Presentation Transcript

1. Health Impact Assessment Training

   Kristin Raab, MLA, PHA MN Climate & Health Program Director Brenda Hoppe, PhD MN Climate & Health Program Epidemiologist May 20, 2014
2. Outline What is HIA? Definitions, background, steps How has HIA been used to improve health? Healthy Corridors for All HIA (St. Paul) HB 2800: Oregon Farm to School and School Garden Policy HIA Above the Falls HIA (Mpls) How do I determine if I should do an HIA? First HIA step: screening

3. What is health?

   Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Source: World Health OrganizationThis definition has not been amended since 1948
4. Current Health Conditions in the US2000 Avg Life Expectancy and Healthcare Spending US ranked 51stin life expectancy for 2012 https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html http://ucatlas.ucsc.edu/spend.php
5. Health Determinants Health status is determined by: 30% by genetics; only 10% by health care; but 60% by social & environmental conditions, and behavior Source: N Engl J Med 2007;357:1221-8.
6. What do Minnesotans die from? Leading causes of death in Minnesota: 2010 Cause Deaths Rate Cancer 9,599 166.9 Heart Disease 7,144 118.7 Unintentional Injury 2,087 36.4 Stroke 2,154 35.8 Chronic Lower Respiratory Disease 2,012 35.1
7. Health Impact Assessment (HIA) A systematic process that uses an array of data sources and analytic methods and considers input from stakeholders to determine the potential effects of a proposed policy, plan, program, or project on the health of a population and the distribution of those effects within the population. HIA provides recommendations on monitoring and managing those effects. National Research Council, Improving Health in the United States: The Role of Health Impact Assessment, 2011.
8. Values of Health Impact Assessment HIA aims to advance the values of democracy equity sustainable development the ethical use of evidence a comprehensive approach to health North American HIA Practice Standards Working Group (Bhatia R, Branscomb J, FarhangL, Lee M, Orenstein M, Richardson M). Minimum Elements and Practice Standards for Health Impact Assessment, Version 2. North American HIA Practice Standards Working Group. Oakland, CA: November 2010. Source: http://www.policylink.org/atf/cf/%7B97c6d565-bb43-406d-a6d5-eca3bbf35af0%7D/PROMOTINGEQUITYHIA_FINAL.PDF
9. Why Conduct an HIA? Identify harms and benefits before decisions are made Identify evidence-based strategies and recommendations to promote health and prevent disease Support inclusive and democratic decision-making and increase transparency in the decision-making process Support community engagement in the decision-making process and foster community empowerment Advance equity and justice Note: There are many ways to insert health into decision-making. HIA is one way.
10. Types of Decisions Influenced by HIA Policy Decisions (bills by state legislature, city council decision, local school board on district-wide policy) Policy Implementation (weigh various implementation options for a policy once it is passed) Project Specific (siting, permitting, construction, design) Comprehensive Plans (neighborhood plan, regional growth plans, master planning documents) Provided by Health Impact Project http://www.healthimpactproject.org/
11. What topics have HIAs addressed? Provided by Health Impact Project http://www.healthimpactproject.org/
12. Completed and in progress HIAs Provided by Health Impact Project & CDC http://www.healthimpactproject.org/hia/us
13. HIA at the National Level Two major national funders Centers for Disease Control & Prevention (CDC) (directly funds granteesand professional organizations) Health Impact Project (PEW and RWJF) SOPHIA (Society of Practitioners of HIA): http://www.hiasociety.org/ Two conferences: HIA of the Americas Workshop (Oakland, CA) National Health Impact Assessment Meeting (WDC) Local Funder: Blue Cross Blue Shield of MN Foundation
14. History of HIA in MN HIAs began with Design for Health in 2006 MDH began providing technical assistance, leading or supporting many HIA-related activities in MN starting in 2009 Almost all 21 HIAs in MN relate to the built environment: comprehensive plans, land use plans, transportation, except School Integration Strategies, St. Paul Emerald Ash Borer, Safe and Supportive MN Schools Act (not listed). New HIAs: Winona Co Active Living Plan & Lincoln Park SAP
