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Planners Using Health Impact Assessments
Frank Robinson PhD, Executive Director Partners for a Healthier Community
Molly Goren-Watts Principal Planner/Manager Regional Information & Policy Center PVPC
Sang Cho, Junior Planner Intern HGSD
Peter Lowitt FAICP, Director Devens Enterprise Commission
Planners Using Health Impact Assessments
A Tool in Developing Public Policy
Thursday, October 23, 2104
Frank Robinson, PhD, Executive Director
Partners for a Healthier Community, Inc
Molly Goren-Watts, Principal Planner
Pioneer Valley Planning Commission
Western Massachusetts Casino
Health Impact Assessment
Overview and Context
Health Impact Assessment (HIA)
HIAs are NOT
Key Values that shape the HIA process
What is a HIA
….
2
HIAs are NOT!
• How is HIA different from other types of assessments?
• 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.
• It’s not a community assessment tool (i.e., MAPP, CHIP, CHA),
but those are used during assessment stage of HIA.
3
Key Principles & Values of a HIA • Democracy - allows participation in policy development
and implementation
• Equity - consider distribution of health impacts, pay
attention to vulnerable groups and recommend ways to
improve proposed decisions for affected groups
• Sustainable development - judge short- and long-term
impacts of a proposal
• Ethical use of evidence - Use evidence to judge impacts
and inform recommendations, not set to support or
refute a proposal; be rigorous and transparent.
• Holistic approach to health - Be guided by the wider
determinants of health
4
What is an HIA? • HIAs are different from other
assessments?
• It’s proactive! It’s meant to inform a proposed policy, program or project currently under consideration
• It’s predictive! It uses data and scientific literature to predict potential health outcomes (evidence – e.g. scientific literature, reports, etc.)
• It’s translational! HIA is the framework that translates data and evidence into well-informed policies.
The Sweet Spot!
Implementation of the Expanded
Gaming Act Legislation
Developing the process for
casino licensure
Developing regulatory
requirements for casino
development and operation
Oversee licensing process and
selection of Casino operators
5
6
HIA Methods Six-Step Process
7
1. Screening
2. Scoping
3. Assessment
4.Recommendations
5. Reporting
6. Monitoring &
Evaluation
Assess value of HIA.
Define scope of assessment (e.g., which health impacts
to evaluate).
Determine how will decisions impact selected health
determinates and health outcomes
Determine how will decisions impact selected
health determinates and health outcomes
Communicate findings &
recommendations
Track impact of HIA and
decision
Western Massachusetts Casino Health Impact
Assessment (WMCHIA) - How will a casino impact
health in Western MA?
November 2011 - Chapter 194 “An Act Establishing Expanded
Gaming in the Commonwealth” Allows “up to 3 destination resort casinos located in 3 geographically diverse regions”
8
Background Proposed Casino Locations
Springfield
South End - MGM
Springfield
North End - Penn
W. Springfield-
Hard Rock Cafe
Palmer –
Mohegan Sun
• Springfield – urban, gateway city (pop 153,000)
• Palmer – rural (pop 12,000)
• West Springfield – suburban and rural (pop 28,000) 9
Background Proposed Casino - Springfield
- Gateway city
- Struggling economy
- Majority community of
color
- Residents face numerous
socioeconomic challenges
and experience health
inequities
- Opportunity for economic
redevelopment
10
About WMCHIA Conducted Spring 2013 – Fall 2013
Lead partners
Partners for a Healthier Community
Springfield Dept. of Health &
Human Services
UMass School of Public Health
Step 1: Screen Determines value and need of HIA
Questions include…
Is HIA likely to add value?
Is it feasible?
Does decision-making process
allow for input from HIA?
