The document summarizes the Western Massachusetts Casino Health Impact Assessment (WMCHIA). The WMCHIA was conducted from 2013-2014 to evaluate potential health impacts of developing a casino in Springfield, MA. It involved stakeholders and experts. The assessment followed the standard 6 steps for HIAs: screening, scoping, assessment, recommendations, reporting, and monitoring. It focused on jobs/employment, gambling access, traffic, and crime/safety. Recommendations addressed strategies to maximize benefits and mitigate harms related to these areas. The report was disseminated to stakeholders and the public to inform decision-making around casino development and regulation.

1. Planners Using Health Impact Assessments
Frank Robinson PhD, Executive Director Partners for a Healthier Community
Molly Goren-Watts Principal Planner/Manager Regional Information & Policy Center PVPC
Sang Cho, Junior Planner Intern HGSD
Peter Lowitt FAICP, Director Devens Enterprise Commission

2. Western Massachusetts Casino
Health Impact Assessment
Planners Using Health Impact Assessments
A Tool in Developing Public Policy
Thursday, October 23, 2104
Frank Robinson, PhD, Executive Director
Partners for a Healthier Community, Inc
Molly Goren-Watts, Principal Planner
Pioneer Valley Planning Commission

3. Overview and Context
Health Impact Assessment (HIA)
HIAs are NOT
Key Values that shape the HIA process
What is a HIA
….
2

4. HIAs are NOT!
• How is HIA different from other types of assessments?
• It’s not used to make the case for why a policy, program or
project should be proposed.
• It’s not an assessment to understand the impacts of a program or
policy once it has been implemented.
• It’s not a community assessment tool (i.e., MAPP, CHIP, CHA),
but those are used during assessment stage of HIA.
3

5. Key Principles & Values of a HIA
• Democracy - allows participation in policy development
and implementation
• Equity - consider distribution of health impacts, pay
attention to vulnerable groups and recommend ways to
improve proposed decisions for affected groups
• Sustainable development - judge short- and long-term
impacts of a proposal
• Ethical use of evidence - Use evidence to judge impacts
and inform recommendations, not set to support or
refute a proposal; be rigorous and transparent.
• Holistic approach to health - Be guided by the wider
determinants of health
4

6. What is an HIA?
• HIAs are different from other
assessments?
• It’s proactive! It’s meant to
inform a proposed policy,
program or project currently
under consideration
• It’s predictive! It uses data and
scientific literature to predict
potential health outcomes
(evidence – e.g. scientific
literature, reports, etc.)
• It’s translational! HIA is the
framework that translates data
and evidence into well-informed
policies.
 The Sweet Spot!
 Implementation of the Expanded
Gaming Act Legislation
 Developing the process for
casino licensure
 Developing regulatory
requirements for casino
development and operation
 Oversee licensing process and
selection of Casino operators
5

7. 6

8. HIA Methods
Six-Step Process
1. Screening
7
2. Scoping
3. Assessment
4.Recommendations
5. Reporting
6. Monitoring &
Evaluation
Assess value of HIA.
Define scope of assessment (e.g., which health impacts
to evaluate).
Determine how will decisions impact selected health
determinates and health outcomes
Determine how will decisions impact selected
health determinates and health outcomes
Communicate findings &
recommendations
Track impact of HIA and
decision

9. Western Massachusetts Casino Health Impact
Assessment (WMCHIA) - How will a casino impact
health in Western MA?
November 2011 - Chapter 194 “An Act Establishing Expanded
Gaming in the Commonwealth”
Allows “up to 3 destination resort casinos located in 3 geographically diverse regions”
8

10. Background
Proposed Casino Locations
Springfield
North End - Penn
Springfield
South End - MGM
W. Springfield-
Hard Rock Cafe
Palmer –
Mohegan Sun
• Springfield – urban, gateway city (pop 153,000)
• Palmer – rural (pop 12,000)
• West Springfield – suburban and rural (pop 28,000)
9

11. Background
Proposed Casino - Springfield
- Gateway city
- Struggling economy
- Majority community of
color
- Residents face numerous
socioeconomic challenges
and experience health
inequities
- Opportunity for economic
redevelopment
10

12. About WMCHIA
 Conducted Spring 2013 – Fall 2013
 Lead partners
 Partners for a Healthier Community
 Springfield Dept. of Health &
Human Services
 UMass School of Public Health
 Step 1: Screen
 Determines value and need of HIA
 Questions include…
 Is HIA likely to add value?
 Is it feasible?
 Does decision-making process
allow for input from HIA?
11

