Analysis

Program Grants Awarded to Integrate Health into Community Decision Making

The Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, is delighted to announce the awarding of six new program grants. These projects will help make health a regular consideration in decision-making in states across the country. 

Each grantee will conduct at least one health impact assessment to inform upcoming state and local planning and policy decisions. In addition, grantees will work to develop streamlined tools, strengthen partnerships, and create sustainable funding mechanisms to integrate HIA into decision-making processes in their respective states or regions. The Health Impact Project selected the grantees from a pool of applicants who responded to its fourth national call for proposals.

In California, the Sequoia Foundation, in collaboration with the California Department of Public Health and the Public Health Institute, will conduct an HIA to provide recommendations to the California Water Board on criteria used to determine funding for drinking water projects, and work to standardize the use of HIAs among California agencies. The state annually revises its drinking water project priorities for the year. Data-driven decisions about funding allocations can improve access to safe and reliable drinking water, especially in rural communities that lack advanced infrastructure. Recommendations from the HIA will also inform future California water resource policies as the state continues to combat a severe drought.

Additionally, the organizations will provide training opportunities, HIA resources and tools, and technical assistance for state and local agencies, with a particular emphasis on collaboration among members of the California Health in All Policies Task Force.  (Support for this project was provided, in part, by a grant from The California Endowment).

In Colorado, the Pediatric Injury Prevention Education and Research Program at the Colorado School of Public Health (CSPH) and Children’s Hospital Colorado (CHC) will conduct two HIAs. The first will inform the development of policies to prevent youth and gang violence in the Aurora Public School District. The focus of the HIA will be disciplinary policy and how the district can best collaborate with the police department in pursuit of shared goals. The HIA will also consider other factors that may influence youth and gang violence, such as how safer spaces may increase opportunities for improved educational attainment and mental health, and reduced violence.

CSPH and CHC will conduct a second HIA in collaboration with the Kempe Center for the Prevention and Treatment of Child Abuse and Neglect to inform the Colorado Department of Human Services’ consideration of new policies surrounding how marijuana use should be handled in child abuse and welfare decision-making. The recent legalization of recreational marijuana in Colorado has raised numerous questions about the implications for public health. Particular attention has been paid to the anticipated impact on children and to policies that can be put in place to help mitigate them. Policies to deal with marijuana use and child abuse and neglect reporting are of special interest. This HIA will generate recommendations to the state regarding which policies and procedures should be adopted to maximize child health.

Under the same grant, CSPH and CHC will develop a model and pilot procedures to standardize the use of HIAs as a part of the hospital community benefit activities that are required for hospitals to acquire and maintain nonprofit status. Nonprofit hospitals are required to conduct community needs assessments and develop implementation plans to improve health in the communities they serve.

In Georgia, the Center for Quality Growth and Regional Development at the Georgia Institute of Technology, in collaboration with the Coastal Region Metropolitan Planning Organization (the regional metropolitan planning authority), will establish a framework for the consideration of health effects in freight planning. The HIA process will focus on infrastructure, commodity, and freight needs, with an emphasis on disproportionate effects on low-income communities and people of color. The recommendations will be integrated into the Coastal Region Metropolitan Planning Organization Freight Transportation Plan.

To encourage future use of the framework in public decision-making about freight, the center will provide technical assistance to university, government, and nonprofit entities and will pilot the framework in a second HIA on the Cargo Atlanta Citywide Freight Study. Both HIAs will consider the potential health implications of freight planning, including diesel emissions, traffic patterns, and employment, which can affect respiratory and cardiovascular disease, injury rates, and general health.

In Massachusetts, the Harvard Center for Population and Development Studies, together with the Metropolitan Area Planning Council, will conduct an HIA to inform state decisions on funding for the Small Business Technical Assistance Program, an initiative that incubates and supports small businesses in underserved Massachusetts communities. The HIA will explore links between the income-generating effects of supporting small business and mental health, overall health, and the ability of small business employees to afford housing, food, and medications. In addition, the center will complete rapid assessments of policies related to criminal justice reform and immigration, which will serve as the foundation for educating students and community partners. These rapid HIAs will inform state legislative decisions surrounding driver’s licenses for formerly incarcerated persons and undocumented immigrants.

As part of the larger program grant, the center will work to standardize the use of HIA by building demand and basic capacity among community-based organizations, developing assessment methodologies for several sectors and health outcomes, creating a full Harvard University course on HIA, and offering in-depth training for students and community-based organizations in classroom, practice, and online forums. Through the course, students will work with the HIA team to complete smaller, rapid assessments of policies related to criminal justice reform and immigration. These coursework projects will serve as the foundation for educating students and partners. Under the program grant, the team will work with community health workers to increase community knowledge and understanding of Health in All Policies approaches, including HIA. This effort will help build capacity among health workers and the populations they serve to demand and engage with HIAs.

In Nebraska, the Douglas County Health Department will conduct two HIAs to inform decisions before the Omaha Planning Department and the Omaha City Council. The first will inform a development review process as it relates to policies that govern how transportation and land use site designs are negotiated with developers and approved. Housing and neighborhood connectivity are directly related to such health outcomes as increased physical activity, decreased injury, and decreased stress. The second HIA will inform the Deer Park Neighborhood Redevelopment Plan, which determines funding priorities for housing in a low-income, predominantly Latino neighborhood. Housing funding has implications for such health issues as lead poisoning, asthma, injury, and stress.

The county Health Department will also strengthen Build With Health, a collaboration among the department, the city of Omaha, and several partners that started under a previous HIA grant from the Centers for Disease Control and Prevention. Build With Health will systematically integrate health and community engagement into the city’s neighborhood design and project approval processes. Part of this work will be creating and implement screening checklists that streamline the consideration of health early in the development review process.

In Texas, the University of Texas at El Paso (UTEP) will conduct two HIAs focused on public transportation and water infrastructure. One will inform the choice of a route for a proposed public transportation system between Las Cruces, New Mexico, and rural towns in southern areas of the state. Public transportation has been linked to positive health outcomes as a result of increased access to health care, opportunities for physical activity, and decreased stress. The second HIA will help guide a decision by the city of Presidio, Texas, on whether to extend the local water system to the neighboring colonia of Las Pampas. Multiple health issues are linked to inadequate access to safe water, including gastrointestinal illnesses and ailments such as Giardia infections, dysentery, hepatitis, and dehydration. Improved local water systems may also have indirect health effects through higher property values and tax revenue that support services important to health, such as clinics and social services.

Under the same grant, UTEP will also develop a collaborative program in the U.S.-Mexico border region to advance the consideration of health and the use of HIA in public policymaking. UTEP will also develop and implement a process for the Border Environment Cooperation Commission to include health impact in infrastructure project decisions and will develop bilingual HIA training modules at UTEP and other border universities.

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