11
Arise for Social Justice Massachusetts Department of Public Health Springfield Police Department (retired
chief)
Behavioral Health Network Massachusetts Gaming Commission Town of Palmer, Health Department
City of West Springfield, Health
Department
New North Citizens' Council Town of Palmer, Planning Department
Develop Springfield Palmer Town Council United Council of Churches of Greater
Springfield
Greater Springfield Chamber of
Commerce
Partners for Community/United Farm Workers United Way of Pioneer Valley
Holyoke Community College Pioneer Valley Planning Commission University of Massachusetts, Amherst
Irene E. And George A. Davis
Foundation
Regional Employment Board of Hampden
County
Western MassCOSH
Lutheran Social Services Springfield City Council Casino Site
Committee
WMCHIA Methods Screening & Stakeholder Engagement
Advisory Committee • Cross-sector stakeholders, HIA experts, casino/gambling experts, decision-makers
host community municipalities, state and local public health, social justice, planning
organizations, non-profit, faith community, police/public safety, immigrant services,
development, academics
12
WMCHIA Methods
Step 1: Screening & Stakeholder
Engagement
Introductory HIA workshop
Community forums
Online Survey
Stakeholder interviews & community contacts
Media
WMCHIA web page
WMCHIA email list
Presentations to stakeholders
13
WMCHIA Goals
Step 1: Screening & Stakeholder
Engagement
1. Promote consideration of potential health impacts in decision-making related to the
licensing, site selection and development of a casino in Western MA, particularly
Host community agreement negotiations (if possible) and implementation
Casino operator applications
Host community public hearing
MA Gaming Commission licensing decisions and casino regulations
Planning for development of licensed casino
2. Recommend possible health or health-related indicators for the Gaming Commission’s
casino monitoring and evaluation plan
14
Casino Licensing Timeline
15
WMCHIA Methods
Step 2: Determining the Scope of WMCHIA
Interest from community in assessing impact on a range
of areas
Process for choosing health determinants and outcomes
in assessment
16
WMCHIA Focus Areas Step 2: Determining the Scope of WMCHIA
• Topic areas
• Jobs and employment
• Access to local casino
gambling
• Traffic
• Crime and Public Safety
• Geographic location
• Focused on host community
impact and in some cases
region
• Other important concerns
not included
• Public safety capacity &
city infrastructure
• Economic development
• City/town revenue
• Housing
17
Step 2: Determining the Scope:
Jobs & Employment Pathway
Casino Opens Resort casino jobs
Shiftwork
Income
Social cohesion w/family
Quality and access to health insurance
Smoking, gambling, alcohol (risk behaviors)**
Sleep disturbance
Life expectancy
Mental health
Chronic disease
Cancer
* Assessment focus is on impact of employment on unemployed ** Relates specifically to casino employees
Health ImpactsDecision
Initial Impact Pathway Impact
Pathway Impact
Employment (resort casino jobs)*
18
Step 2: Determining the Scope:
Access to Local Casino Gambling Pathway
Casino Opens
Access to gambling Problem or
pathological gambling
Life expectancy
Family health/well-being
Job loss and financial resources
Chronic disease
Mental health
Health ImpactsDecision
Injuries
Cancer
Access to health-promoting resources
Suicide
Initial Impact Pathway Impact
Pathway Impact
Financial resources
19
Step 2: Determining the Scope:
Traffic Pathway
Casino OpensTraffic
Motor vehicle and pedestrian accidents
Air pollution
Motor vehicle & pedestrian injuries and mortality
Asthma, CVD, cancer
Health ImpactsDecision
Initial Impact Pathway Impact
20
Step 2: Determining the Scope:
Crime & Public Safety Pathway
Casino Opens
Alcohol use Driving under the influence
Injury and mortality
Crime (actual and perceived)
Mental health
Chronic Disease
Health ImpactsDecision
Initial Impact
Pathway Impact
21
WMCHIA Methods Step 3: Assessment
Assessment process is characterized by:
Expert input
Existing reports
Impacts - some quantitative but primarily
qualitative
Recommendations
Expert and stakeholder input
Based on best practice and local needs
22
WMCHIA Methods
Step 3: Assessment
Provides baseline data profile of health determinants and
conditions being evaluated
Evaluates potential health impacts
Uses scientific literature and other types of evidence to
identify potential impacts
What does literature say?
What is the strength of the evidence
Uses analytic methods and baseline data to predict
impact of decision on target population
23
WMCHIA Methods Step 3: Assessment
24
WMCHIA Methods
Step 4: Recommendations
The Western Massachusetts Casino Health Impact Assessment identified a number of potential positive and negative effects, but its focus was on solutions and recommended actions to strengthen the positives and mitigate the negatives of casino development in Springfield.
