This document summarizes a presentation on a health impact assessment (HIA) of a proposed Kentucky tax credit to encourage worksite wellness programs. The HIA found that such a tax credit could reduce childhood obesity by educating parents through worksite programs. It may also increase jobs by reducing healthcare costs and improving productivity. The tax credit was also found to potentially improve social cohesion and well-being in workplaces. Preliminary recommendations included enacting the tax credit bill and conducting further research on worksite wellness programs in the state.

1. Katherine Hebert, MCRP August 19, 2011 Health Impact Assessments: Bringing Public Health Back to the Decision Table Presentation made possible through funding from the Oak Ridge Institute of Science and Education (ORISE). The findings and conclusions in this presentation have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy.

2. Quick History and Future Direction of Planning, Policy, and Public Health Introduction to the Social Determinants of Health HIA Definition and Purpose HIA Process The Current State of HIA in the United States Resources Agenda

3. Not New Concept- Over Correcting

4. Social Determinants of Health Source: http://www.pharmacymeetspublichealth.org.uk/publichealthbackground_determinants.html

5. Policy & Planning Source: Frieden, A Framework for Public Health Action: The Health Impact Pyramid, AJPM

6. Health Impact Assessments HIA HIA

7. Planning + Policy + Public Health Healthy Communities Health Impact Assessments Healthier Population

8. What HIA IS An HIA is a combination of procedures, methods and tools that systematically and prospectively judges the potential, and sometimes unintended, effects of a policy, plan, program, or project (commonly outside of the health sector) on the health of a population, and the distribution of those effects within the population. HIA identifies appropriate actions to manage those effects. Adapted from the WHO Gothenberg Consensus Paper, 1999

9. Process and Product

10. Transportation Projects Land Use Decisions Housing Agriculture/ Food Security/ Food Supply Sustainability Efforts Comprehensive Plans Energy Water/ Sewer/ Waste Management Economic/ Employment Budget Topics HIA Have Been Applied To

11. Health Impact Assessments Steps

12. Health Impact Assessments Steps

13. Health Impact Assessments Steps

14. Health Impact Assessments Steps

15. Who Are the Players- U.S. Funding PEW RWJF- ALR NCEH-HCDI ASTHO Training 5 Universities APA/NACCHO Webcourse San Francisco Course Guides/Readings Conferences Practitioners Human Impact Partners San Francisco Health Department SOPHIA State & Local Health Officials CPPW States Universities Healthy Design Professionals

16. Completed HIAs in the United States 1999–2010: 79 WA 4 ME 1 MT 3 MN 5 OR 6 WI 1 NH 1 MA 3 PA 2 OH 1 NJ 1 CO 3 CA 30 MD 1 TN 1 NM 1 GA 6 FL 1 AK 5 Map developed in collaboration with A. Wernham, Health Impact Project and A. Wendel and A. Dannenberg, National Center for Environmental Health 16

17. Completed and in Progress HIAs in the United States 1999–2010: 119 WA 8 ME 1 MT 3 MN 6 OR 12 WI 1 NH 2 MA 4 PA 2 OH 1 IL 1 NJ 1 CO 4 CA 47 MD 2 MO1 KY 1 TN 1 NM 1 GA 8 FL 1 TX 1 AK 7 Map developed in collaboration with A. Wernham, Health Impact Project and A. Wendel and A. Dannenberg, National Center for Environmental Health HI 1

18. Community Profile Baseline of Current Community Conditions Help Identify Health Concerns Characterize Population Pay Attention to Scale/ Challenge of Local Data CDC Resources Behavioral Risk Factor Surveillance System Youth Risk Behavior Surveillance System Social Determinants Maps County Prevalence Data Maps State Burden of Chronic Disease State Cancer Rate Information

19. Join the HIA Community of Practice! Go to www.phconnect.org to become a member and find the HIA Community of Practice For more information contact Katherine Hebert at jsx3@cdc.gov

