Aaron Wernham, MD, MS, Director, The Health Impact ProjectElizabeth H. Roberts, Lieutenant Governor,State of Rhode IslandT...
Thank You to OurEDRA44ProvidenceSponsors:
Health Impact AssessmentBuilding new partnerships for healthiercommunitiesAaron Wernham, M.D., M.S.Director | The Health I...
Asthma…Air PollutionHousing
“Get more exercise…”Slide courtesy CDC National Center for Environmental Health
“Eat more fresh fruits and vegetables”And “food swamps”Food Deserts
9
10WISCONSIN: HEALTH OUTCOMES MAP
11WISCONSIN: HEALTH FACTORS MAP
Public health – a turning point“Public health agencies alone cannotassure the nation’s health”Institute of Medicine, 2002....
A turning point:“Health is the responsibility of all sectors”Healthy and Safe Communities:• “Integrate health criteria int...
How do we put this into practice? No common language: Policymakers in other sectors such as transportation andhousing ma...
Health Impact Assessment:National Research Council definition“A systematic process that uses anarray of data sources and a...
HIA ExampleJack London Gateway rapid HIATopic of HIA: proposed housingdevelopment: 61 senior housingunits near two major f...
Jack London Gateway rapid HIAOutcomes:1. Air Quality – developerimplemented air filtration;changed windows facingfreeway.2...
Jack London Gateway rapid HIA:Now people live there…“The way that they designed this building, it’s for yourhealth. We can...
Steps of HIAwww.healthimpactproject.org/hia/processScreeningScopingAssessmentRecommendationsReportingMonitoring and Evalua...
The Value of HIA1. It involves a broad-range of impacted people.2. It’s an effective tool for meaningful cross-sector coll...
21Origins/approaches:-integrated with EIA-urban planning, HiAPWorld Bank and IFC: part of evaluationstandards for large de...
AK 3CA15CO 1FL1MA 2NJ 1Completed HIAs 2007(N = 27)MN 1GA 322
AK 18CA61CO 6MA 11NJ 1Completed and In Progress HIAs2013 (N = 238)MN12GA 7WA 9OR21OH8PA 2MD 5MT 2Federal HIAs: 5NM3TN 3HI ...
HIAs have addressed a wide range oftopicsSocial Policies—education, economy, employment- Legislation for alternatives to i...
Massachusetts low income energyassistance programPolicy Question: energy prices spiked after Katrina, increasing thefinanc...
HIA Examples:Washington Highway 99 Corridor PlanDecision: Plan for redevelopment along a suburban corridor alongHwy 99 in ...
HIA Examples:Washington Highway 99 Corridor PlanRecommendations and Outcomes:• Mixed use: plan adopted idea of focused dev...
HIA ExamplesOregon Farm to School billHIA Outcomes-bill amended to improve ORemployment effects-pilot program funded by le...
“HIA 2.0” – streamlining the processIngham County, MI HIA ChecklistSteps in the process:1. Developer presents a project fo...
Basic topics addressed in the checklistWater QualityWastewaterAir QualitySolid and Hazardous WasteNoiseSocial CapitalPhysi...
HIA ChecklistExamples of outcomes A senior housing development was modified to include abus stop with shelter within seni...
Benefit of HIA checklist Planners ensure that all elements impactinghealth are addressed early on in the project siterevi...
Interested in using HIAs in your work?ResourcesHealth Impact Project:www.healthimpactproject.orgCDC Healthy Community Desi...
Thank you!Aaron WernhamDirector, Health Impact ProjectThe Pew Charitable TrustsTel. 202-540-6862healthimpactproject@pewtru...
Aaron Wernham, MD, MS, Director, The Health Impact ProjectElizabeth H. Roberts, Lieutenant Governor,State of Rhode IslandT...
Evidence-based StrategiesforHealthier CommunitiesTerrie Fox Wetle, Ph.D.Inaugural DeanSchool of Public HealthBrown Univers...
Characteristics of Healthy Communities Physical space/physical activity Environmental quality Healthy food Access to s...
Characteristics of Healthy Communities Physical space for healthy activity Encourages safe and healthy physical activity...
Designing neighborhoods for activity• Complete Streets Purposeful design for mixed use Encourage walking, public transpo...
Healthy Food Obesity is a major and growing health concern 69% of adults are overweight or obese > 30 % of children are...
Characteristics of Healthy Communities• Access to Healthy Food Food deserts Healthy affordable alternatives Policies su...
