Second Annual National Health Impact Assessment Meeting: NewPublicHealth Q&A with Denise Provost
A key panel discussion during the National Health Impact Assessment (HIA) meeting will be on perspectives on health impact assessments with policymakers. Ahead of the meeting, NewPublicHealth spoke with State Representative Denise Provost (D), of Somerville, Mass., who will be one of the panel members.
NewPublicHealth: How does it value governing, communities and population health by factoring health into policies made in other sectors?
Denise Provost: Governance should always take consideration of health. Legislators should actually embrace the first principle of the Hippocratic Oath, which is “first do no harm.” Sometimes by action or inaction we, as a nation, have pursued policies which we’ve discovered are not so good for health. Some are market forces that end up being reinforced by the actions of government. Looking out for the health impact on the population needs to be part of the long-term view of what we do. The particular discipline of looking at health through a health impact assessment is valuable for government because policy makers are often disparaged by scientists for governing by anecdote and that’s a real danger in the absence of quantitative analysis based on peer reviewed studies. The HIAs I’ve seen employ that kind of methodology.
The value of HIAs to communities is that they will in the long term—and even in the short- or middle-term—enjoy better health and fewer negative health effects from government decisions or government failure to reign in market forces that result in conditions that cause bad health as part of their business model.
NPH: Can you give us examples of HIAs in your community that have been innovative and beneficial?
Provost: We’re still in early days with HIAs but one, as contemplated by our 2009 transportation reform bill, has some fairly groundbreaking language in it that requires our secretaries of transportation, health and the environment to convene regularly and look at healthy transportation projects very broadly. They’re also charged with developing tools such as HIAs for use in the evaluation of transportation projects.
I also have experience with an HIA which was just released recently on a proposed transportation project in my city where there is a circa-1920s regional highway of six and eight lanes, which goes through what had previously been an urban neighborhood, a good mile of which is elevated. MASSDOT, the Massachusetts Department of Transportation, is the statewide transportation agency created with 2009 legislation, which for the first time puts all transportation in the state within one agency. The agency decided that instead of continuing to repair the elevated highway—which is functionally outdated and among other things is a physical barrier across a very small city and an impediment to economic development in the area—to consider taking the highway down to street grade. A decision was made to do an HIA on the proposal. There has been good collaboration between MASSDOT and the community for several years.
A key issue to consider is air quality because of what we know about the health impacts of continuously breathing vehicle emissions, as people near highways tend to do. Another critical factor is the active living component: encouraging better exercise and healthy body weight through movement around the community by walking and biking. That was a hard thing to do with such a big highway in what would otherwise be a traditional neighborhood with short blocks and densely built structures and neighborhood shopping. In order to feel safe on a big highway, people feel the need to get in their cars. You have the phenomenon of parents not wanting their kids to walk or bike places—or in extreme cases even play outside. Parents themselves, even if they’re making a half-mile trip, will often drive. The environmental impact assessment also requires an assessment of greenhouse gas emissions from transportation projects. By having an eye toward climate change, that’s another way of reducing negative impacts on human health overall longer term.
NPH: What role do you think HIAs can play in helping to maximize the full potential of new projects, laws and regulations?
Provost: One of the things that trouble me about the nature of our legislature is that we are a culture of mostly lawyers, and since I am a lawyer maybe I’m part of the problem. But I see insufficient participation by scientists in the legislative process. We have two psychologists and three nurses [in the legislature] and that is the sum total of people with scientific and quantitative backgrounds. That skill set can look at studies and apply them to populations. And apart from that, there’s not a lot of dialogue or opportunity for interchange with the scientific community, even though we have a very robust science community in the eastern part of Massachusetts. This community produces data that could be tremendously helpful in making decisions about how to prioritize projects.
You might not want to have hard and fast rules that tie decisions to one class of data or another, but to the extent that we can have robust pools of data, we can evaluate our decisions better. When it comes to our transportation projects, we wouldn’t necessarily prioritize only according to health impacts, but we might want to give ourselves that option. But we don’t have the option without the information.
Part of the problem is that legislators who have become lawyers often leave their quantitative skills behind at a certain point. We stop studying science and higher math, so it drops out of our field of vision. The legal profession promotes a very different approach to proof than the scientists have.
Another HIA I have experience with was conducted by the Metropolitan Area Planning Council for a bill I filed to lower the default speed limit in dense urban areas. The hearing on the bill was last week. I think it’s a promising use of HIAs.
NPH: What other areas could HIAs be helpful in?
Provost: I think other kinds of development and land uses would benefit from health impact assessments. My thinking on this has been shaped over the years because I represent a city which packs almost 90,000 people into four square miles. We have tremendous population density. We have the highest or second-highest incidence of cardiopulmonary diseases, which are presumably linked to our high exposures to products of combustion. We are a regional transportation hub which is a considerable burden when it comes to air quality. Land values keep going up and up. We’ve become very popular with developers, and so people keep trying to cram in more and more building projects.
For years I’ve been commenting on environmental impact filings for all kinds of projects. The typical environmental impact form, which came out of Earth Day in the 70s, is about the human impact on nature. The evaluation of projects is still pretty much stuck in that view of looking at human impact on green fields and endangered species. But in a city like mine and most other population centers across the United States, the biggest impact of human activity is on the humans who surround it. There’s no place to assess that in the classic environmental impact evaluation process. It’s as if the people these projects impact didn’t exist. Every day there are activities going on that affect the health of populations, which are being screened by very outdated analytic tools.
NPH: Do you see a potential for HIAs to lower health costs?
Provost: Yes, if we start doing a lot of HIAs. As we do more they will join the body of scientific knowledge and become a conduit through which science knowledge can be brought to bear on public policy. It will probably take a while, but I think the cost savings potential is absolutely there. I’m hoping conferences like the National HIA meeting will help to turn the tide.
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