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 7 th International Health Impact Assessment Conference Cardiff, 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: , 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: , 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 Besser LM, Dannenberg AL Amer 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 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

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

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 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 SO 2 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 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

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

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