Characteristics of Healthy Communities Environmental Quality Indoor environments Exposure to lead Indoor air quality, ...
Characteristics of Healthy Communities Access to services, housing, employment Contributors to health are multiple and i...
History of Public Health at BrownCorporation recommends Public Health Program 1917Department of Community Health 1971First...
Thank You to OurEDRA44ProvidenceSponsors:
EDRA44Providence plenary presentation 05.31.13
EDRA44Providence plenary presentation 05.31.13
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EDRA44Providence plenary presentation 05.31.13

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Dr. Aaron Wernham, RI Lt.Gov Elizabeth Roberts and Brown University's Terrie Fox Wetle discuss Health Impact Assessments in the Friday plenary session at EDRA44Providence.

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EDRA44Providence plenary presentation 05.31.13

  1. 1. Aaron Wernham, MD, MS, Director, The Health Impact ProjectElizabeth H. Roberts, Lieutenant Governor,State of Rhode IslandTerrie Fox Wetle, PhD, Dean, School of Public Health,Brown UniversityHealth ImpactAssessment: BuildingNew Partnerships for HealthierCommunities
  2. 2. Thank You to OurEDRA44ProvidenceSponsors:
  3. 3. Health Impact AssessmentBuilding new partnerships for healthiercommunitiesAaron Wernham, M.D., M.S.Director | The Health Impact Project901 E Street, NW, Washington, D.C. 20004p: 202.540.6346•e: awernham@pewtrusts.orgwww.healthimpactproject.orgEDRA44May 31, 2013
  4. 4. Asthma…Air PollutionHousing
  5. 5. “Get more exercise…”Slide courtesy CDC National Center for Environmental Health
  6. 6. “Eat more fresh fruits and vegetables”And “food swamps”Food Deserts
  7. 7. 9
  8. 8. 10WISCONSIN: HEALTH OUTCOMES MAP
  9. 9. 11WISCONSIN: HEALTH FACTORS MAP
  10. 10. Public health – a turning point“Public health agencies alone cannotassure the nation’s health”Institute of Medicine, 2002. The Future of the Public’sHealth in the 21st Century
  11. 11. A turning point:“Health is the responsibility of all sectors”Healthy and Safe Communities:• “Integrate health criteria into decision making across multiplesectors”• “The federal government will coordinate investments intransportation, housing, environmental protection and communityinfrastructure to promote sustainable and healthy communities.”Elimination of Health Disparities:“The federal government will support crosssector activities to enhance access to highquality education, jobs, economic opportunityand opportunities for healthy living.”Example: the National Prevention Council
  12. 12. How do we put this into practice? No common language: Policymakers in other sectors such as transportation andhousing may not understand health data. public health professionals don’t understand the constraintsand limitations of the planning process Few formalized requirements Priorities don’t necessarily match:Public health is one consideration of many; transportationdecisions involve many other considerations (movingpeople, funding, technical limitations, local politics, etc)
  13. 13. Health Impact Assessment:National Research Council definition“A systematic process that uses anarray of data sources and analyticmethods and considers input fromstakeholders to determine thepotential effects of a proposedpolicy, plan, program or project onthe health of a population and thedistribution of those effects withinthe population. Health impactassessment providesrecommendations on monitoringand managing those effects.”National Research Council, 2011Download free atwww.nap.edu
  14. 14. HIA ExampleJack London Gateway rapid HIATopic of HIA: proposed housingdevelopment: 61 senior housingunits near two major freeways andthe Port of Oakland..Health Risks:1.Indoor air quality from outdoor pollutionsources (NOT a part of the requiredpermit process) could harm residents2.Noise: related to sleep disturbance,high blood pressure3.Pedestrian Safety – identifieddangerous road crossingsSource: Human Impact Partners,http://www.humanimpact.org/component/jdownloads
  15. 15. Jack London Gateway rapid HIAOutcomes:1. Air Quality – developerimplemented air filtration;changed windows facingfreeway.2. Noise – developer added a noise-buffered courtyard andentranceway away from thehighwaySource:http://humanimpact.org/JLG_case_study_draft.pdf3. Safety – recommendations for “traffic calming” measures(speed bumps, wider sidewalks with narrower lanes, safe crosswalks) to allow residents walking access to nearby retail. Underconsideration.
  16. 16. Jack London Gateway rapid HIA:Now people live there…“The way that they designed this building, it’s for yourhealth. We can open up the air purifiers to get fresh air. I’meven on the side facing the freeway but the building issound-proof, so you can barely hear the traffic. It’s sopeaceful. Before I lived here, I had to have shots for asthmaand go to the hospital for oxygen to get my breathing downto the right level. Since I’ve lived here, I haven’t had to dothat once.I love it!”
