Category Archives: Health Impact Assessment

Apr 26 2012

Health and High Energy Costs: Assessing the Impact of Smart Metering

Megan_Sandel Megan Sandel, National Center for Medical-Legal Partnership.

The connection between health and energy consumption is an area just beginning to be understood, but when some people are forced to choose between paying their energy bill and paying for food or medicine, it becomes critical. The Health Impact Project has just released a new health impact assessment (HIA) of a pilot program run by Illinois' largest electric utility, Commonwealth Edison. The HIA looked at the health effects of implementing "smart metering," which replaces existing mechanical meters with digital meters that record customer usage in 15-minute increments. The new meters are coupled with a new two-way communication system that allow a utility company to remotely connect and disconnect service, as well as get real-time, detailed customer usage. The purpose of this HIA was to evaluate the potential health impacts of smart metering for residential customers in the ComEd service territory in Illinois.

The HIA looked at three key issues:

  • Whether smart metering will raise customer rates for electricity service because of the additional infrastructure investment costs;
  • Whether new energy pricing programs enabled by smart metering will provide benefits to customers or increase costs to vulnerable customers at a time when they can least afford it; and
  • Whether the use of a remote service switch to connect or disconnect service, particularly in the case of disconnection for non-payment, will have adverse impacts on vulnerable populations

NewPublicHealth spoke about the new HIA with lead researcher, Megan Sandel, MD, MPH, who is the interim executive director of the National Center for Medical-Legal Partnership.

NewPublicHealth: Why is energy a health issue?

Megan Sandel: Understanding how energy and health are connected is a burgeoning field. We understand that the cost of energy can sometimes be particularly important because families may have to make tradeoffs, such as trading off between paying for their heat and necessarily eating enough. Or they’re trading off between paying for their heat or their electricity bill and being able to pay for medicine. And while some people may see the potential concern for some users over heating costs, they may not connect those similar problems can occur with cooling costs. People have actually died in heat waves because they were not able to access their energy needs in a timely way. And so, we were interested looking at this energy proposal and being able to add in possible health implications.

NPH: What populations are most vulnerable or affected due to a lack of affordable energy and why is that?

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Apr 11 2012

Inaugural National Health Impact Assessment Meeting: What We Learned

At the recent first-ever National Health Impact Assessment (HIA) meeting, convened by the Health Impact Project and partners, the break-time chatter was just as fascinating as the official sessions. Attendees ranged from a public health graduate student who applied for a scholarship to attend the meeting as part an independent study on HIA, to a veteran of the San Francisco Department of Health who has been conducting health impact assessments for over a decade.

The meeting addressed the burgeoning number of HIAs completed or in progress, but it also addressed issues related to determining the need for an HIA, preparing and engaging stakeholders, and helping HIA practitioners both assess the findings and determine how best to convey them and make recommendations. The wide range of HIAs presented spanned a wide range of disciplines including housing, transportation, built environment, incarceration, community development and more.

We found a session on policy HIAs to be especially interesting as a tool to look at the potential for use of HIA to impact health outcomes. Examples included:

School Discipline Policies

Human Impact Partners is nearing completion of an HIA on school discipline policies, including zero tolerance (suspending or expelling students for any infraction) and restorative justice. In Los Angeles, Oakland and Salinas school districts, the HIA analyzed how these policies impact those being disciplined, other students and the broader communities through pathways to health outcomes from drop-out rates and educational attainment, prison, violence, drug abuse, mental health and community cohesion.

Wisconsin Treatment Instead of Prisons

WISDOM, a statewide congregation-based community organization in Wisconsin, has been advocating for state funding for treatment alternatives to prison for almost a decade. In 2006, WISDOM and their allies succeeded in convincing the state to fund treatment alternatives such as drug courts, mental health courts and bail diversion projects in seven counties. WISDOM has been funded by a Robert Wood Johnson Foundation Roadmaps to Health Community Grant to work on a policy that would increase the funding to a statewide level. Human Impact Partners is conducting an HIA to answer the question: How would increasing treatment alternatives to prison impact the health of individuals targeted for incarceration, their families, their communities and the state?

