Category Archives: Health Impact Assessment
The Supplemental Nutrition Assistance Program (SNAP) is the federal government’s principal program for helping low-income families purchase enough food. More than 47 million Americans currently receive SNAP benefits; approximately half of the beneficiaries are children. As part of the debate over the Farm Bill—legislation that authorizes SNAP and other federal nutrition programs—Congress is considering legislation that would cut SNAP benefits and limit who qualifies for the benefits.
Yesterday, the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, released a white paper that provides a rigorous, objective and nonpartisan analysis of the potential health impacts of the proposed changes to SNAP.
NewPublicHealth spoke with Aaron Wernham, MD, director of the Health Impact Project, along with lead researcher Marjory Givens, to learn more about the study’s findings.
NewPublicHealth: What is the goal of the health impact assessment on the potential changes to the SNAP program?
Aaron Wernham: Congress is deliberating reauthorizing the U.S. Farm Bill, and one of the parts of that is the Supplemental Nutrition Assistance Program or SNAP, which was formerly known as food stamps. This is one of the federal government’s main programs for ensuring that people who have low incomes are able to get enough to eat. We did this health impact assessment because so far the public health effects of these proposed policy changes have not really been a part of the political debate. We wanted to make sure that the best available public health evidence was brought to bear to help ensure that everyone has complete information—those affected by the change, the general public and decision-makers in Congress.
NPH: What’s the big picture on what SNAP has to do with health in the first place?
Wernham: Not having enough to eat—or being what’s called “food insecure”—is attached to a higher risk of a lot of diseases. So, adults who are food insecure have a higher risk of heart disease, high blood pressure, diabetes and some other problems. Children who are food insecure are more likely to be reported by their parents as being in poor health, are more likely to be hospitalized and also have a higher risk for a number of health related problems from asthma, to depression and anxiety. We actually have a number of studies that have looked at the health benefits of receiving SNAP and found, for example, that adults who had access to SNAP when they were children are less likely to have problems in adulthood, such as obesity, high blood pressure and heart disease.
NPH: What did the health impact assessment find?
Wernham: We looked at ways in which the House and Senate have proposed to change how eligibility for SNAP benefits is determined and how the amount of benefits is determined. Both the House and Senate have proposed changes, and we found that as many as 5.1 million people could actually lose eligibility under changes proposed by the House. Under the changes in the Senate, about 500,000 people might receive lower benefit amounts. With the House changes, as many as 1.4 million children and nearly 900,000 older adults would be among those five million people who could be affected. So, for those people, they would lose upward of an average of 35 percent of their total income and would be at higher risk for the health problems that relate to food insecurity.
Under the Affordable Care Act, tax-exempt hospitals are now required to conduct a community health needs assessment at least every three years and develop an implementation strategy to tackle the needs identified by the assessment.
At this week’s AcademyHealth meeting in Baltimore, experts moved from the “guess what you have to do” approach to community benefit heard at some public health meetings to some practical strategies hospitals can follow not only to fulfill the letter of the law, but to actually improve community health.
Peter Sartorius, community benefit director of the Muskegon (Michigan) Community Health Project, which brings together several Mercy hospitals in the region, told the audience that costs of the requirement can range from about $12,000 for a staff person to conduct the needs assessment to about $65,000 if a consultancy, such as a public health institute, does the work. Mercy requires that the County Health Rankings, developed through a collaboration of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, be used by the hospitals in its network as the baseline measures of community health.
Sartorius urged hospitals to choose “collaborative partners” such as community health clinics, United Way agencies and universities, who can help develop the assessment and report and also share in the cost. Others have said that community benefit also offers a ripe opportunity for collaboration between hospitals and public health departments, which already house a lot of data and have similar community needs assessment requirements for voluntary accreditation.
The Second National Health Impact Assessment (HIA) Meeting takes place September 24-25 in Washington, D.C., and the deadline for abstract submissions is fast approaching. The conference will bring together policymakers, public health professionals, HIA practitioners; community-based organizations; researchers and decision makers from non-health agencies all who may use or rely on the results of HIAs in the fields of planning, transportation, housing, agriculture, energy, environment, and education.
The planning committee for this year’s meeting is currently seeking abstracts for a variety of sessions, particularly from presenters who will be releasing new research. Abstracts, due by Wednesday, May 29, should clearly state what new information will be presented and its impact on a specific sector or the field of HIA more generally.
