• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
Health Impact Assessments to Promote Healthy Neighborhoods
 

Health Impact Assessments to Promote Healthy Neighborhoods

on

  • 1,353 views

Presentation by Nisha Botchwey, MCP, PhD at the 2009 Virginia Health Equity Conference.

Presentation by Nisha Botchwey, MCP, PhD at the 2009 Virginia Health Equity Conference.

Statistics

Views

Total Views
1,353
Views on SlideShare
1,351
Embed Views
2

Actions

Likes
0
Downloads
0
Comments
0

1 Embed 2

http://www.slideshare.net 2

Accessibility

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    Health Impact Assessments to Promote Healthy Neighborhoods Health Impact Assessments to Promote Healthy Neighborhoods Presentation Transcript

    • Health Impact Assessments to Promote Healthy Neighborhoods History and Overview Nisha Botchwey, Ph.D. University of Virginia Associate Professor of Urban + Environmental Planning and Public Health Sciences MAPP Lilian Peake, MD, MPH Director, Thomas Jefferson Health Department Charlottesville/Albemarle District VAPHA’s Annual Conference Advancing Health Equity from Theory to Practice September 10-11, 2009
    • HIAs to Promote Healthy Neighborhoods
      • Health Impact Assessments
        • History, US HIAs, Implementation
      • Mobilizing for Action through Planning and Partnerships (MAPP) 2008 Charlottesville, VA
      • Evaluating Multiple Sites for FQHC
        • Does development make sense here, and specifically where from an HIA perspective?
      HIAs MAPP Evaluating Sites for FQHC
    • What is Health?
      • Physical health
      • Mental health
      • Well-being
      • Livability
      • “ a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”
      • World Health Organization
      HIAs MAPP Evaluating Sites for FQHC
    • Community Design and Health
      • Obesity, physical activity, CVD
      • Water quantity and quality
      • Air pollution and asthma
      • Climate change contribution
      • Car crashes
      • Pedestrian injuries
      • Mental health impact
      • Social capital
      • Environmental justice
      Related to land use Related to automobile dependency Related to social processes HIAs MAPP Evaluating Sites for FQHC
    • What is an HIA?
      • A tool to help recognize health consequences.
      • “A combination of procedures, methods and tools by which a policy , program or project may be judged as to its potential effects on the health of a population , and the distribution of those effects within the population .”
              • www.euro.who.int/document/PAE/Gothenburgpaper.pdf
      HIAs MAPP Evaluating Sites for FQHC
    • Value of Health Impact Assessment
      • Focuses attention of decision-makers, who typically do not have a health background, on the health consequences of projects and policies that they are considering
      • Ideally an HIA will lead to a better informed decision
      HIAs MAPP Evaluating Sites for FQHC
    • A Vision of Health Impact Assessment
      • Community planners and zoning boards will request information on potential health consequences of projects and policies as part of their decision-making process
      • Local health officers will have a tool to facilitate their involvement in community planning and land use decisions that impact health
      HIAs MAPP Evaluating Sites for FQHC
    • Steps in Conducting an HIA
      • Screening
        • Identify projects/policies for which HIA useful
      • Scoping
        • Identify which health impacts to include
      • Risk assessment
        • Identify how many and which people may be affected
        • Assess how they may be affected
      • Recommendations
        • Identify changes to promote health or mitigate harm
      • Reporting of results to decision-makers
      • Evaluation of impact of HIA on decision process
      HIAs MAPP Evaluating Sites for FQHC
    • Scoping: Health Impacts to Consider in an HIA
      • Physical activity, obesity, cardiovascular disease
      • Air quality, asthma, other respiratory diseases
      • Water quality, waterborne diseases
      • Food quality, foodborne diseases, nutrition
      • Motor vehicle, pedestrian and other injuries
      • Accessibility for persons with disabilities
      • Noise
      • Mental health
      • Social capital, community severance
      • Access to jobs, stores, schools, recreation
      • Social equity, environmental justice
      HIAs MAPP Evaluating Sites for FQHC
    • Voluntary vs. Regulatory Approach to Using an HIA
      • Voluntary (a tool used by a health officer to inform a planning commission)
        • Simpler, less expensive, less litigious
        • Less likely to be used if not required
        • More politically acceptable
      • Regulatory (modeled on a required environmental impact statement)