Another theme that emerged throughout the conference was the critical nature of engaging communities and diverse partners throughout every step of the HIA. During a plenary session, Health Impact Project director Aaron Wernham said of the recommendations from one HIA he conducted in Alaska, "A lot of these recommendations fall outside anyone’s regulatory authority. If you’re going to get anything done there needs to be a strong relationship with the community." Wernham said he expects to convene a national meeting again in about a year and a half. And he knows they’ll need a bigger facility next time!

Catch up on the rest of our coverage of the National HIA Meeting:

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Apr 10 2012

Health Impact Assessments: Low-Income Rental Housing Inspections

Last week’s inaugural National Health Impact Assessment (HIA) Meeting held in Washington, discussed the impact of decisions in a broad range of sectors on the health of individuals and communities, and housing sector decisions featured prominently. In a recent interview with NewPublicHealth, Aaron Wernham, MD, MPH, director of the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and the Pew Charitable Trusts, said he was excited to see the growing number of housing HIAs, which he called “very important to health.” Among the housing HIAs presented at the conference were two on low-income rental housing inspections—one on a rental housing inspection program in Portland, Ore. and the other on interagency housing inspection coordination based out of Ohio. NewPublicHealth spoke with lead authors of both HIAs.

>>Follow our coverage from the National HIA Meeting.

Ohio Housing Inspections

Holly Holtzen Holly Holtzen, Ohio Housing Finance Agency

Ohio currently has a proposal on the books to streamline the rental housing inspection program on affordable housing units, including improved interagency coordination. An HIA is underway to help inform decisions on the proposal. Right now, separate individual inspections are conducted or required by local housing authorities, the U.S. Department of Housing and Urban Development (HUD), the Internal Revenue Service, and the U.S. Department of Agriculture (USDA) to help identify and repair substandard physical conditions such as water leaks and mold, pests, peeling paint and structural hazards, which can contribute to a wide range of health problems including asthma, injury and burns, and mental illness.

NewPublicHealth spoke with Holly Holtzen, PHD, Strategic Research Coordinator at the Ohio Housing Finance Agency, about the HIA.

NewPublicHealth: What is the goal of the HIA?

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Apr 6 2012

James Hodge: Q&A on Public Health Law and Health Impact Assessment

James Hodge James Hodge, Network for Public Health Law and Arizona State University Public Health Law and Policy Program

A new report finds that some existing laws on the books across the nation offer critical opportunities to improve Americans’ health through the use of health impact assessments.

>>Read more on the new report.

>>Follow our coverage from the National HIA Meeting.

NewPublicHealth spoke with Professor James G. Hodge, Jr., JD, LLM, principal investigator and director of the Western Region of the Network for Public Health Law, about the report.

NewPublicHealth: What’s the background on the report?

James Hodge: This project that we’ve done in conjunction with The Pew Charitable Trusts and the Robert Wood Johnson Foundation has taken a very interesting and important look at the role of law in relation to support for the use and implementation of health impact assessments nationally. This was really uncovered material prior to our research in this arena. We were aware of specific instances where federal, state, tribal or local governments had suggestively made HIAs an important component of particular reviews for public safety or public health through laws, but we had not done any national, systematic study to really assess how extensive that is, particularly in non-health sectors. So, for example, in areas like transportation and environment and waste management, to what extent did law support the use of HIAs? The report has provided some initial answers that really are quite profound in this attempt to illustrate just how extensively law can be supportive of these particular initiatives.

NPH: Based on your review of the laws, is it still a novel concept to consider health impacts in projects in sectors as varied as the environment and transportation?

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Apr 6 2012

New Report: Laws and Policies that Support Health Impact Assessment

A new report, "Legal Review Concerning the Use of Health Impact Assessments in Non-Health Sectors," released yesterday at the inaugural National Health Impact Assessment Meeting, finds that a wide variety of existing laws offer important opportunities to improve Americans’ health.

>>Follow our coverage from the National HIA Meeting.

