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Boosting Advocacy with Health Impact Assessments

Boosting Advocacy with Health Impact Assessments

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Published by Mary Lauran C Hall
Health impact assessments (HIAs) can be important tools when planning for bicycle and pedestrian facilities. In a transportation decision-making process, HIAs bring public health issues to the forefront so that planners and policymakers outside the public health world can incorporate everyday wellness into the built environment. On this call, planners and health practitioners discussed how advocates and officials can use health impact assessments to boost biking and walking.
Health impact assessments (HIAs) can be important tools when planning for bicycle and pedestrian facilities. In a transportation decision-making process, HIAs bring public health issues to the forefront so that planners and policymakers outside the public health world can incorporate everyday wellness into the built environment. On this call, planners and health practitioners discussed how advocates and officials can use health impact assessments to boost biking and walking.

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Published by: Mary Lauran C Hall on Oct 01, 2013
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Boosting Advocacy withHealth Impact Assessments
Alliance for Biking & Walking Mutual Aid CallWednesday, September 11, 2013
1
Health impact assessments (HIAs) can be important tools when planning or healthy transportation. In adecision-making process, HIAs bring public health issues to the oreront so that planners and policymakersoutside the public health world can incorporate everyday wellness into the built environment. On this call,planners and practitioners discussed how advocates and ocials can use HIAs to boost biking and walking.
Advice from Katherine HebertDavidson Design 4 Life Coordinator,Town of Davidson
Background: Why HIAs?
•
We are experiencing epidemics in multiple chronic diseases. At this point, it is impracti-cal to cure these illnesses and better to ocus on preventing them. But in order to do so,we need some upstream approaches.
•
Many important public health decisions are made outsidePublic Health departments. Upront policy work in the builtenvironment is important to allow us to really prevent chronicdisease.
•
Built environment decisions have huge public health impacts,and these decisions —locating biking & walking acilities,instituting complete streets plans, connecting the overall transportation networks — arebeing made at a planning department or agencies.
•
Yet traditionally, health is not a consideration in transportation decisions. ransporta-tion policymakers oen don’t consider how good biking and walking inrastructure areor health. Tis is where Health Impact Assessments come in.
Policy work in thebuilt environmentis important forpreventing chronicdisease.
What is an HIA?
•
Te purpose o an HIA is to look at the health impacts – both positive and negative – sothat public ocials can consider health in decision-making.
•
An HIA can be used to evaluate policy, programs, plans or projects.
•
Its a scientically based decision-support tool that involves a democratic process withstakeholder engagement and community participation.
Steps of an HIA
1. Screening 
– First, practitioners evaluate whether or not do an HIA. Are there potentialsignicant health impacts? Is the burden disproportionate? Will an HIA realistically add to decision-making process, and are decision makers open to the eedback? Isthere enough time, and are there sucient resources and data? I any o these key ele-ments aren’t there, it may not be the right time to do an HIA.
2. Scoping 
– Practitioners choose how they will perorm the HIA. Identiy the popula-tions that might be aected. Choose the impacts to assess. Identiy what to do givenlimited time and resources. Establish the team and game plan.
3. Assess
– Practitioners establish a community prole and baseline health data or thecommunity at hand. Using literature reviews, ocus groups, quantitative modeling and
 
Boosting Advocacy withHealth Impact Assessments
Alliance for Biking & Walking Mutual Aid CallWednesday, September 11, 2013
2
The National Research
Council defnes HIAs
with six steps.
qualitative data, HIA practitioners analyze the potential health impact. Stakeholderengagement throughout is important.
4. Develop recommendations
– Practitioners developa set o proposals to maximize health. An HIA may recommend ways to lower negative impacts or enhancepositive ones. It may recommend against a project alto-gether, or make suggestions on how to alter a policy to maximize health. It’s importantthat recommendations be actionable, realistic and site-specic. HIAs can also includea health plan to show how implementers can manage the health implications even aerthe decision has been made.
5. Reporting 
– HIA practitioners communicate their process, ndings and recommenda-tions. Tis may entail dierent ormats or dierent stakeholder groups. HIAs should bemade publicly available to serve as a resource or the public and or other HIA practi-tioners.
6. Evaluation & monitorin
– Tere are three types o evaluation:
•
Process
– How well was HIA conducted? Practitioners can ask people who wereinvolved how well they thought it went and identiy areas to improve. Tis is espe-cially important i the practitioners want to do other HIAs with other groups.
•
Impact
– Did your HIA infuence the decision?
•
Outcome
– Practitioners try to determine whether the decision had the suspectedhealth outcome. Tis step is important to growing Health Impact Assessments by providing inormation on how public health practitioners are impacting decisions.But it’s also very hard to do – many policies, programs, projects or plans can takemany years to have an eect.
Advice from Don KostelecPrincipal,Kostelec Planning, LLC
Lessons from performing HIAs
•
Silo-busting and cross-sector collaboration are important components o HIAs. Tehealth people get to meet the planning people and work together.
•
While the message is almost always positive or health/active transportation assess-ments, don’t be araid to identiy and address potential negative impacts and infuences.Tey do exist, and HIA is a great method to eectively address them.
•
It’s important to work with partners throughout an HIA. For an HIA about a bicycleplan in Haywood County, NC, Kostelec partnered with Healthy Heywood to use BMIdata in the assessment. Although the BMI inormation was proprietary, the HIA prac-titioners were able to weight their HIA with BMI data without directly reporting thenumbers.
•
Funding or an HIA can come rom public unds or grant money. In Haywood County,
 
Boosting Advocacy withHealth Impact Assessments
Alliance for Biking & Walking Mutual Aid CallWednesday, September 11, 2013
3
HIAs can lead to unex-pected, powerful part-nerships for advocates.
a local advocacy council ound the money, got the grant and led the process.
•
HIAs can and do create unexpected partners or advocates because the process requiresintegrating dierent proessions and conversations. In Haywood, the advocacy councildiscovered that the schools had a 15 year old bicyclefeet. As part o the HIA, they got a grant to purchasenew bicycles and held a ribbon-cutting at the end o theHIA process.
Advice from Brendon Haggerty Program Coordinator,Clark County Public Health
Case study: Clark County 
 
•
In Clark County, Washington, the public health department, planning department anda local nonprot partnered to perorm an HIA to inorm the county’s decision aboutwhether or not to adopt a potential bike/ped plan.
•
A 15 – 20 person planning committee representing various constituencies and neighbor-hood interests perormed the majority o the work over the course o a year.
•
Te planning committee took an iterative approach to releasing recommendations. First,they released their preliminary ndings, then needs and concerns, and nally recom-mendations.
•
Te HIA’s nal recommendations included:
•
Low-speed roadway design
•
Open Streets programs
•
Bike and walking access to healthul ood
•
Policies to prioritize projects to boost walkability and increase residential density 
•
Te planning committee’s scoring tool included many variables about equity and health.Tese recommendations trickled up to the MPO, who included similar criteria in theirnext assessment.
•
In a suburban county with a diversity o political opinions, some o the traditional argu-ments in avor o active transportation don’t have as much relevance. Beore the HIA,many stakeholders were ocusing on recreation rather than utilitarian travel; the HIAbroadened the discourse. Messages about public health proved quite eective, allowingpolicymakers to rerame discussions in terms o childrens health and public wellness.
•
Planners and elected ocials reported that the HIA broadened their perspectives andinfuenced the plan. Te process also exposed equity issues that would not have beenbrought up elsewhere.

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