Transcript Slide 1

COMPATIBLE
FRAMEWORKS?
Health Impact Assessment and
the Policy Sciences
Katrina Smith Korfmacher, PhD
1
Associate Professor of Environmental Medicine
Director, Community Outreach and Engagement Core
Environmental Health Sciences Center
University of Rochester
PRESENTATION GOALS:

How is this framework compatible with a policy
sciences perspective on problem solving?

What can/has the policy sciences contribute to this
framework?

What potential does this framework have for
expanding the practice of the PSF (explicitly or not)
2
OVERVIEW
 Health
in All Policies (HiAP)
 Health Impact Assessment (HIA) and
Policy Sciences Frameworks
 Rochester’s Local Waterfront
Revitalization Program (LWRP)
 Healthy Waterways Project
 HIA and PS, revisited
3
FACTORS RESPONSIBLE FOR POPULATION HEALTH
Health status is determined by: genetics (5%), health care
(10%), behavior (30%), Social Conditions (55%)
- WHO Commission on the Social Determinants of Health (2008)
4
HEALTH IN ALL POLICIES (HIAP)
 Many
public decisions affect
health - not only health policies!
 BUT….few non-health decisions
even consider health outcomes
 How can we promote health through nonhealth policies?
 “Health in All Policies” (HiAP)
 Health Impact Assessment (HIA): one way
to support HiAP
5
HEALTH IMPACT ASSESSMENT (HIA)
DEFINITION: “A combination of procedures, methods and
tools that systematically judges the potential, and
sometimes unintended, effects of a policy, plan, program
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.”
-International Association for Impact Assessment, 2006
HISTORY OF HIAS
Europe, Canada, New Zealand
US: California, Alaska….
Human Impact Partners (www.humanimpact.org)
PEW/RWJ Foundation (www.healthimpactproject.org)
7
HIA AND DETERMINANTS OF HEALTH
How does the proposed
project, plan, policy
Affect health
determinants like:
Housing
Air quality
Noise
Safety
Social networks
Nutrition
Parks and natural space
Private goods and services
Public services
Transportation
Livelihood
Water quality
Education
Inequities
8
and lead to
health outcomes
INCORPORATING HEALTH INTO DECISION-MAKING
The world would look different if we considered health impacts of decisions on…
9
Development
Farm Policy
Incarceration
Immigration
Ports
Education
HIA EXAMPLES FROM OTHER STATES
Alaska - North Slope Oil Development: HIA led to
compromise lease plan; reduced impacts on hunting
and fishing and avoided litigation
 Illinois - Smart Metering in Chicago: showed
health risks from automatic electricity disconnects;
now require site visit prior to shutoff and monitor
impacts on low income people
 CA -Senior Housing in Oakland: predicted
respiratory problems from air pollution; developer
incorporated central air filtration and moved air
intake away from high traffic area.

BUT WHAT IS HIA???
An ANALYSIS that…
• Clarifies health effects of a proposed project, plan or policy
• Includes quantitative and/or qualitative information
• Highlights health disparities; makes health impacts explicit
• Considers multiple health outcomes
• Provides recommendations
• Shapes public decisions & discourse
A PROCESS that…
Engages & empowers community
Builds consensus
Builds relationships & collaborations
11
STEPS OF A HIA
12
Screening
Determines the need and value of a HIA
Scoping
Determines which health impacts to evaluate, methods for
analysis, and a workplan
Assessment &
Recommendations
Provides:
1) a profile of existing health conditions
2) evaluation of potential health impacts/alternatives
3) strategies to manage identified adverse health impacts
Reporting
Includes:
1) development of the HIA report
2) communication of findings & recommendations
Monitoring
Tracks:
1) Process: impacts on decision-making processes and
the decision
2) Outcomes: impacts of the decision on health
determinants
HIA AND THE POLICY SCIENCES: PROBLEM ORIENTATION
Screening
Clarifying goals
Scoping
Clarifying goals
Assessment &
Recommendations
Describing trends
Analyzing conditions
Projecting developments
Inventing, evaluating, and selecting alternatives
Reporting
[Social process]
Monitoring
[Social process]
HIAs are only conducted when likely to affect pending decision
13
WHO DOES HIA?
-HIA is a collaborative process
-HIA may be LED by: health departments,
planners, developers, consultants,
community members, or interest groups
-HIAs involve:
•
•
•
14
The public for relationship building, capacity for
advocacy, and empowerment
Public health and other agencies for relationshipbuilding, data, information, and resources
Decision-makers/industry to ensure that
recommendations are realistic and account for the
practical, economic, and technical limitations on
the decision at hand
HIA AND POLICY SCIENCES: STANDPOINT

Goal is to be a source of “objective information”

Normative orientation toward ‘equity’
Identify ‘vulnerable populations’
 Assess distribution of health impacts
 Aim to reduce health disparities


