all about health impact assessments health planning and policy tarrant county public health
TRANSCRIPT
All About Health Impact Assessments
Health Planning and Policy Tarrant County Public Health
Presentation Objectives
At the end of this presentation participants will be informed regarding:
• Definition of a Health Impact Assessment (HIA)• Steps required to complete an HIA• Working examples about the HIA process
Definition
Health Impact Assessment:A systematic process that uses an array of datasources and analytic methods and considersinput from stakeholders to determine the potentialeffects of a proposed policy, plan, program orproject on the health of a population and thedistribution of those effects within the population.
Why Conduct a Health Impact Assessment?
HIAs:• Raise the profile of health and health issues, and
make it more likely that they’ll be considered in all circumstances
• Champion a participatory approach that values, includes, and empowers the community
• Bring the community together • Promote healthy behaviors and practices• Promote equity and ensure health disparities are
considered• Improve decision-making
Types of HIAs
Type TimeHealth Impact Review
Use Methods Example
Desktop 2-6 wks.
Broad Over-view with significant details
Time andresourcesare limited
Collect and analyze accessible data
Sacramento, Ca., a Desktop HIA assessed the Safe Routes to School Program
Rapid HIA6-12 wks.
Detailed overview with some input
Time andresourcesare limited
Collect, analyze existing data with limited expert input; literature review
Decatur, GA., Georgia Tech.: Rapid HIA for transportation plan; literature review & workshop
Intermediate12 wks.
to 6 mos.
Thorough assessment of data and pathways
Requires significant time and resources
Analyze existing data, gather qualitative data from stakeholder
Alameda County, CA. Took 1.5 months - Focused on greening the landscape
Comprehensive6 mos.
to 1 yr.
Assessment of all potential health impacts
Requires significant time and resources
Stakeholder participation; data collection using various methods and sources
In 2011-14 The San Antonio Metropolitan Health District and Urban Strategies conducted HIA of the housing plan.
How do you select the HIA type?
• Status (stage) and complexity of the proposal
• Resources (funding, data, personnel, time)
• Purpose of the HIA and its goals
• Potential scale and severity of health impacts
• Quality of the health evidence base
• Access and availability of quality data
• Support for HIAs at local and/or state level
HIA Processes/Steps
Typical HIA Process
ScreeningScoping
AssessmentRecommendations
ReportingEvaluation and Monitoring
Screening:Establishing Need for the Value of HIA
Timing
Sufficiency of information
Decision’s potential impacts on health
Feasibility, timeliness, value
Openness of the decision making process
Users and uses for HIA
Who are the decision makers?Who are potential HIA partners?Who are the other stakeholders?
Screening:Know Your Partners/Audience
Project Developers Health Department
Planning Department Universities (UNTHSC, UTA,TCC)
Transportation Homeowners/Business Owners
Other Government Departments
Community GroupsNeighborhood Association
Mayor/ City Council JPS Network
Screening Scenario: Bridging the Gap
Stakeholders, including affected communities in transit corridors, have been invited to provide input into the project.
City L has decided to replace a local bridge, including bridge widening to add an additional lane in either direction.
Officials must decide whether the new lanes will:
• Accommodate motor vehicles only• Be a designated bus – only lane• Or be separated bike-only lane.
They will choose only one lane type.
Screening: Check list…..
Screening QuestionsResponses, Supporting
Facts or Rationale
• Does the HIA have potential of adding value to the decision-making process? In what ways?
• What are the most important health concerns?
• Who are the stakeholders and decision-makers?
• Do they have an interest? Do they have the capacity to participate?
• Would stakeholders use the HIA to inform the decision making process?
• What are some challenges (and by what stakeholders) might you anticipate?
Screening: Check list…Bridging the Gap
Other Considerations Responses, Supporting Facts, Rationale
• Is decision making process open to HIA recommendations for changes to design, mitigations and alternatives?
• Are there decision alternatives that are more or less advantageous to public health?
• Have public concerns about the impacts of the decision been documented?
• Do research methods exist to analyze health impacts of concern?
• Is it feasible to analyze health impacts of decision in decision making time frame?
• What are some barriers to timely completion?
• What additional information do you need to decide overall value of this HIA?
Should the HIA be done???
Yes!
