National HIA Meeting 2013: Poster Session


Using HIA in a Food Desert (PDF)

Presenters:Cynthia Stone, Indiana University Fairbanks School of Public Health; Sandra Cummings, Marion County Public Health Department; Stephen Clarke, Indiana University Fairbanks School of Public Health; Susan Hancock, Indiana University Fairbanks School of Public Health

The Marion County Public Health Department and the Indiana University Richard M. Fairbanks School of Public Health are conducting a health impact assessment of the potential development of a full-service grocery store within the Meadows community. The project is funded by the Indiana Minority Health Coalition. This project is being completed as a service learning project for P644 Health Impact Assessment at IU Fairbanks School of Public Health. The Meadows community is designated as a federal food desert by the U.S. Department of Agriculture. The assessment was utilized to inform policy makers on their decision to grant a tax increment financing district for the community and will be used by a local foundation for land use development planning decisions and for seeking additional development funds.

To date, key informant interviews have been completed and the literature review performed. A baseline health assessment of the community was completed using a telephone survey, a neighborhood survey, and focus groups. A food environment survey will be done using the NEMS-S. Specific data results and recommendations are in process, but final data and report will be available at the time of the national meeting.


HIA for Health in All Policies: 12 Case Studies in Korea (PDF)

Presenter: Eunjeong Kang, Soon Chun Hyang University 

There are two streams of HIA in Korea: one is a group of HIAs intended to realize Health in All Policies and the other is a legally based HIA embedded in Environmental Impact Assessment. The former was initiated in 2009 by the Korea Institute for Health  and Social Affairs, which involved local governments in HIA through its demonstration project funds. The purpose of this study was to review the content of the 12 HIA cases conducted by KIHASA with eight local governments, four of which were located in the Seoul metropolitan area and four in other areas, between 2009 and 2011, and to suggest future directions in HIA development for Health in All Policies. In sum, various sectors were involved in HIA projects, equity concerns were well   addressed in HIA, and qualitative evidence was sufficient to make recommendations to decision makers. We also found that local government was easier to exercise Health in All Policies through HIA than the central government. However, it may be necessary to develop quantitative models to communicate with more quantitative data-oriented departments. Future research should  focus on the development of assessment tools that are ready to use in specific areas, such as housing, transportation, education, etc.


Use of Process and Impact Evaluation to Gauge Effectiveness of Advisory Committee Engagement and Short-term Outcomes of a Health Impact Assessment (PDF)

Presenter: Meghan Crane, Portland State University

While Health Impact Assessment (HIA) is becoming more common in the United States, evaluation of HIA implementation and influence on decision-making is needed to demonstrate the tool’s effectiveness. In 2012, the Oregon Health Authority (OHA), with support from a regional government authority, conducted a HIA on the Climate Smart Communities Scenarios (CSCS) region planning project, with the goal of having public health and health equity considered in the selection and implementation of final transportation and land use policies aimed at reducing greenhouse gas emissions. Using in-depth qualitative interviews and an online questionnaire, this project utilized process and impact evaluation on the Advisory Committee (AC) engagement and participation strategies employed, as well as the short-term outcomes of the HIA. This work contributes to evaluation research pertaining to HIA and demonstrates how HIA can be an effective tool for including health in regional planning policy decisions.


A Review of Health Impact Assessment in the U.S.: Current State-of-Science, Best Practices, and Areas for Improvement (PDF)

Presenters: Justicia Rhodus, CSS-Dynamac; Florence Fulk, U.S. Environmental Protection Agency

A systematic review was conducted of over 80 health impact assessments (HIAs) from the U.S. to obtain a clear picture of how HIAs are being implemented nationally. The review was focused on HIAs from the four sectors that the U.S. Environmental Protection Agency’s (EPA’s) Sustainable and Healthy Communities Research Program has identified as target areas for empowering communities to move toward more sustainable states. These four sectors are transportation, housing/buildings/infrastructure, land use, and waste management/revitalization. A review framework was developed to systematically document organizations involved in conducting the HIAs; funding sources; the types of community-level decisions made; data, tools, and models used; self-identified data needs; methods of stakeholder engagement; pathways and endpoints; judgment and prioritization of impacts; decision-making outcomes and recommendations; monitoring and follow-up measures; HIA defensibility and effectiveness; attainment of the Minimum Elements of HIA; areas for improvement; and identification of best practices. Results of this comprehensive review are presented to identify the state of the HIA practice in the U.S., including best practices and potential areas for improvement. While HIAs have helped to raise awareness and bring health into decisions outside traditional health-related fields, the effectiveness of HIAs in bringing health-related changes to pending decisions in the