13. WMCHIA Methods
Screening & Stakeholder Engagement
Advisory Committee
• Cross-sector stakeholders, HIA experts, casino/gambling experts, decision-makers
host community municipalities, state and local public health, social justice, planning
organizations, non-profit, faith community, police/public safety, immigrant services,
development, academics
 Arise for Social Justice  Massachusetts Department of Public Health  Springfield Police Department (retired
chief)
 Behavioral Health Network  Massachusetts Gaming Commission  Town of Palmer, Health Department
 City of West Springfield, Health
Department
 New North Citizens' Council  Town of Palmer, Planning Department
 Develop Springfield  Palmer Town Council  United Council of Churches of Greater
Springfield
 Greater Springfield Chamber of
Commerce
 Partners for Community/United Farm Workers  United Way of Pioneer Valley
 Holyoke Community College  Pioneer Valley Planning Commission  University of Massachusetts, Amherst
 Irene E. And George A. Davis
Foundation
 Regional Employment Board of Hampden
County
 Western MassCOSH
 Lutheran Social Services  Springfield City Council Casino Site
Committee
12

14. WMCHIA Methods
Step 1: Screening & Stakeholder
Engagement
 Introductory HIA workshop
 Community forums
 Online Survey
 Stakeholder interviews & community
contacts
 Media
 WMCHIA web page
 WMCHIA email list
 Presentations to stakeholders
13

15. WMCHIA Goals
Step 1: Screening & Stakeholder
Engagement
1. Promote consideration of potential health impacts in decision-making related to the
licensing, site selection and development of a casino in Western MA, particularly
 Host community agreement negotiations (if possible) and implementation
 Casino operator applications
 Host community public hearing
 MA Gaming Commission licensing decisions and casino regulations
 Planning for development of licensed casino
2. Recommend possible health or health-related indicators for the Gaming Commission’s
casino monitoring and evaluation plan
14

16. Casino Licensing Timeline
15

17. WMCHIA Methods
Step 2: Determining the Scope of WMCHIA
 Interest from community in assessing impact on a range
of areas
 Process for choosing health determinants and outcomes
in assessment
16

18. WMCHIA Focus Areas
Step 2: Determining the Scope of WMCHIA
• Topic areas
• Jobs and employment
• Access to local casino
gambling
• Traffic
• Crime and Public Safety
• Geographic location
• Focused on host community
impact and in some cases
region
• Other important concerns
not included
• Public safety capacity &
city infrastructure
• Economic development
• City/town revenue
• Housing
17

19. Step 2: Determining the Scope:
Jobs & Employment Pathway
Casino
Opens Resort casino jobs
Shiftwork
Social cohesion
w/family
Income
Quality and
access to
health
insurance
Smoking, gambling,
alcohol (risk
behaviors)**
Sleep disturbance
Chronic disease
Cancer
Mental health
Life expectancy
* Assessment focus is on impact of employment on unemployed
** Relates specifically to casino employees
Health Impacts
Decision
Initial Impact Pathway
Impact
Pathway
Impact
Employment (resort
casino jobs)*
18

20. Step 2: Determining the Scope:
Access to Local Casino Gambling Pathway
Casino
Opens
Access to
gambling Problem or
pathological
gambling
Health Impacts
Life
expectancy
Job loss and
financial
resources
Family
health/well-being
Cancer
Chronic
disease
Mental
health
Decision
Injuries
Access to health-promoting
resources
Suicide
Initial Impact Pathway
Impact
Pathway
Impact
Financial
resources
19

21. Step 2: Determining the Scope:
Traffic Pathway
Casino Opens
Traffic
Motor vehicle and
pedestrian accidents
Air pollution
Health Impacts
Motor vehicle & pedestrian
injuries and mortality
Asthma, CVD,
cancer
Decision
Initial Impact Pathway Impact
20

22. Step 2: Determining the Scope:
Crime & Public Safety Pathway
Casino
Opens
Alcohol use Driving under
the influence
Health Impacts
Chronic Disease
Injury and
mortality
Crime (actual and
perceived)
Mental health
Decision
Initial
Impact
Pathway
Impact
21

23. WMCHIA Methods
Step 3: Assessment
 Assessment process is characterized by:
Expert input
Existing reports
Impacts - some quantitative but primarily
qualitative
Recommendations
Expert and stakeholder input
Based on best practice and local needs
22