        • More complex, more expensive, more litigious
        • More likely to be used if required
        • Less politically acceptable
      HIAs MAPP Evaluating Sites for FQHC
    • Environmental Impact Assessments Performed by planners, consultants, environmental scientists, etc. Explores effect of policies, programs and projects on the environment Began in US in the 1970s Statutory requirement in many countries to undertake EIA EIA does not typically include assessment of health effects; when it does it may be narrowly focused and solely quantitative in nature. HIAs MAPP Evaluating Sites for FQHC                                                                                                   
    • HIA Relationship to Environmental Impact Assessment (EIA)
      • HIA components could logically and legally fit within an EIA process
      • HIA incorporated into EIA is necessarily regulatory
      • Extending an EIA to include an HIA may work in some settings
      HIAs MAPP Evaluating Sites for FQHC
    • HIA Level of Complexity
      • Qualitative – describe direction but not magnitude of predicted results
        • Easy to predict; hard to use in cost/benefit models
        • Example: Build a sidewalk and people will walk more
      • Quantitative – describe direction and magnitude of predicted results
        • Difficult to obtain data; useful for cost/benefit models
        • Hypothetical example: Build a sidewalk and 300 people who live within 200 yards of location will walk an average of 15 extra minutes per day
      HIAs MAPP Evaluating Sites for FQHC
    • Review of 38 Health Impact Assessments Conducted in the United States, 1999-2008 HIAs MAPP Evaluating Sites for FQHC
    • AK 4 CA 16 CO 1 FL 1 MA 2 NJ 1 Completed HIAs in the United States 1999–2008 (N = 38) MN 4 GA 3 WA 3 OR 1 OH 1 PA 1 HIAs MAPP Evaluating Sites for FQHC
    • HIAs in the U.S.
      • Conducted: California (n=15), Alaska (n=3), Georgia (n=3), Massachusetts (n=2), Colorado (n=1), Florida (n=1), Minnesota (n=1), New Jersey (n=1)
      • Projects:
        • Wage Policies
        • Walk-to-School Programs
        • Residential and Commercial Redevelopment
        • After-school programs
        • Land-use planning
        • Farm policy
        • Transportation, Parks and Trails
        • Power Plants
        • Land-leasing policy for oil exploration
        • Public subsidies for housing and home heating
      HIAs MAPP Evaluating Sites for FQHC
    • Quantitative and Qualitative Health Indicators in HIAs in U.S.
      • Quantitative
        • Physical activity
        • Pedestrian injuries
        • Mortality
        • Impact of particulate matter in air
        • Crime
        • Parks and greenspace
      • Qualitative
        • Academic performance
        • Income adequacy; social equity
        • Diet, nutrition, food safety, food insecurity
        • Adolescent risk behaviors – alcohol, drugs, sex
        • Noise
        • Mental health; stress
        • Social capital, community severance
        • Access to jobs, stores, schools, recreation
        • Housing adequacy and affordability
      HIAs MAPP Evaluating Sites for FQHC
    • HIAs in the U.S. (cont’d)
      • Investigators:
        • Local health department N =16
        • Academic group; CDC N =15
        • Tribal council/health agency N = 4
        • Private consultants N = 3
      • Decision-makers:
        • County and city councils and planning agencies
        • State agencies and legislatures
        • Federal agencies and the U.S. Congress
      • Funding:
        • Scope of work
        • Volunteer
        • RWJ Foundation, California Endowment, CDC, anonymous donors, fellowships, local governments
        • In conjunctions with EIAs
      HIAs MAPP Evaluating Sites for FQHC
    • HIA Capacity Building Activities
      • Several ad hoc training workshops on HIA have been held in past few years
      • Graduate course on HIA is taught annually by Rajiv Bhatia at University of California, Berkeley
      • HIA training manuals are available online
      • Feet First group in Seattle manages an HIA listserve for the United States
      • Several states and one U.S. Senator have mentioned HIA in proposed legislation
      HIAs MAPP Evaluating Sites for FQHC
    • U.S. HIA Training Materials Available On-line
      • UCLA: www.ph.ucla.edu/hs/health-impact/training.htm
      • American Planning Association: http://professional.captus.com/Planning/hia/default.aspx
      • Human Impact Partners, California: www.humanimpact.org/Tools.html
      • UC Berkeley: http://ehs.sph.berkeley.edu/hia/
      • San Francisco Department of Public Health www.sfphes.org/enchia/HIA_Training_2008.htm
      HIAs MAPP Evaluating Sites for FQHC
