Health Impact Assessment
Training

Kelly Muellman
MN Climate & Health Program Planner
Brenda Hoppe, PhD
MN Climate & Health Program Epidemiologist
December 18, 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.
 Special thank you to Blue Cross Blue Shield of
Minnesota Foundation for their sponsorship
of the training space and refreshments.
2
Agenda

Welcome & Introductions

Connections between health and the environment

Introduction to HIA

Step 1: Screening

Example HIA: Cloquet Transportation Planning HIA

Step 2: Scoping

Example HIA: St. Paul Emerald Ash Borer HIA

Scoping Exercise

Steps 3 & 4: Assessment & Recommendations

Step 5 & 6: Reporting & Evaluation and Monitoring

Training Evaluation
3
Today . . . . .
Think “Health”
Slide 1
Complete Street’s Photostream - Flickr
Slide 2
Slide 3
7
Slide 4
8
Slide 5
9
Slide 6
10
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
11

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.
14
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 & 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.
17
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:
18
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
19
Types of HIAs
Types of HIA
20
HIA in the U.S.
300 HIAs
(12/16/2013)
Source: Health Impact Project website
21
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)
22
HIA in Minnesota
 MN HIA Coalition
 BlueCross BlueShield
Foundation of
Minnesota
 MDH website/listserv
 Training
 Technical Assistance
MDH Health Impact Assessment website
23
MN HIA Coalition: Draft Goals
The purpose of the MN HIA Coalition will be to bring together communities
and organizations in Minnesota to:

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 and funding for HIAs and Health in All Policies.

Seek funding to support MN HIAs.

Develop a strategic plan/workplan to accomplish goals.
24
History of HIA in MN
designforhealth.net
History of HIA in MN (cont.)
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
27
Step 1: Screening

28
Step 1: Screening: What is 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? 29
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
30
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
31
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?
32
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?
33
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
34
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 impacted? 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?
35
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?
36
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?
37
5 Minute Brainstorm
 Project, Plan or Policy that might benefit from
an HIA
38
Cloquet Transportation Planning HIA
39
Step 2: Scoping

40
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
41
Scoping: Create the Plan for the HIA
Determine:
 Team responsible for
conducting the HIA
 Group who will oversee
the HIA process
 Stakeholder engagement
42
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
43
Scoping: Identify 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
44
Scoping: How to Involve Stakeholders
How should stakeholders
and the affected
communities be involved?
 Advisory Committee
 Steering Committee
 Technical Committee
 Public meetings
 Small group discussions
45
Scoping: How to Involve Stakeholders (cont.)
How should stakeholders
and the affected
communities be involved?
 Comment forms
 Project website
 Workshops
 Surveys
 Focus groups
 Design charrettes
46
Gary/New Duluth: Information Flow Chart
47
Gary/New Duluth: Stakeholder Engagement
 Technical Advisory Committee
 Community survey
 Paper (distributed widely)
 Online (Survey Monkey)
 Public meetings
 One-on-one meetings or calls
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
100
Scoping: 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
50
Scoping: First Meetings
First meeting(s):
 Discuss HIA workplan, timeline,
decision and alternatives
 Ground rules
 Goals of HIA & screening
 Communications plan
 Geographic area
 Population(s) and
subpopulations to be studied
51
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
52
Examine Range of Health Issues
 Concerns identified during stakeholder engagement
 Start baseline data investigation
53
Examine Range of Health Issues (cont.)
 Concerns identified during stakeholder engagement
 Start baseline data investigation
Population below Population under
poverty level
18 below poverty
level
Census Tract 38
Duluth
Minnesota
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%
54
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
55
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
56
St. Paul Emerald Ash Borer HIA