24. WMCHIA Methods
Step 3: Assessment
 Provides baseline data profile of health determinants and
conditions being evaluated
 Evaluates potential health impacts
 Uses scientific literature and other types of evidence to
identify potential impacts
 What does literature say?
 What is the strength of the evidence
 Uses analytic methods and baseline data to predict
impact of decision on target population
23

25. WMCHIA Methods
Step 3: Assessment
24

26. WMCHIA Methods
Step 4: Recommendations
 The Western Massachusetts Casino Health Impact
Assessment identified a number of potential positive and
negative effects, but its focus was on solutions and
recommended actions to strengthen the positives and
mitigate the negatives of casino development in Springfield.
 Planned strategies (e.g. MGC, casino operator) that
community stakeholders thought was important to show
support for
 Enhancement on planned strategy
 Add-in new focus areas where no current plans
 Recommendations are targeted to variety of stakeholders e.g.
MGC, casino operator, host community, state agencies
25

27. Step 4: Recommendations:
Predicted Impacts - Jobs and Employment
 Casino would bring needed
local jobs given high
unemployment rate
 Estimated 3,000 new jobs,
2,200 FT
 ~65% of casino jobs will require
H.S. diploma/GED
 Casino Careers Training Institute
will train for new positions
 Local hiring goals
 Diversity goals
 New jobs locally
 -> improved health
61%
26

28. Step 4: Recommendations:
Predicted Impacts - Jobs and Employment
Challenges to meeting goals to improve local unemployment
 Anticipated turnover rates of ~40%
 Local and regional barriers to obtaining and retaining entry-level
positions prevent most in need of new jobs from obtaining
 Workforce readiness capacity
 Access to needed ABE and EOSL
 Public transit service capacity
27

29. Step 4: Recommendations:
Predicted Impacts - Jobs and Employment
• Wages touted as high may not allow for self-sufficiency
Foxwoods Crossroads Casino Report - Average Wage by Category
Category of Position Average per capita wage Annual Cash Tips
and/or Casino Tokes
Total Average Per
Capita Wage
Executive/Director $189,331 -- $189,331
Management $67,418 -- $67,418
Skilled Salary & Supervisory $53,583 -- $53,583
Hourly, Casino Tokes $17,374 $31,124 $48,498
Hourly, Cash Tips $18,388 $21,856 $40,244
Line Level and Administrative $29,806 -- $29,806
• 28% would be estimated to be line level and administrative
support – this does not meet family economic self-sufficiency
standards – 2 parents family (1 parent working
full-time) with 2 kids residing in Greater Springfield
28

30. Step 4: Recommendations:
Predicted Impacts - Jobs and Employment
Casino employees may experience negative health impacts
 Casino employees found to have higher prevalence of health risk
behaviors
 Shift-work found to negatively impact health
Gaming Employees Non-Gaming Employees
Hours Percent Hours Percent
5:00 a.m. – 1:00 p.m. 20% 8:00 a.m. – 4:00 p.m. 20%
1:00 p.m. – 9:00 p.m. 40% 4:00 p.m. – 12:00 p.m. 60%
9:00 p.m. – 5:00 a.m. 40% 12:00 p.m. – 8:00 a.m. 20%
Source: Casino Careers Training Institute
29

31. Step 4: Recommendations:
Predicted Impacts - Jobs and Employment
 Casino operator plan to reach targeted local hiring levels given
documented regional workforce barriers
 Infrastructure funding for regional cross-sector collaboration to
address workforce barriers
 Casino operator
 Health and wellness programs
 Best practices to reduce impacts of shiftwork
 Employment indicator monitoring and reporting – diversity/equity,
where hired from, etc.
30

32. Step 4: Recommendations:
Predicted Impacts - Access to Local Casino Gambling &
Disordered Gambling
 Likely increase problem
gambling prevalence with
casino (estimated 30%)
 Many vulnerable populations
in Springfield would be at
increased risk
 Young people
 Communities of color
 Low-income individuals
 Limited community capacity
to prevent/address problem
gambling
Problem and Pathological Gamblers
Geography Current After Casino
Opens - Initial
(~1 year)
After Casino Opens -
Over Time
(~5 years)
Springfield 3,993 5,191 3,993
Hampden
County
12,114 15,748 12,114
31

