THE HEALTH IMPACT PROJECT: Promoting the use of Health Impact Assessment in the U.S. HIA in the Americas March, 2010 Aaron Wernham, M.D., M.S. Director | The Health Impact Project 901 E Street, NW, Washington, D.C p: e: 1

HIA in the U.S.: HIA in the U.S.: Current status

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 3

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How did we get here? How did we get here? 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 2006Human Impact Partners – first non-profit dedicated to HIA in the U.S. Many new foundations enter the arena EPA funds HIA work in AK and CA 2009Health Impact Project – collaboration of RWJF and Pew; broad goal of institutionalizing HIA

How did we get here? How did we get here? 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

The Health Impact Project: The Health Impact Project: A collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts Overall Objective: To promote and support the use of HIA as a tool to ensure that decisions in non- health sectors, whether at the local, state, tribal, or federal level, are made with health in mind.

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 1. A national Center to support the field: A website with resources, case studies, policy briefs Forming a community of practice: both online and in- person forums Convening trainings, meetings, and policy-oriented discussions Collaborating with and supporting current centers with established expertise in the field Supporting agencies new to HIA

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 2. Building the case for HIA: see the CFP at a series of demonstration projects that address real-time decisions on proposed policies, programs, and projects at the local, state, and tribal level: see the CFP at Building a technical assistance network to support new HIA practitioners A “rapid response” fund to support rapid HIAs or provide key resources to allow an HIA to go ahead (training, TA, research expertise, etc).

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 3. Federal Policy HIAs

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 4. Review of existing legal constructs that may support the inclusion of health – zoning laws, growth plans, regulatory impact analysis, administrative procedures, etc.

The Health Impact Project: The Health Impact Project: A collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts 5. Advocating for new policies that support HIA: Guidance for implementing HIA within existing laws and policies Research to determine the best governance structures and incentives to promote HIA wherever it adds value Providing evidence to support legislation or administrative efforts to build HIA into public decision- making.

Proposals from 43 States!

Subject Area

15 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

16 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

Why is there so much interest in HIA? Is there more to it than predicting 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 Develop public health input and recommendations sensitive to the political, regulatory, and economic context.

Discussion? 18