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THE HEALTH IMPACT PROJECT:Promoting the use of Health Impact Assessment in the U.S.

HIA in the AmericasMarch, 2010

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

HIA in the U.S.:Current status

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

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http://www.healthimpactproject.org/hia_submit

How did we get here?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

2006 • Human Impact Partners – first non-profit dedicated to HIA in the U.S.

• Many new foundations enter the arena

2008-2009 • EPA funds HIA work in AK and CA

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

How did we get here?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

www.healthimpactproject.org

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.

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

The Health Impact Project:A collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts

2. Building the case for HIA:• Funding 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 www.healthimpactproject.org

• 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).

The Health Impact Project:A collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts

3. Federal Policy HIAs

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: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!HI INME OK SC UT WV CT KS MT NE NH

CODC

ID

MD

MS

NM

WY

AZMINJ

TNVA

WAWIAK

ARIL

KYLA

ORMN

MOPAGAOH

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 Resources and Energy, 6%

Education; 3%

Housing Policy; 2%Climate Change; 2%

Health Promotion, 2%

Labor/ Employment Policy, 2%

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

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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

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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.

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Discussion?