15. MDH’s Role in Promoting HIA Leading/performing HIAs: (7) Douglas County Comprehensive Plan; St. Louis Park Comprehensive Plan; Duluth 6th Ave Redesign Plan; Divine Mercy HIA; Gary/New Duluth Small Area Plan HIA; Winona County Active Living Plan HIA; Lincoln Park Small Area Plan HIA Providing technical assistance: (6)Healthy Corridor for All HIA; Bottineau Transitway HIA; HIA on the Fort DuPont Redevelopment ProjectDE; Second Street Redevelopment Plan GA; Emerald Ash Borer HIA; MN School Location & Design HIA Providing HIA training:(10+) (250+ people)
16. MDH’s Role in Promoting HIA (II) (http://www.health.state.mn.us/divs/hia/) Promoting Health in All Policies EAW & Comprehensive Plans Tool Development (EAW, comp planning, brownfields, climate change) Sharing information on HIA:website & listserv (500+) Promoting HIA through Collaboration
17. Collaboration HIA Interagency Workgroup: (12 agencies) MN HIA Coalition: (70+ members) (http://www.health.state.mn.us/divs/hia/coalition.html)
18. HIA Methodology Six steps Stakeholder engagement in all steps Equity considered throughout the steps Scalable
19. Six Steps of HIA Screening - to determine if an HIA is useful for a specific project or policy Scoping - identify which health effects to consider Assessment - determine which people may be affected and how they may be affected Recommendations - suggest changes to proposal to promote positive or mitigate adverse health effects Reporting - present the results to decision-makers Monitoring and evaluating - determine the affect of the HIA on the decision process
20. Types of HIAs Modified from Harris et al. 2007. Health impact assessment: A practical guide, Centre for Health Equity, Training, Research and Evaluation (CHETRE), Part of the UNSW Research Centre for Primary Health Care and Equity, UNSW: (http://www.hiaconnect.edu.au/hia_a_practical_guide.htm)
21. Evaluation of HIA Reviewed 23 HIAs completed in the U.S. between 2005 and 2013 11 HIAs directly contributed to decision outcomes—the way projects, plans, and policies were developed or implemented 14 HIAs influenced changes beyond the decision under consideration 16 HIAs showed key stakeholders the health effects of non-health policies and programs. 17 HIAs built consensus HIAs amplified community member voices in the decision-making process Bourcier, E., Charbonneau, D., Cahill, C., & Dannenberg, A. (2014). Do health impact assessments make a difference? A national evaluation of HIAs in the United States. Seattle: Center for Community Health and Evaluation.
22. Case Studies Healthy Corridor For All (MN) http://sapcc.org/node/600
23. Healthy Corridor for All 1st Comprehensive HIA in MN: funded by Health Impact Project Rezoning ordinance Lead by three organizations: ISAIAH, Take Action MN, PolicyLink Community driven: The HIA Steering Committee (20+) was made up of community leaders and residents http://www.policylink.org/atf/cf/{97c6d565-bb43-406d-a6d5-eca3bbf35af0}/HEALTHYCORRIDOR_SUMMARY_FINAL_20120111.PDF
24. Community Concerns Transit-oriented development can be very beneficial for communities by providing opportunities for people to live, work, and play without having to get into a car, potentially reducing congestion, air pollution, and increasing access to opportunity for transit-dependent households. Yet, as TOD has been constructed in many cities, it has often been associated with displacement of low-income people and communities of color. This HIA helped support equitable development— ensuring that low-income households and communities of color benefit from TOD without being displaced.
25. Scoping First meetings: Discussed vision for the community Discuss range of possible issues Voted 3 Areas of Assessment: Healthy Economy Healthy, Affordable Housing Safe and Sustainable Transportation
26. Key research questions: how will the proposed zoning… Healthy Economy Obj 1: change the amount and quality of jobs that will be available to residents in the corridor neighborhoods? Obj 2: affect, small, locally and minority-owned businesses by the corridor? Affordable, Healthy Housing Obj 3: affect the likelihood of neighborhood gentrification and the involuntary displacement of current residents? Obj 4: impact the cost of housing in the neighborhood and the availability of affordable housing? Safe and Sustainable Transportation Obj 5: coordinate with and affect affordable and accessible public trans? Obj 6: coordinate with and affect access to safe and connected routs to from and around rail and bus stops?