Recommendations and Reporting are intended to
influence decisions (analysis/advocacy)
15
HOW DO HIAS ASSESS?
• Conduct a literature review
• Find out about other communities’ experiences
• Gather existing data or conduct new analysis on health,
environmental and social indicators
• Compare data to existing regulatory criteria, standards, &
benchmarks
• Utilize community expertise - e.g., focus groups, surveys
• Apply specialized data collection tools for observational
data, forecasting, and modeling
• MAP environmental, social, health data
• NOT “new research” (usually)
16
HIA AND POLICY SCIENCES: MULTIPLE METHODS
Focus on integrating/applying existing information
 Most HIAs elicit information from stakeholders

Surveys
 Focus Groups
 Interviews

Evidence summaries rate the ‘strength of evidence’
from literature, reports, case studies
 Recommendations based on weight of all evidence

17
CASE STUDY 1: PAID SICK DAYS
A Health Impact Assessment of the California Healthy
Families, Healthy Workplaces Act of 2008
Does public health evidence support the
hypothesized impacts of a mandatory requirement
for paid sick days on health?
18
PAID SICK DAYS POLICY: SCREENING
• Nationally, 60 million lack paid sick days
• Potential benefits to individual, family and
community health
• Limited legislative analysis of health
• Legislative sponsors enthusiastic about
framing bill using health
• Methods exist to contribute to analysis
• CA legislation and HIA as national model
19
PSD PATHWAY SCOPING
Additional pathways for dependents completed
as well
20
PAID SICK LEAVE: HEALTH ADVOCATES HELP WIN A
COMMON SENSE POLICY (SEPTEMBER 10, 2014)
“HEALTHY WORKPLACES, HEALTHY FAMILIES ACT”
Imagine waking up sick with
the flu. Wouldn’t you want to
take a day off from work? What
if not working meant going
without pay? After July 1, 2015,
fewer California workers will
have to struggle with this
choice. Last week, California
Governor Jerry Brown signed
AB 1522 making California the
second state (after
Connecticut) to guarantee
most workers some paid sick
leave.
www.humanimpact.org
In 2008, Human Impact Partners authored
a health impact assessment on California’s
first attempt to legislate paid sick days. …
Public health arguments were clearly
central to last week’s passage of AB 1522…
21
HIA AND POLICY SCIENCES: SOCIAL PROCESS
Participants: HIA often involves broader range of
participants than official decision process
 Perspectives: Solicits different views on decision
 Situations: May create new forums for interaction;
BUT HIA takes the policy context as given
 Base values: HIA process may enhance base values;
recommendations may enhance scope values
 Strategies

Diplomatic – integrate decision makers
 Ideological – public communication of recommendations


Outcomes and Effects: emphasizes evaluation of:
Process (how did it shape decision)
 Outcome (how did decision affect health determinants)

22
HIA AND POLICY SCIENCES: HEALTH AND BASE VALUES







Power: Highlighting health costs gives more power to
groups suffering from health disparities
Wealth: HIA connects economic security to better health,
promoting interests of low income groups
Enlightenment: Education is linked to better health
outcomes; HIAs often support education improvments
Skill: HIA may engage new groups in decision-making,
improving their capacity for future participation
Affection: Social connectedness, and communitybuilding are well established health determinants
Well-being: stress and poor mental health are important
health outcomes and also affect physical health
Respect and Rectitude: Participation, equity emphasis,
and valuing community knowledge promote these
23
HIA AND ENVIRONMENTAL HEALTH PROBLEM SOLVING
Explicitly connects environment and health
 Integrating multiple sources of data
 Making use of available data
 Clarifying equity impacts of decisions
 Communicating policy consequences in health terms
engages diverse stakeholders
 Health care reform: Clarifying health impacts
(especially health disparities) = monetization
 Informing decisions, not “doing research”

24
BRINGING HIA TO ROCHESTER
Initiated by County Health Director(2009)
 National dialogue - Can HIA help Monroe County?
 Guide MCDOPH input to local decision makers?
 Childhood lead poisoning efforts were like HIA
 Shape health-promoting decisions;
 HIA “Learning Group” (2010)
 40 participants
 Presentations, work groups, project planning
 Pew Health Impact Project grant (2012): Healthy Waterways
 City of Rochester’s Local Waterfront Revitalization Program
 “Healthy Waterways” HIA

APPLYING HIA TO ROCHESTER’S LOCAL
WATERFRONT REVITALIZATION PROGRAM
NEW YORK STATE’S
LOCAL WATERFRONT REVITALIZATION PROGRAM



Develop long-term
plan for waterfront
Guides decisions at all
levels of government
Opportunities for
public involvement

13 policy statements

Many relate to health

Not required to
consider health
27
ROCHESTER’S LWRP
1990 LWRP; drafted update in 1999
 Revision underway; expected completion 2014
 Waterfront Advisory Committee (WAC)
 Involves City, County, Community, NYS DOS
 Once approved by NYS Department of State,
applies to all activities within waterfront zone

28
Communications Bureau, City of Rochester
HEALTHY WATERWAYS: HOW MIGHT THE
LWRP IMPACT HEALTH?
What are the biggest health
issues in Rochester?
 How do these relate to the
waterfront?
 How could waterfront
changes affect health?


