C OMPATIBLE F RAMEWORKS ? Health Impact Assessment and the Policy Sciences 1 Katrina Smith Korfmacher, PhD Associate Professor of Environmental Medicine.

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COMPATIBLE FRAMEWORKS?Health Impact Assessment and the Policy Sciences

Katrina Smith Korfmacher, PhDAssociate Professor of Environmental MedicineDirector, Community Outreach and Engagement CoreEnvironmental Health Sciences CenterUniversity of Rochester

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PRESENTATION GOALS:

How is this framework compatible with a policy sciences perspective on problem solving?

What can/has the policy sciences contribute to this framework?

What potential does this framework have for expanding the practice of the PSF (explicitly or not)

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OVERVIEWHealth in All Policies (HiAP)Health Impact Assessment (HIA)

and Policy Sciences FrameworksRochester’s Local Waterfront

Revitalization Program (LWRP)Healthy Waterways ProjectHIA and PS, revisited

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FACTORS RESPONSIBLE FOR POPULATION HEALTH

Health status is determined by: genetics (5%), health care (10%), behavior (30%), Social Conditions (55%)

- WHO Commission on the Social Determinants of Health (2008)

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HEALTH IN ALL POLICIES (HIAP)Many public decisions affect

health - not only health policies!BUT….few non-health decisions

even consider health outcomesHow can we promote health

through non-health policies? “Health in All Policies” (HiAP)Health Impact Assessment (HIA):

one way to support HiAP

HEALTH IMPACT ASSESSMENT (HIA)

DEFINITION: “A combination of procedures, methods and

tools that systematically judges the potential, and

sometimes unintended, effects of a policy, plan, program

or project on the health of a population and the distribution

of those effects within the population. HIA identifies

appropriate actions to manage those effects.”

-International Association for Impact Assessment, 2006

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HISTORY OF HIAS

Europe, Canada, New Zealand

US: California, Alaska….

Human Impact Partners (www.humanimpact.org)

PEW/RWJ Foundation (www.healthimpactproject.org)

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HIA AND DETERMINANTS OF HEALTH

HousingAir quality

NoiseSafety

Social networksNutrition

Parks and natural spacePrivate goods and services

Public servicesTransportation

LivelihoodWater quality

EducationInequities

How does the proposed project, plan, policy

Affect health determinants like:

and lead to health outcomes

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INCORPORATING HEALTH INTO DECISION-MAKING

The world would look different if we considered health impacts of decisions on…

Development

Immigration

Farm Policy

Ports

Incarceration

Education

HIA EXAMPLES FROM OTHER STATES Alaska - North Slope Oil Development:

HIA led to compromise lease plan; reduced impacts on hunting and fishing and avoided litigation

Illinois - Smart Metering in Chicago: showed health risks from automatic electricity disconnects; now require site visit prior to shutoff and monitor impacts on low income people

CA -Senior Housing in Oakland: predicted respiratory problems from air pollution; developer incorporated central air filtration and moved air intake away from high traffic area.

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BUT WHAT IS HIA???

An ANALYSIS that…•Clarifies health effects of a proposed project, plan or policy•Includes quantitative and/or qualitative information•Highlights health disparities; makes health impacts explicit•Considers multiple health outcomes•Provides recommendations•Shapes public decisions & discourse A PROCESS that…

Engages & empowers community

Builds consensus

Builds relationships & collaborations

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STEPS OF A HIA

Screening Determines the need and value of a HIA

Scoping Determines which health impacts to evaluate, methods for analysis, and a workplan

Assessment & Recommendations

Provides:

1) a profile of existing health conditions2) evaluation of potential health impacts/alternatives 3) strategies to manage identified adverse health impacts

Reporting Includes: 1) development of the HIA report 2) communication of findings & recommendations

Monitoring Tracks: 1) Process: impacts on decision-making processes and the decision2) Outcomes: impacts of the decision on health determinants

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HIA AND THE POLICY SCIENCES: PROBLEM ORIENTATION

Screening Clarifying goals

Scoping Clarifying goals

Assessment & Recommendations

Describing trendsAnalyzing conditionsProjecting developmentsInventing, evaluating, and selecting alternatives

Reporting [Social process]

Monitoring [Social process]

HIAs are only conducted when likely to affect pending decision

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WHO DOES HIA?