Planned strategies (e.g. MGC, casino operator) that community stakeholders thought was important to show support for
Enhancement on planned strategy
Add-in new focus areas where no current plans
Recommendations are targeted to variety of stakeholders e.g. MGC, casino operator, host community, state agencies
25
Step 4: Recommendations:
Predicted Impacts - Jobs and Employment
Casino would bring needed
local jobs given high
unemployment rate
Estimated 3,000 new jobs,
2,200 FT
~65% of casino jobs will require
H.S. diploma/GED
Casino Careers Training Institute
will train for new positions
Local hiring goals
Diversity goals
New jobs locally
-> improved health
61%
26
Step 4: Recommendations: Predicted Impacts - Jobs and Employment
Challenges to meeting goals to improve local unemployment
Anticipated turnover rates of ~40%
Local and regional barriers to obtaining and retaining entry-level
positions prevent most in need of new jobs from obtaining
Workforce readiness capacity
Access to needed ABE and EOSL
Public transit service capacity
27
Step 4: Recommendations: Predicted Impacts - Jobs and Employment
Category of Position Average per capita wage Annual Cash Tips
and/or Casino Tokes
Total Average Per
Capita Wage
Executive/Director $189,331 -- $189,331
Management $67,418 -- $67,418
Skilled Salary & Supervisory $53,583 -- $53,583
Hourly, Casino Tokes $17,374 $31,124 $48,498
Hourly, Cash Tips $18,388 $21,856 $40,244
Line Level and Administrative $29,806 -- $29,806
• Wages touted as high may not allow for self-sufficiency Foxwoods Crossroads Casino Report - Average Wage by Category
• 28% would be estimated to be line level and administrative support – this does not meet family economic self-sufficiency standards – 2 parents family (1 parent working full-time) with 2 kids residing in Greater Springfield
28
Step 4: Recommendations: Predicted Impacts - Jobs and Employment
Casino employees may experience negative health impacts
Casino employees found to have higher prevalence of health risk
behaviors
Shift-work found to negatively impact health
Gaming Employees Non-Gaming Employees
Hours Percent Hours Percent
5:00 a.m. – 1:00 p.m. 20% 8:00 a.m. – 4:00 p.m. 20%
1:00 p.m. – 9:00 p.m. 40% 4:00 p.m. – 12:00 p.m. 60%
9:00 p.m. – 5:00 a.m. 40% 12:00 p.m. – 8:00 a.m. 20%
Source: Casino Careers Training Institute
29
Step 4: Recommendations: Predicted Impacts - Jobs and Employment
Casino operator plan to reach targeted local hiring levels given
documented regional workforce barriers
Infrastructure funding for regional cross-sector collaboration to
address workforce barriers
Casino operator
Health and wellness programs
Best practices to reduce impacts of shiftwork
Employment indicator monitoring and reporting – diversity/equity,
where hired from, etc.
30
Step 4: Recommendations: Predicted Impacts - Access to Local Casino Gambling &
Disordered Gambling
Likely increase problem
gambling prevalence with
casino (estimated 30%)
Many vulnerable populations
in Springfield would be at
increased risk
Young people
Communities of color
Low-income individuals
Limited community capacity
to prevent/address problem
gambling
Problem and Pathological Gamblers
Geography Current After Casino
Opens - Initial
(~1 year)
After Casino Opens -
Over Time
(~5 years)
Springfield 3,993 5,191 3,993
Hampden
County
12,114 15,748 12,114
31
Step 4: Recommendations: Predicted Impacts - Access to Local Casino Gambling &
Disordered Gambling
Public Health Trust Fund funding to create infrastructure for
regional cross-sector collaboration to address increases in
problem gambling
Public awareness campaign
Targeted campaigns and strategies to vulnerable populations that
are accessible (e.g. culturally competent, appropriate literacy
level)
Casino implement responsible gambling framework
32
Step 4: Recommendations Predicted Impacts – Traffic
Estimated 15-30,000 new vehicle
trips per day
Potential adversely affect the City’s
many residents living in EJ areas
High hospitalization rates for
diseases affected by air pollution –
asthma, CVD, COPD
Large racial/ethnic disparities
33
Step 4: Recommendations Predicted Impacts – Traffic
• Greatest health impact likely due to near roadway air pollution
– Latinos experiencing disparities and live along likely casino routes and most likely to be impacted
• May be impact in traffic related collisions due to traffic increase
34
Step 4: Recommendations Predicted Impacts – Traffic
Funding to create infrastructure for regional cross-sector
collaboration to address increases in traffic
Promote use of public transportation and alternative methods of
transport
Assess impact of near roadway pollution on vulnerable
populations and develop strategies to mitigate harms
35
Step 4: Recommendations Predicted Impacts – Crime & Safety
• Uncertain the extent crime will increase – Literature conflicting
– Factors impacting • Community preparedness
• Community design
• DUIs and alcohol-related fatalities may increase with accessibility to free alcohol at casinos – Expanded Gaming Act allows for free alcohol on gaming floor b/t
8:00 a.m. – 2:00 a.m.