  17. 17. Steps of HIAwww.healthimpactproject.org/hia/processScreeningScopingAssessmentRecommendationsReportingMonitoring and Evaluation
  18. 18. The Value of HIA1. It involves a broad-range of impacted people.2. It’s an effective tool for meaningful cross-sector collaboration.3. There is a strong business case for HIA.4. Identifies harms & benefits before decisions are made.5. Identifies evidence-based strategies to promote health & preventdisease.6. Increase transparency, support inclusiveness, democracy, andcommunity engagement in the policy decision-making process.Source: Human Impact Partners, HIA Toolkit, 3rd Edition
  19. 19. 21Origins/approaches:-integrated with EIA-urban planning, HiAPWorld Bank and IFC: part of evaluationstandards for large development loansCorporations: multinational oil and gasand mining companies.Business case for HIA• Lower business costs• Corporate social responsibility• Healthy workforce• Risk managementHealth Impact AssessmentOrigins in International practice
  20. 20. AK 3CA15CO 1FL1MA 2NJ 1Completed HIAs 2007(N = 27)MN 1GA 322
  21. 21. AK 18CA61CO 6MA 11NJ 1Completed and In Progress HIAs2013 (N = 238)MN12GA 7WA 9OR21OH8PA 2MD 5MT 2Federal HIAs: 5NM3TN 3HI 1IL 4KY 3MO4NH 3TX 5ME2WI 8DC 1KS 2MI 8NY 1SC 2VA 1NE 3AZ 2CT 3NC 6DE 1FL 2IN3Map created through a partnership between Health ImpactProject and the Centers for Disease Control and Prevention’sHealthy Community Design InitiativePuerto Rico: 1
  22. 22. HIAs have addressed a wide range oftopicsSocial Policies—education, economy, employment- Legislation for alternatives to incarceration—WI- State policies regarding school integration—MN- Paid sick days legislation—several statesLand Use, Transportation, housing- Comprehensive plans, zoning, neighborhood revitalization- Transit corridors, Transit-oriented development, highway upgrades- Green space, bike routes- Housing inspectionEnergy, natural resources- Hard rock mining, oil and gas development, power plants
  23. 23. Massachusetts low income energyassistance programPolicy Question: energy prices spiked after Katrina, increasing thefinancial burden for families. Should LIHEAP funds be increased?Health Effects:• Pneumonia• Burns• CO poisoning• Hunger and poor nutritionRecommendations and Outcomes:• Increased funding for LIHEAP—state controller noted the importanceof the bill to public health in his evaluation of fiscal impacts• New evaluation parameters to ensure adequate data on outcomes ofprogramimplications for Medicaidexpenditures
  24. 24. HIA Examples:Washington Highway 99 Corridor PlanDecision: Plan for redevelopment along a suburban corridor alongHwy 99 in WA.Findings:• Mixed use: conflicts between arterial and freeway traffic and plan’sintent to create walkable/bikeable community.• Air quality: plan would increasewalking/biking near pollution hotspots.• Traffic risks: corridor contains 4 ofthe highest volume intersections,with high volume of accidents.Plan did not address.