Goal:
Make policy and planning
recommendations to
minimize health risks and
maximize benefits in LWRP
29
Communications Bureau, City of Rochester
LWRP “ELEMENTS” ASSESSED
 Waterfront
trails
 Beaches
 Residential/commercial
 Water-based
 Stormwater
development
recreation
management
30
ASSESSMENT METHODS:
County health data
 Community surveys
 Stakeholder interviews
 Published literature
 Case studies

Communications Bureau, City of Rochester
31
TRAIL USER SURVEYS/COUNTS
SURVEYS:
265 Trail users surveyed
Demographics, trail use frequency
Preferences for trail improvement
COUNTS:
12 sites, 54 hours of observation
Counted 2019 trail users
User numbers vary by location
National model estimates total use
at sites from 25,000 to 300,000/year
WHO USES THE
TRAIL?
•Demographically similar to
County population
•EXCEPT: 69% male
•44% walkers live less than
half a mile from trail (locals)
•Incomes of local users close
to City average
•76% of local users use trail
at least weekly
•Trail is an important
exercise resource, especially
for low income neighbors
33
•40% of Rochester’s population
lives in a ‘waterfront
neighborhood’
•Includes 45% of DEC
“environmental justice” areas
•The mean income in PLEX, a
southwest neighborhood , is a
third lower than city average
•The PLEX low birth weight rate
is nearly double that of the
County
•Mean Years Potential Life Lost
(YPLL) in PLEX is twice as high
as County average
34
PHYSICAL ACTIVITY IN SOUTHWEST ROCHESTER

63% residents reported meeting
CDC’s weekly recommended
activity level (150 minutes
exercise); similar to county mean





71% of whites
58% of blacks
County health data show racial
differences in obesity, heart
disease, diabetes, etc.
Obesity cost calculator
“If the trail weren’t here, I
wouldn’t exercise.”
TRAIL is more than a “recreation destination” – opportunity for
physical activity and transportation by low income waterfront
residents
35
EXAMPLE: TRAIL RECOMMENDATIONS
 Policies: “Prioritize connecting trail through downtown and
to adjacent neighborhoods”
 Projects: “Add amenities like better lights, water fountains,
benches, fishing areas, or exercise equipment to encourage use”
 Programs: “Expand programs to encourage trail use by
diverse populations, especially waterfront residents;”
 Communication: “Improve signage TO trail from
neighborhoods and vice versa.”
 Monitoring: “Conduct annual trail user surveys”;
“Establish trail management group to coordinate improvements,
maintenance, use by neighbors and visitors”
36
SUMMARY:
HEALTHY WATERWAYS AND THE LWRP
 Health considered
as a ‘goal’ in LWRP
 Community health data included in
inventory and analysis
 Shifted focus from “destination” to
include “waterfront neighbors”
 Recommendations integrated into
LWRP subpolicies
 New partners identified for
implementation (future grants,
projects,
planning,
monitoring)
Full report: bit.ly/QorjRS or
37
http://www2.envmed.rochester.edu/envmed/EHSC/outreach/coec/projects/HIA/HealthyWaterways.html
PROVIDENCE, RI RIVERWALK
In
1994, replaced the world’s
widest bridge at 1,147 feet with new
streets, cobblestone pathways,
Venetian-style bridges, sculptures,
fountains, boat landings, and parks
including the four acre Waterplace
Park with an open air auditorium.
The
Riverwalk hosts year round
public art and cultural events
Waterfire
events regularly attract
over 350,000 people.
Hotel
room rentals doubled
between 1999 and 2000, and in
August 2003 they rose over 50%.
Payne, Thomas. Waterfire Providence Organization.
13 June 2012. Web. http://waterfire.org/about/history/
HIA AND PSF: DECISION PROCESS
Intelligence: HIA assessment
 Promotion: HIA reporting
 Prescription: HIA recommendations + assessed
decision process
 Invocation: ??
 Application: ??
 Appraisal: HIA evaluation
 Termination: ??

39
WHAT CAN PSF BRING TO HIA

Standpoint:


Social process:


Can one be ‘objective,’ ‘collaborative’, decision-relevant
recommendations’ and ‘equity promoting’?
HIA takes the “decision context” as fixed; other
‘situations’ may matter
Decision process:

HIA engages primarily in intelligence and promotion
Helps explain frequent “recommendations beyond
the recommendations.”
 Plan better for monitoring/evaluation of impact on
decision, implementation, and health outcomes?

40
WHAT CAN HIA CONTRIBUTE TO PSF
HIA is both an analysis and a process – limited, but
broader than what would happen without it (partial
application?)
 Language of health is easy to understand and has
broad support; includes equity, participation, and
well-being

41
SUMMARY: HIA AND PSF

How is this framework compatible with a policy sciences
perspective on problem solving?


Goal = multimethod, problem-oriented, equity-promoting ways
to improve of policy decisions
What can/has the policy sciences contribute to this
framework?
Provide conceptual grounding for practice
 Heighten awareness of limits to HIA role in policy process


What potential does this framework have for expanding
the practice of the PSF (explicitly or not)
Translation of ‘base values’ into ‘health language’ / data
 Cross walk into public health issues
 Growing field of ‘practicioners’ with problem orientation

42