Transcript Document

Research Informing Policy:
the Potential of Health Impact Assessments
Academy Health
June, 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: [email protected]
www.healthimpactproject.org
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By RWJF and University of
Wisconsin Madison, County
Health Rankings program:
www.countyhealthrankings.or
g/about-project/background
“Health in all Policies…”
"(The) toxic combination of bad policies, economics, and
politics is, in large measure, responsible for the fact that a
majority of people in the world do not enjoy the good health that
is biologically possible.” WHO Commission on Social Determinants of
Health, 2009
Health in all policies. APHA supports
requiring all new federal policies and
programs to take into consideration all
Impacts, both positive and negative, on
the public’s health.
Health in all policies, but…
 No common language:
 transportation engineers don’t understand health data.
 public health professionals don’t understand the constraints
and limitations of the planning process
 Few routine/formalized requirements
 No standard forums where health works with other
sectors
 No funding for new public health activities
 “Going out on a limb:”
Public health is science-driven, and policy and planning are
governed by many other considerations: economics, politics,
technology, deadines, etc …
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Definitions
IAIA
A combination of procedures, methods and tools that
systematically judges the potential effects of a policy,
programme or project on the health of a population
and the distribution of those effects within the
population. HIA identifies appropriate actions to
manage those effects.
(IAIA, 2006)
Analytical Framework
Proposed policy,
project, program
Determinants of
health
Health outcomes
• Broad framework: considers multiple determinants and
dimensions of health
• Considers direct, indirect, and cumulative pathways
• Both qualitative and quantitative methods used, as is
expert opinion
• Focus: predicting outcomes or pathways/linkages, in order
to manage effects
The HIA Process
1.Screening –is HIA feasible and likely to add value?
2.Scoping – determine the important health effects,
affected populations, available evidence, etc
3.Assessment – analyze baseline conditions and likely
health effects
4.Recommendations – develop health-based recs and a
feasible plan for implementing them
5.Reporting – disseminate the report to the public,
stakeholders, solicit input
6.Monitoring and Evaluation
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Examples of Housing HIAs
Jack London Gateway (JLG) Senior Housing Project
Authors: Human Impact Partners and
SFDPH
Decision: Plan for 61 new senior housing
units close to 2 freeways & Port of
Oakland.
Outcomes:
Impacts: indoor & outdoor air quality,
• Many recommendations
noise, safety, retail planning
adopted.
• Additional HIA projects
Recommendations: AQ monitoring;
installation of ventilation systems; noise- were funded.
insulating windows; pedestrian protection • Healthy Development
checklist adopted by the
medians; traffic calming measures; and
Development Committee.
many others.
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Integrating HIA into the environmental
impact statement process:
Decision: Bush energy plan
proposed expanded oil leasing
in Alaska’s North Slope,
necessitating an EIS
•Local government
became a “cooperating
agency” – a role through
which local governments
can formally participate
in an EIS
• The community health
agency drafted an HIA
through this role
• The lead federal
agency incorporated
the HIA into the EIS
Oil and gas leasing on Alaska’s Arctic
Slope
A small Inupiat community 7 miles from large oil development
Community testimony:
Benefits: revenues pay
for services,
infrastructure
Risks: social change,
drugs and alcohol, STIs,
contaminants, cancer,
and breathing problems,
interference with
hunting and fishing
Result of the NPR-A HIA?
Health Concern
Mitigation
Dietary change from
interference with hunting
and fishing (exacerbating
risk of diabetes, obesity,
etc)
“Social ills”: alcohol,
STIs,
Air pollution
BLM withheld critical hunting areas
from leasing in part because of
health and broader cultural impacts
Contamination of local
food sources
Baseline levels and ongoing
monitoring
Expand cultural orientation for
workers
Additional baseline, modeling, and
monitoring above CAA requirements.
Examples of HIAs
Paid Sick Days
Workers’ rights issue vs. Public health issue
Disparities: income, race/ethnicity, occupation
Methods: Lit and health data review,
statistical analyses, focus groups
Key Findings: ER visits, flu spread
restaurant workers, nursing homes
Outcomes: Changed discourse,
revitalized campaigns across US
What are the elements that define HIA?
1.
2.
3.
4.
Forward-looking: addresses a proposed action
Seeks to inform decision-making
Follows 6 steps (5 in some texts)
Broad framework: broad def’n of health; considers social,
economic and environmental influences on health
5. Participatory process: engages the public and other
stakeholders
6. Cross-disciplinary: effective collaboration with decisionmakers, other agencies
7. Focus on vulnerable populations/equity
The Health Impact Project:
A collaboration of the Robert Wood Johnson
Foundation and The Pew Charitable Trusts
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.
Visit www.healthimpactproject.org
The Health Impact Project
Funded Projects
1.State Budget Process: New Hampshire Center for Public Policy
will address the NH budget
2.State Cap-and-Trade regulations: CA DPH an HIA to inform the
rulemaking process for California’s carbon cap and trade rule
3. Agriculture Policy: Kohala Center, a nonprofit in HI, will do an
HIA to inform HI County’s A non-profit would engage in a
county agricultural plan that will shape the local economy, land
use patterns, and diet.
4.Wilshire Transportation Corridor, LA: LA DPH and UCLA will
do an HIA of planned transportation corridor in LA
5.Farm to School Legislation: a non-profit in OR will do an HIA to
inform deliberations on a farm to school bill.
The Health Impact Project CFP
Funded Projects
7. Transit Oriented Development:
a. ISAIAH (a faith-based coalition) will use HIA to address planning
decisions on a light-rail project in the Twin Cities.
b. TSU will use HIA to look at a proposal for TOD
8. Coal Gasification Plants: Green River Health Department will
do an HIA of 3 proposed “clean coal” plants in KY
9. Construction waste power plant: Mass. Dept of Public Health
will do an HIA of a proposed biomass power plant in an
economically depressed area of Springfield, MA
10. Farm to School legislation: an OR non-profit public health
group will undertake and HIA of proposed legislation to fund
farm to school programs
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HIA and Science
HIA practitioners may be
experienced and well-versed in
public health, but it is a misguided
conceit to predict the nature and
extent of a health impact without
substantiating this by reference to
empirical data (…most of which is
uncertain and won’t substantiate
impacts)
Thompson
…it is not reasonable to
suggest that uncertainty should
prevent HIA from making any
predictions. Certainty or even
high probability are luxuries
which HIA practitioners do not
enjoy…it is little help to the
decision-maker to be told that
they should wait 5 years for
more research
Kemm
Questions for discussion
1. Are there minimum standards of evidence that could be
applied without restricting the range of potential
applications of HIA? What are they?
2. How should HIA handle predictions in which there are
potentially important health effects and a high degree of
uncertainty regarding the predictions?
3. How can HIA avoid becoming a biased tool for advocacy
when it relies on subjective judgments
Discussion?
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Northeast NPR-A Example: hunting and diabetes
Baseline:
• Type 2 diabetes prevalence low: ~2.5%
• Diet: ~50% “wild foods” – caribou, salmon, marine
mammals
Impact Assessment:
Pipelines
Displace caribou
Dietary
Diabetes
farther from village
“Seismic”
Change
Risk
Fuel & equipment
for hunting
Revenue
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Assessment
Your data are incomplete, your predictions are uncertain…
What to do?? …
Adaptive Management
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