20. www. cdc.gov/healthyplaces/hia.htm

21. www.healthimpactproject.org/project/opportunities

22. www.hiaguide.org/

23. Resources on HIA NACCHO, HIA Quick Guide http://www.apho.org.uk/resource/item.aspx?RID=82413 Human Impact Partners, HIA Toolkit http://www.humanimpact.org/component/jdownloads/finish/11/81 University of Minnesota, Rapid HIA Toolkithttp://www.designforhealth.net/pdfs/HIA/BCBS_Rapidassessment_011608.pdf Websites: HIA Gateway, HIA CLIC, CDC HIA, WHO HIA, San Francisco Bay HIA Collaborative, phConnect

24. Katherine Hebert, MCRP Community Planner and Researcher Centers for Disease Control and Prevention Division of Nutrition, Physical Activity, and Obesity jsx3@cdc.gov, 770-488-5247

25. Health Impact Assessment (HIA)Project Kentucky Worksite Wellness Tax Credit Teresa Lovely MS CHES Elaine Russell MS RD LD Dr. Cecilia Watkins CHES Cabinet for Health and Family Services

27. $15,000

28. Build capacity to conduct HIAs

29. Conduct first HIA project

30. Collaborate with partners

31. Share findings and recommendations

32. Produce a final report

33. Monitor the outcome of the target project Cabinet for Health and Family Services

34. HIA of Kentucky Worksite Wellness Tax Credit

35. Kentucky Worksite Wellness Tax Credit Proposed House Bill HB 74 AN ACT relating to encourage healthy lifestyles. Original bill introduced 2008 Total credit not to exceed $100 / number of employees annually $3,000,000 cap Kentucky Worksite Wellness Tax Credit

37. Childhood obesity

38. Jobs

39. Social cohesion in the workplaceCabinet for Health and Family Services

41. Kentucky’s obesity levels particularly for children

42. Need for an integrated approach

43. Workplace’s potential role – where parents are

44. Parent’s impact on children’s health (obesity)

45. The need to look at the environment and policyCabinet for Health and Family Services

47. A worksite wellness program would address teaching employees (parents) about diet and physical activity

48. The education and support that employees (parents) receive in the workplace can positively influence the family.

49. Programs would need to include children and families, focus on child behavior and environment

50. Parents can be advocates for their children’s environment whether at home, daycare or school. Cabinet for Health and Family Services

52. In 2008 launched this program to help parents assist their children in maintaining a healthy weight.

53. The 12-week web-based program includes a $150 cash rebate that rewards participation.

54. 2/3 of employees who participated reported that their children were exercising

55. 59% of children and 64% of adults improved body weight or maintained a healthy weight.

56. Parents and children improved in healthy eating and physical activity behaviors and a reduction in screen timeSource: Business Group on Health Cabinet for Health and Family Services

58. Reducing health care costs, improving productivity through wellness programs could lead to an increase in jobs in the state

59. A tax credit could lead to an increase in wellness jobsCabinet for Health and Family Services

61. State’s Work Environment Index score fell from 48.3 in 2009 to 46.8 in 2010 leading to a drop in state ranking from 32 to 36 in this index

62. Specific populations such as urban areas and rural, particularly Appalachian reported less well-being in some factors.

63. Wellness programs have been shown to affect morale and improve the work environmentCabinet for Health and Family Services

65. However most not comprehensive

66. 94% of companies have less than 50 employees

67. Firms with less than 100 employees accounted for 35 percent of total employment in Kentucky.

68. A worksite wellness tax credit would increase the number of worksite wellness programs particularly in smaller companies Cabinet for Health and Family Services

71. Conduct an in depth assessment of worksite wellness programs in the state

72. Recognize the worksite venue as a means to improve health of Kentucky residents – not just employees

73. Incorporate tax credit criteria to include programs to assist families improve health

74. Kentucky economy can be improved through worksite wellness programsCabinet for Health and Family Services

75. QUESTIONS? Teresa.Lovely@ky.gov Cecilia.watkins@wku.edu Elaine.russell@ky.gov Cabinet for Health and Family Services