Health Impact Assessments at APHA: A "Valuable and Promising Tool"
Aaron Wernham, director of the Health Impact Project, a joint project of the Pew Charitable Trusts and the Robert Wood Johnson Foundation, is leading a health impact assessment training and two sessions on the health impact assessments during the annual meeting of the American Public Health Association.
Health impact assessments have only become more widely used in the last few years but are growing in their use by cities, states and community based organizations to identify and address health risks and benefits of decision made outside the health sector.
HIAs, as they are known, are showing great promise as a means to factor health into a wide range of decisions that do not normally focus on health, such as transportation and land use planning, permitting of natural resource development and energy production projects housing projects and policies, and social policies and programs such as living wage and paid sick days legislation, energy assistance, and rental voucher programs. Currently, based on tracking by the Health Impact Project and the Centers for Disease Control and Prevention, over 130 HIAs have been completed or are being conducted right now.
NewPublicHealth spoke with Aaron Wernham about the state of HIAs, successes in the field and strategies that will be driving greater use of the tool in the future.
NewPublicHealth: Do you think that many attendees at the APHA meeting will have greater familiarity with the concept of an HIA than they might have a year or two ago?
Dr. Wernham: Absolutely. I think I’ve been giving talks on HIA at the APHA annual meeting since 2007 where I think there was just one session on HIAs at the whole meeting and this year I believe we’re up closer to six or seven groups from around the country coming to talk about HIA. I really think this reflects a lot of the developments that have been going on in the field in the last year.
We had a National Research Council committee that just finished a report on the field in the US and developed a framework and guidance for the practice. I think one of the most important findings of the committee is simply that HIA is a very valuable and promising tool for addressing the health consequences of non-health decision making, decisions made in other sectors like transportation and agriculture and education.
NPH: What sessions are you involved in during the APHA meeting?
Dr. Wernham: I gave a training session on Sunday with our colleagues at Human Impact Partners. One of my sessions is looking at health impact assessment as a tool to help incorporate health into what’s commonly being called nowadays a health in all policies framework. The idea is looking at HIA as a tool to help decision makers outside the health sector factor health in. And I’m giving another talk with a group of HIA practitioners from around the country about the National Research Council’s findings, defining HIA, the steps of HIA, how it’s done, and then they’ll all be providing some examples.
NPH: One interesting session involves the built environment and older adults. Have you seen the issue addressed before?
Dr. Wernham: I think it’s the first talk that I’ve seen on that. I have certainly seen HIA being used with that population on a number of occasions. One of the things made me want to take this field on was the fact that HIA is a particularly well adapted tool for addressing vulnerable populations such as young children, elders, people with chronic illness. Often, those are the people who suffer the most ill effects when we don’t factor health into decisions. So urban planning is a perfect example. If you haven’t planned streets where people can easily walk, then you can imagine the challenges that someone who is elderly or disabled may face trying to get from an apartment building across the street to a grocery store. These are the source of considerations that I think we often see HIA as taking into account.
NPH: Transportation is also on the agenda—is that issue particularly well suited to HIAs?
Dr. Wernham: The transportation sector has been one of the most common topics for health impact assessments. There are wide ranging risks and benefits associated with transportation and public transit projects and decisions, and I think HIA is proving to be a really exciting tool. There are two developments I’d point to. First of all, just from our own recent call for proposals which closed about two months ago—and we’re getting ready to make some selections on funded proposals in December--We had no proposals coming from metropolitan planning organizations which are the region level planning bodies that plan transportation projects and make regional transportation plans in our first round of funding. This time around I think we had 12 or 14 proposals from metropolitan planning organizations around the country really indicating a greatly increased interest in HIA. The Transportation Research Board last year had a full day session at their annual meeting devoted to HIA, and I think the other thing that I would really point to is there’s now a state law—the Massachusetts Healthy Transportation Compact. It’s one of the first state laws, that mandates HIA in a consideration of health and planning new transportation projects, and the state health department and transportation project are off to a great collaboration. We just gave a training there to help them get started on their first collaborative HIA project, and I think that both sides are very excited about the benefits for Massachusetts.
NPH: So, the wide ranging applicability of HIA is becoming widely known?
Dr. Wernham: Well, I think that’s exactly right. HIA is really meant to be a flexible framework for systematically considering the health implications of any decision that might be important to health. So you can see an HIA being done in a matter of weeks for a small local project. You can see HIAs being done on larger state or even national policies. We’ve seen HIAs being done to help with developing regulations to implement California’s greenhouse gas regulations. We’ve seen HIAs, on a wide range of sort of socioeconomic legislative decisions. So things like a minimum wage ordinance, things like domestic workers, regulations governing the conditions under which domestic workers are working and a range of topics like that.
The State of Alaska recently announced its health impact assessment program. This came out of work the Robert Wood Johnson Foundation funded where the tribes began working with federal agencies there and the state health department to better incorporate health considerations into oil and gas and mine permitting. This has really taken off there and now the state health department has a fully funded health impact assessment program. They are part of the large project permitting team run by the Department of Natural Resources there, and the state health department is now at the table for the planning and permitting of any major project in the state. This is a fully funded role for the health department and I think people on all sides have felt like it’s really adding a tremendous value to the state’s historic approach to permitting.
We’ve seen many local health departments applying for funding, and even more exciting than that though is that they’re just beginning to do this on their own as part of the way that they do their business. We’re supporting a collaboration with the National Association of City and County Health Officials right now, and simply providing some travel funds to hook health departments who have done HIAs together with health departments who are interested in learning how to do them up with each other, and now the mentor and mentee health departments are just getting started on a series of HIAs. We’re supporting four different mentor/mentee pairs around the country.
NPH: And can you give us a preview of the HIA conference the Health Impact Project will be holding in April in Washington, D.C.?
Dr. Wernham: The conference in early April is going to be the first national HIA meeting open to any audience that is either involved in HIA or interested in learning more about it. We’re really hoping to target several specific audiences. The first is HIA practitioners and public health professionals at large, people who we think would be interested in using HIA or are using it currently, and for them we’ll have a number of sessions that look at specific sectors and topics in HIA practice, that will have innovative sessions from leaders in developing analytic methods and tools, people who have done novel applications – used HIA in novel applications, people who have taken on HIAs and found them to be very successful and achieved a lot of the sort of big objectives that people often go into them with.
We’ll also be having what we’re calling an HIA 101 tract, which is meant really for people who attend the full two days of that as an introductory course in HIA. And finally, and I think one of the ones I’m most excited about is a track for policy makers where we’re really hoping to show people how HIA is being used in regulatory decisions, where it’s being incorporated into law or where it’s being used to facilitate compliance with an existing law, where decision makers outside of any legal requirement can use HIA in a way that will actually really help make their lives easier and help them build healthier communities.