U.S. varies greatly. The review found that there is considerable variation in the quality and rigor of HIAs being conducted. Improving the overall quality and rigor of HIAs, combined with increased monitoring, health impact management, and other follow-up would substantially improve overall utilization and effectiveness of HIAs in the U.S. 


Using Quantitative Methods to Improve HIA for Transportation Projects: Applications of the DYNAMO-HIA Model for Active Transportation Infrastructure Improvements (PDF)

Presenter: Theodore Mansfield, University of North Carolina at Chapel Hill 

We use the DYNAMO-HIA modeling package to estimate the HEAL impacts associated with three active transportation infrastructure improvement projects in the state of North Carolina. Specifically, we estimate reduced all-cause mortality and reduced incidence of coronary heart disease (CHD), diabetes, hypertension, and stroke due to increased walking resulting from pedestrian improvements using a Markov Chain approach. We apply our model to three development contexts (rural, suburban, and urban) and at three geographic scales (project, small area plan, and comprehensive plan). We find that project context plays a large role in determining estimated health impacts—health impacts for the rural project are largely negligible; in contrast, we estimate 7 avoided deaths, 220 population years of life gained, 5 avoided cases of CHD, 13 avoided cases of diabetes, 27 avoided cases of hypertension, and 4 avoided cases of stroke for the urban project. Predicted health outcomes are also converted into economic terms using monetization methods to enhance the relevancy of findings in typical transportation decision-making processes. Overall, we find that quantitative methods, such as Markov Chain models, are very useful in integrating epidemiological, behavioral, and demographic information in a credible manner to provide estimates of health impacts at a variety of scales that are meaningful to decision makers in fields outside of public health. 


A Health Impact Assessment of a Proposal to Provide Free Transportation Passes to Students

Presenters: Lauren Gase, Los Angeles County Department of Public Health; Tony Kuo, Los Angeles County Department of Public Health; Steven Teutsch, Los Angeles County Department of Public Health 

In many school districts in Los Angeles County (LAC), school buses do not serve all children. In fall 2012, based on feedback received during town hall meetings, the LAC School Attendance Task Force (SATF) commissioned a workgroup to explore the possibility of developing a program to further subsidize the cost of bus passes for low-income students in order to increase school attendance. The LAC Department of Public Health (DPH) partnered with the SATF to conduct a Health Impact Assessment (HIA) of the SATF’s proposal to provide free transit passes to all students, kindergarten through college. Due to strong interest in the proposal from key stakeholders, the timeline for taking the proposal to decision makers was greatly accelerated. In order to ensure that results of the HIA would be useful and timely, DPH conducted a rapid HIA of the estimated potential costs and benefits impacts by utilizing a rapid assessment approach. Based on stakeholder input, the following impacts were prioritized and assessed: transit ridership, school attendance and after-school program participation, the number of fare evasion citations issued, traffic congestion, revenue for schools, and family disposable income. Where possible, associated health outcomes and costs of these changes were quantified and compared with the estimated costs of providing the free passes to students. By employing a rapid-assessment, focused approach for the HIA, DPH was able to provide the SATF with key information that was useful to them in sharing their proposal with decision makers.  


Madison Alcohol License Density Ordinance Health Impact Assessment (PDF)

Presenter: Denise Attard Sacco, Independent Consultant 

This poster presentation will present the process, results, recommendations, and final reflections of the intermediate health impact assessment (HIA) being currently performed on the Madison Alcohol License Density Ordinance (ALDO), first passed in 2007 by the Madison City Council (WI State Journal, 2011). This Ordinance was reviewed on July 5, 2013 (City of Madison, 2011). This HIA was conducted by Public Health–Madison and Dane County in Madison, WI, in conjunction with the Wisconsin Public Health Association, HIA Section, and concluded in August 2013. 