Aside from the typical poster sessions and presentations, the HIA Meeting will also feature opportunities to dive deep on specific and cross-cutting topics.
The Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, recently announced eight new grant recipients that will receive funding to conduct health impact assessments (HIAs). The projects will bring health considerations into upcoming decisions on topics including education, sanitation infrastructure, and energy.
“Our new grantees will use health impact assessments to uncover opportunities to improve health in a wide range of policy decisions, as well as to identify and avoid potential unintended consequences,” said Aaron Wernham, MD, director of the Health Impact Project. “These eight HIAs are the latest in a fast-growing field, as more cities and states find them a useful way to bring health into decisions in other sectors.”
By the end of 2007, there were 27 completed HIAs in the United States. There are now more than 225 completed or in progress, according to the Health Impact Project map of HIA activity in the United States.
Funding for some of the new proposals was also provided by the Blue Cross and Blue Shield of Minnesota Foundation and The California Endowment.
Some of the new HIAs that have received funding include:
- Partners for a Healthier Community, Inc. will undertake an HIA to inform decisions about a proposed casino in western Massachusetts. Decision-makers—including the state gaming commission, local government officials, and voters—will consider siting options as well as licensing, regulation, design and development of the casino. The HIA will examine health risks that might be linked to gambling—including substance abuse, mental health, and injury—and potential health benefits related to employment opportunity, access to health insurance, and community revenues.
- The University of Texas at El Paso, will conduct an HIA on the impacts of proposed water and sanitation improvement projects on the town of Vinton, Texas. Vinton primarily relies on failing septic tanks and cesspools for wastewater removal and domestic wells with poor water quality. Poor water and sanitation are associated with gastrointestinal illnesses and other serious health conditions such as hepatitis, dysentery, and dehydration. Improved systems could not only improve public health but also support economic development and long-term sustainability of local businesses and industry.
- An HIA by the Kentucky Environmental Foundation, in collaboration with the Purchase District Health Department, will examine the potential health benefits and risks of the retrofit or retirement of the Shawnee coal plant in Paducah, KY, operated by the Tennessee Valley Authority. The HIA will analyze environmental health concerns associated with air and water pollution from the plant and the effects of its closure on the community including employment, individual income, and revenue for local services important to health.
NewPublicHealth recently spoke with two of the researchers conducting the Shawnee coal plant HIA, Elizabeth Crowe, executive director of the Kentucky Environmental Foundation, and Deborah Payne, energy and health coordinator for the Foundation.
NewPublicHealth: What is the scope of the HIA you’re conducting?
The American Public Health Association (APHA) is currently accepting applications through April 8 for the association’s one-year Public Health Fellowship in Government. Fellows work in a congressional office on legislative and policy health issues. The position gives Fellows the opportunity to learn about the legislative process in Washington, DC, which can be a critical skill once they return to their positions in public health, since policies are an important tool that can be used to protect Americans and their communities from preventable, serious health threats. And it also allows Fellows to provide critical input, drawing on their knowledge and experience, on the decisions that impact public health at the national policy level.
To get some background on the role of a Fellow and the impact that public health practitioners can have when working in the national policy arena, NewPublicHealth recently spoke with Fern Goodhart, current legislative assistant to Senator Tom Udall (D-New Mexico), who spent the tenure of her fellowship working in the office of Senator Robert Menendez (D-New Jersey). Ms. Goodhart was the first person awarded the APHA policy fellowship and served in 2007-2008.
NewPublicHealth: What was your background before you took the fellowship?
Fern Goodhart: I have worked in public health for 30 years including at a state health department; as director of health education at an ambulatory center; as a medical school instructor; as a member of an autonomous board of health; and as a member of my city council. So I’ve had the opportunity to see how policy was made on the local level and the state level. What brought me to the APHA Fellowship was the desire to see firsthand how policy was made at the federal level.
NPH: What kind of work did that involve?
