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Use of Health Impact Assessment in the United States: An Update

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Title: Use of Health Impact Assessment in the United States: An Update


1
Use of Health Impact Assessment in the United
States An Update
  • Andrew L. Dannenberg, MD, MPH
  • National Center for Environmental Health
  • Centers for Disease Control and Prevention, USA
  • acd7_at_cdc.gov
  • 7th International Health Impact Assessment
    Conference
  • Cardiff, Wales, April 5, 2006

2
Health and Community Design Workshop CDC,
Atlanta, May 2002
  • Purpose To identify research needs linking
    health and community design
  • Participants Experts in physical activity,
    injury prevention, air pollution, water quality,
    urban planning, architecture, transportation,
    epidemiology, land use, mental health, social
    capital, health policy, housing, social marketing
  • Findings 37 research areas highlighted
    including Health Impact Assessment
  • Summary Dannenberg AL, et al. American Journal
    of Public Health. 931500-1507, September 2003

3
Health Impact Assessment Workshop RWJF and CDC,
Princeton, October 2004
  • Purpose To move HIA forward in the United
    States
  • Participants HIA experts from UK, Canada, and
    WHO, and US participants from local health
    departments, academia, transportation,
    environmental health, urban planning, CDC, and
    the Robert Wood Johnson Foundation (RWJF)
  • Findings Priority needs are to conduct pilot
    tests, develop staff capacity, develop database
    of HIA resources, build political support for HIA
    use, and conduct evaluations
  • Summary Dannenberg AL, et al. American Journal
    of Public Health. 96262-270, February 2006

4
A Vision of Health Impact Assessment
  • Community planners and zoning boards will request
    information on potential health consequences of
    projects and policies as part of their
    decision-making process
  • Local health officers will have a tool to
    facilitate their involvement in community
    planning and land use decisions that impact health

5
Transportation Planning and Land Use Choices
Source Atlanta Journal-Constitution, March 10,
2006
6
Voluntary vs. Regulatory Approach to Using an HIA
  • 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

7
Relationship of HIA to Environmental Impact
Assessment
  • HIA components could logically fit within an EIA
    process
  • HIA incorporated into EIA is necessarily
    regulatory
  • Extending an EIA to include an HIA likely to
    encounter resistance from developers who see it
    as an additional barrier

8
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

9
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

10
Building Capacity to Conduct HIAs
  • February 2006 HIA training workshop
  • 11 pairs of local health officials and planners
    selected competitively
  • Organized by National Association of County and
    City Health Officials and American Planning
    Association
  • International HIA expert Alex-Scott Samuel
  • Some attendees are beginning to conduct HIA pilot
    projects based on training

11
Other HIA Capacity Building Activities
  • Course on HIA now being taught by Rajiv Bhatia at
    University of California, Berkeley
  • Denver health department has requested
    consultants to teach HIA course for their staff
  • Seattle group has begun an HIA listserve for the
    United States
  • Several states and one U.S. Senator are beginning
    to mention HIA in proposed legislation

12
Minutes of Walking To and From Public Transit Per
Day
Data from National Household Travel Survey, 2001,
USDOT N 3312 transit users
Besser LM, Dannenberg AL Amer J Prev Med 29273,
2005
13
Examples of Health Impact Assessments Conducted
in the United States
14
HIA of Housing Redevelopment Projects Rajiv
Bhatia, San Francisco Health Department
  • Rapid assessment of health impacts in two housing
    redevelopment projects and one area plan
  • Qualitative review of Environmental Impact
    Report, community engagement, secondary data
    analysis
  • Findings Effects on housing affordability,
    vehicle commutes, displacement of residents,
    segregation, and public infrastructure
  • HIA analyses led to improvements in project plans
  • Funded conducted by city public health
    department

15
HIA of City Living Wage Ordinance Brian Cole,
UCLA, Los Angeles
  • Estimate of potential mortality reduction from
    proposed ordinance to raise minimum wage for city
    contract workers or provide them with health
    insurance
  • Quantitative assessment
  • Findings Employers are more likely to increase
    wages than to offer health insurance, thereby
    losing much of health benefit intended by
    ordinance
  • Funded by Robert Wood Johnson Foundation

16
HIA on Housing Rental Voucher Program Child
Health Impact Working Group, Boston
  • Examined impact of changes to Massachusetts
    housing rental assistance program for families
    who otherwise would be homeless or live in
    substandard dwellings
  • Primarily qualitative assessment
  • Findings Program alterations may lead to
    reduced program eligibility, increased housing
    instability, and adverse effects on childrens
    health
  • Funded by multiple public agencies, two anonymous
    donors, and in-kind donations by working group
    members

17
HIA of Coal-Fired Power Plant McLeod and
Simmons, Healthy Development, Inc.
  • Examined health impacts of proposed 800 megawatt
    coal-fired power plant in Florida
  • Rapid, quantitative assessment
  • Findings Fine particulate matter pollution
    containing SO2 will decrease life expectancy by 2
    days after 16 years of plant operation
  • Full HIA now funded to recommend social and
    economic interventions to improve local health
  • Conducted by private HIA consultants with county
    health department funding

18
HIA of Proposed Speedway and Sports
Facilities Carol Maclennan, Tri-County Health
Dept., Colorado
  • Desktop review of proposed motor sport speedway,
    sport shooting, golf and equestrian facilities
    near Denver
  • Letter from health department sent to county
    planning and zoning commission highlighted
    potential adverse health impacts related to
    noise, air quality, water quality, and wastewater
    management
  • Proposal subsequently withdrawn
  • Review conducted by existing health department
    staff without additional funding

19
HIA of Highway Redevelopment Candace Rutt, CDC,
Atlanta
  • HIA of proposed redevelopment of Buford Highway
    corridor
  • Area known for its high risk to pedestrians
  • Quantitative assessments physical activity,
    injury
  • Qualitative assessments noise, traffic, crime,
    air pollution, social capital, economic
    development
  • HIA has facilitated dialog between CDC and local
    department of transportation
  • Funded by Robert Wood Johnson Foundation

20
HIA of Beltline Trail and Transit Loop Catherine
Ross, Georgia Tech, and CDC staff
  • Proposed 22-mile urban trail and light rail loop
    using abandoned rights-of-way and promoting new
    parks and redevelopment in Atlanta
  • Qualitative and quantitative assessments
    community input
  • HIA being conducted during ongoing project
    planning
  • Expected findings positive health impacts on
    physical activity, air pollution, injuries,
    social capital, brownfield redevelopment
  • Funded by Robert Wood Johnson Foundation

21
HIA in the United States Next Steps
  • Conduct pilot tests of existing tools for HIA of
    projects and policies
  • Develop staff capacity to conduct HIAs including
    training materials and train-the-trainer
    workshops
  • Develop incentives and political support for use
    of HIAs
  • Develop a database for measuring health impacts
    of common projects and policies
  • Conduct process, impact and outcome evaluations
    of HIAs

22
Health Impact Assessments can help guide
community design and land use choices to promote
human health
www.cdc.gov/healthyplaces
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