Using a sample of 36 jurisdictions in the United States, the research found that existing laws offer many opportunities for health to be factored into a range of decisions, in which it typically would not otherwise be considered. The sample included laws and policies in 20 states, 10 localities, five tribal nations and the federal government.

The new report is the first comprehensive study of its kind and found an unexpectedly large number of laws that facilitate the consideration of health effects in fields such as transportation, energy and agriculture. Many of these legal requirements may be satisfied by conducting health impact assessments (HIAs), a type of study that helps decision-makers identify and address the potential and often unrecognized health risks and benefits of their decisions.

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Apr 2 2012

PedNet: Highlighting the Link Between Transportation and Health

overview-publictransit Public transportation in Columbia, Missouri. Photo courtesy of PedNet Coalition.

The County Health Roadmaps project, a collaboration of the Robert Wood Johnson Foundation and the University of Wisconsin Public Health Institute, includes efforts to build connections within and between local communities and national partners, including grants to coalitions across the U.S. The grantees will build on the County Health Rankings model, which highlights the critical role that education, jobs, income, and other aspects of the community in influencing health.

Roadmaps to Health grantees are working to create healthier places to live, learn, work and play. One such grant was recently awarded to the PedNet Coalition in Columbia, Mo., and NewPublicHealth spoke with several health leaders who will be implementing the grant—Stephanie Browning, health director of the Columbia/Boone County Department of Public Health and Human Services, Stacia Reilly, a health educator for the health department, and Michelle Windmoeller, assistant director of PedNet.

NewPublicHealth: Tell us about the PedNet Coalition and its mission.

Michelle Windmoeller: The PedNet Coalition was formed in April of 2000 with the mission of establishing an interconnected set of trails and walkways and basic infrastructure to encourage people to bike, walk, even use a wheelchair for their transportation needs. Since then, PedNet has evolved to be engaged in a lot of different health aspects. We have some grants that deal with healthy food and food production in the community. We have grants that deal with public transportation and we still have our basic programs that encourage biking and walking like our walking school bus and our bicycle education classes.

NPH: And can you tell us about the scope of the Roadmaps to Health Community Grant you received?

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Apr 2 2012

Aaron Wernham: First National Health Impact Assessment Meeting Kicks Off Tomorrow

Wernham Aaron Wernham, director of the Health Impact Project

In response to burgeoning national interest in using health impact assessment (HIA) as a tool to factor health into policy decisions, the Health Impact Project and other leading health organizations will convene a first-ever National HIA Meeting this week from April 3 through April 4 in Washington, D.C. Policy-makers, public health professionals, community-based organizations, researchers and elected and appointed officials from across the country will hear the latest on how HIA can be used to inform policy decisions outside health in areas such as planning, transportation, housing, agriculture, energy, education and the environment. Community leaders and policy-makers want to protect the health of their communities, but they need sound, objective data to identify what could help or hurt people’s health in order to guide their decision-making.

The meeting is being organized by The California Endowment, the National Network of Public Health Institutes, the Centers for Disease Control and Prevention Healthy Community Design Initiative and the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts.

NewPublicHealth spoke with Aaron Wernham, MD, director of the Health Impact Project.

NewPublicHealth: The first ever national HIA meeting is coming up. Who is coming to the conference, and what do you think the key sessions will be?

Aaron Wernham: Well, we really aimed for a broad audience. HIA practitioners as well as people who have been interested in starting to use HIA but just haven’t really begun will all be in the audience. A lot of people from related public health fields will be coming. We’ve also created programming that will be relevant and interesting to people outside the health sector because HIA is really a bridge that aims to help practitioners collaborate with people in a great many sectors, such as transportation planning or housing or energy policy.

NPH: What do you think some of the hallway conversations might be?

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Mar 27 2012

Arthur Wendel, CDC's Healthy Community Design Initiative: A NewPublicHealth Q&A

file Arthur Wendel, CDC Healthy Community Design Initiative

The first national meeting on Health Impact Assessment begins April 3 in Washington, D.C., and interest is so high that registration has been at capacity for weeks. The meeting capitalizes on the growing interest in health impact assessments (HIAs) and will convene policymakers, public health professionals, HIA practitioners and anyone with an interest in learning more about the value of health impact assessments.

