Health Impact Assessments: "The Future of Public Health Depends on Working Much More Collaboratively"

May 4, 2011, 8:32 PM, Posted by NewPublicHealth

How could the Central Corridor Light Rail Transit line — a light rail system under construction in St. Paul, Minn. — affect low-income and immigrant communities?

That’s the big question behind a health impact assessment (HIA) currently underway. It will look at how the new transit system might reduce air pollution as it increases access to grocery stores, parks and open space — all without displacing local residents and businesses.

That HIA is part of the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The national initiative, started in 2009, promotes the use of HIAs as a decision-making tool for policymakers. HIAs use a flexible, data-driven approach that identifies the health consequences of new policies and develops practical strategies to enhance their benefits and minimize adverse effects.

file Aaron Wernham of the Health Impact Project

NewPublicHealth spoke with Aaron Wernham, director of the Health Impact Project, about current HIAs and the future of the valuable public health tools.

NewPublicHealth: The Health Impact Project has been up and running for about a year and a half. Can you update us on projects in the field?

Aaron Wernham: We’ve really been surprised to see relatively rapid growth in the use of health impact assessments around the country. We’ve gone from roughly twenty-five health impact assessments in the U.S. two yearsago to over seventy that have been completed, and probably another fifty or sixty on top of that that are in progress. As far as what’s going on with the Health Impact Project, we just recently released a new call for proposals to fund another set of demonstration project health impact assessments around the U.S. and we’re receiving quite a few applications already.

NPH: Has anything surprised you about the projects underway?

Wernham: I think the first thing that surprised us was just the pent-up demand for support for HIAs. We actually received over 220 applications from 43 states. The practice at that point when we first started, had really been limited to just a few states around the country and this was a surprising amount of interest from states that hadn’t done HIAs yet. We’ve also really been learning the importance of stakeholder engagement — we’re finding that the HIAs that seem to be getting the most traction and being the most successful are ones where there’s been a very strong partnership between the team actually leading the HIA, the community stakeholders that are potentially affected by the decision, and the decision-makers.

NPH: Are you pleased with the rate of inquiry that you’re getting on health impact assessments?

Wernham: We’re very pleased. Aside from the response to our funding initiatives, we’ve also had just innumerable inquiries from legislative offices at the state and federal level, as well as the local legislators interested in HIA. We’ve been working with a number of federal agencies, such as Departments of Transportation and Housing and Urban Development, who are beginning to look at effective ways to build health into their initiatives and interested in using HIA to do so. And we’ve even worked with a couple of offices at The White House.

NPH: This is a time of extremely tight budgets in cities and states across the county. What do you say to policy-makers who worry about the cost of doing a health impact assessment?

Wernham: You know I really think that the future of Public Health is going to depend on working much more collaboratively with other sectors — such as transportation, urban planning — than we have previously. We’re going to have to start finding ways to effectively bridge to decisions being made in other sectors where we really have an opportunity to improve health. I think the other thing to point out is that in tough economic times it’s more important than ever to begin to control health care costs, which are a substantial portion of public and private spending in the U.S. — and that really requires making smart decisions to recognize hidden opportunities to protect and promote health.

NPH: As you go through your next grant cycle, what have you learned from the grants that you’ve seen so far that could help you help grantees improve the applications that their putting in the future?

Wernham: Probably the most important thing is to recognize that health impact assessment is really a tool that works best in one setting — and that is in the setting of an active decision-making process that wouldn’t otherwise be taking health into account. So that might be planning for a new road or highway. It might be pending legislation. But really defining the decision that the HIA is going to address and understanding exactly how it is that the HIA might be able to be used is probably the most important thing for applicants.

NPH: You’ll be speaking at the National Network for Public Health Institutes in just a couple of weeks. What will you be talking to them about that is very specific to HIAs?

Wernham: The Public Health Institutes really fill a unique role in our public health system. They are often the bridge that maintains a very close relationship with the local health departments and state health departments — but at the same time an independent voice for public health. They have been beginning to do a lot of work in health impact assessment and my talk is mainly going to focus on really how Public Health Institutes can begin using this tool to more effectively do their work.

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