Use of Health Impact Assessment

in the United States: An Update

Andrew L. Dannenberg, MD, MPHNational Center for Environmental Health

Centers for Disease Control and Prevention, USAacd7@cdc.gov

7th International Health Impact Assessment ConferenceCardiff, Wales, April 5, 2006

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. 93:1500-1507, September 2003

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. 96:262-270, February 2006

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

Source: Atlanta Journal-Constitution, March 10, 2006

Transportation Planning and Land Use Choices

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

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

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

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

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

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

Minutes of Walking To and From Public Transit Per Day

10

19

31

0

10

20

30

40

Min

ute

s p

er d

ay

Besser LM, Dannenberg ALAmer J Prev Med 29:273, 2005

Data from National Household Travel Survey, 2001, USDOT

N= 3312 transit users

Examples of Health Impact Assessments

Conducted in the United States

HIA of Housing Redevelopment ProjectsRajiv 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

HIA of City Living Wage OrdinanceBrian 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

HIA on Housing Rental Voucher ProgramChild 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 children’s health

• Funded by multiple public agencies, two anonymous donors, and in-kind donations by working group members

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

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

HIA of Highway RedevelopmentCandace 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

HIA of Beltline Trail and Transit LoopCatherine 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

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

Health Impact Assessments can help

guide community design and land use choices to promote human health

www.cdc.gov/healthyplaces