57
Health Impact Assessment (HIA)of
St. Paul’s Emerald Ash Borer
Management Plan
Sarah Rudolf, Project Coordinator
Minnesota Pollution Control Agency
Summary of EAB HIA Project
• 1 year comprehensive HIA
• Inform St. Paul’s EAB Management Plan
• Updated annually
• Does not currently consider human health
• Dedicated staff: 1 FTE, 1 PT student
• Steering Committee:
• City of St. Paul, State agencies, U of MN,
USDA
Value of EAB HIA Project
•
•
•
•
Plan does not account for human health
EAB activity reaching critical mass
Municipal funds limited
How can we best manage EAB?
• Activities
• Funding sources
• Public education/awareness
Ash Mortality from EAB
EAB 101
• Invasive Asian beetle
• Discovered in St. Paul in May 2009
• Targets ash trees
• 100% mortality
EAB in Action
Before and After EAB
Before EAB
After EAB
What Can Be Done?
• Monitoring
What Can Be Done?
• Monitoring
• Sanitation
• Infested trees
• Non-infested trees
What Can Be Done?
• Monitoring
• Sanitation
• Infested trees
• Non-infested trees
• Reforestation
What Can Be Done?
• Monitoring
• Sanitation
• Infested trees
• Non-infested trees
• Reforestation
• Pesticide treatment
What Can Be Done?
• Monitoring
• Sanitation
• Infested trees
• Non-infested trees
• Reforestation
• Pesticide treatment
• Public Awareness
What Can Be Done?
• Monitoring
• Sanitation
• Infested trees
• Non-infested trees
• Reforestation
• Pesticide treatment
• Public Awareness
• Biocontrols
HIA Activities to Date
• Completed
• 3 steering committee meetings (monthly)
• Project Coordinator hired
• Screening summary completed
• In Process
• Hire student worker
• Stakeholder engagement plan
• Scoping
Scoping
• Stakeholders
• Group brainstorm
• “Gain or lose” winnowing
• Quadrant exercise
Group Brainstorm
Stakeholder
group/ key
contact
St. Paul City
Council
Mayor’s Office
Excel Energy
Tree service
companies
Tree advisory
councils
District
councils
Why are they interested
in the HIA or related
decision?
Budget decisions for
Forestry
Power to
influence the
decision
How and
when (what
stage) to
engage?
Quality of life in St. Paul
Budget decisions for
Forestry
High
Reporting
Quality of life in St. Paul
Trees/power lines
High
Energy conservation via
shade
Privately owned ash trees
Potential
role in/
contribution Barriers/Challenges to
to HIA
engagement
Competing priorities
Competing priorities
Reporting
May not recognize EAB
as an issue impacting
their business.
Medium
City contractors
Highly interested in trees
and related issues
Low
?
Low
Throughout
Connection to residents
Low
Many companies, no
clear spokesperson
Gain or Lose
Category
Community based organizations
Residents
Service providers
Elected officials
Small businesses
Industry/ developers/big business
Public agencies
(Note: this group is also the HIA
steering committee)
Statewide/national advocacy
organizations
Academic, learning and research
institutions
Stakeholder Name(s)
Tree Advisory Panel
Cultural groups (Somali, Hmong, Native, Hispanic, African-American)
Watershed Management Orgs
District councils
Outdoor recreation groups (hiking clubs, etc.)
Xcel Energy
Healthcare providers/clinics/hospitals (example Children’s Hospital)
St. Paul City Council
St. Paul Mayor’s Office of Environmental Sustainability
St. Paul state delegation (eg Legislative Reps/Senators)
County Commissioners
Tree service/wood chipping companies
Firewood suppliers
Plant nurseries/MNLA (replacement trees)
St. Paul Chamber of Commerce
Home Improvement Centers (Home Depot, Menards, etc.) (pesticide and replacement trees)
St. Paul City Parks/Recreation Forestry Division
State & Federal agencies (MDH, MDA, USDA, MPCA, DNR)
