Using HIA on Climate Change Policy: A Training Course for Public Health Professionals

Chapter 3: Screening

Steps of an HIA: Screening1.Screening Determines the need and value of an HIA

2.Scoping Determines health impacts to evaluate, methods for analysis, and a workplan

3.Assessment Profiles existing health conditions and evaluates the direction and magnitude of potential health impacts

4.Recommendations Provide strategies to manage identified adverse health impacts

5.Reporting Communicates the HIA findings and recommendations

6.Monitoring and Evaluation

Tracks: 1) impacts on decision-making and the decision2) Impacts on health determinants

Screening: Learning Objectives

• Evaluate appropriateness of HIA on various climate change policy types.

• Understand how HIAs on climate change policy can address equity.

• Determine the apparent co-benefits and co-costs for climate change policy.

Resources

Art of Screening

Policy Relevance

Evidence Base

Evidence Base• Demonstrates policy can lead to changes in

health outcomes.

• Quantitative evidence is stronger than qualitative for evaluation of magnitude.

• Qualitative can be compelling to decision-makers because it can draw on local context.

Policy Relevance• Politically feasible

• Ability to influence the decision making process

• Adds value to the dialogue

Environmental Community

BusinessCommunity

Political Relevance

ResourcesComprehensive

6 – 12 mo’s, 1 full time person +

Comprehensive assessment

Requires significant time & resources

Collect & analyze data from multiple sources (qualitative and quantitative)

Fewer impacts ----------------------------------------------------------- More impacts

Type

Time & Staff

Health Impacts Review

Use

Methods

Desk Based

2-6 weeks, 1 full time person

Broad overview

Time & resources limited

Collect & analyze accessible data

Intermediate

12 weeks – 6 mo’s, 1 full time person +

Thorough assessment of select pathways

Requires significant time & resources

Collect & analyze existing data, gather qualitative data from stakeholders

Rapid

6-12 weeks, 1 full time person

More detailed overview

Time & resources limited

Collect & analyze existing data with limited expert input

Source: Harris et al. 2007

Good Participatory Process• Considers who is impacted• Considers what technical expertise you

need• Chooses respected technical advisors • Chooses advisors who are not polarizing• Designs engagement process to solicit

diverse community opinions• Avoids controversial debates• Input most important in scoping and

recommendations

Opportunity: Address Inequities

LIMITED ACCESSLOW-INCOME

HIGH POLLUTION AREAS

PRE-EXISTING HEALTH CONDITIONS

YOUNG ELDERLYCOMMUNITIES OF COLOR

Source: U.S. Census Bureau 2011 Census Abstract, Consumer Expenditure Survey, Table 687 – Average Annual Expenditures Of All Consumer Units by Income Level: 2008

Current Income Inequities

<$70,000 $70-$79k $80-$99k $100,000 and over0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0 8.8

7.26.8

5.2

Percent of Total U.S. Household Expenditures on Utilities (2008)

Under $10k -

$29,999

$30k - $39,999

$40k - $49,999

$50k - $74,999

$75k - $99,999

$100k and above

05

101520253035404550

28.2

10.3 8.8

18.412.5

21.7

Income Level, Percent White Alone 2008

Under $10k - $29,999

$30k - $39,999

$40k - $49,999

$50k - $74,999

$75k - $99,999

$100k and above

05

101520253035404550

23.7

8.5 7.5

15.612.3

32.3

Income Level, Percent Asian Alone 2008

Under $10k -

$29,999

$30k - $39,999

$40k - $49,999

$50k - $74,999

$75k - $99,999

$100k and above

05

101520253035404550

38.2

13.810.3

16.9

9.2 11.7

Income Level, Percent Hispanic Alone 2008

Under $10k - $29,999

$30k - $39,999

$40k - $49,999

$50k - $74,999

$75k - $99,999

$100k and above

05

101520253035404550 44.4

12.3 9.715.4

8.1 10

Income Level, Percent Black Alone 2008

Source: U.S. Census Bureau, Income, Poverty, and Health Insurance Coverage in the United States: 2008; Current Population Reports, P60-236(RV), and Detailed Tables -- Table HINC-06, September 2009.Table 692.

Vulnerability Assessment• In Screening phase, identify where appropriate to

complete a vulnerability assessment.

• Identify particular groups or areas of concern.

• Determines risk to that group of adverse outcomes based on climate change or other factor.

• Vulnerability characterized by exposure, sensitivity and adaptive capacity.

Opportunity: Address Inequities

Climatechangepolicies

Indirect impact of social and economic disruption onhealth

Direct impactof weatheron health

Policy co-benefits improve health

Policy co-costs diminish health

Co-Benefits Example: VMT Policies

↓Injuries/Fatalities

↓Asthma↓ Lung disease↓ Cancers↓ Mortality

↑ Fuel tax↓Collisions

↓Air pollution↑ Parking fees

↑ VMT tax↓ Driving

Co-Benefits

Policy Health OutcomesDirect Impacts Intermediate Outcomes

Co-Benefits Example: Taylor County Coal Plant

Coal plant development

Increase hiring of African American workers

Income of low salary jobs

Income of median salary jobs

Over $175 million in "community contribution" over 40 years

Invest in I.T. infrastructure

Invest in k-12 school quality

Invest in pre-k school enrollment

Begin small business development program

↑ Mental health↑ Food security↓Income based mortality rates

Co-Benefits

Policy Health OutcomesDirect Impacts Intermediate Outcomes

Opportunity: Mitigate Co-Costs

Policy co-costs diminish health

Climatechangepolicies

Indirect impact of social and economic disruption onhealth

Direct impactof weatheron health

Policy co-benefits improve health

Co-Costs General Project With Climate Change Element: Taylor County Coal

Plant

Coal plant development

CO2 emissions Global climate change

Minimal ground level ozone

Co-Costs

Minimal mercury emissions

Minimal particulate emissions

Increase hiring of African American workers

Income of low salary jobs

Income of median salary jobs

↑ Mental health↑ Food security↓Income based mortality rates

Climate change related outcomes:↓Heat-related illness↓Water-, food-, vector-borne disease

HIA practitioner suggestions

Policy Health OutcomesDirect Impacts Intermediate Outcomes

Co-Costs Mitigation Example

Co-costs

No overall changes in air pollution

↑ Severe collisions ↑ Fatalities & injuries

↑ Congestion prices

Time and route change

↓ All-cause mortality↓ Chronic disease incidence

↑ Public transit use

↑ Physical activity

Policy Health OutcomesDirect Impacts Intermediate Outcomes

Adaptation Example: Co-Costs and Co-Benefits

↑Mental health

↑Human capital

Low-income families cannot meet financing requirements Paying higher

energy costs

Lower home energy usage (adaptation)

↓ Poor health outcomes related to climate change

No added debt burdenFinancing for

home owners

Living wages Health care Career training

Policy Health OutcomesDirect Impacts Intermediate Outcomes

GHG reduction (mitigation)

“High road standard” work program

Home retrofits (middle income homes)

Exercise 2: Screening a PolicyDirections:• Review the four policy descriptions. • Determine climate change policy type (e.g.

adaptation, mitigation or emergency management).

• Value of a Health Impact Assessment? • Political relevance?• Sufficient data or literature?• Sufficient resources?• HIA type (rapid, desk-based, comprehensive or

intermediate)?