In advance of the meeting NewPublicHealth spoke with Arthur Wendel, MD, MPH, team lead for the Healthy Community Design Initiative at the Centers for Disease Control and Prevention. The Initiative is helping to plan the upcoming HIA conference.

NPH: What is the overarching goal of the Healthy Community Design Initiative?

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Mar 26 2012

Arthur Wendel, CDC's Health Community Design Initiative: A NewPublicHealth Q&A

The first national meeting on Health Impact Assessment begins April 3 in Washington, D.C., and interest is so high that registration has been at capacity for weeks. The meeting capitalizes on the growing interest in health impact assessments (HIAs) and will convene policymakers, public health professionals, HIA practitioners and anyone with an interest in learning more about the value of health impact assessments.

In advance of the meeting NewPublicHealth spoke with Arthur Wendel, MD, MPH, team lead for the Healthy Community Design Initiative at the Centers for Disease Control and Prevention. The Initiative is helping to plan the upcoming HIA conference.

NewPublicHealth: What started your interest in helping to create healthy communities?

Arthur Wendel: When I was in eighth grade I wrote a research paper on alternative transportation and fuels of the future, and through that process I learned about alternative fuels and some of the impact it was having on public health. I started there. When I went to college, I did a public policy and chemistry degree and I wrote my thesis on air pollution and public health. I simultaneously got my MD and MPH degrees and worked on another project that was related to alternative fuel vehicles and public health and saw that one way policies could change was through public health efforts and I wanted to be a part of that. So here I am.

NPH: What is the overarching goal of the Healthy Community Design Initiative?

Arthur Wendel: Our mission is to understand and improve the relationship between built environment and public health. We deploy very traditional public health tools and practices towards that mission, thinking about the essential public health services. One thing we’re working on now is an evaluation of walking to transit—how much people walk to transit, how many minutes of physical activity do they get. We've also looked at the impact of hybrid vehicles on pedestrian fatalities to see whether or not they’re different than their conventionally fueled counterparts, given that they’re quieter and some people may have trouble hearing the hybrids approaching.

NPH: Tell us about the Initiative's interest in health impact assessment (HIA)—a tool that looks at potential health impacts of policies and projects in other sectors?

Arthur Wendel: We’ve been engaging in HIAs since 2003, and we funded one state to develop an HIA capacity-building pilot program in 2008, added three states in 2009... We are now funding 6 HIA programs throughout the U.S. In 2008, we published a research article that showed 27 completed HIAs in the U.S. and by 2010, we had worked with organizations like Pew to track 150 HIAs that were either completed or in progress, so that it’s growing by leaps and bounds almost to the extent that it’s hard to keep up with the all the HIAs that are going on in the U.S.

We work with the Health Impact Project extensively. We’ve worked with them to develop good methodology and deploy that.

NPH: What is your role in the Inaugural HIA meeting next month?

Arthur Wendel: We’re partial funders and we have an HIA grantee preconference meeting with Health Impact Project on April 2, the day before the conference begins. Our grantees and their grantees are going to meet for the first part of the day separately, do our own thing, and then the second part of the day, we’re going to have a joint session between the two grantee groups to be able to talk about what’s going on in the different regions and specific topic areas of interest among the partners. So we’re intermingling the grantees so they can learn from each other. For the main conference, we’re helping with the planning and moderating the HIA 101 session and we are fielding session speakers.

NPH: What HIA subset does the Initiative focus on?

Arthur Wendel: We’ve tried to focus on healthy community design, though the full practice of HIA is of interest to us in general and we’re helping to develop good strategies for engaging in health impact assessment across the U.S.

NPH: How does the work of your office break down?


Arthur Wendel: At this point 10-15% or so is research. Another 10-15% is trying to improve surveillance and assessment activities, engaging with other partners that are doing surveillance work such as surveys where we can include built environment questions. A substantial chunk of our work – perhaps half, is on health impact assessment, particularly, being able to think about how to translate some of the evidence and surveillance information to inform policy. And then the last part is the evaluation component, and in that phase we engage with organizations such as Safe Routes to School and Complete Streets.