    • HIA in the United States: Next Steps
      • Conduct pilot tests of existing tools for HIA of projects and policies
      • Develop staff capacity to conduct HIAs including training materials and train-the-trainer workshops
      • Develop incentives and political support for use of HIAs
      • Develop a database for measuring health impacts of common projects and policies
      • Conduct process, impact and outcome evaluations of HIAs
      HIAs MAPP Evaluating Sites for FQHC
    • MAPP HIAs MAPP Evaluating Sites for FQHC
    • Charlottesville HIA Framework
    • America’s Healthiest City “ All residents have access to high-quality health care services. We have a community-wide commitment to personal fitness and wellness, and all residents enjoy our outstanding recreational facilities, walking trails, and routes to schools. We have a strong support system in place for families and for the elderly and disabled. Our emergency response time is among the nation’s best.” -Charlottesville City Council Vision Statement HIAs MAPP Evaluating Sites for FQHC
    • Demographics HIAs MAPP Evaluating Sites for FQHC
    • Factors for Analysis
      • Promoting Physical Health
        • Air Quality
      • Promoting Physical Activity
        • Convenience
        • Quality of Design
        • Safety
      • Promoting Mental Health
        • Community Space
      HIAs MAPP Evaluating Sites for FQHC
    • Air Quality
      • Consideration of:
      • Walkability
      • Ventilation
      • Material Toxicity
      HIAs MAPP Evaluating Sites for FQHC
    • Convenience
      • Connectivity
      • Proximity
      HIAs MAPP Evaluating Sites for FQHC
    • Quality of Design
      • Street Design
        • Social Attractiveness
      • Site Design
        • Size and Orientation of Building
        • Placement of Parking
        • Engaging Facade
      HIAs MAPP Evaluating Sites for FQHC
    • Safety
      • Crime and Perception of Safety
      • Pedestrian Safety
      HIAs MAPP Evaluating Sites for FQHC
    • Community Space
      • Promoting Mental and Social Health
      • Encourages healthy Activity
      HIAs MAPP Evaluating Sites for FQHC
    • Creating a Framework HIAs MAPP Evaluating Sites for FQHC
    • HIAs MAPP Evaluating Sites for FQHC
    • HIAs MAPP Evaluating Sites for FQHC
    • HIAs MAPP Evaluating Sites for FQHC
    • Framework Applied
      • 301 West Main Proposed Rezoning
      HIAs MAPP Evaluating Sites for FQHC
    • HIAs MAPP Evaluating Sites for FQHC
    • HIAs MAPP Evaluating Sites for FQHC
      • Break into two groups – one of only public health professionals and another of public health professionals, planners and other professionals.
      • Using the HIA template provided, review the area specified (Main Street to Preston Avenue and 10 th to 4 th Streets) to house a FQHC in Charlottesville, VA and determine:
      • The overall assessment of this area.
      • Whether the development should be placed in this area based on the HIA.
      • An ideal location within the larger area.
      • Select a team member to report your response.
      HIAs MAPP Evaluating Sites for FQHC
    • HIAs MAPP Evaluating Sites for FQHC
    • HIAs MAPP Evaluating Sites for FQHC
    • HIAs MAPP Evaluating Sites for FQHC
    • HIAs MAPP Evaluating Sites for FQHC
    • HIAs MAPP Evaluating Sites for FQHC
    • HIAs MAPP Evaluating Sites for FQHC
    • HIAs MAPP Evaluating Sites for FQHC
    • Methods for Identifying Completed HIAs in the U.S.
        • Networking among small group of HIA investigators who have been involved in most HIAs done in United States
        • Requested completed HIAs on HIA-USA listserve; updated September 2007
        • Literature search on Medline, Google Scholar, and other databases
        • List of HIAs identified may be incomplete
    • HIAs of Projects (N=19)
        • Housing redevelopment: Trinity Plaza CA
        • Housing redevelopment: Rincon Hill CA
        • Mixed-use redevelopment: Executive Park CA
        • Senior housing: Jack London Gateway CA
        • Transit Village: MacArthur BART station CA
        • Transit-related greenway: Alameda County CA
        • Urban redevelopment: Oak to Ninth CA
        • Urban redevelopment: Commerce City CO
        • Corridor redevelopment: Buford Highway GA
        • Corridor redevelopment: Lowry Avenue MN
    • HIAs of Projects continued (N=19)
        • Walk/bike trail development: Bloomington MN
        • Transit station: Beacon Hill WA
        • Replacement highway bridge: Seattle WA
        • Replacement highway bridge: Portland OR
        • Boxer’s walking trail: Philadelphia PA
        • Transit, parks and trails: Atlanta Beltline GA
        • Coal-fired power plant: Taylor County FL
        • Farmers market revitalization: Trenton NJ
        • Zinc mine expansion: Red Dog AK