27. Housing Pathway
28. Assessment: Availability of Affordable Housing Existing Conditions: 14% of total housing units in CC are subsidized affordable units (80% of Area Median Income or less). 65% of corridor residents make less than 80% of the AMI 59% of resident spend more than 30% of their income on housing, compared with 40% St. Paul & 37% Ramsey 68% of renters pay more than 30% of their income in rent
29. Assessment: Availability of Affordable Housing (II) Key Impact Assessment Findings: Market projections suggest nearly 7000 new residential units may be built in station areas by 2030 of which several hundred may be affordable ifprojects use public funding % of existing subsidized affordable hosing units is likely to decrease, increasing housing burdens and potentially leading to involuntary displacement Rising rents and home values will likely decrease the amount of affordable housing If property values near transit stations continue to rise, acquisition of land for affordable housing near transit will be more difficult due to higher land costs
30. Recommendations: 5 Policies Community Equity Program: Pilot program requiring residential and mixed use projects within ¼ mi of transit stations to make a % of units affordable or facilitate the production of affordable housing Codify Commitment to Affordable Housing: make explicit statements in the ordinance of the intent to promote diversity and provide a range of affordable housing Density Bonus Program: expand incentives in the ordinance to offer increased density in the form of floor area and height bonuses and/or modification of parking requirements for affordable housing
31. Recommendations (II): 5 Policies Relieving Lack of Commercial Parking: adopt regulations that would allow use of undeveloped parcels for temporary parking lots to relieve parking problems during construction First Source Hiring: all construction contractors notify the St. Paul Human Rights and Equal Economic Opportunity Department of available job openings—a referral system shall identify targeted applications who meet contractor’s qualifications. Contractor would be required to keep a log of referrals and applicants hired to monitor the program for compliance.
32. Monitoring/Evaluation Increased relationships among SC members who never worked together in the past Increased community capacity to understand land use policy and its impacts on health and equity Research and data SC leaders can continue to use City Council: resolution to create affordable housing workgroup Commissioned a feasibility analyses on a number of affordable housing recommendations Shifted policy debate to include more community voices and introduced health into the discussion
33. Farm to School and School Garden Policy Bill 2800 (HB 2800), the Farm to School and School Garden legislation, as introduced in January of 2011: (1) allocate $19.6 million in state funds, equivalent to 15 cents per lunch and 7 cents per breakfast, to reimburse schools for purchasing Oregon food products, and (2) provide $3 million in competitive education grants to support food, garden and agriculture activities, up to 150 school teaching gardens each fiscal year. Source: Henderson, T., Rader, M., Sorte, B., Ratcliffe, M. M., Lawrence, A., Lucky, J., and Harris, C. (2011) Health Impact Assessment: Farm to School and School Garden Policy, HB 2800, Upstream Public Health and the Health Impact Project. http://www.upstreampublichealth.org/sites/default/files/F2SHIA_FINAL.pdf
34. Screening/Scoping: Health Determinants Employment Diet & Nutrition Farm to School & School Garden Education Environmental Health Social Capital All pictures and text from: http://www.upstreampublichealth.org/sites/default/files/F2SHIA_FINAL.pdf
35. Key Research Questions HB 2800 Farm to School http://www.healthimpactproject.org/resources/document/Upstream-HIA-Oregon-Farm-to-School-policy.pdf
36. Assessment Literature review Secondary data analysis (food insecurity, school meal eligibility, school nutrition services, unemployment) Economic analysis Interviews, committee feedback, community forums All pictures and text from: http://www.upstreampublichealth.org/sites/default/files/F2SHIA_FINAL.pdf
37. Assessment: Employment All pictures and text from: http://www.upstreampublichealth.org/sites/default/files/F2SHIA_FINAL.pdf
38. Current Conditions/Assessment Oregon’s unemployment rate was 10.5% in December 2010, higher than the national average of 9% . The recession hurt Oregon’s farms: almost 2/3 of farms reported net losses. Small & mid-sized farms especially are struggling to compete. Unemployed are up to twice as likely to die earlier than others of the same age and sex. The meal reimbursement program would create jobs and stimulate economic growth. All pictures and text from: http://www.upstreampublichealth.org/sites/default/files/F2SHIA_FINAL.pdf
39. Conclusions All pictures and text from: http://www.upstreampublichealth.org/sites/default/files/F2SHIA_FINAL.pdf
40. Assessment: Farm to School & School Garden Education All pictures and text from: http://www.upstreampublichealth.org/sites/default/files/F2SHIA_FINAL.pdf