NPH: How far along are you in terms of making stakeholders aware of what’s available to improve health in communities?


Arthur Wendel: That’s part of the reason why we’re engaging in the health impact assessment arena. Because it is a mechanism for communities who are interested in engaging in these issues to do something applied and real, and so for the six communities that we’re funding, which include some states, it allows them to try out working in this area and to do a health impact assessment along those topics. After an HIA, once those partnership relationships are established, it can provide options for other working experiences.



NPH: Who are your early adopters for the built environment concept?

Arthur Wendel: It is different people community to community. In general, planners tend to be pretty involved and on the ball with some of these issues. We’ve had a relationship with the American Planning Association (APA) for some time. One of the things that we do with them is sponsor a health impact assessment online training module and it’s the most popular online training module that APA has. So that’s a group that tends to be a little more engaged in these issues. It does vary from community to community. With local public health departments, some will see this as an important issue to help move their community forward in some of their outcomes and some are still trying to sort out exactly what HIA means.


NPH: Given that the US is made up of urban, rural, suburban and hybrid communities, are there some overarching design principles for the built environment?

Arthur Wendel: There are some design principles that kind of overarch that whole area and I think that there have certainly been examples of good approaches even in rural areas of implementing solutions that work. I can think of a – safe routes to school program that happened in an area about twenty miles from my rural hometown where they built an asphalt sidewalk from basically the general store to the K-12 school that facilitates walking from that school to the population center in the “downtown” in a town of about 200. So, there are certainly some challenges with rural environments. The farms, for instance, are going to be difficult to have the infrastructure for walking and biking. But for most of the population, there are opportunities to build healthier communities and even in rural settings, there are some opportunities for changes.


NPH: When you start with school children, can you build the built environment into their thinking from a very early age?

Arthur Wendel: Yes, and that’s why I think the safe routes to school concept is a critical piece. It brings together youth who have got eighty years of their life ahead of them, potentially. It brings together transportation, it brings together public health and kids can’t drive on their own, so if they’re going to take ownership of their own transport, they have to do something that’s either walking or bicycling or rollerblading. We’ve partnered with the Safe Routes to School National Partnership and the National Center for Safe Routes to School. That’s a critical component for improving community design.

I deal with this a little bit in my own neighborhood. I’ve got a first grade son we walk to school and there are no sidewalks. It’s a challenge. Cars are going by at 35-40 mph even though it’s a 25 mph residential area. It does not feel safe and I worry about what that’s going to do for kid’s physical activity as they get older. I see my own son, when he doesn’t get enough physical activity, he doesn’t behave as well and I think about that on a population level. And motor vehicle crashes are the leading cause of death for that age group, and so, making sure that they have got a way to walk to school safely is critical.

NPH: How much has the recession impacted on progress of the built environment?

Arthur Wendel: Well, it’s a double edge sword, isn’t it? Because it also increases demand for things like transit and walking and bicycling, which are cheaper forms of transportation than driving your car when gas is $4 a gallon? So there tends to be some popular enthusiasm for better community design. It’s an opportunity in an economically constrained environment to try and be able to think strategically about what we can and can’t do and how to make decisions that will help for the next time there’s a recession so that environment is composed in such a way that it makes it easier for people to get out of that financial bind.

NPH: Why are destinations for the walkers, bikers, runners, so pivotal to the built environment?

Arthur Wendel: when we originally created our zoning laws, they were done to separate noxious industrial pollution from residential areas. Because we’ve got environmental laws in this country and because we’ve shifted some of our economy away from heavy duty industry to commerce and other sorts of industries, we had the opportunity to put these things back together in a way that won’t adversely impact the population’s health through environmental pollution. By thinking strategically about how to do that we can start to think about how to improve physical activity, reducing motor vehicle injuries and essentially make our society more livable.


NPH: Many new walkable communities seem to cater to the highest incomes. How can the concept be more inclusive?


