Boosting Advocacy with Health Impact Assessments Alliance for Biking & Walking Mutual Aid Call Wednesday,

September 11, 2013

Health impact assessments (HIAs) can be important tools when planning for healthy transportation. In a 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 practitioners discussed how advocates and officials can use HIAs to boost biking and walking.

Advice from Katherine Hebert Davidson Design 4 Life Coordinator, Town of Davidson
Background: Why HIAs?
We are experiencing epidemics in multiple chronic diseases. At this point, it is impractical to cure these illnesses and better to focus on preventing them. But in order to do so, we need some upstream approaches. Many important public health decisions are made outside Public Health departments. Upfront policy work in the built environment is important to allow us to really prevent chronic disease. Policy work in the built environment is important for preventing chronic disease.

Built environment decisions have huge public health impacts, and these decisions locating biking & walking facilities, instituting complete streets plans, connecting the overall transportation networks are being made at a planning department or agencies. Yet traditionally, health is not a consideration in transportation decisions. Transportation policymakers often dont consider how good biking and walking infrastructure are for health. This is where Health Impact Assessments come in.

What is an HIA?
The purpose of an HIA is to look at the health impacts both positive and negative so that public officials can consider health in decision-making. An HIA can be used to evaluate policy, programs, plans or projects. Its a scientifically based decision-support tool that involves a democratic process with stakeholder engagement and community participation.

Steps of an HIA
1. Screening First, practitioners evaluate whether or not do an HIA. Are there potential significant health impacts? Is the burden disproportionate? Will an HIA realistically add to decision-making process, and are decision makers open to the feedback? Is there enough time, and are there sufficient resources and data? If any of these key elements arent there, it may not be the right time to do an HIA. 2. Scoping Practitioners choose how they will perform the HIA. Identify the populations that might be affected. Choose the impacts to assess. Identify what to do given limited time and resources. Establish the team and game plan. 3. Assess Practitioners establish a community profile and baseline health data for the community at hand. Using literature reviews, focus groups, quantitative modeling and 1

Boosting Advocacy with Health Impact Assessments Alliance for Biking & Walking Mutual Aid Call Wednesday, September 11, 2013
qualitative data, HIA practitioners analyze the potential health impact. Stakeholder engagement throughout is important. The National Research 4. Develop recommendations Practitioners develop Council defines HIAs a set of proposals to maximize health. An HIA may with six steps. recommend ways to lower negative impacts or enhance positive ones. It may recommend against a project altogether, or make suggestions on how to alter a policy to maximize health. Its important that recommendations be actionable, realistic and site-specific. HIAs can also include a health plan to show how implementers can manage the health implications even after the decision has been made. 5. Reporting HIA practitioners communicate their process, findings and recommendations. This may entail different formats for different stakeholder groups. HIAs should be made publicly available to serve as a resource for the public and for other HIA practitioners. 6. Evaluation & monitoring There are three types of evaluation: Process How well was HIA conducted? Practitioners can ask people who were involved how well they thought it went and identify areas to improve. This is especially important if the practitioners want to do other HIAs with other groups. Impact Did your HIA influence the decision? Outcome Practitioners try to determine whether the decision had the suspected health outcome. This step is important to growing Health Impact Assessments by providing information on how public health practitioners are impacting decisions. But its also very hard to do many policies, programs, projects or plans can take many years to have an effect.

Advice from Don Kostelec Principal, Kostelec Planning, LLC

Lessons from performing HIAs
Silo-busting and cross-sector collaboration are important components of HIAs. The health people get to meet the planning people and work together. While the message is almost always positive for health/active transportation assessments, dont be afraid to identify and address potential negative impacts and influences. They do exist, and HIA is a great method to effectively address them. Its important to work with partners throughout an HIA. For an HIA about a bicycle plan in Haywood County, NC, Kostelec partnered with Healthy Heywood to use BMI data in the assessment. Although the BMI information was proprietary, the HIA practitioners were able to weight their HIA with BMI data without directly reporting the numbers. Funding for an HIA can come from public funds or grant money. In Haywood County, 2

Boosting Advocacy with Health Impact Assessments Alliance for Biking & Walking Mutual Aid Call Wednesday, September 11, 2013
a local advocacy council found the money, got the grant and led the process. HIAs can and do create unexpected partners for advocates because the process requires integrating different professions and conversations. In Haywood, the advocacy council discovered that the schools had a 15 year old bicycle HIAs can lead to unexfleet. As part of the HIA, they got a grant to purchase new bicycles and held a ribbon-cutting at the end of the pected, powerful partnerships for advocates. HIA 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 and a local nonprofit partnered to perform an HIA to inform the countys decision about whether or not to adopt a potential bike/ped plan. A 15 20 person planning committee representing various constituencies and neighborhood interests performed the majority of the work over the course of a year. The planning committee took an iterative approach to releasing recommendations. First, they released their preliminary findings, then needs and concerns, and finally recommendations. The HIAs final recommendations included: Low-speed roadway design Open Streets programs Bike and walking access to healthful food Policies to prioritize projects to boost walkability and increase residential density The planning committees scoring tool included many variables about equity and health. These recommendations trickled up to the MPO, who included similar criteria in their next assessment. In a suburban county with a diversity of political opinions, some of the traditional arguments in favor of active transportation dont have as much relevance. Before the HIA, many stakeholders were focusing on recreation rather than utilitarian travel; the HIA broadened the discourse. Messages about public health proved quite effective, allowing policymakers to reframe discussions in terms of childrens health and public wellness. Planners and elected officials reported that the HIA broadened their perspectives and influenced the plan. The process also exposed equity issues that would not have been brought up elsewhere.

Boosting Advocacy with Health Impact Assessments Alliance for Biking & Walking Mutual Aid Call Wednesday, September 11, 2013
Citations and Additional Resources
Davidson Design for Life - This site is packed with resources, guides and toolkits about Health Impact Assessments. Health Impact Assessment Training Process - A video by the Town of Davidson about using Health Impact Assessments in transportation planning. Health Impact Process - A joint project of PEW and the Robert Wood Johnson Foundation, this site provides resources on HIA, including sample Haywood County Comprehensive Bike Plan - Information on the HIA to evaluate a bike plan in Haywood County, North Carolina. Don Kostelek worked on this project. Clark County Bicycle and Pedestrian Master Plan - Information on the HIA to evaluate the bicycle and pedestrian plan in Clark County, Washington. Brandon Haggerty was a lead coordinator on this project. Davidson Street Design HIA - All about an HIA that evaluated the health impacts of street designs in Davidson and Mecklenburg County, North Carolina. Pedestrian and Active Transportation Plan HIA - Information about the HIA that will be done concurrently with a new active transportation plan in Davidson County, NC.