• The public for relationship building, capacity for advocacy, and empowerment

• Public health and other agencies for relationship-building, data, information, and resources

• Decision-makers/industry to ensure that recommendations are realistic and account for the practical, economic, and technical limitations on the decision at hand

-HIA is a collaborative process-HIA may be LED by: health departments, planners, developers, consultants, community members, or interest groups-HIAs involve:

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HIA AND POLICY SCIENCES: STANDPOINT Goal is to be a source of “objective

information”

Normative orientation toward ‘equity’ Identify ‘vulnerable populations’ Assess distribution of health impacts Aim to reduce health disparities

Recommendations and Reporting are intended to influence decisions (analysis/advocacy)

HOW DO HIAS ASSESS?• Conduct a literature review • Find out about other communities’ experiences• Gather existing data or conduct new analysis on health,

environmental and social indicators• Compare data to existing regulatory criteria, standards, &

benchmarks• Utilize community expertise - e.g., focus groups, surveys• Apply specialized data collection tools for observational

data, forecasting, and modeling• MAP environmental, social, health data• NOT “new research” (usually)

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HIA AND POLICY SCIENCES: MULTIPLE METHODS

Focus on integrating/applying existing information

Most HIAs elicit information from stakeholders Surveys Focus Groups Interviews

Evidence summaries rate the ‘strength of evidence’ from literature, reports, case studies

Recommendations based on weight of all evidence

CASE STUDY 1: PAID SICK DAYS

A Health Impact Assessment of the California Healthy Families, Healthy Workplaces Act of 2008

Does public health evidence support the hypothesized impacts of a mandatory requirement for paid sick days on health?

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• Nationally, 60 million lack paid sick days• Potential benefits to individual, family and

community health• Limited legislative analysis of health• Legislative sponsors enthusiastic about

framing bill using health• Methods exist to contribute to analysis• CA legislation and HIA as national model

PAID SICK DAYS POLICY: SCREENING

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PSD PATHWAY SCOPING

Additional pathways for dependents completed as well

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PAID SICK LEAVE: HEALTH ADVOCATES HELP WIN A COMMON SENSE POLICY (SEPTEMBER 10, 2014) “HEALTHY WORKPLACES, HEALTHY FAMILIES ACT”

Imagine waking up sick with the flu. Wouldn’t you want to take a day off from work? What if not working meant going without pay? After July 1, 2015, fewer California workers will have to struggle with this choice. Last week, California Governor Jerry Brown signed AB 1522 making California the second state (after Connecticut) to guarantee most workers some paid sick leave.

In 2008, Human Impact Partners authored a health impact assessment on California’s first attempt to legislate paid sick days. … Public health arguments were clearly central to last week’s passage of AB 1522…

www.humanimpact.org

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HIA AND POLICY SCIENCES: SOCIAL PROCESS Participants: HIA often involves broader range of

participants than official decision process Perspectives: Solicits different views on decision Situations: May create new forums for interaction;

BUT HIA takes the policy context as given Base values: HIA process may enhance base

values; recommendations may enhance scope values Strategies

Diplomatic – integrate decision makers Ideological – public communication of recommendations

Outcomes and Effects: emphasizes evaluation of: Process (how did it shape decision) Outcome (how did decision affect health determinants)

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HIA AND POLICY SCIENCES: HEALTH AND BASE VALUES Power: Highlighting health costs gives more power to

groups suffering from health disparities Wealth: HIA connects economic security to better

health, promoting interests of low income groups Enlightenment: Education is linked to better health

outcomes; HIAs often support education improvments Skill: HIA may engage new groups in decision-making,

improving their capacity for future participation Affection: Social connectedness, and community-

building are well established health determinants Well-being: stress and poor mental health are important

health outcomes and also affect physical health Respect and Rectitude: Participation, equity emphasis,

and valuing community knowledge promote these

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HIA AND ENVIRONMENTAL HEALTH PROBLEM SOLVING

Explicitly connects environment and health Integrating multiple sources of data Making use of available data Clarifying equity impacts of decisions Communicating policy consequences in

health terms engages diverse stakeholders Health care reform: Clarifying health

impacts (especially health disparities) = monetization

Informing decisions, not “doing research”

BRINGING HIA TO ROCHESTER Initiated by County Health Director(2009)

National dialogue - Can HIA help Monroe County?Guide MCDOPH input to local decision makers?Childhood lead poisoning efforts were like HIAShape health-promoting decisions;

HIA “Learning Group” (2010)40 participantsPresentations, work groups, project planning

Pew Health Impact Project grant (2012): Healthy WaterwaysCity of Rochester’s Local Waterfront Revitalization Program“Healthy Waterways” HIA

APPLYING HIA TO ROCHESTER’S LOCAL WATERFRONT REVITALIZATION PROGRAM

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NEW YORK STATE’S LOCAL WATERFRONT REVITALIZATION PROGRAM

Develop long-term plan for waterfront

Guides decisions at all levels of government

Opportunities for public involvement

13 policy statements

Many relate to health

Not required to consider health

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ROCHESTER’S LWRP 1990 LWRP; drafted update in 1999 Revision underway; expected completion

2014 Waterfront Advisory Committee (WAC) Involves City, County, Community, NYS DOS Once approved by NYS Department of State,

applies to all activities within waterfront zone

Communications Bureau, City of Rochester

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What are the biggest health issues in Rochester?

How do these relate to the waterfront?

How could waterfront changes affect health?

