Transcript Estimation Of Health Benefits Accruing From A Local Living

Health Impact Assessment:
Towards Institutional Accountability
to the Public’s Health
Prepared for the Grantmakers In Health
February 25th, 2009 Audio Conference
Rajiv Bhatia, MD, MPH
San Francisco Department of Public Health
Our Nations Health: Intolerable Facts
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Annual health care
spending $6405 per person
(1st place)
Average life expectancy is a
full year less than peercountries (30th place)
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The most affluent live 4.5
years longer than the
least affluent
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Neighborhood to
neighborhood differences
in life-expectancy within
cities can exceed ten years
of life.
Rajiv Bhatia, MD, MPH
Health Impact Assessment
HIA Overview
Page 1
Diverse social and environmental conditions impact
human health!
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Employment wages and job quality predict
disease and mortality from most causes
Asthma aggravated and lung development
and life expectancy compromised for
residents near freeways
Physical activity & mental functioning
improved by access to parks and green space
Heart disease, hypertension, and sleep
disturbance triggered by traffic noise
exposure
Pedestrian injuries and deaths increased for
people near busy roads
Crowding, displacement, infectious diseases,
hunger, and exposure aggravated by
unaffordable housing.
Rajiv Bhatia, MD, MPH
Health Impact Assessment
HIA Overview
Page 2
An Institutional Vision For A Healthy Public Policy
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A public health community
engaged in informing policy
making
The public and decision
makers aware of the health
impacts of public decisions
Health objectives achieved
through institutional
policies in all sectors
Institutions accountable to
health protective rules and
mandates
Rajiv Bhatia, MD, MPH
Health Impact Assessment
HIA Overview
Page 3
Case Study: Sprawl
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Public policies resulted in
sprawl
Sprawl promised healthy
communities!
What did we miss?
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Environmental
consequences
Urban Disinvestment and
Blight
Inequities
Health Impacts
Rajiv Bhatia, MD, MPH
Health Impact Assessment
HIA Overview
Page 4
The Case for Considering Health Impacts in Public
Policy
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Prevent harm
Leverages public investments to
promote health
Supports community engagement
in policy
Stimulates cross-sector ownership
of health objectives
Mobilizes political support for
social change
Rajiv Bhatia, MD, MPH
Health Impact Assessment
HIA Overview
Page 5
Health Impact Assessment Definition
Health Impact Assessment is a
systematic process to make evidencebased judgments on the health impacts
of public decisions
Rajiv Bhatia, MD, MPH
Health Impact Assessment
HIA Overview
Page 6
HIA responds to the question:
How do decisions affect our health?
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Mobilizes and synthesizes evidence to
forecast the health impacts of public
decisions, considering health holistically
Communicates findings to inform and
influence the policy process
Involves stakeholders in both assessment and
communication
Rajiv Bhatia, MD, MPH
Health Impact Assessment
HIA Overview
Page 7
The HIA Process
Screening
Determine the need for and value of a HIA
Scoping
Determine priority health impacts and the data and
methods for analysis
Assessment
Judge the magnitude and certainty of potential health
impacts
Reporting
Communicate the results to stakeholders and decisionmakers
Monitoring
Track the decision outcomes
Rajiv Bhatia, MD, MPH
Health Impact Assessment
HIA Overview
Page 8
HIA is Different from…
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Community Assessment
Health Risk Assessment
Systematic Reviews
Health Element of the General Plan
Healthy Development criteria
Design and Planning Exercises
Rajiv Bhatia, MD, MPH
Health Impact Assessment
HIA Overview
Page 9
Several Existing Institutional Rules
Promise Healthy Public Policy
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The National Environmental Health Policy Act
(NEPA) requires analysis health and safety
problems caused physical changes
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National and State Environmental Justice Policy
mandates agencies to identify and address
adverse health effects on low income and
minority populations
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Federal rules require cost-benefit analysis of
environmental quality regulations
Rajiv Bhatia, MD, MPH
Health Impact Assessment
HIA Overview
Page 10
Three Common Contexts for HIA
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Required by HIA policy, regulation or law
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Conducted to comply with requirements of
EIA regulations
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Initiated by project proponent, stakeholder,
responsible public agency, or policy-maker
Rajiv Bhatia, MD, MPH
Health Impact Assessment
HIA Overview
Page 11
Policy settings appropriate to the application
of HIA
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Transportation - Speed policy; highways; transit
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Housing - Public housing; Housing Subsidies
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Labor - Minimum wage; employment benefits
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Agriculture - Crop and water subsidies
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Natural - Dams; oil drilling; water
Rajiv Bhatia, MD, MPH
Health Impact Assessment
HIA Overview
Page 12
Health Impacts of a Living Wage (1999)
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Quantified the following Health and
Social Benefits of a Living Wage
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Life-expectancy
Graduation rates
Teenage childbearing
Depression’
Sick days
HIA Outcomes
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Support for local living wage laws
Public health could contribute
analysis to social and economic policy
Rajiv Bhatia, MD, MPH
Health Impact Assessment
HIA Overview
Page 13
HIA of the Healthy Families, Healthy Workplaces Law
(2008)
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Paid Sick Day mandate proposed in
California Legislature
Legislative sponsors requested HIA
HIA found health benefits from
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Taking leave from work to care for ill
children and dependents.
Reduced community and workplace
transmission of communicable
disease
Protection of household budget
Sponsors used HIA to develop a public
health communication frame for the
legislation
Requests for replication nationwide
Rajiv Bhatia, MD, MPH
Health Impact Assessment
HIA Overview
Page 14
Environmental Impact Assessment:
Key Requirements
When EIA is required, Public Agency’s must:
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Analyze the decision’s environmental effects
 including direct and indirect health effects
Identify mitigations for adverse effects;
Consider alternatives;
Document analysis;
Respond to public comment.
