Health Impact Assessment HIA A combination of procedures

Health Impact Assessment (HIA) 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 (Gothenburg consensus statement, 1999)

Health Impact Assessment § Tool to objectively evaluate a project/policy before it is implemented – Provide recommendations to increase positive and minimize negative health outcomes § Encompasses a variety of methods and tools – Qualitative and quantitative – Community input and/or expert opinion § Has been performed extensively in Europe, Canada and other countries – Regulatory and voluntary basis

Potential Contributions of HIA § Bring potential health impacts to the attention of policy-makers, particularly when they are not already recognized or are otherwise unexpected § Highlight differential effects on population sub-groups

Using HIA for Projects vs. Policies § Projects: Physical developments (highway, rail line, park, trail, housing complex, etc) – Affect smaller population – More detailed plans – Easier to define target population, stakeholders, and perform impact estimation § Policies: Set of rules and regulations that govern activities and budget expenditures (zoning, farm subsidies, living wage law, etc. ) – Affect larger population – Greater impact on public health – Health impacts may be harder to quantify

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

Voluntary vs. Regulatory § 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

Community Involvement in Conducting an HIA § Increases community buy-in to project § Helps identify social issues as well as health issues § Commonly used in HIAs in Europe § May add substantially to time and resources needed to conduct HIA § Combining lay vs. expert knowledge § Difficult to identify all stakeholders

Timing of HIA § HIAs best done as early as practical in decision process § Ongoing work with decision makers and planners is best § Ideally decision makers will ask for HIA to be done and may provide comments on draft HIA § HIA needs to wait until sufficient details about project or policy are defined § Close involvement with decision makers could compromise HIA independence

Tools & Guidelines § § § § § Merseyside Guidelines for HIA – general European Policy HIA Guide New Zealand Guide to HIA Swedish County Council model – inequities focus British Columbia model – policy focus West Midlands, Univ of Birmingham – checklist IMPACT – rapid HIA tool WHO Healthy Cities website – HIA toolkit Framework developed for current CDC/UCLA HIAs

Relationship of HIA to Environmental Impact Assessment § EIA – Regulatory – Thousands conducted each year – HIA components could logically fit within an EIA

Learning from EIA § But EIAs… – Long, complex documents – Process is time-consuming and expensive – Often litigious process – Tends to focus on projects, not policies – Tends to stop short of considering health outcomes

HIA efforts outside the U. S. § § Extensive work for nearly a decade Increasing interest Usually focused on local projects Often linked to EIA or focused on facilitating community participation

HIA in the U. S. § To date only a handful have been completed § Voluntary basis § Very few people currently trained to complete HIAs § However, there is a lot of interest in HIA (APA, NACCHO, CDC, RWJF, FHWA, ARC, CQGRD)

Examples of Completed HIAs § London Transportation Strategy § California’s After School Programs § California’s Living Wage Ordinance

Steps in Conducting a Health Impact Assessment § Screening – Identify projects or policies for which an HIA would be useful § Scoping – Identify which health impacts should be included § Risk assessment – Identify how many and which people may be affected – Assess how they may be affected § Reporting of results to decision-makers – Create report suitable in length and depth for audience § Evaluation of impact on actual decision process

Screening – When to do HIA § In general, HIA is most useful – For policy-decisions outside health sector – When there are likely to be significant health impacts that are not already being considered – The HIA can be completed before key decisions are made and stakeholders are likely to use information – There are sufficient data and resources available

Scoping - Health Impacts to Consider in an HIA § § § § § Physical activity, obesity, CVD Air quality, asthma, other respiratory diseases Water quality, waterborne diseases Food quality, food borne diseases, nutrition Motor vehicle, pedestrian and other injuries Accessibility for persons with disabilities Noise Mental health Social capital Social equity, environmental justice

Risk Assessment § § Logic frameworks Assessing research evidence Qualitative vs. quantitative outcomes Calculate estimates of morbidity and mortality § Cost-effectiveness when feasible

Reporting of Results § Full report – Provides details of scoping, literature review, analysis, assumptions, findings, sensitivity analysis, level of uncertainty, discrepant views, and recommendations – Helpful to others conducting similar HIAs § Non-technical report – – Often litigious process Short and easy to read Include background, findings, and recommendations Created for decision makers, community stakeholders, and lay audiences

Evaluation of HIA § Three major forms of evaluation – Process evaluation of HIA process steps done – Impact evaluation of effect of HIA on project or policy – Outcome evaluation of later health impacts from project or policy compared to predicted § Also evaluate level of stakeholder involvement § Some HIA evaluations have been completed; more needed § Develop a list of criteria for HIA evaluation § Variability in HIA reporting makes evaluation difficult

Examine Feasibility of HIA is U. S. § Received funding from RWJF to complete two case studies of HIA § Worked with UCLA to complete these case studies § Both case studies are still in progress but preliminary results from one case study will be presented

Screening – Initial List of HIAs § § § § § General Walkability Walk to School Trails (recreation and transportation) Active Commuting to Worksite Interventions Mass Transit Zoning Location Efficient Mortgage Buford Highway Beltine

Screening - Selection Criteria § Specific enough to create quantitative estimates § Impact physical activity § High quality data § Not overly complicated § Political interest § Target at risk populations § Foundation for other HIAs § Generalizability

Screening - Selecting Case Studies § Walk-to-school HIA – – Natomas school district in Sacramento, CA Little seasonal variation Poor and ethnically mixed Lots of political interest and ongoing in many communities § Buford Highway HIA – – – Highway redevelopment in Atlanta, GA Part of International Corridor Most dangerous highway in Atlanta for pedestrians Many similar locations around the U. S. Hypothetical redevelopment plan created by Georgia Tech.

Case Study: Buford Highway HIA § Hypothetical redevelopment included: – Reduce the number of lanes from 7 to 4 – Build sidewalks and add crosswalks – Add bike lanes – Add center median – Change local parking requirements to allow shared parking and on-street parking – Increase density and land-use – Develop unused greenspace