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. 2004

p: 202.540.6346

e: awernham@pewtrusts.org

www.healthimpactproject.org

AK 3

CA 25

CO 2

FL 1

MA 2

NJ 1

Completed HIAs in the United States1999–2009 (N = 54)

MN 5

GA 4

WA 4

OR 2

OH 1PA 1

MD 1

MT 1

MI 1

Courtesy A. Dannenberg, A. Wendel, CDC NCEH

2

A brief history of HIA in the U.S.

1999 SFDPH – Living wage HIA

2001 First RWJF grant on HIA – P4P, Fielding

2004 Workshop on advancing HIA in the U.S. (see “Growing the Field of HIA in the U.S., AJPH 2005)

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

2008-2009 • EPA funds HIA work in AK and CA, and comments on need for HIA in NEPA reviews

2009 Health Impact Project – collaboration of RWJF and Pew; broad goal of institutionalizing HIA

Building the field in the U.S. -- The role of foundations

RWJF California Endowment

Public Welfare Foundation Northwest Health Foundation

Liberty Hill Foundation Blue Cross Blue Shield of Massachusetts Foundation

San Francisco Foundation The Annie E. Casey Foundation

Family Values at Work Unitarian Universalist Congregation

ASTHO Centers for Disease Control

NACCHO American Ass’n of State Highway and Transportation Officials

Active Living Research Silicon Valley Health Trust

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 – www.healthimpactproject.org • Collaborating with organizations with established expertise,

and supporting agencies and organizations new to HIA

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

Proposals from 43 StatesHI INME OK SC UT WV

CT

KS MTNENH

CODC

ID MD

MS

NM

WY

AZ

MI

NJ

TN

VA

WA

WI

AK

AR

IL

KY

LA

ORMN

MOPAGA

OH

NC

MA

FL

NY

TX

CA

Subject Area

Land Use/Development/

Transporta-tion/ Urban

Planning 28%

Obesity Preven-tion/Fitness/

Nutrition, 13%

Healthcare; 12%Maternal/Child

Health; 8%

Economic Policy; 6%

Other; 6%

Agriculture; 6%

Air Quality/ Con-taminant

Cleanup, 6%

Natural Re-sources and Energy, 6%

Education; 3%

Housing Policy; 2%

Climate Change; 2%

Health Promotion, 2%

Labor/ Employment Pol-icy, 2%

Topic of HIA:Proposals for funding from the Health Impact Project

9

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: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: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?