CDC Vital Signs: 1 in 5 Teen Births is a Repeat Birth
Although teen births have fallen over the past 20 years, nearly one in five is a repeat birth, according to a Vital Signs report from the U.S. Centers for Disease Control and Prevention (CDC). More than 365,000 teenage girls ages 15-19 years gave birth in 2010, and almost 67,000 (18.3 percent) of those were repeat births. A repeat birth is a second (or more) pregnancy resulting in a live birth before the mother turns 20. “Teen birth rates in the United States have declined to a record low, which is good news,” said CDC Director Tom Frieden, MD, MPH. “But rates are still far too high. Repeat births can negatively impact the mother’s education and job opportunities as well as the health of the next generation. Teens, parents, health care providers, and others need to do much more to reduce unintended pregnancies.” Data from CDC’s National Vital Statistics System show that repeat teen births in the United States decreased by more than 6 percent between 2007 and 2010. Despite this decline, the number of repeat births remains high and there are substantial racial/ethnic and geographic differences. Repeat teen births were highest among American Indian/Alaska Natives (21.6 percent), Hispanics (20.9 percent), and non-Hispanic blacks (20.4 percent), and lowest among non-Hispanic whites (14.8 percent). Read more on maternal and child health.
Health Impact Project Announces Eight New Funded Projects
The Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, has recently added eight more grantees who will receive funding to conduct health impact assessments, or HIAs. The projects will bring health considerations into upcoming decisions on topics including education, sanitation infrastructure, and energy. “Our new grantees will use health impact assessments to uncover opportunities to improve health in a wide range of policy decisions, as well as to identify and avoid potential unintended consequences,” said Aaron Wernham, MD, director of the Health Impact Project. “These eight HIAs are the latest in a fast-growing field, as more cities and states find them a useful way to bring health into decisions in other sectors.” By the end of 2007, there were 27 completed HIAs in the United States. There are now more than 225 completed or in progress, according to the Health Impact Project map of HIA activity in the United States. Read more on health impact assessment.
Post-ER Visit for Chest Pain Reduces Heart Attack Risk
Seeing a doctor within a month of an emergency room visit for chest pain significantly reduced the risk of a heart attack or death among high risk patients, according to a recent study in the journal Circulation. Researchers analyzed data on 56,767 adults (average age 66, 53 percent men) in Ontario, Canada, who were diagnosed with chest pain in an emergency room between April 2004 and March 2010 and had been previously diagnosed with heart disease or diabetes. They tracked data for a median 3.7 years and accounted for differences in key patient characteristics such as age, gender, health status and location. According to the study, only 17 percent of high risk chest pain patients seen in the emergency room were evaluated by cardiologists within a month; 58 percent saw a primary care physician and 25 percent had no physician follow-up within a month. Patients who followed up with a cardiologist within 30 days were 21 percent less likely to have a heart attack or die within one year, compared with patients who failed to seek additional care within that time. Patients seen by a primary care physician were 7 percent less likely to have a heart attack or die compared to those patients who sought no follow up care. Read more on heart health.
An article in the New York Times this week looks at the role of health impact assessments (HIAs), a tool that helps policymakers at all levels of government more fully understand the health effects of proposed laws, regulations, programs and projects—from big infrastructure projects to school curriculum development—and craft recommendations that capitalize on opportunities to improve health.
HIAs are a fast growing tool: nearly 225 of the assessments have been completed or are in process across the U.S., according to the Health Impact Project, a national initiative designed to promote the use of health impact assessments as a decision-making tool for policymakers. The Health Impact Project is a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts.
“People in the public health world and in the business and development world are waking up to the need to get at health care problems and bring down health care costs,” says Aaron Wernham, MD, MPH, director of the Health Impact Project, in the New York Times article. “So we see a fair amount of uptake in certain sectors — the health impact assessment is out there and growing.”
Growth of the tool is also well indicated by last year’s sold out Inaugural National Health Impact Assessment Meeting. Registration has just opened for the second National Health Impact Assessment Meeting, to be held in Washington, D.C., September 24 and 25, 2013.
The meeting will bring together policymakers, public health professionals, HIA practitioners; community-based organizations; researchers and decision makers from non-health agencies all who may use or rely on the results of HIAs in the fields of planning, transportation, housing, agriculture, energy, environment, and education.
The health upside to a new casino can be the increased quality of life and life expectancy associated with new jobs. But, it can bring health downsides too, including the fallout associated with gambling addiction. Those are some of the key findings in a new health impact assessment (HIA) from the Kansas Health Institute (KHI), released this week. The HIA was funded by a grant from the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and the Pew Charitable Trusts, and conducted by KHI together with the University of Kansas School of Medicine-Wichita.