33. Step 4: Recommendations:
Predicted Impacts - Access to Local Casino Gambling &
Disordered Gambling
 Public Health Trust Fund funding to create infrastructure for
regional cross-sector collaboration to address increases in
problem gambling
 Public awareness campaign
 Targeted campaigns and strategies to vulnerable populations that
are accessible (e.g. culturally competent, appropriate literacy
level)
 Casino implement responsible gambling framework
32

34. Step 4: Recommendations
Predicted Impacts – Traffic
 Estimated 15-30,000 new vehicle
trips per day
 Potential adversely affect the City’s
many residents living in EJ areas
 High hospitalization rates for
diseases affected by air pollution –
asthma, CVD, COPD
 Large racial/ethnic disparities
33

35. Step 4: Recommendations
Predicted Impacts – Traffic
• Greatest health impact likely due
to near roadway air pollution
– Latinos experiencing disparities
and live along likely casino routes
and most likely to be impacted
• May be impact in traffic related
collisions due to traffic increase
34

36. Step 4: Recommendations
Predicted Impacts – Traffic
 Funding to create infrastructure for regional cross-sector
collaboration to address increases in traffic
 Promote use of public transportation and alternative methods of
transport
 Assess impact of near roadway pollution on vulnerable
populations and develop strategies to mitigate harms
35

37. Step 4: Recommendations
Predicted Impacts – Crime & Safety
• Uncertain the extent crime will
increase
– Literature conflicting
– Factors impacting
• Community preparedness
• Community design
• DUIs and alcohol-related fatalities may increase with accessibility
to free alcohol at casinos
– Expanded Gaming Act allows for free alcohol on gaming floor b/t
8:00 a.m. – 2:00 a.m.
36

38. Step 4: Recommendations
Predicted Impacts – Crime & Safety
 Community design strategies to prevent crime and enhance
perception of safety
 City should support and complement casino operator proposed
design elements
 Strategies to prevent DUIs
 Public health campaign
 Expanded sobriety checks, etc.
37

39. Step 4: Recommendations
General Findings
 Integrating resort casino plans with those of other initiatives has the
best potential to address existing regional needs
 Large existing health inequities in Hampden County and Springfield
could be reduced or exacerbated by impacts of a casino depending on
strategies implemented
 Data-driven evaluation and modification of activities to ensure that
stated goals are achieved, including
1. Publicly available casino impact data
2. Periodic evaluation of impact on identified existing regional needs and health
equity areas by multi-sector stakeholder groups
3. Modifications of strategies and plans as needed
4. Reallocation of money to fund modified strategies
38

40. Step 5: WMCHIA Report
39

41. WMCHIA Reporting
 Involved key stakeholders in review
process
 MGC, SEIGMA, MGM, etc.
 General dissemination
 Email blast, press release, etc.
 Presentations
 Key decision-makers: MGC, MGC
staff, Springfield Mayor
 Other key stakeholders
 Problem-gambling groups (WMCGA,
MA Council Compulsive Gambling,
local problem gambling panel)
 Local outreach worker group
 Others
 MAPC – examining surrounding
community impacts
 MPHA Policy Subcommittee- deciding
whether to take position on upcoming
ballot questions
40

42. Step 6: WMCHIA Impacts
 MA Gaming Commission and University of Massachusetts, School of Public
Health and Health Sciences (SEIGMA - Social and Economic Impacts of Gaming
in Massachusetts )
 Health Equity lens for evidence-based research that includes community voice;
 Support for implementation activities – e.g. responsible gaming framework
 information on certain indicators
 Springfield Mayor - considering adoption of recommendations and using it to
advocate for funding to implement recommendations
 Community residents and organizations
 Local neighborhood council reviewed report to understand impacts and identify
recs for advocacy
 Gardening the Community used info in WMCHIA to successfully apply for
funding
 WMCHIA recs used to support advocacy for MGM to purchase from local small
farmer cooperative
41

43. Step 6: Monitoring Impacts (Context –
Uncertainty)
• Impacts on decision-making
processes and
decision
• Impacts of decision on
health determinants
42

44. Devens Grant Road Redevelopment
Regulations Health Impact Assessment
Peter Lowitt, FAICP
Sang Cho
Neil Angus, AICP, LEED AP
SNEAPA
October, 2014

