Health Impact Assessment: A health lens for public policy Aaron Wernham, M.D., M.S. Director | The Health Impact Project 901 E Street, NW, Washington, D.C p: e:

AK 3 CA 25 CO 2 FL 1 MA 2 NJ 1 Completed HIAs in the United States 1999–2009 (N = 54) MN 5 GA 4 WA 4 OR 2 OH 1 PA 1 MD 1 MT 1 MI 1 Courtesy A. Dannenberg, A. Wendel, CDC NCEH 2

A brief history of HIA in the U.S. 1999SFDPH – Living wage HIA 2001First RWJF grant on HIA – P4P, Fielding 2004Workshop on advancing HIA in the U.S. (see “Growing the Field of HIA in the U.S., AJPH 2005) present RWJF, Cal Endowment fund multiple HIAs – CA, AK, CDC Foundation, others SFDPH continues to grow its HIA program Use of HIA under federal and state EIA law Human Impact Partners – first non-profit dedicated to HIA in the U.S. New foundations and agencies enter the arena EPA funds HIA work in AK and CA, and comments on need for HIA in NEPA reviews 2009Health Impact Project – collaboration of RWJF and Pew; broad goal of institutionalizing HIA

Building the field in the U.S. -- Building the field in the U.S. -- The role of foundations RWJFCalifornia Endowment Public Welfare FoundationNorthwest Health Foundation Liberty Hill FoundationBlue Cross Blue Shield of Massachusetts Foundation San Francisco FoundationThe Annie E. Casey Foundation Family Values at WorkUnitarian Universalist Congregation ASTHOCenters for Disease Control NACCHOAmerican Ass’n of State Highway and Transportation Officials Active Living ResearchSilicon Valley Health Trust

A collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts The Health Impact Project: A collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts A national Center to support and promote HIA: Strategic funding for HIAs at the local & state level around the U.S. – demonstrate value and range of applications HIAs of federal legislation or administrative decisions Supporting HIA institutionalization in government – legislation, building agency capacity, policy briefs. A website with resources, training materials, case studies, policy briefs – Collaborating with organizations with established expertise, and supporting agencies and organizations new to HIA

What are the potential applications of HIA? What are the potential applications of HIA? Lessons from the Health Impact Project call for proposals

Proposals from 43 States

Subject Area

9 Finding good ideas for an HIA: Finding good ideas for an HIA: Proposals we’ve received suggest no shortage… 1.State Budget Process: state budget decisions -- weigh the relative consequences of cuts/spending in various sectors 2.BRAC Redevelopment: a Public Health Institute would do an HIA to shape redevelopment plans for a closed military base. 3.Prison Reform: A university-based policy institute would address a state legislative package of 6 bills on prisoner reentry 4.Agriculture Policy: A non-profit will help develop a county agricultural plan that will shape the local economy, land use patterns, and diet. 5.State immigration legislation: a university would examine proposed state legislation to restrict access to public services 6.Coal gasification plants: a local health dept. will look at the health effects related to pollution as well as social & demographic change

10 Finding good ideas for an HIA: Finding good ideas for an HIA: and on and on… 7. Regional passenger and freight rail policy: a university would partner with regional transit planners on a large rail plan 8. City planning decisions on use of vacant lots: a coalition of faith- based groups would weigh options including community gardens, commercial farming, and new industry in an economically devastated urban area 9. CAFO Regulation: an environmental organization would attempt to introduce health and social welfare considerations into the state permitting process. 10. State energy policy: an environmental group would address a comprehensive energy plan in a coal belt state 11. Foreclosure mitigation: a university would address state legislation seeking to prevent foreclosures

What makes HIA a good tool to address such a wide range of decision-making? Is there more to it than just assessing impacts, making recommendations, and writing a report? A new way to engage: brings public health professionals, community stakeholders, planners, developers, and decision- makers to the table, with a focus on practical, realistic solutions. Address public concerns early and directly Ensure that public health input and recommendations are sensitive to the political, regulatory, and economic context.

12 Does every decision need an HIA? Screening… Are there likely health effects? Is health already a focus of the project, program, or bill? (HIA may add the most value to decisions where health is not the focus.) Does the public have health concerns? Is the HIA likely to be successful? What are the barriers? Are there legal or regulatory levers that would allow implementation of health recommendations. Do you have the resources to do the HIA?

Conference on Foundations: Conference on Foundations: Group HIA screening exercise Participants please consider: What are your organization’s primary policy interests & initiatives? From these, please choose 1-2 that might benefit from using a health lens, and which could be appropriate targets for HIA. We will select 4-6 policy targets, and in groups, work through the screening questions on the previous slide

Discussion?