41. Current Conditions/Assessment (II) Current Oregon learning standards do not require children to learn where food comes from or how it is made. Cafeterias are not connected to classroom curriculum. 1 in 4 Oregon adolescents are overweight or obese. 58% of 11th graders eat three or less servings of fruits and vegetables a day. Research on F2S & SG programs report that children choose more fruits and vegetables - leading to potential increases in consumption. Studies show that children who spend time in the garden learn better, get physical activity and behave better in the classroom. All pictures and text from: http://www.upstreampublichealth.org/sites/default/files/F2SHIA_FINAL.pdf
42. Conclusions (II) All pictures and text from: http://www.upstreampublichealth.org/sites/default/files/F2SHIA_FINAL.pdf
43. Recommendations Amend HB 2800 to specify that schools can only get reimbursed for foods produced/processed in OR Food, Agriculture and Garden education grants will be preferentially given to school districts serving: a low-income student population schools with a racially diverse student population schools in rural or urban areas with limited food access Support schools developing multiple-component programs, having at least one element in each of the following categories: Education, Promotion, Procurement and Community Involvement All pictures and text from: http://www.upstreampublichealth.org/sites/default/files/F2SHIA_FINAL.pdf
44. Above the Falls Master Plan (2000) City of MSP & MPRB adopted redevelopment plan for Upper Mississippi Riverfront Phase out heavy industry, address land use conflicts Some projects completed, but not to scale Stakeholders raised concerns over practicalities, costs (2012) Above the Falls Policy Review and Implementation Study
45. ATF: Screening Feasible Resources (staff, money, info) Interest Timely Fit into timeline for incorporation of Review & Implementation Study Stakeholders already mobilized Value Opportunity to increase awareness of health impacts & disparities Research unknowns Highlight common ground & accelerate implementation
46. ATF: Scoping Identify Alternatives Many land use alternatives to consider so developed criteria for selection 4 measurable land use decision alternatives that HIA would investigate
47. ATF: Scoping (II) Determine Study Area Determine Goals Elevate health considerations Maximize benefits & mitigate risks Collect input from diverse stakeholders, esp. untapped groups Serve as catalyst for redevelopment efforts
48. ATF: Scoping (III) Identify pathways Obesity Environmental quality (air, noise, water quality) Mental health Safety & security Neighborhood cohesion Neighborhood livability Employment
49. ATF: Scoping (IV) Scoping Results Research questions What draws/inhibits residents to RF? Links to health? Which land uses draw the most residents to RF locally & regionally? Links to health? Which land uses could improve/harm health of residents? Measurable health indicators Proposed research methods
50. ATF: Assessment Literature review Baseline Health Profile Analysis of Impacts
51. ATF: Assessment (II) ATF Research Activities: Review of literature and previous HIAs Secondary data analysis of health indicators Community Input Survey Resident input from community events and forums
52. ATF: Assessment (III)
53. ATF: Assessment (IV) Baseline Health Profile Demographics Existing land use Pollution in the area Evidence & existing conditions related to 4 land use alternatives: Park Access + Obesity + Mental Health Parkland + Environmental Quality Trails & River Connection + Health Employment + Health
54. ATF: Recommendations
55. ATF: Recommendations (II)
56. ATF: Monitoring & Evaluation
57. ATF: Monitoring & Evaluation (II) Internal Evaluation Report Collected feedback from key stakeholders Evaluated overall HIA process and various steps Focus on if goals were achieved Included Impact Evaluation
58. Screening helps determine if HIA… … is feasible sufficient information about the decision? resources available to conduct the HIA? … can be done in time fit within the decision-making time frame? … would add value to the decision making process health already being considered? will decision benefit from an HIA, promote health, influence positive change?
59. When not to do an HIA No added value Chula Vista Plan to Improve Walkability Plan was already considering health Health advocates involved in design Resources better focused elsewhere No influence on decision Milwaukee Zoo Interchange Project Insufficient time to complete HIA for drafts Stakeholders (DOT) not open to considering health Source: Wisconsin Department of Health Services, Health Impact Assessment: A Tool to Increase Health Equity in Decision-Making, Great Lakes Intertribal Council, April 23, 2012
60. Concerns about HIA Source: Wisconsin Department of Health Services, Health Impact Assessment: A Tool to Increase Health Equity in Decision-Making, Great Lakes Intertribal Council, April 23, 2012
61. Getting Started How to start the screening process: Define the decision What is being proposed? What is the timeline for the decision? Project Launch Final Decision Draft Plan Available Can the HIA be ready here?