“Our first HIA intended to inform the discussion of potential casino development…” says Robert F. St. Peter, MD, who is KHI’s chief executive officer. “In many cases,” says St. Peter, issues like these may not seem to have direct connections to health, making them a good fit for [a] health impact assessment.”
The results of the new HIA suggest that there may be positive impacts of casino development related to new jobs; the negative impacts would be related to increases in pathological gambling, which is also associated with nicotine dependence, substance abuse, depression, insomnia, and domestic violence. The HIA offered recommendations including:
- Train physicians to screen for problem gambling behaviors
- Eliminate smoking within and around casino buildings
- Strengthen local services to treat and prevent gambling addictions and related conditions
- Operate a “safe ride” program for patrons and residents
- Use a “loss limit” strategy to prevent substantial financial losses among casino visitors
Read a recent NewPublicHealth interview with Tatiana Lin, KIH senior analyst and strategy team leader, who was the director of the Casino HIA.
The Network for Public Health Law will sponsor the 2012 Public Health Law Conference, with the theme “Practical Approaches to Critical Challenges,” from October 10 through 12, 2012, in Atlanta. Follow NewPublicHealth during the conference for interviews and session updates. Goals of the conference include:
- Examining practical legal approaches to address priority public health issues
- Learning about helpful public health law resources and evidence-based research
- Discussing public health legal questions and answers
- Building partnerships to accomplish public health objectives and foster innovation
According to the Network, target audiences for the conference include attorneys, local, state, tribal and federal public health officials and practitioners, policy-makers, advocates and academics and researchers.
NewPublicHealth spoke with Dan Stier, director of the Network for Public Health Law about the Network’s accomplishments since its founding two years ago, and upcoming goals.
>>BONUS: Read our earlier Q&A with Dan Stier, offering a sneak preview of what's to come at the 2012 Public Health Law Conference.
NewPublicHealth: How much has awareness of the Network grown since you launched in 2010?
Dan Stier: The volume of the requests has grown greatly, as have the complexity and timeliness of the requests. The fact that people are becoming increasingly aware of us means that we really are addressing issues in real time. Dramatic current examples include legal questions on public health services related to West Nile virus and Hurricane Isaac in real time.
>>Read an interview with James Hodge of the Network on legal questions on these and other recent public health crises.
Other requests include longer-term issues like shared services among local health departments. State and local health departments face budget cuts and so they are figuring out ways to do things more efficiently and economically, and oftentimes, that involves shared service agreements between local health departments. We’ve seen much more activity along those lines. More recently we’ve gotten an increasing number of questions on maternal and child health, particularly with respect to the provisions relating to children in the Affordable Care Act, so we now advertise that as another area of specialty.
NPH: How have people become aware of what the Network offers?
Quebec will be the host city of the 12th HIA International Conference this week, the first time the meeting will be held in North America.
Quebec is a strong choice as host city. In 2001, the province of Quebec institutionalized health impact assessments (HIAs) by requiring that all laws and by-laws that could have an effect on health be evaluated for their impact. To help develop effective strategy, internal procedures were created at the Ministry of Health and Social Services to respond to requests, as well as HIA guidelines, a research program, and communication tools to help disseminate the HIA outcomes. Over 500 requests for advice have been generated since the requirement was put in place.
NewPublicHealth recently spoke with Alain Poirier, MD, chairman of the HIA meeting’s local organizing committee and the former National Public Health Director and Assistant Deputy Minister in Quebec’s Ministry of Health and Social Services.
NewPublicHealth: How did the 2001 law come about?
Dr. Poirier: The Health Minister at the time had been an official with the World Health Organization and so was well acquainted with the work being done in some European countries on evaluation the impact of laws on health. Our Public Health Act said the health minister “shall” be consulted, not “should” be consulted on any measures resulting from a new law or by-law that could have an impact on health.
And just saying that is not enough. I was made the person in charge in the Ministry of Health and Social Services of taking responsibility for the evaluations with the help of different groups, including academia. We also have a public health institute, the Institute National de Santé Publique du Quebec, which also has a mandate to help evaluate public policies and counsel the health minister about the impact of public policy.
We’ve had a lot of demand to evaluate new proposals, in part because every five years all the ministers in Quebec are required to issue a report on strategic planning. So when we screen the strategic planning we could foresee in advance what is going to be worked on in other ministries.
NPH: What is an example in Quebec of an HIA that was done that has resulted in a change in policy?