  25. 25. HIA Examples:Washington Highway 99 Corridor PlanRecommendations and Outcomes:• Mixed use: plan adopted idea of focused development in walkablehubs throughout the region, to minimize conflicts with high-volumearteries and allow more exercise.• Air quality: buildingmodifications forresidences nearestmajor traffic.• Traffic risks: prioritizetraffic calmingmeasures in the 4 roadsegments identified asposing the greatest risk
  26. 26. HIA ExamplesOregon Farm to School billHIA Outcomes-bill amended to improve ORemployment effects-pilot program funded by legislatureSee HIA at:www.healthimpactproject.org/hia/usHB 2800: Bill to increase availabilityof fresh produce in school lunchesHIA findings:-Improved nutrition in schools, betterchance for lifelong healthy dietchoices-Create 260 jobs, improving overallhealth in rural communities andaccess to health insurance
  27. 27. “HIA 2.0” – streamlining the processIngham County, MI HIA ChecklistSteps in the process:1. Developer presents a project for site plan review2. Planner from Meridian Township and developer gothrough all of the checklist questions3. Planner provides recommendations to developers basedon HIA checklist review in relations to proposed project4. Developer makes the changes needed in the plan beforeit goes to committee review for approvalSlide courtesy of Janine Sinno, Ingham County HealthDept. and Harmony Gmazel, Tri-county RegionalPlanning Commission
  28. 28. Basic topics addressed in the checklistWater QualityWastewaterAir QualitySolid and Hazardous WasteNoiseSocial CapitalPhysical Activity and Injury PreventionHealth Equity and Food SystemsRegional Growth ObjectivesSlide courtesy of Janine Sinno, Ingham County HealthDept. and Harmony Gmazel, Tri-county RegionalPlanning Commission
  29. 29. HIA ChecklistExamples of outcomes A senior housing development was modified to include abus stop with shelter within senior citizens walking distance. A developer agreed to move a wetland mitigation area tocreate more green space in the neighborhood. The nutrition section of the HIA encouraged a developer toestablish a space in the center of the housing project for anopen air farmers market. This developer will use this projectas a pilot to repeat it in his other future housingdevelopment projects if it turns successful. For a mixed-use development, inclusion of on-site rainwatercollection, installation of bicycle parking, better pedestrianconnectivity, installation of public art and spaces,harmonious designSlide courtesy of Janine Sinno, Ingham CountyHealth Dept. and Harmony Gmazel, Tri-countyRegional Planning Commission
  30. 30. Benefit of HIA checklist Planners ensure that all elements impactinghealth are addressed early on in the project sitereview Developer benefits: incorporating importantelements early cuts back on review time andproject implementation delays. Sustainable: It’s proven to be buildingcollaboration in development and a win/winSlide courtesy of Janine Sinno, Ingham County HealthDept. and Harmony Gmazel, Tri-county RegionalPlanning Commission
  31. 31. Interested in using HIAs in your work?ResourcesHealth Impact Project:www.healthimpactproject.orgCDC Healthy Community DesignInitiative:http://www.cdc.gov/healthyplaces/Registration now open, but going fast!www.nationalhiameeting.org
  32. 32. Thank you!Aaron WernhamDirector, Health Impact ProjectThe Pew Charitable TrustsTel. 202-540-6862healthimpactproject@pewtrusts.org
  33. 33. Aaron Wernham, MD, MS, Director, The Health Impact ProjectElizabeth H. Roberts, Lieutenant Governor,State of Rhode IslandTerrie Fox Wetle, PhD, Dean, School of Public Health,Brown UniversityHealth ImpactAssessment: BuildingNew Partnerships for HealthierCommunities
  34. 34. Evidence-based StrategiesforHealthier CommunitiesTerrie Fox Wetle, Ph.D.Inaugural DeanSchool of Public HealthBrown University
  35. 35. Characteristics of Healthy Communities Physical space/physical activity Environmental quality Healthy food Access to services, housing, employment Convenient public transportation
  36. 36. Characteristics of Healthy Communities Physical space for healthy activity Encourages safe and healthy physical activity Supports social interaction Benefits of exercise Reduced obesity and related diseases Improved lung and cardiovascular function Stronger bones and muscles Better cognitive function, less depression
  37. 37. Designing neighborhoods for activity• Complete Streets Purposeful design for mixed use Encourage walking, public transport, walking and autos Safer Aesthetics
  38. 38. Healthy Food Obesity is a major and growing health concern 69% of adults are overweight or obese > 30 % of children are overweight or obese Greater prevalence for blacks/Hispanics Greater prevalence for lower socio-economic groups Obesity increases risk for… Heart disease Stroke Type II Diabetes Cancer Sleep apnea Reproductive problems
  39. 39. Characteristics of Healthy Communities• Access to Healthy Food Food deserts Healthy affordable alternatives Policies supporting healthy food Urban garden plots Fresh to You
  40. 40. Characteristics of Healthy Communities Environmental Quality Indoor environments Exposure to lead Indoor air quality, second hand smoke Home safety Outdoor environments Air quality Toxic exposures
  41. 41. Characteristics of Healthy Communities Access to services, housing, employment Contributors to health are multiple and interacting Important social context of health Convenient and affordable public transportation Encourages walking and reduces pollution from autos Provides access to important services
  42. 42. History of Public Health at BrownCorporation recommends Public Health Program 1917Department of Community Health 1971First Public Health Research Center 1982Masters of Public Health launched 2000Public Health Building Purchased 2005Four Departments approved 2011Approval for School of Public Health 2013
  43. 43. Thank You to OurEDRA44ProvidenceSponsors:

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