Goal: Make policy and planning recommendations to minimize health risks and maximize benefits in LWRP

HEALTHY WATERWAYS: HOW MIGHT THE LWRP IMPACT HEALTH?

Communications Bureau, City of Rochester

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LWRP “ELEMENTS” ASSESSED Waterfront trails Beaches Residential/commercial development Water-based recreation Stormwater management

County health data Community surveys Stakeholder interviews Published literature Case studies

ASSESSMENT METHODS:

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Communications Bureau, City of Rochester

TRAIL USER SURVEYS/COUNTS

SURVEYS:265 Trail users surveyedDemographics, trail use frequencyPreferences for trail improvement

COUNTS:12 sites, 54 hours of observationCounted 2019 trail usersUser numbers vary by locationNational model estimates total use at sites from 25,000 to 300,000/year

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WHO USES THE TRAIL?

•Demographically similar to County population•EXCEPT: 69% male•44% walkers live less than half a mile from trail (locals)•Incomes of local users close to City average•76% of local users use trail at least weekly•Trail is an important exercise resource, especially for low income neighbors

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•40% of Rochester’s population lives in a ‘waterfront neighborhood’•Includes 45% of DEC “environmental justice” areas•The mean income in PLEX, a southwest neighborhood , is a third lower than city average •The PLEX low birth weight rate is nearly double that of the County•Mean Years Potential Life Lost (YPLL) in PLEX is twice as high as County average

PHYSICAL ACTIVITY IN SOUTHWEST ROCHESTER 63% residents reported meeting CDC’s

weekly recommended activity level (150 minutes exercise); similar to county mean 71% of whites 58% of blacks

County health data show racial differences in obesity, heart disease, diabetes, etc.

Obesity cost calculator “If the trail weren’t here, I wouldn’t

exercise.”

35TRAIL is more than a “recreation destination” – opportunity for physical activity and transportation by low income waterfront residents

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EXAMPLE: TRAIL RECOMMENDATIONSPolicies: “Prioritize connecting trail through downtown and

to adjacent neighborhoods”

Projects: “Add amenities like better lights, water fountains, benches, fishing areas, or exercise equipment to encourage use”

Programs: “Expand programs to encourage trail use by diverse populations, especially waterfront residents;”

Communication: “Improve signage TO trail from neighborhoods and vice versa.”

Monitoring: “Conduct annual trail user surveys”; “Establish trail management group to coordinate improvements, maintenance, use by neighbors and visitors”

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SUMMARY: HEALTHY WATERWAYS AND THE LWRPHealth considered as a ‘goal’ in LWRPCommunity health data included in

inventory and analysisShifted focus from “destination” to

include “waterfront neighbors” Recommendations integrated into

LWRP subpoliciesNew partners identified for

implementation (future grants, projects, planning, monitoring)

Full report: bit.ly/QorjRS or http://www2.envmed.rochester.edu/envmed/EHSC/outreach/coec/projects/HIA/HealthyWaterways.html

PROVIDENCE, RI RIVERWALK

In 1994, replaced the world’s widest bridge at 1,147 feet with new streets, cobblestone pathways, Venetian-style bridges, sculptures, fountains, boat landings, and parks including the four acre Waterplace Park with an open air auditorium.

The Riverwalk hosts year round public art and cultural events

Waterfire events regularly attract over 350,000 people.

Hotel room rentals doubled between 1999 and 2000, and in August 2003 they rose over 50%.

Payne, Thomas. Waterfire Providence Organization. 13 June 2012. Web. http://waterfire.org/about/history/

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HIA AND PSF: DECISION PROCESS

Intelligence: HIA assessment Promotion: HIA reporting Prescription: HIA recommendations +

assessed decision process Invocation: ?? Application: ?? Appraisal: HIA evaluation Termination: ??

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WHAT CAN PSF BRING TO HIA Standpoint:

Can one be ‘objective,’ ‘collaborative’, decision-relevant recommendations’ and ‘equity promoting’?

Social process: HIA takes the “decision context” as fixed; other

‘situations’ may matter Decision process:

HIA engages primarily in intelligence and promotion Helps explain frequent “recommendations

beyond the recommendations.” Plan better for monitoring/evaluation of impact

on decision, implementation, and health outcomes?

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WHAT CAN HIA CONTRIBUTE TO PSF

HIA is both an analysis and a process – limited, but broader than what would happen without it (partial application?)

Language of health is easy to understand and has broad support; includes equity, participation, and well-being

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SUMMARY: HIA AND PSF How is this framework compatible with a policy

sciences perspective on problem solving? Goal = multimethod, problem-oriented, equity-

promoting ways to improve of policy decisions What can/has the policy sciences contribute to this

framework? Provide conceptual grounding for practice Heighten awareness of limits to HIA role in policy

process

What potential does this framework have for expanding the practice of the PSF (explicitly or not) Translation of ‘base values’ into ‘health language’ / data Cross walk into public health issues Growing field of ‘practicioners’ with problem orientation