Ramsey County/St. Paul Public Health
Other City Agencies (Public Works, Designers, etc.)
American Lung Association
Environmentally focused nonprofits (example GRG, Friends of Mississippi, Tree Trust)
Beekeepers/Pollinator Advocates
MNSTAC
Colleges/Universities in St. Paul
SPPS
U of MN Extension (RCMG)
Quadrant Exercise
High
interest
High power
Low power
St. Paul City Parks & Recreation/Forestry
St. Paul Mayor’s Office Environmental
Sustainability
WMOs
St. Paul City Council
Ramsey County
MDH
MDA
USDA
MPCA
DNR
Ramsey County Parks
Ramsey County Public Health
Tree Advisory Panel
Tree service/chipping companies
Firewood suppliers
Plant nurseries (MNLA)
MNSTAC
Beekeeper/pollinator advocates
Colleges and Universities in St. Paul
District Councils
 Cultural groups
Home Improvement Centers
Outdoor Recreation groups
American Lung Association
Environmental nonprofits
St. Paul Public Schools
Low interest St. Paul state delegation e.g. state
reps/senators
County commissioners
Xcel Energy
U of MN Extension/Ramsey County MGs
St. Paul Chamber of Commerce
Other city agencies
Healthcare community
Scoping
• Stakeholders
• Group brainstorm
• “Gain or lose” winnowing
• Quadrant exercise
• Goals
• Implications
• Scoping questions
• Identify existing data
Project Goals
• Inform the future of the St. Paul EAB
Management Plan and build capacity to advance
recommendations emerging from this HIA
• Identify impact of trees on human health
• Advance the dialogue of how urban trees impact
human health, and the importance of including
human health impact as a factor in urban treerelated decisions
• Forge lasting relationships among
partners/stakeholders that will go beyond this HIA
• Build capacity for HIA among project partners
Implications
•
•
•
•
•
•
•
•
•
•
Other cities'/states’ EAB Management Plans
Street tree master plan
Right of way trees, park trees
Urban Community forestry management plan
Plans for management of other tree species-specific pests/diseases
Educate residents on tree selection and care, and importance of
trees on private property
Identifying sustainable funding for urban forestry (federal, state,
local levels)
Further defining role/potential of urban forestry in improving air
quality
Improving/maintaining health of St. Paul residents via tree benefits
Assemble baseline human health data for future
Scoping Questions
• What decision alternatives will be evaluated?
• Which potential health impacts will be
considered?
• What are the demographic/geographic
boundaries?
• What data exist regarding existing/baseline
conditions?
• What are the priority health determinants?
• What new, or primary, data needs could be
considered?
Data
Name of Dataset
File Format
Geographic area or
population
covered
How
granular is
the data?*
Relevance to
Project (air,
water, tree,
housing, etc.)
Where is this
data
currently
housed?
Notes/Misc.
Example:
Asthma diagnosis
children <5
Excel
Ramsey County
Block group
Air
St. PaulThis data is from 2011
Ramsey
County Public
Health
Scoping Next Steps
•
•
•
•
•
•
Complete stakeholder chart
ID contacts and connect with stakeholders
Create pathway diagrams
Determine data holes
Develop research questions
Formal scope and workplan
Challenges
• HIA is new to PCA
• Steering committee
comprised of experts
• “Decision point”
• Implications beyond
stated purpose
Lessons Learned
•
•
•
•
Individual meetings with steering committee
Be strategic about how you work
Expect discomfort
Iterative process
Questions/Discussion
Sarah Rudolf, Project Coordinator
Health Impact Assessment
Minnesota Pollution Control
Phone 651-757-2564
Email sarah.rudolf@state.mn.us
Scoping II: Pathway Diagrams

