1. Health Impact Assessment and Housing Presentation to HUD Office of Healthy Homes and Lead Housing Control Aaron Wernham, M.D., M.S. Director | The Health Impact Project 901 E Street, NW, Washington, D.C. 2004 p: 202.540.6346 e: awernham@pewtrusts.orgawernham@pewtrusts.org www.healthimpactproject.org 1

2. By RWJF and University of Wisconsin Madison, County Health Rankings program: www.countyhealthrankings.or g/about-project/background

3. Definitions Definitions 2. IAIA A combination of procedures, methods and tools that systematically judges the potential effects of a policy, programme or project on the health of a population and the distribution of those effects within the population. HIA identifies appropriate actions to manage those effects. (IAIA, 2006) A practical approach for collaboration between health and other sectors, translating public health research into predictions and reasonable recommendations that policy makers can use to ensure that new public decisions contribute to healthier communities.

4. Analytical Framework Proposed policy, project, program Determinants of health Health outcomes Broad framework: considers multiple determinants and dimensions of health Considers direct, indirect, and cumulative pathways Both qualitative and quantitative methods used Focus: predicting outcomes or pathways/linkages, in order to manage effects

5. HIA is NOT… Evaluation: not best for looking at effects of an existing policy or program, or evaluating the impacts of a past action Risk assessment: HIA should not be used to look at one narrow subset of issues. Best when it starts by asking “what are the potential direct and indirect impacts on health” Exhaustive: despite it’s breadth, HIA should not catalogue every theoretical risk, but should instead focus on the effect pathways that appear to be the most important, of greatest concern to the impacted community, and best supported by evidence Focused on quantifying risk: the most important task is to use reasoned judgment about risk to promote sound management strategies

6. The HIA Process 1.Screening –is HIA feasible and likely to add value? 2.Scoping – determine the important health effects, affected populations, available evidence, etc 3.Assessment – analyze baseline conditions and the direct, indirect, and cumulative pathways through which health can be affected. 4.Recommendations, Implementation and Advocacy 5.Reporting – disseminate the report to the public, stakeholders, solicit input 6.Monitoring and Evaluation 9

7. Important points to clarify in developing an HIA proposal 1.Timing: HIA should be done early enough to inform design & decision- making Developers may prefer to have health criteria available at the outset of their planning. 2. Stakeholder engagement and participation (see next slide) Engaging stakeholders (project proponents, affected communities, and decision-makers) is essential Clear plan for how input will be solicited, and how the HIA will respond to input 3. Recommendations: effective recommendations must take into consideration the political, regulatory, practical, and economic context, not only health concerns.

8. Examples of Housing HIAs Jack London Gateway (JLG) Senior Housing Project Authors: Human Impact Partners and SFDPH Decision: Plan for 61 new senior housing units close to 2 freeways & Port of Oakland. Impacts: indoor & outdoor air quality, noise, safety, retail planning Recommendations: AQ monitoring; installation of ventilation systems; noise- insulating windows; pedestrian protection medians; traffic calming measures; and many others. http://humanimpact.org/JLG_case_study_draft.pdf 8 Outcomes: Many recommendations adopted. Additional HIA projects were funded. Healthy Development checklist adopted by the Development Committee.

9. 9 Trinity Plaza Apartments Author: SFDPH Decision: A developer proposed to demolish 360 unit rent-controlled apartments to build 1400 condominiums Impacts: related to displacement, risk of homelessness, decreased social cohesion, and a range of related health impacts Recommendations/Outcome: Developer agreed to provide 360 replacement units, at current rents

10. Examples of Housing HIAs: Accessory Dwelling Units (HIA in progress) Authors: Benton County Health Department, CO Decision: Benton County currently prohibits all rural residents from building ADUs on their properties. The Benton County Planning Department receives frequent complaints from the public concerning the ordinance banning the construction of ADUs and has a strong interest in addressing the issue to better serve the residents of rural Benton County. The HIA project aims to inform the Benton County Planning Department on how proposed changes to the ordinance will affect residents of rural Benton County. 10

11. Examples of Housing HIAs “Child Health Impact Assessment” of the Massachusetts Rental Voucher Program Decision: Modifications to the Massachusetts Rental Voucher Program (MRVP), which provides low-income families with rental subsidies. Impacts: asthma, injuries, access to healthcare, mental health conditions, and developmental & educational attainment. Key Findings: Time limits for housing subsidies puts children's health at risk due to budget trade-offs between housing expenses and other basic needs. Instituting work requirements will likely result in MRVP disenrollments for some families. Increasing the frequency of eligibility re-determinations may increase the number of families who disenroll from the program. 11

12. Additional Housing-related HIAs 1.HOPE SF – an HIA to inform SF’s new public housing policies. http://www.humanimpact.org/SF_Housing_HIA_Poster.pdf http://www.humanimpact.org/SF_Housing_HIA_Poster.pdf 2.29 th St/San Pedro LA – 450 affordable housing units http://www.humanimpact.org/LA_29thSt_HIA_ExecSummary.pdf http://www.humanimpact.org/LA_29thSt_HIA_ExecSummary.pdf 3.Pittsburg Railroad Ave, CA – TOD sector plan: 1,590 units, 15% affordable 4.(proposed) County Board of Health would do HIA to inform CDBG renewal 5.Good Poster on Housing HIAs: http://www.who.int/hia/conference/poster_gilhuly.pdf http://www.who.int/hia/conference/poster_gilhuly.pdf

13. “HIA 2.0” – beyond project-specific applications Should a new HIA be done for each new project or program? Can HIA be a formative learning tool that results in adoption of new “healthy by design” principles that obviate the need for HIA on every projects?

14. “HIA 2.0” – beyond project-specific applications “HIA 2.0” – beyond project-specific applications The Healthy Development Measurement Tool

16. Ingram County, MI (Lansing): Local health dept now using “HIA Checklist” This Website has case study and link to the checklist: http://www.cacvoices.org/h ealthylifestyles/environmen tal/HIA/

17. Tradeoffs between HIA and Checklist approaches: ChecklistHIA Influence project design at an earlier phase Take time to develop, but may reduce time demands in the long run Developers may favor a static checklist approach for predictability But…may sacrifice project- specific detail Public engagement process Requires interagency collaboration, with many benefits: insight into the project, public education, new collaborative relationships, building public trust, etc

18. Discussion? 18

19. Hybrid approach: Hybrid approach: Using a health checklist, with triggers for HIA under specific circumstances

20. 20 Northeast NPR-A Example: hunting and diabetes Baseline: Type 2 diabetes prevalence low: ~2.5% Diet: ~50% “wild foods” – caribou, salmon, marine mammals Impact Assessment: Pipelines Revenue “Seismic” Displace caribou farther from village Fuel & equipment for hunting Dietary Change Diabetes Risk

21. 21 Assessment Assessment Your data are incomplete, your predictions are uncertain… What to do?? … Adaptive Management