Arthur Wendel: Demand is so high, that’s why prices are going up. People see this as a need, something that they want. But I also think it’s an opportunity for communities that can afford this to take advantage of that increased demand by implementing policies that facilitate the inclusion of affordable housing units or other ideas to try and minimize as much displacement as possible and help keep communities intact and make sure things are equitable as their neighborhoods are developed. I think that, overall if we want to improve health in the U.S., we’ve got to move towards communities that allow healthy choices to be the easy choice, but there are some policy crutches that we can do to make sure that equity is not challenged at the same time. There has to be the right mix of jobs and services in the area that support people of all income scales. You can’t always have a high end grocery in one place; you have to have something that has affordable, healthy food as well.


NPH: When do you want participants to take away from the Inaugural National HIA Meeting?



Arthur Wendel: I think the most important thing that they should leave knowing is who to go to in their community to partner with to make it better. Whether it’s their planner who came to the meeting, or their local public health department. In addition, we’d like them also to feel comfortable with their respective partner on how to move things forward in their community and potentially have a tool that they’ve heard about, and something they’ve learned at the meeting that they can use to test out the waters. Health impact assessment is an opportunity to do that.

In this country we spend about $2.6 trillion on healthcare costs, and the majority of that is public dollars in some shape or another. I’ve often heard said that physical activity, if you could bottle it, would be one of the best drugs to be able to give to people to help prevent a myriad of illnesses from diabetes to heart disease to some types of cancer. Obviously, we can’t bottle physical activity; you can’t even put it in the water so everybody just drinks it. But we do have the opportunity to change communities, to get people physically active, to provide an opportunity for them to engage in activity safely, and to help improve the likelihood that people won’t be run over or killed as they’re going from place to place. And I think that health impact assessments and other policy changes around community design are critical ways of going forward.

Feb 14 2012

Safe Routes to School: Q&A with Deb Hubsmith

Deb-Hubsmith Deb Hubsmith, Safe Routes to School National Partnership

Sixteen years ago, Deb Hubsmith was on her daily drive after work and another vehicle violently smashed into the passenger side of her car. Her car was totaled. As the crash took place, Hubsmith vowed to herself that if she survived, she'd give up owning a car for good. Hubsmith, who told her story here, went on to found and direct the Safe Routes to School National Partnership and spearhead a national movement to create healthier, more walkable communities where children can walk or bike to school every day.

NewPublicHealth caught up with Deb Hubsmith to talk about why safe routes to school are critical for the nation’s health.

NewPublicHealth: Why are safe routes to school important for the nation's health and quality of life?

Deb Hubsmith: The trip to school is a trip every child in America makes. Safe Routes to School is the only federal funding that is dedicated to infrastructure and programs that help kids be able to walk and bike to school in their daily life. By building sidewalks and pathways and safer street crossings, and focusing on safe routes to school, we can change the built environment and also change the culture. This creates opportunities for safe and healthy physical activity for children across the country.

NPH: How did you come to found the Safe Routes to School National Partnership?

Deb Hubsmith: I’ve always cared a lot about the environment and public health. After I got into a car accident 16 years ago, I decided to try living life without a car. It was very difficult to do this. So, I became an advocate for transportation choices. I started off by working with parents and teachers and advocates at the local school in my community. We worked on ways to get kids to school safely by walking and biking, and by carpooling and busing. I became interested in how this could be done on a larger scale, so I started working within the county. When I heard that Congressman Oberstar was looking for ways to improve safe routes to school and walking and biking in America, I had the great fortune of meeting him and having the opportunity to run a national pilot program for safe routes to school in Marin County, Calif. In that program, in one year we increased the number of kids walking and biking to school by 57 percent. This made national news.

The childhood obesity epidemic was rising at that time, and Mr. Oberstar wanted to do something to help all of America, so I worked with his staff on crafting federal legislation, and the Safe Routes to School program was included in the transportation bill in 2005. I launched the Safe Routes to School National Partnership at the same time because I knew we needed a grassroots organization to truly build a movement. This movement needed to be diverse, with partners from health, education, equity, environmental and transportation organizations. Now, our national partnership includes about 600 organizations.

NPH: You've said the concept of safe routes to school has reached the point where it's become a true movement. How did this shift come about?

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