A Five-years Literature Review on HIA Subject, Methods, and Quantification (PDF)

Presenter: Claudia Viviane Viegas, Universidade Federal de Santa Catarina—Brazil 

HIA has been claimed as a pluralistic type of assessment due its large spectrum of subject coverage and as lacking regulation in several countries (Cornburn and Bhatia, 2007; Mindell et al., 2008). This paper performs a theoretical research review of HIA- related studies from 2008 to 2012. Under Scopus/Science Direct research, indicating “Health Impact Assessment” for title in advanced search mode, 78 references were found: 8 academic studies in 2008; 11 in 2009; 12 in 2010; 19 in 2011, and 28 in 2012. Three main questions were posed for this research: What is the main subject proposed for the studies? What are the methods adopted? Is there any measuring performed in these studies? 


Superfund Cleanup and Community Gentrification (PDF)

Presenters: Jonathan Childers, University of Washington; BJ Cummings, Duwamish River Cleanup Coalition 

The Duwamish River serves the needs of a mixed industrial and residential area in Seattle and King County, WA. Past and present activities have contaminated the shoreline, sediments, and resident fish and shellfish. Due to health risks from exposure to this contamination, in 2001–02, the U.S. Environmental Protection Agency (EPA) and the Washington Department of Ecology listed the Lower Duwamish Waterway as a priority site for cleanup under the federal Superfund law and Washington’s Model Toxics Control Act. Given its environmental, social, cultural, and economic implications, the Lower Duwamish Superfund Cleanup may result in a variety of unintended health consequences. The University of Washington, in collaboration with the Duwamish River Cleanup Coalition/Technical Advisory Group (DRCC/TAG) and Just Health Action, received funding from the Health Impact Project (a collaboration of The Pew Charitable Trusts and the Robert Wood Johnson Foundation) to conduct a Health Impact Assessment (HIA) of the EPA’s proposed Cleanup plan. One major portion of the HIA examined potential health impacts in two residential communities (Georgetown and South Park) from Cleanup-spurred reinvestment, revitalization, and gentrification. We found that gentrification is already under way in these communities, and the Cleanup could substantially worsen the related health risks for vulnerable populations. In collaboration with community advisors, we identified and prioritized tools for promoting more equitable revitalization and associated recommendations, to be submitted to the EPA and other agencies responsible for the Cleanup and its direct and indirect consequences.  


Climate Smart Communities Scenarios HIA—Methods and Assessment Results (PDF)

Presenter: Andrea Hamberg, Oregon Health Authority 

The Oregon Health Authority (OHA) recently completed the Climate Smart Communities Scenarios HIA in order to provide recommendations for including health in Portland, Oregon’s greenhouse gas reduction planning process. The HIA was  innovative in its use of the Integrated Transport and Health Impacts Modeling tool (ITHIM). ITHIM facilitates direct comparisons of the health impacts of greenhouse gas reduction scenarios, and has been applied to only one other metropolitan area in the United States. OHA found that, while all scenarios under consideration by Portland’s regional government could potentially benefit the health of area residents, specific scenario elements were most health-promoting and should be included in the preferred option that will be implemented throughout the region.  


Health Impact Assessment of Vehicle Speed Impacts on a State Highway in Corvallis, Oregon (PDF)

Presenter: Kathleen Johnson, Benton County Health Department 

The City of Corvallis Public Works requested a speed investigation in 2013 for a state highway, South Third Street/Highway 99, which runs through part of Corvallis, Oregon. In conjunction with the speed investigation, the Benton County Health  Department conducted a health impact assessment (HIA) to inform the decision of whether or not to adopt a 25 mph speed  limit for a one-mile stretch of South Third Street/Highway 99. The decision makers include Oregon Department of Transportation and City of Corvallis Public Works department. The Benton County Health Department used relevant health data to describe the potential impact to health a change in traffic speed could have to the residents of south Corvallis, particularly regarding safety, opportunities for physical activity, social networks, and access to goods and services. 

