Health Impact Assessment 101. Candace Rutt, Ph.D. Centers for Disease Control and Prevention

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1 Health Impact Assessment 101 Candace Rutt, Ph.D. Centers for Disease Control and Prevention

2 Public Health and Planning Planning + Public Health Healthy Communities Healthier Population

3 Public Health and Planning Commonly used planning terms: Land Use Density Connectivity Sprawl Allied movements in Urban Planning: New Urbanism Smart Growth

4 What is an HIA? An HIA is a combination of procedures, methods and tools by which a policy 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. -WHO Gothenberg consensus paper 1999

5 What HIA is not... What HIA is 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. The Sweet Spot It s proactive! It s meant to inform a proposed policy, program or project currently under consideration. It s not a community assessments tool (i.e., MAPP, CHIP, CHA, PACE-EH), but those could be used during scoping or assessment stage of HIA. HIA is the process or framework that translates that data into well-informed policies.

6 When is an HIA appropriate? Outside the health sector Significant health impacts that are not already being considered The HIA can be completed before key decisions are made Stakeholders will use information Sufficient data & resources are available

7 When is an HIA inappropriate? Information is vague & unreliable Little or no local support for an HIA Stakeholders will not consider health impacts Decisions have already been made

8 Goal of HIA To focus the attention of decision-makers on the health consequences of the projects and policies they are considering. An HIA should lead to a better informed decision with respect to health.

9 Environmental Impact Assessments 1969 National Environmental Policy Act (NEPA) The purpose of NEPA is to protect the human environment and stimulate the health and welfare of man (NEPA, 1979, sec. 2)

10 Challenges of Incorporating HIA into EIA HIA components could logically fit within an EIA but... Long, complex documents Time-consuming, expensive and litigious Focus on projects not policies Focus on adverse effects Often too late to affect design Funded by decision proponent Reactive public involvement

11 Opportunities for Incorporating HIA into EIA Do not need to change the law Has been done before in California and Alaska and in other countries Thousands of EIAs and EAs are done each year and are mandatory Reduces duplication of effort Has teeth mitigations are required Can act as cooperating agency

12 HIA in the USA There was a realization that some of our health problems are the result of our built environment. The British have a longer history of conducting HIAs and have taught us much about the process. The world of planning and public health have a lot to learn from each other. HIA is a new and emerging science in the US.

13 WA 4 OR 6 Completed HIAs in the United States : 79 MT 3 MN 5 ME 1 WI 1 NH 1 CA 30 CO 3 OH 1 PA 2 MA 3 NJ 1 MD 1 NM 1 TN 1 GA 6 FL 1 AK 5 13 Map developed in collaboration with A. Wernham, Health Impact Project and A. Wendel and A. Dannenberg, National Center for Environmental Health

14 Completed and in Progress HIAs in the United States : 119 WA 8 OR12 6 MT 3 MN 6 ME 1 WI 1 NH 2 CA 47 CO 4 IL 1 OH 1 MO1 KY 1 PA 2 MA 4 NJ 1 MD 2 NM 1 TN 1 TX 1 GA 8 FL 1 AK 7 HI 1 Map developed in collaboration with A. Wernham, Health Impact Project and A. Wendel and A. Dannenberg, National Center for Environmental Health

15 Key Results in 56 HIAs in U.S. Most identified improvements needed to mitigate adverse health impacts Redevelopment projects that lacked affordable housing; pedestrian improvements along a dangerous highway A few encouraged projects or policies that would be health-promoting Walk-to-school program; Beltline One concluded that proposed program would fail to reach its intended target population After-school programs

16 Shades of HIA Scope Projects vs. policies Voluntary vs. regulatory

17 Types of HIAs Rapid Intermediate Comprehensive

18 A Rapid HIA Provides a broad overview of possible health impacts Can be used at an early policy development stage or where limited time/resources are available Involves collecting and analyzing existing data and researching previous HIAs Is usually carried out in days to weeks with minimal resources

19 An Intermediate HIA Provides more detailed information of possible health impacts Most frequent HIA approach Involves reviewing available evidence, any similar HIAs and collecting and analyzing new data Can take weeks to months to complete May involve community input

20 A Comprehensive HIA Provides a thorough assessment of potential health impacts Contains most robust definitions of impacts, but least frequently used Involves collecting and assessing new data using multiple methods and sources (quantitative and qualitative data including stakeholders opinions) Takes a long time to complete Involves community input

21 What Values Underpin an HIA? Democracy Equity Sustainable Development Scientific and Robust Practice Holistic Approach to Health

22 Steps in Conducting an HIA Screening Scoping Assessment Reporting Evaluation

23 Steps in the Screening Process Define the policy, program or project Determine whether you should conduct an HIA Determine what type of assessment to complete Briefly assess the potential health impacts Review decision with stakeholders

24 Steps in the Scoping Process 1. Establish ground rules 2. Define the policy or project 3. Gather preliminary information 4. Specify what impacts to assess 5. Consider assessment approach

25 Assessment Characterize the population Determine the health status of the population Identify health risk behaviors and locations where at-risk groups may be concentrated Determine the environmental conditions

26 Finding the Information Health & Demographic Databases Gray literature Peer reviewed literature Key informants or stakeholders who provide local information Experts in relevant fields who can identify the health related outcomes

27 Qualitative Methods to Determine Health Impacts Use evidence from the literature to determine direction (positive, negative, neutral, or can t estimate effect) and certainty (speculative, probable, definite)

28 Quantitative Methods to Determine Health Impacts Construct quantitative models and estimate potential health effects Perform sensitivity analysis (a.k.a. confidence intervals) List the assumptions and limitations

29 not everything that can be quantified is important and not everything that is important can be quantified -Mindell, et al (page 173)

30 Considerations When does the HIA need to be completed? Will adding numbers have a greater impact on the decision that is made? What is the availability and quality of the data for each health outcome? Will you need to make too many assumptions?

31 Assessment Most HIAs will use a combination of quantitative and qualitative data Quantitative HIAs should not be seen as superior to qualitative HIAs The most important point is that the HIA has an impact on the decision

32 Components of Good Reports Deliver clear recommendations Provide findings that will support decision making Use a format that addresses the audience Be aware of bias and barriers for each audience

33 How to Formulate Recommendations Explore what has been done elsewhere Use common sense Determine what is feasible but also consider what is possible look for win/win situations Look to the community and stakeholders for solutions Provide incentives such as tax breaks or quick approval process

34 Benefits of HIA Evaluation Improve the HIA process Modify future procedures or models Assess the accuracy of predictions made during appraisal

35 Three Types of HIA Evaluation Process evaluation Impact evaluation Outcome evaluation

36 Funder of HIA Robert Wood Johnson Foundation via Active Living Research and the PEW Charitable Trust Health Department University fellowship Centers for Disease Control The California Endowment

37 Key Challenges of HIA Uncertainties (data, models, policy) Timeliness Relevance to stakeholders and decision makers Capacity to conduct HIAs Training and funding

38 Next Steps for HIA Determine which projects and policies are most suitable for HIA Standardizing and streamlining impact estimation Determine feasibility of different types of tools in various settings Training

39 Summary HIA is a new and evolving science in the U.S., however it is a promising new approach to quantify health impacts of a wide variety of policies and projects HIA provides only one piece of information (health) in complex decisions and stakeholders may have different priorities HIA provides an outlet for health to be appropriately factored into complex decisions

40 Thank You