62. Engaging Stakeholders 2. Decide who will be involved in the screening process Identify the stakeholders (i.e., residents, business owners, regional agencies, local organizations, elected officials) 3. Determine if potential partners are ready to work on the HIA Do they have resources available to conduct an HIA?
63. HIA Screening 4. Evaluate the program, plan, or policy based on screening criteria (including will the program have a significant impact on health) Utilize a Screening Worksheet or a Checklist There are a number to choose from Use the one that best meets your needs
64. Screening Criteria Has a project, plan or policy been proposed? Is there time to conduct HIA before decision is made? Will decision affect health? Would health inequities be impacted? How? Are impacts likely to be significant in terms of number of people impacted, severity, immediacy or permanence? Is there expertise, evidence and/or research methods available to analyze health impacts?
65. Screening Criteria (cont.) Is health already being considered? Are there clear links between the proposal and health? Are decision-makers open to considering HIA findings? Do stakeholders have interest, capacity/resources to participate in the HIA?
66. HIA Screening: Final Task The Final & Essential Screening Task Define the decision and its alternatives Decide who will be involved in the screening process Determine if potential partners are ready to work on the HIA Evaluate the project plan, or policy based on screening criteria 5. Notify stakeholders of your decision
67. Example: Above the Falls Master Plan Focus area includes or adjacent to diverse neighborhoods with large health disparities Land use barriers to accessing the river Proposal to transition predominantly industrial -> parks and residential land uses Health concerns: water, noise and air pollution Master Plan update – incorporate findings from: ATF Policy Review & Implementation study Park Board’s RiverFirst visionary design HIA recommendations
68. Ex Screening Example screening
69. ATF Screening ATF Screening Criteria the strength of the connection between the land use alternative and health; the extent of potential impact (i.e. reach) among the resident populations; timing of implementation of the land use alternative such that it could be informed by the HIA; stakeholder support for the alternative; potential health effects on current health status of priority populations; and effect on the local economy.
70. More Examples from HIP Paid Sick Days HIA (national, state, local) Treatment Instead of Prison HIA (WI) School Integration Strategies HIA (MN) Federal Farm Bill HIA (national) HIA for proposed coal mine at Wishbone Hill (AK) Lower Duwamish Waterway Superfund Site (WA) HIA for open burning enforcement in La Crosse county (WI)
71. HIA Reports Improving Health in the United States: The Role of Health Impact Assessment (http://www.nap.edu/catalog.php?record_id=13229) Minimum Elements and Practice Standards for Health Impact Assessment (http://www.humanimpact.org/doc-lib/finish/11/9) Guidance and Best Practices for Stakeholder Participation in Health Impact Assessments (http://www.hiasociety.org/documents/guide-for-stakeholder-participation.pdf) Promoting Equity through the Practice of Health Impact Assessment: (http://www.policylink.org/atf/cf/%7B97c6d565-bb43-406d-a6d5-eca3bbf35af0%7D/PROMOTINGEQUITYHIA_FINAL.PDF)
72. Resources: HIA Websites MDH HIA webpage (http://www.health.state.mn.us/divs/hia/) CDC Healthy Places webpage (http://www.cdc.gov/healthyplaces/hia.htm) World Health Organization HIA webpage (http://www.who.int/hia/en/) HIA Gateway – Public Health England (http://www.apho.org.uk/default.aspx?QN=P_HIA) UCLA – HIA Guide web (http://www.hiaguide.org/) Health Impact Project website (http://www.healthimpactproject.org/) Design for Health website (http://www.designforhealth.net/resources/healthimpact.html) Healthy Development Measurement Tool website (http://www.thehdmt.org/) Source: http://www.policylink.org/atf/cf/%7B97c6d565-bb43-406d-a6d5-eca3bbf35af0%7D/PROMOTINGEQUITYHIA_FINAL.PDF
73. Contact Information Kristin Raab, MPH, MLA Director MN Climate & Health Program Minnesota Department of Health 651.201.4893 kristin.raab@state.mn.us Brenda Hoppe, PhD Senior Epidemiologist MN Climate & Health Program Minnesota Department of Health 651.201.4908 Brenda.hoppe@state.mn.us