The HIA stemmed from residents’ deep concerns regarding the accessibility and safety of South Third Street/Highway 99, particularly for those who are the most vulnerable. South Corvallis is among the most diverse neighborhoods in Corvallis.  Overall, more residents in south Corvallis identify as Hispanic/Latino as compared to all of Corvallis. There is a higher percentage of youth living in south Corvallis, and 42 percent of south Corvallis’ residents are living below 185% of the Federal Poverty Level. Community input was collected through a needs assessment, community forums, and technical advisory group meetings.


Modeling and Cost-benefit Analysis of Bicycle Infrastructure in the BICY Project (PDF)

Presenter: Jason Meggs, Escher City Associates 

The BICY Project, an EU-funded effort to increase bicycling in Central Europe, conducted a transnational, detailed mobility survey (7 countries, 7 languages, 14 cities, target n>=1500) in an effort to understand the factors which increase the use of bicycling, walking and public transport. Models were generated using the survey and background data. The models were then used to estimate the behavior changes expected from investment in bicycle infrastructure. From these estimates, cost-benefit analysis was conducted for both carbon emissions and health effects. The Health Economic Assessment Tool (HEAT) was employed across five scenarios, predicting a substantial reduction in all-cause mortality equated to a many-times return on investment using standardized estimates of the economic value of life. The transferability of the model and method to the United States is explored.


A Community-based Assessment  of  Subsistence Fishing  in Seattle’s  Urban Waters : Characterizing  the Health Impacts of a Superfund Site Cleanup (PDF)

Presenter: Amber Lenhart, University of Washington 

In February 2013, the Environmental Protection Agency (EPA) released a proposed plan to clean up the Lower Duwamish Waterway (LDW) Superfund Site in Seattle, Washington. To address the potential unintended health impacts of the EPA’s cleanup plan on local residents, affected tribes, subsistence fishers, and workers in local industries, the University of Washington, in partnership with the Duwamish River Cleanup Coalition/Technical Advisory Group and Just Health Action, conducted a health impact assessment. A variety of individuals rely on the LDW for subsistence fishing. Little is currently known about these subsistence fishers, and identifying their potential health impacts would be difficult without a clear picture of the culture, behaviors, and needs of this population. The findings from this research project informed the recommendations of the health impact assessment of the EPA’s cleanup plan. Findings from focus group discussions and key informant interviews suggest that there is a need for creative, novel approaches to minimize harms and maximize benefits of fish consumption in these communities. Reactions to alternatives to institutional controls were mixed, suggesting a need for innovative thinking about how to discourage fishing for resident fish and shellfish on the Duwamish River and how to promote safe and healthful fishing alternatives.


Health Impact Assessment (HIA) of the Choice Neighborhood Transformation Plan for a Community in Albany, Georgia (PDF)

Presenters: Nisha Botchwey, Georgia Institute of Technology; Arthi Rao, Center for Quality Growth and Regional Development 

The Center for Quality Growth and Regional Development (CQGRD) at the Georgia Institute of Technology conducted a rapid- intermediate Health Impact Assessment (HIA) jointly with the Georgia Department of Public Health (GA DPH) to assess the health impacts of the redevelopment of a public housing project, McIntosh Homes, located in Albany, Georgia. The Transformation Plan for McIntosh Homes was developed by the Albany Housing Authority (AHA) through a grant provided by the U.S. Department of Housing and Urban Development (HUD) under the Choice Neighborhood Program. Although health is specified as one of the components required by HUD for inclusion in the “People” section of the Transformation Plan, the HIA provided the AHA with additional data, resources, stakeholder input, and ultimately recommendations to consider health in a much more explicit way. 

The HIA was particularly valuable as a supplement to the Transformation Plan, since the study area population is characterized by a number of health risk factors, such as low socioeconomic status, exposure to crime, and chronic disease. Additionally, the study area includes many vacant and poorly maintained properties, lacks greenspace, and offers limited healthy food sources. The presentation will describe the HIA process, methods, and recommendations. Some recommendations have been quickly implemented and will be described in detail as part of the findings from the ongoing HIA process and impact evaluation. This HIA was unique in that it created a clear opportunity for state resources to be utilized to augment an existing federal program for a greater positive impact.

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