Health Impact Assessment Training

1. Health Impact Assessment Training Kelly Muellman MN Climate & Health Program Planner Brenda Hoppe, PhD MN Climate & Health Program Epidemiologist December 18, 2013

2. Acknowledgements • This HIA training is supported by a grant from the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. • Special thank you to Blue Cross Blue Shield of Minnesota Foundation for their sponsorship of the training space and refreshments.

3. Agenda • Welcome & Introductions • Connections between health and the environment • Introduction to HIA • Step 1: Screening • Example HIA: Cloquet Transportation Planning HIA • Step 2: Scoping  • Example HIA: St. Paul Emerald Ash Borer HIA • Scoping Exercise • Steps 3 & 4: Assessment & Recommendations • Step 5 & 6: Reporting & Evaluation and Monitoring • Training Evaluation

4. Today . . . . . Think “Health”

5. Slide 1 Complete Street’s Photostream - Flickr

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11. Learning Objectives • The purpose of an HIA: to provide health information to decision-makers before important decisions are made, so they can make a more informed decision • Six HIA steps and HIA process

12. 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

13. Something is wrong2000 Avg Life Expectancy and Healthcare Spending http://ucatlas.ucsc.edu/spend.php

14. 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.

15. 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

16. Health & the Built Environment • Health Issues • Physical Inactivity • Poor Diet & Nutrition • Mental Health Issues • Decreased Social Capital • Poor Air Quality • Increase in Car Crashes • Increase in Bike/Ped Injuries • Poor Water Quality • Planning/Design Issues • Disconnected Land Use Patterns • Land Fragmentation (Loss of farmland, open space, wetlands, etc…) • Low Density • Auto Dependency • Congestion • Trail/Sidewalk Gaps • Limited Choices

17. Health Impact Assessment (HIA) • Definition: 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 projecton 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.

18. 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

19. Why Conduct HIA? • Identify harms and benefits before decisions are made • Identify evidence-based strategies and recommendations to promote health and prevent disease • Increase transparency in the policy decision-making process • Support inclusive and democratic decision-making • Support community engagement in the decision-making process • Advance equity and justice • Shift decision-making from an economic to a quality of life framework • Inform a discussion of trade-offs involved with a project or policy • Facilitate decisions and their implementation

20. Types of HIAs Types of HIA

21. HIA in the U.S. 300 HIAs (12/16/2013) Source: Health Impact Project website

22. HIA at the National Level • Two major national funders • Centers for Disease Control & Prevention (CDC) (directly funds grantees; ASTHO-HIAs, training, TA) • 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 (Washington DC)

23. HIA in Minnesota • MN HIA Coalition • BlueCross BlueShield Foundation of Minnesota • MDH website/listserv • Training • Technical Assistance MDH Health Impact Assessment website

24. MN HIA Coalition: Draft Goals The purpose of the MN HIA Coalition will be to bring together communities and organizations in Minnesota to: • Educate on and promote the appropriate use of HIA. • Share information, tools, best practices and lessons learned (especially what works and what doesn’t) from HIAs. • Collaborate on and coordinate (when applicable) HIA-related activities. • Seek and vet future projects for HIA funding opportunities. • Promote/systematize policies and funding for HIAs and Health in All Policies. • Seek funding to support MN HIAs. • Develop a strategic plan/workplan to accomplish goals.

25. History of HIA in MN designforhealth.net

26. History of HIA in MN (cont.)

27. 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 • Evaluation and Monitoring - determine the affect of the HIA on the decision process

28. Step 1: Screening

29. Step 1: Screening: What is Screening? What is HIA Screening? The Screening process helps determine if: • … the HIA is feasible • Is there sufficient information about the decision? • Is there available resources to conduct the HIA? • … the HIA can be done in a timely manner • Can the HIA fit within the decision-making time frame? • … the HIA would add value to the decision making process • Is health already at the table? • Will the proposed project benefit from an HIA and promote health and influence positive change to the community?

30. Screening: 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 • Time: insufficient time to complete HIA for drafts • Stakeholders: DOT was not open to considering health (recommendations seen as another obstacle or more red tape) 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

31. 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

32. HIA Screening: 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?

33. HIA Screening: 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 the resources available to conduct an HIA?

34. 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 of worksheets to choose from • Use the worksheet that best meets your needs

35. Screening Criteria • Has a project, plan or policy been proposed? • Is there time to conduct HIA before decision is made? • Will the project, plan or policy affect health? • Would health inequities be impacted? How? • Are health impacts likely to be significant in terms of number of people impacted (magnitude), severity of impact, or immediacy or permanence of impacts? • Is there expertise, evidence and/or research methods available to analyze health impacts?

36. 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? • Will the HIA process have potential health impacts? • Do stakeholders have the interest and capacity/resources to participate in the HIA?

37. HIA Screening: Notify Stakeholders The Final & Essential Screening Task • Define the decision and its alternatives • Decide who will be involved in the screening process • Determine if potential partners area ready to work on the HIA • Evaluate the project plan, or policy based on screening criteria 5. Notify stakeholders of your decision • Will you be conducting an HIA?

38. 5 Minute Brainstorm • Project, Plan or Policy that might benefit from an HIA

39. Cloquet Transportation Planning HIA

40. Step 2: Scoping

41. Step 2: Scoping: Two Main Goals Two Main Goals: • Create the plan for the HIA • Determine health indicators to be assessed Health issues that will be assessed

42. Scoping: Create the Plan for the HIA Determine: • Team responsible for conducting the HIA • Group who will oversee the HIA process • Stakeholder engagement

43. Scoping: Stakeholder Engagement • In addition to promoting inclusive, healthy, and equitable communities, stakeholder participation can improve the efficacy of an HIA by helping to: • identify important stakeholder concerns • bring important reflections of experience, knowledge, and expertise • ground truth findings and recommendations by ensuring that the lived reality matches priorities, data, and analysis • support the value of equity and democracy within the HIA • create more support for the implementation of HIA recommendations • shape communication and dissemination methods

44. Scoping: Identify Stakeholders Who are the stakeholders? • Public health agencies • Community residents/ organizations • Public agencies • Policy makers • Businesses Populationslikelytobeimpactedbyadecisionshouldbe involvedandhaveanoversightroleintheHIAprocess

45. Scoping: How to Involve Stakeholders How should stakeholders and the affected communities be involved? • Advisory Committee • Steering Committee • Technical Committee • Public meetings • Small group discussions

46. Scoping: How to Involve Stakeholders (cont.) How should stakeholders and the affected communities be involved? • Comment forms • Project website • Workshops • Surveys • Focus groups • Design charrettes

47. Gary/New Duluth: Information Flow Chart

48. Gary/New Duluth: Stakeholder Engagement • Technical Advisory Committee • Community survey • Paper (distributed widely) • Online (Survey Monkey) • Public meetings • One-on-one meetings or calls

49. StakeholderEngagement:Challenges • Developingandmaintainingrelationships • Establishingcommongoals,expectations,groundrules • Managingconflictinginterestsandperspectives • Ensuringmeaningfulinvolvementthatleadstoempowerment 100

50. Scoping: Stakeholder Analysis