Scoping: Part II
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
86
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…
87
Scoping – Pathways: Ex 1
Source: Oregon Farm to School and School Garden
Policy, HB 2800 Health Impact Assessment
88
Scoping – Pathways: Ex2
Source: Healthy Corridors for All HIA
89
Pathway Exercise
Proposed
Changes
Short Term
Outcomes
Intermediate
Outcomes
Health
Outcomes
Proposed
change
90
Pathway Diagrams

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
Gary/New Duluth: Recreation & Programming
Research Questions: Recreation & Programming
Determining research questions/health indicators and
data sources
Ex: Recreation & Programming
 Research question:

What impact would more parkland have on the health of
residents in Gary/New Duluth and surrounding
neighborhoods?
 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
93
Gary/New Duluth: Access to Healthy Foods
Research Questions: Access to Healthy Foods
Determining research questions/health indicators and data
sources
Ex: Access to Healthy Foods
 Research question:
 Does the Gary/New Duluth SAP increase the number of
households with access to fresh produce within ½ mile of
their home?
 Health indicators:
 Percentage of households within ½ mile of fresh produce?
 Proposed new businesses that might sell fresh produce
 Projected number of new residents
95
HIA Scoping Worksheet
Project:
Health
Determinant:
Geographic
Scope:
Existing
Impact
Conditions
Research
Research
Questions
Questions
Indicators
Data
Sources
Methods
Priority
Notes
96
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
97
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
98
Health Impact Assessment
Training

Step 3: Assessment
Brenda O. Hoppe, PhD
MN Climate & Health Senior Epidemiologist
December 18, 2013
99
Case Studies: Healthy Corridor for All
Healthy Corridor For All (MN)
http://sapcc.org/node/600
100
Case Studies: Farm to School & School Garden
HB 2800: Farm to School and School Garden Policy (OR)
101
Photos from: http://www.upstreampublichealth.org/sites/default/files/F2SHIA_FINAL.pdf
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
102
Step 3: Assessment: Main Goals
Main goals:
1. Profile baseline conditions, characteristics of target
populations
2. Analyze potential health effects of decisions
103
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.
105
Baseline Profile: Data limitations
Scale discrepancies
Proxy measures
106
Baseline Profile: Healthy Corridor for All
Healthy Corridor For All
 Health Economy
 Affordable, Healthy Housing
 Safe & Sustainable
Transportation
107
Baseline Profile: Healthy Corridor For All (2)
Healthy Corridor For All
 Measurability
 Availability
 Time & Resources
 Ability to answer research
questions, objectives
 Relevance
108
Baseline Profile: Data summary table
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”
109
Baseline Profile: Healthy Corridor for All - 1
110
Baseline Profile: Healthy Corridor for All - 2
111
Baseline Profile: Healthy Corridor for All - 3
112
Baseline Profile: Farm to School - 1
HB 2800 Farm to School
http://www.healthimpactproject.org/resources/document/Upstream-HIA-Oregon-Farm-to-School-policy.pdf
113
Baseline Profile: Farm to School - 2
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
114
Step 3: Assessment – Main Goals
Main goals:
1. Profile baseline conditions, characteristics of target
populations
2. Analyze potential health effects of decisions
115
Assessment: Literature Review
Literature Review
116
Assessment: Qualitative & Quantitative
Qualitative
Quantitative
 Behaviors, beliefs
 Statistics, models
 Focus groups, interviews,
surveys, transcripts
 Census data,
epidemiological studies,
direct sampling, modeling
117
Assessment: Healthy Corridor for All - 1
Healthy Corridor For All
 Mixed methods
 Qualitative: literature
review, public meetings
 Quantitative: extensive use
of existing data for
summary statistics and
predicting impacts
118
Assessment: Healthy Corridor for All - 2
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
119
Assessment: Farm to School
HB 2800 Farm to School
 Mixed methods
 Qualitative: literature review,
interviews, community forums
 Quantitative: secondary data
analysis, economic
procurement analysis (IMPLAN)
120
Photos from: http://www.upstreampublichealth.org/sites/default/files/F2SHIA_FINAL.pdf
Assessment: Analysis Tools
121
Assessment: Summary Tables
HB 2800 Farm to School
122
Assessment: Limitations
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
123
Assessment: Final Points
 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
124
Step 4: Recommendations

125
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
126
Step 4: Recommendations
Assessment work
•
•
•
Baseline profile
Lit Review
Impact analyses
Stakeholder
input
•
•
Recommendations
•
•
•
•
Mitigate negatives
Promote positives
Offer alternatives
Take a position
Decision leaders
Affected parties
127
What makes a good HIA
recommendation?