36
Step 4: Recommendations Predicted Impacts – Crime & Safety
Community design strategies to prevent crime and enhance
perception of safety
City should support and complement casino operator proposed
design elements
Strategies to prevent DUIs
Public health campaign
Expanded sobriety checks, etc.
37
Step 4: Recommendations General Findings
Integrating resort casino plans with those of other initiatives has the
best potential to address existing regional needs
Large existing health inequities in Hampden County and Springfield
could be reduced or exacerbated by impacts of a casino depending on
strategies implemented
Data-driven evaluation and modification of activities to ensure that
stated goals are achieved, including
1. Publicly available casino impact data
2. Periodic evaluation of impact on identified existing regional needs and health
equity areas by multi-sector stakeholder groups
3. Modifications of strategies and plans as needed
4. Reallocation of money to fund modified strategies
38
Step 5: WMCHIA Report
39
WMCHIA Reporting Involved key stakeholders in review
process
MGC, SEIGMA, MGM, etc.
General dissemination
Email blast, press release, etc.
Presentations
Key decision-makers: MGC, MGC staff, Springfield Mayor
Other key stakeholders Problem-gambling groups (WMCGA,
MA Council Compulsive Gambling, local problem gambling panel)
Local outreach worker group
Others MAPC – examining surrounding
community impacts
MPHA Policy Subcommittee- deciding whether to take position on upcoming ballot questions
40
Step 6: WMCHIA Impacts
MA Gaming Commission and University of Massachusetts, School of Public Health and Health Sciences (SEIGMA - Social and Economic Impacts of Gaming in Massachusetts ) Health Equity lens for evidence-based research that includes community voice; Support for implementation activities – e.g. responsible gaming framework information on certain indicators
Springfield Mayor - considering adoption of recommendations and using it to advocate for funding to implement recommendations
Community residents and organizations Local neighborhood council reviewed report to understand impacts and identify
recs for advocacy Gardening the Community used info in WMCHIA to successfully apply for
funding WMCHIA recs used to support advocacy for MGM to purchase from local small
farmer cooperative
41
Step 6: Monitoring Impacts (Context –
Uncertainty)
• Impacts on decision-
making processes and
decision
• Impacts of decision on
health determinants
42
Devens Grant Road Redevelopment Regulations Health Impact Assessment
Peter Lowitt, FAICP Sang Cho
Neil Angus, AICP, LEED AP SNEAPA
October, 2014
Introduction
• Regional Context & Devens Redevelopment
• Grant Road HIA
• Recommendations
Regional Background • Neighboring towns:
Harvard, Shirley, Lancaster and Ayer
• Fort Devens located on Route 2, just outside Boston’s second beltway ring – I-495
• Rural character typical of Massachusetts outside Boston influence still exists in this area
• Excellent transportation access including Heavy Rail and Commuter Rail
1994 Reuse Plan
Grant Road
The purpose/function of HIA is to:
• Inform and influence the decision maker
• Help address inequalities in health
• Place public health on the agenda
• Reduce conflict between stakeholders
• Encourage sustainable development
HIA is an approach that gets people to think about what they are doing and how it may alter people’s health. It promotes health-and in the long term contributes to the health of local population.
HIA Methodology
• Screening
• Scoping
• Assessment 1. How will it be done?