Screening: Bridging the Gap
• Break into groups and choose a scenario
• Use screening checklist to determine if HIA would have value
• You are encouraged to make assumptions about facts that you might need, but that are not included, in order to complete this exercise
• Report your findings
Screening Exercise
Typical HIA Process
ScreeningScoping
AssessmentRecommendations
ReportingEvaluation and Monitoring
Scoping:The Strategizing Steps in HIA
What
When
Where
How
Who
Scoping: Planning
Research Plan
• HIA goals
• Decision alternatives that will be evaluated
• Potential health impacts and their pathways
• Demographic, geographic and temporal boundaries
• Vulnerable populations affected
• Data, methods and tools needed
• How the HIA will characterize health effects
Scoping: Planning
Work Plan Who Will Be Involved
• Timeframe and resources • Roles of researchers, experts and stakeholders
• Who will be involved with data collection and analysis
• Plan for stakeholder engagement and public review
• Process for determining significance of impacts
• Plan for external review, findings, dissemination
Scoping:Determining potential health impacts and their pathways
1. Start broad – Most social decisions affect health indirectly through effects on social or environmental conditions
2. Initial scope should consider all factors that collectively influence health:
3. Final scope should focus on impacts with greatest likelihood of occurrence and of greatest public concern
Initial ScopePhysical and mental health outcomes (mortality, disability)
Public services
Behavioral factors Environmental conditions
Neighborhood conditions Economic and political factors
Consider all pathways that link the proposed decision to health. Use pathway diagrams as a way to demonstrate these links:
Scoping:The General Components of a Pathways Diagram
On PolicyPlans orProjects
Impacts on Economic, Environmental, Social, Political
Conditions
Exposuresand Risk
Behaviors
DiseaseInjury
Mortality
There are many potential configurations and pathways
Decision Direct Impacts
Behavioral Impacts
Health Impacts
Indirect Impacts
Scoping: Possible causal pathways between a change in policy (introduction of market-related rents) and health outcomes
Scoping:Which health impacts to evaluate?
The scope should focus on impacts with greatest likelihood of occurrence and of greatest public concern. Include data and methods to reveal inequities in conditions or impacts based on population characteristics, including, but not limited to:
• Age
• Gender
• Income
• Place (disadvantaged locations)
• Ethnicity
Methods requiring least resources
Methods requiring most resources
• Expert opinion• Review of available reports and data• Interviews of focus groups• Systematic literature review• Environment measurement or
modeling• Epidemiologic or spatial analysis• Development or application of
quantitative forecasting methods• Original quantitative data collection
and analysis
Scoping:Determining methods
• Break into groups and choose a scenario
• Work through the steps to complete the scoping step for one of the scenarios you’ve been presented.
• You are encouraged to make assumptions about facts that you might need, but that are not included, in order to complete this exercise
• Report your findings
Scoping Exercise
Discuss:
Establish a policy goal or goals
What populations are going to be impacted by the potential policy? identify: geographic boundaries, vulnerable populations, preliminary data sources and methods
As a group develop pathway diagrams, stakeholder engagement and roles
What are your potential research questions?
Are there identified negative health impacts that could result from your policy?
How will the HIA be communicated and reported
Scoping Exercise
Typical HIA Process
Screening
Scoping
Assessment
Recommendations
Reporting
Evaluation and Monitoring
Developing Community Indicators
Validity
Relevance
Reliability
Measurability
Clarity
Assessment:Criteria for Good Indicators
Assessment: Community IndicatorsIndicator 1: Health Systems
Measures access to and quality of preventative and acute medical care.Factors: physical access to health facilities, transportation, and health insurance status. Note: The timely use of primary care may prevent morbidity and hospitalizations from a number of chronic diseases.Note: Federally Qualified Health Centers, in medically underserved areas, can lower preventable hospitalization rates.
Objectives & Indicators
HS. 1. Assure affordable and high quality public health facilities
HS.1.a. Public health facility transit accessHS.1.b. Hospital bed access
HS.2. Assure access to preventative, outpatient health services
HS.2.a. Early prenatal careHS.2.b. Preventable hospitalizations
The San Francisco Indicator Project
HS.1.a. Public health facility transit access
Assessment Indicator 1: Health Systems
Why Is This An Indicator Of Health and Sustainability?The availability of public transportation to community health facilities is one factor among many that affect access to good quality, affordable, reliable health care.
MethodsTo calculate the Transit Resource Scores, the distance from each residential intersection (intersections within 100 meters of residential lots) to each transit route stop (multiple route stops can be found at one location when multiple transit routes share stop or station) within 1 mile of the intersection was calculated.
Clinics and hospitals with good or very good transit resource scores 2012
Transit Resource Areas
Total Facilities
# in good or very good
% in good or very good
DPH Clinic 22 16 73%Clinic Free 43 36 84%GAC Hospital 13 12 92%Total 78 64 82%
Assessment Indicator 2: Community
The Community indicator includes measures of social inclusion, ethnic and economic integration, and political participation.