Rajiv Bhatia, MD, MPH
Health Impact Assessment
HIA Overview
Page 15
Infill Development & Residential Displacement
Trinity Plaza Case Study, San Francisco (2003)
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Organized tenants challenged the demolition and
redevelopment of 360 rent-controlled apartments
citing human impacts
SFDPH provided an HIA as a comment on the scope
of an EIA documented adverse health effects of on
stress, social cohesion, and housing
Outcomes:
 City required study through EIA or mitigations
 Project redesigned to provide replacement
housing at current rents
 City level planning policy changes for
replacement housing
Rajiv Bhatia, MD, MPH
Health Impact Assessment
HIA Overview
Page 16
Integrating HIA / EIA for the Eastern Neighborhoods
Rezoning, San Francisco (2007)
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City proposed rezoning of
historically industrial lands;
Potential environmental impacts on
residents from noise, air pollutants,
traffic hazards, and limited
infrastructure
SFDPH contributed analysis and
mitigations to EIR as “cooperating
agency”
EIA required new mitigations to
protect respiratory health, reduce
noise exposure and added
“improvement measures” to
reduce pedestrian injuries
Rajiv Bhatia, MD, MPH
Health Impact Assessment
HIA Overview
Page 17
Vehicle-Pedestrian Collision Analysis for the
Eastern Neighborhoods EIR
Predicted
% change in
pedestrian injury
20%
collisions based
on estimated
changes in
21% resident
population and
traffic volume.
15%
24%
Rajiv Bhatia, MD, MPH
Health Impact Assessment
HIA Overview
Page 18
Modeling Vehicle
PM2.5 for a
Residential
Development
using CAL3QHCR—
Harrison and Beale
Streets, San
Francisco
Rajiv Bhatia, MD, MPH
Health Impact Assessment
HIA Overview
Page 19
West Oakland Port Expansion HIA (2009)
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Growth of goods movements
Expansion plans subject to EIA
Health impacts on neighborhoods
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Air Pollution
Noise
Vehicle collisions
Retail Environment
Employment Opportunities
Available analytic methods
Port of Oakland HIA case study
Rajiv Bhatia, MD, MPH
Health Impact Assessment
HIA Overview
Page 20
Freight Routes and Truck-related collisions in
West Oakland
San Francisco
RajivDepartment
Bhatia, MD,of
MPH
Public Heath
Health Impact
Health
Assessment
Impact Assessment
Mini-Course – July 2008
Port of Oakland
HIA
Case
Overview
Study
Page 21
Health Impacts of Congestion Pricing (2009)
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San Francisco is considering a fee to drive
A transportation study will addresses impacts on
traffic, transit, and business
Strong and vocal public pushback already
emerging
In progress HIA evaluating impacts on
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Air Pollution exposure
Environmental noise
Pedestrian and Vehicle Injuries
Walking environments
Household budgets
Expected Outcomes of HIA
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More fair and balanced discussion of costs and
benefits
Potential public support for proposal
Rajiv Bhatia, MD, MPH
Health Impact Assessment
HIA Overview
Page 22
HIA in the Bay Area: Key Lessons
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HIA resonates with community needs and concerns
Not every Public Decision Requires a HIA - need to pick
issues, plans, policies strategically
A scientific approach along with practical solutions in HIA
can successfully change decisions outcomes
Stakeholder involvement is critical to HIA outcomes
EIA is underutilized to protect public health
Need to conduct objective analysis
Rajiv Bhatia, MD, MPH
Health Impact Assessment
HIA Overview
Page 23
Value of integrating Health Into EIA
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EIA is an established regulatory tool
A broad scope of policies, plans, programs, and
projects trigger EIA
EIA requires health effects analysis
Costs of EIA analysis internalized
Integrated analysis builds on existing data, creates a
setting for inter-disciplinary research, and fosters
cross-sector ownership of public health objectives
EIA analysis catalyzes both new regulations and
subsequent policy design
Rajiv Bhatia, MD, MPH
Health Impact Assessment
HIA Overview
Page 24
HIA is One of Several Tools for Healthy Public
Policy
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Assess and monitor of health-relevant
environmental conditions
Contribute to policy design
Develop and enforce needed health-protective
laws & regulations
Conduct health impact assessments of policies,
plans, and projects
Monitor institutional accountability to existing
health protective laws and institutions
Use authoritative power to advocate for
healthy policy
Rajiv Bhatia, MD, MPH
Health Impact Assessment
HIA Overview
Page 25
HIA: Practice and Research Needs
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Public and policy-maker awareness of the value of HIA
Guidelines and standards to ensure HIA practice quality
Resources for HIA practice
HIA practice evaluation Research and technical tools
development to fill gaps in evidence to assess policies
Engagement in the EIA process
Rajiv Bhatia, MD, MPH
Health Impact Assessment
HIA Overview
Page 26
San Francisco Bay Area HIA Collaborative
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Includes: San Francisco Department of Public
Health, UC Berkeley, & Human Impact Partners
Conducts:
 HIA practice
 Academic instruction & professional training
 Facilitation and mentorship
 Technical tools, guidelines, and standards
 HIA policy development
Rajiv Bhatia, MD, MPH
Health Impact Assessment
HIA Overview
Page 27
SF HIA Collaborative Resources
SF Department of Public Health
 www.sfdph.org/phes/
UC Berkeley HIA Group
 http://sites.google.com/site/ucbhia/
Human Impact Partners
 www.humanimpact.org
Healthy Development Measurement Tool
 www.TheHDMT.org
Rajiv Bhatia, MD, MPH
Health Impact Assessment
HIA Overview
Page 28