2. Community Participation
3. The Study Area
4. Behavior Risk Factor Surveillance System data
5. Analytic Method
• Reporting
Process
• Literature review
• Consultation with HGSD and HSPH faculty and graduate students
• Invitation to community and professionals to participate
• Development of background materials and two mock development scenarios, handouts, HIA checklist, and workshop schedule
120 Unit Development Scenario #1 (30 acres)
Housing Mix: 30 single family 16 single fam. cottage 16 two-family 28 – multi-family (#of units) 30 multi-family (9x 3-4 units) (4x 6-12 units)
Park
Park
Com Gdn
ComGdn
1
1
1
1
1
1
1
1
1
1
1
1 1
1 1
1
1 1 1
1
1
1
1
1
1
1
1
1 1
1
1 1
1
3
3
4
4
2 2
2 3
6
8
2
2
2
3 3
2
8
4
4
2
2 3
12
1c
1c
1c
1c
1c
1c
1c 1c 1c 1c
1c 1c 1c 1c
*
*Cedar Street – Neighborhood Road
120 Unit Development Scenario #2 (60 acres)
Housing Mix: 80 single family 22 two-family 12 – 3-4 family 6 multi-family (#of units) (1x6 unit)
1
1
1
1
1
1
1
1
1 1
1
1 1 1
1
1
1
1
1
1
1 1
1 1
1
1
1 1 1
1
1
1 1 1
1
1 1
1 1
1 1 1
1
1 1
1 1
1 1
1 1 1
1
1
1
1 1
1 1 1
1
1
1
1
1 1
1
1 1
1 1
1 1
1
1 1 1
1
4
4
2
2
2
2
2
2
2
2
2
2 6
4
2
1 1
Proximity to Local Services
Homes Shops Schools Work Play
½ mile walk/bike distance
Key Features of Development Scenarios
Key Features of Development Scenarios cont…
Links between Housing and related factors and Health
Example Use of HIA checklist
HIA Checklist and Results
HIA Checklist and Results
HIA Checklist and Results
Recommendations
• Introduce traffic calming measures to reduce speeds • Install Rotary at intersection of Grant, Pine and Hospital Roads • Use architecture to assure privacy and access to green space is available
on all lots • Incentivize community gardens and have plots available for employees
and neighboring communities • Support measures to introduce shuttles to commuter rail line to support
increased transit use • Support existing food pantry serving healthy foods • Provide nutrition classes for residents and offer classes on gardening • Attract residents from surrounding communities onto Devens through
courses, programming and educational events • Organize community walks and other events that promote healthy
lifestyles
For more information:
• A pdf of the Grant Road Redevelopment Regulations HIA is available at www.devensec.com/news.html
• Contact: Peter Lowitt, FAICP, [email protected]
Health Impact Assessments:Health Impact Assessments:Health Impact Assessments:Health Impact Assessments:What Roles Can a Regional What Roles Can a Regional Planning Agency Play?Planning Agency Play?Planning Agency Play?Planning Agency Play?
Presented at SNEAPA 2014Presented at SNEAPA 2014Thursday, October 23
Molly Goren-Watts, Principal Planner/Manager Regional Information & Policy Center
Pioneer Valley Planning Commission
Lead or ProvideLead or ProvideLead or ProvideLead or ProvideTechnical AssistanceTechnical Assistance
All HIAs need technical expertise, topic knowledge, and community connections and engagement.
Model 1 – Lead with technical expertise. Engage partners for topic knowledge and/or community connections as needed.
Model 2 – Provide technical expertise to community research partner (expert in specific field or community organization facing the question at hand)
Model 3 – Conduct HIA as partnership led by RPA and one or more topic or community-specific organizations.
PVPC Participation in PVPC Participation in PVPC Participation in PVPC Participation in Casino HIACasino HIA
•Partners for a Healthier Community was lead.
• As RPA to all three proposed host communities, PVPC had to remain neutral in fact and appearance to all communities involvedneutral in fact and appearance to all communities involved.
•PVPC provided:•Data collection and understanding data sources
•Mapping
•Topic area specialists – traffic, transit, land use, economic development (for analysis and proofing of recommendations)
•Networking/Connecting with other specialists in the region (city/town government, workforce development agencies (REB), police department, transit authority, others doing related work for stakeholder engagement) stakeholder engagement) •Analytical assistance such as review of pathway diagrams
PVPC Roles in Other HIAsPVPC Roles in Other HIAsPVPC Roles in Other HIAsPVPC Roles in Other HIAs
•Overall Management
•Literature review
•Analysis and writing
•Stakeholder engagement•Stakeholder engagement
Questions?Questions?Questions?Questions?