Measures of community or social cohesion includes the presence and strength of social networks, social relationships, social capital, civic engagement, group membership and political participation. These are positively associated with health, whereas social exclusion, segregation and isolation negatively impact health.
Objectives and Indicators:
C.1. Promote socially cohesive neighbor-hoods, free of crime and violenceC.1.a. Violent crimesC.1.b. Property crimesC.1.c. Residential mobilityC.1.d. Community center accessC.1.e. Alcohol outlet densityC.1.f. Likelihood of leaving San Francisco
C.1.g. Neighborhood block partiesC.1.h. Spiritual and religious centersC.1.i. Perceived safetyC.2. Increase civic, social, and community engagementC.2.a. Voting ratesC.2.b. VolunteerismC.2.c. Public meeting attendance
Assessment Indicator 3: Education
Education measures the distribution, sufficiency, and quality of public education and child care facilities. Evidence shows that:
• Educational outcomes are positively associated with lifetime earnings, positive health behaviors, and prolonged life expectancy
• When schools are located closer to home, more children walk and/or bicycle to school and vehicle pollution emissions fall
• High quality child care positively affects childhood growth, physical development, and physical health, cognitive, behavioral and school outcomes
Objectives & Indicators
ED.1. Assure affordable and high quality child care for all neighborhoodsED.1.a. Child care capacityED.1.b. Child care subsidiesED.1.c. Child care costs
ED.2. Assure accessible and high quality educational facilitiesED.2.a. Elementary School ScoreED.2.b. School choiceED.2.c. School academic performanceED.2.d. School gardensED.2.e. School graduation ratesED.2.f. Public school participation
Assessment Indicator 4: Economy
Measure economic opportunity and equality. A secure livelihood is a fundamental human need and one of the strongest and most consistent predictors of health and disease in public health research. • Unemployment is associated with premature mortality, cardiovascular
disease, hypertension, depression, and suicide. • Sufficient income is needed for basic material needs; food, clothing,
transportation and shelter. Insufficient income is associated with premature death.
• Among the offspring of low wage workers, higher wages are associated with ‐improved educational outcomes and a reduced risk of early childbirth.
1.a. Jobs paying at least self-sufficiency wage1.b. Worker residents1.c. Job density1.d. Job openings and educational requirements2.a. Health insurance coverage2.b. Occupational non-fatal injury rates
2.c. Paid sick days3.a. Income inequality3.b. Employment3.c. Bank or credit union access3.d. Minority and women owned businesses4.a. Green businesses
Typical HIA Process
ScreeningScoping
AssessmentRecommendations
ReportingEvaluation and Monitoring
Quantitative Estimation in HIA
Is there a causal relationship?Does the data allow for quantitative predictions?• Information on exposure• Baseline health status• Information on exposure
responseIs there a demand for
quantitative information?Can all health effects be quantified?
Identify experts to review analyses or provide
assistance along the way
Assessment:Quantitative Estimation in HIA
Assessment: Quantitative Estimation in HIA
Estimating Freeway Air Pollution Impact on Life Expectancy of
Nearby Residents: Overview of Quantitative Approach
1. Evaluate causal evidence for impacts of traffic air pollutants
2. Obtain baseline measures of mortality in population
3. Estimate (model) air pollutant concentrations attributable to freeway traffic
4. Select and apply exposure response function
5. Assess confidence/uncertainties
Does the data allow for quantitative predictions?• Information on exposure• Baseline health status• Information on exposure
response
In San Francisco, the method people use to travel – by car, bus, foot, or bike –
affects the city's environment and residents' health both positively
and negatively.
The transportation system affects physical activity, air pollution and asthma, injury collisions, and even stress and heart disease.
Analyzing the health impacts of proposed changes to transportation can help us make more informed decisions, save lives, and prevent disease.
Case Study: How Could Road Pricing Impact Our Health?
Can all health effects be quantified?
Identify experts to review analyses or provide
assistance along the way
Case Study: How Could Road Pricing Impact Our Health?
The SFDPH’s Program on Health, Equity and Sustainability received funding from the Robert Wood Johnson Foundation's Active Living Research program to conduct a health impact assessment (HIA) of a congestion pricing policy under study in San Francisco, California.
The SF County Transportation Authority (SFCTA) is studying a potential program that would charge $3 during AM/PM rush hours to travel into or out of the congested northeast quadrant of SF.
This scenario road-pricing fee would fund public transit, road maintenance, and bicycle and pedestrian street improvements.