    • HIAs of Policies (N=19)
        • Local planning: Eastern neighborhoods CA
        • Area plan & rezoning: Eastern neighborhoods CA
        • After-school programs: Statewide CA
        • Walk-to-school programs: Sacramento CA
        • Public housing flooring policy: San Francisco CA
        • Living wage ordinance: San Francisco CA
        • Living wage ordinance: Los Angeles CA
        • Paid sick leave policy: Statewide CA
        • Highway sub-area plan: Clark County WA
        • Community transportation plan: Decatur GA
    • HIAs of Policies continued (N=19)
        • Area plan to promote physical activity: Columbus OH
        • Comprehensive plan: Carver County MN
        • Comprehensive plan: Ramsey MN
        • Low income rent subsidies: Statewide MA
        • Low income home energy subsidies: Statewide MA
        • Oil and gas leasing: Outer continental shelf AK
        • Oil and gas leasing: Chukchi Sea AK
        • Oil and gas leasing: National Petroleum Reserve AK
        • Federal farm bill: National
    • Decision-Making Organization for Project or Policy (n=38)
        • City council; planning commission N=25
        • State government N= 7
        • US federal agency N= 3
        • US Congress N= 1
        • Non-profit organization N= 1
        • Local cooperative N= 1
    • Organizations that Conducted 38 HIAs in the US, 1999-2008
        • Local health department N =16
        • Academic group; CDC N =15
        • Tribal council/health agency N = 4
        • Private consultants N = 3
    • Funder of HIA (n=27)
        • Robert Wood Johnson Foundation N = 7
        • Health department - internal staff N = 7
        • Volunteer; multiple sources N = 5
        • University fellowship N = 3
        • Centers for Disease Control N = 2
        • Health department - external contract N = 2
        • The California Endowment N = 1
    • Scoping: Health Determinants Considered in HIAs in U.S.
      • Physical activity and obesity
      • Housing adequacy and affordability
      • Pedestrian injuries
      • Air quality, asthma, other respiratory diseases
      • Parks and greenspace
      • Income adequacy; housing; social equity
      • Diet, nutrition, food safety, food insecurity
      • Adolescent risk behaviors – alcohol, drugs, sex
      • Noise
      • Mental health
      • Social capital, community severance
      • Access to jobs, stores, schools, recreation
    • Population Affected by Project or Policy in 27 HIAs in U.S.
        • Small area within city N = 13
        • City or county-wide N = 7
        • Statewide N = 6
        • National N = 1
        • --------------------------
        • Primary impact on:
        • Persons with low income N = 17
        • Children/adolescents N = 2
        • Whole population N = 6
    • Community Involvement in Conduct of 27 HIAs in U.S.
        • Community input involved in conduct of 20 of 27 HIAs
        • Barriers to community involvement in HIAs include lack of time or resources, human subjects research, or federal management restrictions
    • Conduct of HIAs in U.S.
      • Screening
        • Some targeted to create change, others more academic
      • Scoping
        • Generally clearly described
      • Risk assessment
        • Various quantitative and qualitative methods
      • Recommendations
        • Most made recommendations, actionable ones best
      • Reporting
        • Most on web, a few published; public testimony
      • Evaluation
        • Relatively little conducted
    • Key Results in HIAs in U.S.
        • Most identified improvements needed to mitigate adverse health impacts
          • Redevelopment projects that lacked affordable housing; rental voucher program
        • A few encouraged projects or policies that would be health-promoting as designed
          • Walk-to-school program; Beltline transit project
        • One concluded that proposed program would fail to reach its intended target population
          • After-school programs
    • Impact of HIA on Subsequent Decisions in 27 HIAs in U.S.
        • Documentable impacts were evident for some HIAs
          • Plan improvements to increase pedestrian safety
          • Change in redevelopment plans to provide 1:1 housing replacement for affected families
          • Noise mitigation measures required
          • Living wage ordinance adopted
          • Urban road corridor plans improved
        • Most HIAs raised awareness of health issues for some audiences
    • Other Challenges in Conducting HIAs in the U.S.
      • Resources - who pays?
      • Resistance - some decision-makers may not want health input
      • Evaluation of impacts of HIA requires time and resources
      • Quality of science - cause and effect may be difficult to prove