45. Introduction
• Regional Context & Devens Redevelopment
• Grant Road HIA
• Recommendations

46. Regional Background
• Neighboring towns:
Harvard, Shirley, Lancaster
and Ayer
• Fort Devens located on
Route 2, just outside
Boston’s second beltway
ring – I-495
• Rural character typical of
Massachusetts outside
Boston influence still
exists in this area
• Excellent transportation
access including Heavy
Rail and Commuter Rail

47. 1994 Reuse Plan
Grant
Road

48. The purpose/function of HIA is to:
• Inform and influence the decision maker
• Help address inequalities in health
• Place public health on the agenda
• Reduce conflict between stakeholders
• Encourage sustainable development
HIA is an approach that gets people to think about what they are
doing and how it may alter people’s health. It promotes health-and
in the long term contributes to the health of local
population.

49. HIA Methodology
• Screening
• Scoping
• Assessment
1. How will it be done?
2. Community Participation
3. The Study Area
4. Behavior Risk Factor Surveillance System data
5. Analytic Method
• Reporting

50. Process
• Literature review
• Consultation with HGSD and HSPH faculty and
graduate students
• Invitation to community and professionals to
participate
• Development of background materials and
two mock development scenarios, handouts,
HIA checklist, and workshop schedule

51. 120 Unit Development Scenario #1 (30 acres)
Com
Gdn
Housing Mix: 30 single family 16 single fam. cottage 16 two-family 28 – multi-family
(#of units) 30 multi-family (9x 3-4 units)
(4x 6-12 units)
Park
Park
ComGdn

52. 1
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4
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2
3 2
12
1c
1c
1c
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1c
1c
1c
*
*Cedar Street – Neighborhood Road

53. 120 Unit Development Scenario #2 (60 acres)
Housing Mix: 80 single family 22 two-family 12 – 3-4 family 6 multi-family
(#of units) (1x6 unit)

54. 1
1
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55. Proximity to Local Services
Homes
Shops
Schools
Work
Play
½ mile walk/bike distance

56. Key Features of Development Scenarios

57. Key Features of Development Scenarios cont…

58. Links between Housing and related factors
and Health

59. Example Use of HIA checklist

60. HIA Checklist and Results

61. HIA Checklist and Results

62. HIA Checklist and Results

63. Recommendations
• Introduce traffic calming measures to reduce speeds
• Install Rotary at intersection of Grant, Pine and Hospital Roads
• Use architecture to assure privacy and access to green space is available
on all lots
• Incentivize community gardens and have plots available for employees
and neighboring communities
• Support measures to introduce shuttles to commuter rail line to support
increased transit use
• Support existing food pantry serving healthy foods
• Provide nutrition classes for residents and offer classes on gardening
• Attract residents from surrounding communities onto Devens through
courses, programming and educational events
• Organize community walks and other events that promote healthy
lifestyles

64. For more information:
• A pdf of the Grant Road Redevelopment
Regulations HIA is available at
www.devensec.com/news.html
• Contact: Peter Lowitt, FAICP, peterlowitt@devensec.com
• SangCho@devensec.com
• Neilangus@devensec.com

65. Health Impact Assessments:
What Roles Can a Regional
Planning Agency Play?
Presented at SNEAPA 2014
Thursday, October 23
Molly Goren-Watts, Principal Planner/Manager
Regional Information & Policy Center
Pioneer Valley Planning Commission

66. Lead or Provide
Technical Assistance
All HIAs need technical expertise, topic knowledge, and
community connections and engagement.
Model 1 – Lead with technical expertise. Engage partners for
topic knowledge and/or community connections as needed.
Model 2 – Provide technical expertise to community research
partner (expert in specific field or community organization
facing the question at hand)
Model 3 – Conduct HIA as partnership led by RPA and one or
more topic or community-specific organizations.

67. PVPC Participation in
Casino HIA
•Partners for a Healthier Community was lead.
• As RPA to all three proposed host communities, PVPC had to remain
neutral in fact and appearance to all communities involved.
•PVPC provided:
•Data collection and understanding data sources
•Mapping
•Topic area specialists – traffic, transit, land use, economic
development (for analysis and proofing of recommendations)
•Networking/Connecting with other specialists in the region
(city/town government, workforce development agencies (REB),
police department, transit authority, others doing related work for
stakeholder engagement)
•Analytical assistance such as review of pathway diagrams

68. PVPC Roles in Other HIAs
•Overall Management
•Literature review
•Analysis and writing
••Stakeholder engagement

69. Questions?