Congestion Pricing Boundaries for the Northeast Cordon Scenario
Is there a demand for quantitative information?
Case Study: Pathways through which Road Pricing Policies Potentially Effect Health
Is there a causal relationship?
Stakeholder Engagement
ScreeningScoping
AssessmentRecommendations
ReportingEvaluation and Monitoring
Typical HIA Process
Provide valuable input
Build individual/organizational capacityProvide community outreach resourcesProvide quantitative/ qualitative data
Help ground truth findings
Contribute political connections important to an HIA’s successContribute financially and in-kind
Help create buy-in
StakeholdersWhy Engage Community in HIA?
Typical HIA Process
ScreeningScoping
AssessmentRecommendations
Reporting and CommunicationEvaluation and Monitoring
Know Your Audience(s)
Clearly Synthesize and Prioritize Findings• Overall magnitude of health
benefit• Benefit to most vulnerable
populations• Feasibility of solutions• Perceived public concerns
Tailor and Target Your Messages
Work with Stakeholders to Communicate, Translate
Successful analysis and reporting not necessarily result in change…
Reporting and CommunicationsKey Points
Methods of Communication
Briefing PaperComment LetterPeer-Reviewed Journal Article
Fact Sheet
• Document the HIA process and findings in writing• Prioritize findings and recommendations• Provide an opportunity for public review• Identify stakeholders as communicators• Develop messages and communication approaches for
specific audiences• Use opportunities in the decision’s regulatory process
(public hearings, EIA comment)• Engage with decision makers and the media
Reporting and CommunicationsOverview
Typical HIA Process
ScreeningScoping
AssessmentRecommendations
ReportingEvaluation and Monitoring
Evaluations and MonitoringEvaluation
Don’t evaluate too late!Continuously ask the question:
“Is the HIA process on track?”
ScreeningScopingAssessmentRecommendationsReportingEvaluation and Monitoring
Process Evaluation – can provide lessons about why and how the HIA worked
• How was the HIA undertaken – details of time, place, geographic area/population affected, what the proposal sought to achieve, and the methods used?
• Resources used (financial, human, time) and what was the cost?
• Evidence used, and how was it utilized to develop recommendations?
• How were health inequalities assessed?
• How were recommendations formulated and prioritized?
• How were the decision makers involved in the process?
• How were the recommendations delivered to the decision-makers? When?
• What did those involved in the HIA think about the process?
Evaluation
Impact Evaluation – can consider whether, and how well, the HIA worked•How and when were the recommendations accepted and implemented by the decision makers – what factors contributed to this?
•What are the likely reasons why recommendations were rejected?
•Were the aims and objectives of the HIA met?
• What other impacts were associated with the HIA? • improved partnership working • raising the profile of local health needs • putting health on partner agencies’ agendas • organizational development and new ways of working within and
across the organizations involved
Evaluation
The HIA should include a follow-up monitoring plan to track the decision outcomes as well as the effect of the decision on health impacts and/or determinants of concern.
The monitoring plan should include:
1. Goals for short and long-term monitoring
2. Outcomes and indicators for monitoring
3. Lead individuals or organizations to conduct monitoring
4. A mechanism to report to decision-makers and HIA stakeholders
5. Triggers or thresholds that may lead to review and adaptation
6. Identified resources to conduct, complete, and report the
monitoringMinimum Elements and Practice Standards for Health Impact Assessment - November 2014, North American HIA Practice Standards Working Group
Monitoring
• Recommended mitigations should be developed and integrated into an HIA. Clearly outline how each mitigation measure will be implemented.
• Include information on: deadlines, responsibilities, management structure, potential partnerships, engagement activities and monitoring and evaluation related to the implementation of the HIA mitigations.
• HIA management plans should be developed in collaboration with the entity responsible for implementing the plan.
• Management plans are living documents that will need to be revised and improved on an on-going basis.
• Make methods and results from monitoring available to the public.
Monitoring
Common HIA Funding Resources
• The Health Impact Project (Pew Charitable Trusts and the RWJ Foundation)
• Robert Wood Johnson Foundation
• Association of State and Territorial Health Officials (ASTHO)
• The Centers for Disease Control and Prevention
• National Association of County & City Officials (NACCHO)-www.naccho.org
• American Planning Association- www.planning.org
HIA Information Resources
• Human Impact Partners HIA resources www.humanimpact.org/hips-hia-tools-and-resources
• National Research Council Report, “Improving Health in the United States: The Role of Health Impact Assessment” www.nap.edu/catalog.php?record_id=13229
Questions?