Specific & immediately actionable

Identifies lead organizations & roles in implementation

Best practices or evidence-based

Reflect scoping priorities & pathways

Broad focus on good, bad, & different

Identify evaluation measure

Feasible

Economical
128
What makes a good HIA
recommendation: Specific & Actionable
 Specific & immediately actionable
Increase commercial parking
vs
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)
129
What makes a good HIA
recommendation: Assign roles
 Identifies lead organizations & roles in
implementation
Increase efforts to market food products from Oregon
vs
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)
130
What makes a good HIA
recommendation: Use best practices
 Best practices or evidence-based
…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)
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)
131
What makes a good HIA
recommendation: Relates to findings
 Reflect scoping priorities & pathways
132
What makes a good HIA
recommendation: Broad focus
 Broad focus on good, bad, & different
Assessment work
• Baseline profile
• Lit Review
• Impact analyses
Stakeholder input
• Decision leaders
• Affected parties
Recommendations
•
•
•
•
Mitigate negatives
Promote positives
Offer alternatives
Take a position
133
What makes a good HIA
recommendation: Identify evaluation
 Identify evaluation measure
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)
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)
134
What makes a good HIA
recommendation: Practical (to a point)
 Feasible (technically & politically)
 Economical
 However…
Measurable
Feasible
Economical
Creative
Controversial
Bottom Line: Positive Health Impact &
Community Supported
135
Recommendations: Process & Outcome
 Can focus on Process and/or Outcomes
To improve the process of
decision making to be more
inclusive of health & affected
populations
Recommendations
To lessen identified adverse
health impacts or promote
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
136
Step 5: Reporting

137
Step 5: Reporting
 Objective
 Develop HIA report and communicate
findings and recommendations
138
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
139
Reporting: Refer to Communication Plan
 Refer to HIA Communications Plan
 Goals
 Audiences
 Objectives, Strategies, Tactics
 Key messages
 Spokespeople and messengers
140
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.
141
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
142
Report Structure
 Intro/Project Background
 Screening
 Scoping
 Stakeholder Engagement
 Assessment
 Recommendations
 Reporting
 Monitoring & Evaluation
143
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
144
Step 6: Evaluation & Monitoring

145
Step 6: Evaluation & Monitoring
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
146
Evaluation: Process Evaluation
 Process evaluation—seeks to understand
how the HIA was conducted
 It typically looks at:
 How the HIA was actually done compared to
the workplan and applicable standards
 How stakeholders and decision makers
participated
 How challenges were addressed
 How resources were used
147
Process 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
148
Impact Evaluation
Impact evaluation seeks to understand the impact of
the HIA itself on the decision and the decisionmaking process
 It typically looks at:
 How HIA recommendations were/were not
considered or incorporated in the decision
and other related processes
 How the HIA process influenced the
decision-making process through building
new collaborations and increasing
awareness of previously unrecognized
health impacts
149
Evaluation: Monitoring Plan
 The monitoring plan should include:
1. goals for short- and long-term monitoring;
2. outcomes and indicators for monitoring;
3. lead individuals or organizations to conduct
monitoring;
4. a mechanism to report monitoring outcomes to
decision-makers and HIA stakeholders;
5. triggers or thresholds that may lead to review and
adaptation in decision implementation; and
6. identified resources to conduct, complete, and
report the monitoring.
Source: HIA Minimum Elements & Practice Standards
150
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?
151
Example Evaluation: Above the Falls HIA

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
152
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
153
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
154
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)
Evaluation
 Please fill out the evaluation
form!
157
Thank you!!!
Kelly Muellman
kelly.muellman@state.mn.us
651-201-5637
Special thanks to Health
Impact Project and Blue
Cross Blue Shield of MN
Foundation
Brenda Hoppe
HIA Program Director:
brenda.hoppe@state.mn.us
Kristin Raab
651-201-4908
kristin.raab@state.mn.us
651-201-4893
MDH HIA website
MDH Climate & Health website
158