National Health Impact Assessment Meeting: NewPublicHealth Q&A with the CDC's Arthur Wendel

Sep 25, 2013, 10:56 AM

Arthur Wendel, MD, MPH Arthur Wendel, MD, MPH

One of the most sought-after experts at the second national Health Impact Assessment (HIA) meeting, currently underway in Washington, D.C., is Arthur Wendel, MD, MPH, team lead for the Healthy Community Design Initiative at the U.S. Centers for Disease Control and Prevention (CDC), which is a sponsor of the HIA meeting. Health impact assessments are decision-making tools that help identify the health consequences of policies in other sectors.

NewPublicHealth caught up with Dr. Wendel just after the first plenary session.

NewPublicHealth: How’s the meeting so far?

Arthur Wendel: The first plenary speaker, councilman Joseph Cimperman form Cuyahoga County in Cleveland, was just an outstanding speaker and made such a good impression for the whole conference. When you have a policymaker come in and provide a fresh perspective about how health impact assessments can make a difference, that sets the stage for attendees.

>>Editor’s Note: NewPublicHealth will be speaking with Councilman Cimperman later this week about his championing of HIA work in Cleveland, including a health impact assessment on the city’s budget, the first time the tool has been used that way.

NPH: How long has CDC been involved in health impact assessments?

Arthur Wendel: CDC has been involved with health impact assessments, through the Healthy Community Design Initiative, since 2003. The initiative is part of CDC’s National Center for Environmental Health, and initially we were just kind of trying to figure out the field of health impact assessments, learn a little bit about it from some domestic and international groups that conducted health impact assessments. Some of the initial steps were just trying to provide technical assistance for a few HIAs. That gave us a little bit of flavor for how health impact assessments were done, and from that initial effort we started to compile some research. One of the initial papers that came out of our group was identifying the first 27 HIAs that were conducted in the United States and some of the common characteristics among them.

>>Looking for examples of successful HIAs? Read stories from the field from CDC grantees.

As we gained more experience with health impact assessments, we started with a pilot program to do more than just individual HIAs in order to build state capacity for conducting HIAs. So it had a training component because what we had seen in other places was that when you integrate training and the opportunity to actually do an HIA, then you can get more done. We started that out with first state, then grew it to four states, and we were able to put the lessons we learned from that pilot program into the current cooperative agreement that we have going on with the six communities. So there’s been a lot of learning in terms of how we have engaged in HIA over the past ten years, and there’s still a lot both in terms of research and practice that we’re still trying to sort out with our partner.

NPH: What is CDC funding currently in terms of HIAs?

Wendel: We’re in our third year of funding and are currently given grants to six communities and states: San Francisco, Oregon; Douglas County, Nebraska; the Massachusetts Department of Public Health; Baltimore; and a small town called Davidson, North Carolina. We just recently met with the grantees. I think that one of the exciting things about having a multi-year partnership with these communities is that they’re able to not just conduct the HIAs, but they’re able to invest the time into following the HIAs’ outcomes and to provide some feedback, and then build that coalition so that the efforts that they made building partnerships in getting the HIA off the ground, and having it conducted, continue to be effective. And that’s regardless of what sector—transportation, housing—the HIA was focused on. So they made the first inroads in their first year and now they’re able to use those inroads to conduct more health impact assessments.

NPH: What is an example of a health community design HIA that’s had strong and usable results?

Wendel: A few years ago, through that initial pilot program, we provided a small grant to the State of Oregon to conduct health impact assessments. Fast forward that three years from 2010 and Crook County, Oregon, won NACCHO’s small local health department of the year award for an HIA on the transportation plan for the city. That’s a testament to having a program that can continue to engage and track these results, because the HIA data that was created through really quite a small grant process was used to apply for a transportation grant, and they received a $500,000 grant to improve and implement their bike improvement plan. They were able to use it to efficiently focus their limited resources on sidewalk repairs and updates that would make a greater public health difference, as well as improve pedestrian safety around schools through enforcement.

And in addition, and more broader based, they brought the hospital to the table as a community partner to help with trail improvements throughout the county and they added a light on Main Street to improve the safety of pedestrians who would cross there. Because of all this successful collaboration, the Crook County Health Department was invited to be a partner for the development of the 20-year transportation plan.

Those are specific examples of how a local health department can make a difference through an HIA—through a relatively small, relatively rapid HIA—and get changes to the environment that we know are associated with health improvements. It’s also an example of how a single HIA can start the development of partnerships that can lead to even more fruitful opportunities in the future.

NPH: What sorts of public health practitioners are attending the second national HIA meeting?

Wendel: On the first day of the meeting they took an informal poll to see how many attendees were new to this conference compared to last year, and the room was relatively split for the people that had been to the last conference and the people that are new. The field continues to grow and evolve, and if you look at the health impact projects map on the expansion of HIA throughout the United States, it looks like there’s an epidemic of HIA, which is a good thing. I hope this year’s attendees will create foundational relationships, particularly across sectors.  

And as people get more experienced with HIA, they’re transitioning from not just an “I need to learn about this,” but also “this is an opportunity for me to meet somebody from a different area of the country who’s dealing with the same problems and troubles that I am and we can connect and we can help solve the problem together.” I think that this conference offers a tremendous opportunity to be able to do that because, as you know, health impact assessment is not something that’s necessarily easy, and there are a lot of different knowledge components that allow it to be done smoothly. There’s a public health component; there’s sector specific knowledge and how it works; there’s the communication and outreach component and being able to integrate well with communities and meet their needs and their questions; and then there’s the need to actually be able to deliver the message in an appropriate fashion to the decision makers. And I think those are all different skills and nuances, and when you bring people together in a setting like this, you have the ability to learn a lot from people who have those different skills and to bring those skills to bear to the table, and to perhaps see in your own community what’s missing and what’s needed.

One of the things that I’d like to see around health impact assessment is its incorporation in some of the higher level policies that are coming out. So, for instance, the National Prevention Strategy identifies health impact assessment as a means of achieving improved population health, and I think that’s helpful to the field as a whole to be recognized that this is a means of connecting transportation folks, agriculture folks and all those people that are within the National Prevention Council together.

>>Read NewPublicHealth’s Q&A with Wendel before last year’s first national meeting on Health Impact Assessment.

This commentary originally appeared on the RWJF New Public Health blog.