other
vulnerable populations to
access the Riverfront such as
planning for off-road trails to
accommodate biking and
walking traffic and public
transit.
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Recommendations: Example
Farm to School HIA:
Recommendations to legislation (HB 2800)

Reimburse schools only for purchased foods “produced” or
“processed” in Oregon so as to increase economic activity in our
state.

Agriculture and Garden education grants will be preferentially
given to schools serving:

1.
a low-income student population
2.
schools with a racially diverse student population
3.
schools in rural or urban areas with limited food access
Ensure grants support schools developing multiple-component
programs that increase child health benefits
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Recommendations: Example
Healthy Corridor for All HIA:
 Five Policy Recommendations for Moving Forward
1.
2.
3.
4.
5.
Community Equity Program
Codifying the Commitment to Affordable Housing
Density Bonus Program
Relieving the Lack of Commercial Parking
First Source Hiring
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Step 5: Reporting

107
Step 5: Reporting
 Two main products:
 Develop full HIA
report and
communicate findings
and recommendations
 Develop a succinct
summary for effective
communication
108
Reporting: Essential Tasks
 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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Report Structure
 Intro/Project Background
 Screening
 Scoping
 Stakeholder Engagement
 Assessment
 Recommendations
 Reporting
 Monitoring & Evaluation
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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)
Will incorporate feedback
from stakeholders and the
public into final HIA report
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Examples of HIA Reporting
 Letters to proponents and
decision-makers
 Comment letters on or reports
included in draft Environmental
Impact Assessment
 Formal report
 Presentations
 Peer-reviewed publications
Source: Human Impact Partners. HIA General Training Slides. August 27, 2012.
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Step 6: Monitoring & Evaluation
 Monitoring—What happened?
 Monitor recommendations & implementation
 Were the HIA recommendations adopted?
 Has the policy, program or plan been
implemented?
 Monitor health determinants and outcomes
 Were there changes in exposures, health
outcomes/determinants & any unexpected
consequences
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Monitoring Plan
 Develop a monitoring plan
 The monitoring plan should include:
1.
2.
3.
4.
5.
6.
goals for short- and long-term monitoring;
outcomes and indicators for monitoring;
lead individuals or organizations to conduct
monitoring;
a mechanism to report monitoring outcomes to
decision-makers and HIA stakeholders;
triggers or thresholds that may lead to review and
adaptation in decision implementation; and
identified resources to conduct, complete, and report
the monitoring.
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Evaluation
 Process evaluation—Considers whether the HIA
was carried out according to the plan and HIA
standards
 Impact evaluation—Seeks to understand the
impact of the HIA itself on the decision-making
process or on other factors outside the specific
decision being considered
 Outcome evaluation—Focuses on the changes in
health status/health indicators resulting from
implementation of the recommendations
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Evaluation
 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/Impact Evaluation from ATF HIA
 Performed a self-evaluation.
 Answered key questions:
 What was accomplished during the various steps of




the HIA process and how was it accomplished?
What were some of the major successes and
challenges during each step of the process?
What changes happened to the Above the Falls Plan
because of the HIA?
What partnerships have formed from the HIA process?
How do you see these partnerships working in the
future?
How has health data been useful in the process?
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Some findings from the ATF HIA Eval

Process: Training & technical assistance
was important for HIA fidelity

Process: Documentation & writing of
reports took a long time

Process: Challenges with
screening/scoping/focus—too many
possible land-use decisions under
consideration; diversity of perspectives
& stakeholders

Impact: Elevated health considerations
in the ATF Plan—HIA was incorporated
into the adopted plan

Impact: Received input from diverse
stakeholders including groups not
previously reached
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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
119
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. Monitoring & Evaluating - determine the affect of the
HIA on the decision process
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HIA Reports

Improving Health in the United States: The Role
of Health Impact Assessment

Minimum Elements and Practice Standards for
Health Impact Assessment

Guidance and Best Practices for Stakeholder
Participation in Health Impact Assessments

Promoting Equity through the Practice of Health
Impact Assessment
Resources: HIA Websites

MDH HIA website

Centers for Disease Control HIA
website

World Health Organization HIA website

Public Health England HIA website

UCLA HIA Clearinghouse

Health Impact Project website

Design for Health: HIA Resources

Sustainable Communities Index
(formerly HDMT)
Thank you
Kristin Raab
Kelly Muellman
kristin.raab@state.mn.us
kelly.muellman@state.mn.us
651-201-4893
651-201-5637
Brenda Hoppe
brenda.hoppe@state.mn.us
651-201-4908
Special thanks to Health
Impact Project for
providing funding for the
training
MDH HIA website
MDH Climate Change website
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