Rajiv Bhatia, M.D., University of California - Berkeley and The Civic Engine

1. Democratizing Data for Health:
Lessons from health impact
assessment at the local level
Rajiv Bhatia
Founder, The Civic Engine
Visiting Scholar, UC Berkeley

2. In the late 1990s,
San Francisco began
repurposing historically
industrial land for
residential and office uses.

3. The city planned for the
most intense development
on its eastern side, in
historically industrial and
commercial districts with
greater density and
transportation services
The primary driver of
development was housing
demand; environmental
quality and neighborhood
infrastructure received scant
attention.

4. Concerned that plans and
existing environmental
rules would not create
healthy neighborhoods,
many residents rallied
against the growth plans.

5. In 2003, when a developer
proposed to demolish the Trinity
Plaza Apartments, he offered
residents $1000 for relocation.
Tenants said that displacement
would lead to stress, the loss of
jobs, distance from friends and
family, budget strain, and
overcrowding.

6. One of the first Health Impact
Assessments in the US was
conducted for the planning
department on behalf of tenants
at the Trinity Plaza Apartments.
The HIA validated the residents’
concerns. The developer later
ensured the tenants’ homes
would be replaced in the new
building.

7. Over the next few years,
the San Francisco conducted
other Health Impact
Assessments resulting in city
policy action on:
- affordable housing
- concentrated poverty
- traffic safety
- parks and open space
- quality schools
- community facilities
- labor laws

8. In 2004, the Departments of
Health and Planning attempted
a more pro-active approach to
addressing the needs of health
in development.
The city brought together non-
governmental organizations,
businesses, and public agencies
to look critically at land use
plans for growth from a health
and equity lens.

9. A product of the city process was
the Healthy Development
Measurement Tool (later
renamed the Sustainable
Communities Index), a system of
performance indicators to
evaluate land use and growth
plans.

10. Mapping indicators for health resources
demonstrated that neighborhoods with planned
growth excelled in some health resources
but had significant gaps with others.
The data provided evidence for a policy
response, including impact fees to build new
infrastructure in communities undergoing
growth.

11. Local scale air pollution modeling
demonstrated “hot spots” of air
pollution invisible to existing
regional air pollution monitors.
This data justified new citywide
health regulations requiring a higher
standard of building ventilation in the
hotspot zones.

12. Indicators also a disproportionate
concentration of pedestrian
injuries on a a minority of city
streets.
This data led the city to re-
prioritize engineering and
enforcement resources to the
high-injury corridors.

13. What made HIA and Community Indicators Work
Effective in San Francisco?
Focused on existing policy and political priorities and
controversies
Leveraged public health agency voice and authority
Leveraged existing regulatory and planning processes
Brought new human-scale data and solutions to development
challenges
Demonstrated disproportionate impacts and solutions
Valued and enabled a participatory democratic process

14. Pivoting Upstream: Focusing HIA on Policy,
Unanswered Questions, and Emerging Issues
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15. Implications for HIA Practice
 HIA is a means not an end
 HIA needs to be embedded in policy
processes but as one of many tools to
advance healthy development
 HIA’s value is greatest when applied as a
learning tool
 HIA is a powerful tool for civic engagement and
accountability
 HIA can be (should be) redundant in the context
of planning and design
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