Applications and Funding of Health Impact Assessment in the US

Health Impact Assessment: A health lens for public policy Aaron Wernham, M.D., M.S. Director | The Health Impact Project 901 E Street, NW, Washington, D.C. 2004 p: 202.540.6346 e: awernham@pewtrusts.org www.healthimpactproject.org

Completed HIAs in the United States 1999 2009 (N = 54) WA 4 MT 1 MN 5 OR 2 MI 1 MA 2 PA 1 OH 1 NJ 1 CO 2 CA 25 MD 1 GA 4 FL 1 AK 3 Courtesy A. Dannenberg, A. Wendel, CDC NCEH 2

A brief history of HIA in the U.S. 1999 2001 2004 SFDPH Living wage HIA First RWJF grant on HIA P4P, Fielding Workshop on advancing HIA in the U.S. (see Growing the Field of HIA in the U.S., AJPH 2005) RWJF, Cal Endowment fund multiple HIAs CA, AK, CDC Foundation, others SFDPH continues to grow its HIA program Use of HIA under federal and state EIA law Human Impact Partners first non-profit dedicated to HIA in the U.S. New foundations and agencies enter the arena EPA funds HIA work in AK and CA, and comments on need for HIA in NEPA reviews Health Impact Project collaboration of RWJF and Pew; broad goal of institutionalizing HIA 2005- present 2008-2009 2009

Building the field in the U.S. -- The role of foundations RWJF California Endowment Public Welfare Foundation Northwest Health Foundation Liberty Hill Foundation Blue Cross Blue Shield of Massachusetts Foundation San Francisco Foundation The Annie E. Casey Foundation Family Values at Work Unitarian Universalist Congregation Centers for Disease Control American Ass n of State Highway and Transportation Officials ASTHO NACCHO Active Living Research Silicon Valley Health Trust

The Health Impact Project: A collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts A national Center to support and promote HIA: Strategic funding for HIAs at the local & state level around the U.S. demonstrate value and range of applications HIAs of federal legislation or administrative decisions Supporting HIA institutionalization in government legislation, building agency capacity, policy briefs. A website with resources, training materials, case studies, policy briefs www.healthimpactproject.org Collaborating with organizations with established expertise, and supporting agencies and organizations new to HIA

What are the potential applications of HIA? Lessons from the Health Impact Project call for proposals

Proposals from 43 States ME OK UT KS SC HI IN WVCT MTNENH CA CO DC MD ID MS NM WY TX AZ MI NY NJ TN VA FL WA WI AK MA AR IL NC KY LA OH OR MN GA MO PA

Subject Area Subject Area Topic of HIA: Proposals for funding from the Health Impact Project Climate Change, 2% Health Promotion, 2% Housing Policy, 2% Education, 3% Labor/ Employment Policy, 2% Natural Resources and Energy, 6% Land Use/ Development/ Transportation/ Urban Planning 28% Air Quality/ Contaminant Cleanup, 6% Agriculture, 6% Other, 6% Obesity Prevention/Fitnes s/ Nutrition, 13% Economic Policy, 6% Healthcare, 12% Maternal/Child Health, 8%

Finding good ideas for an HIA: Proposals we ve received suggest no shortage 1.State Budget Process: state budget decisions -- weigh the relative consequences of cuts/spending in various sectors 2.BRAC Redevelopment: a Public Health Institute would do an HIA to shape redevelopment plans for a closed military base. 3.Prison Reform: A university-based policy institute would address a state legislative package of 6 bills on prisoner reentry 4.Agriculture Policy: A non-profit will help develop a county agricultural plan that will shape the local economy, land use patterns, and diet. 5.State immigration legislation: a university would examine proposed state legislation to restrict access to public services 6.Coal gasification plants: a local health dept. will look at the health effects related to pollution as well as social & demographic change 9

Finding good ideas for an HIA: and on and on 7. Regional passenger and freight rail policy: a university would partner with regional transit planners on a large rail plan 8. City planning decisions on use of vacant lots: a coalition of faith- based groups would weigh options including community gardens, commercial farming, and new industry in an economically devastated urban area 9. CAFO Regulation: an environmental organization would attempt to introduce health and social welfare considerations into the state permitting process. 10. State energy policy: an environmental group would address a comprehensive energy plan in a coal belt state 11. Foreclosure mitigation: a university would address state legislation seeking to prevent foreclosures 10

What makes HIA a good tool to address such a wide range of decision-making? Is there more to it than just assessing impacts, making recommendations, and writing a report? A new way to engage: brings public health professionals, community stakeholders, planners, developers, and decision- makers to the table, with a focus on practical, realistic solutions. Address public concerns early and directly Ensure that public health input and recommendations are sensitive to the political, regulatory, and economic context.

Does every decision need an HIA? Screening Are there likely health effects? Is health already a focus of the project, program, or bill? (HIA may add the most value to decisions where health is not the focus.) Does the public have health concerns? Is the HIA likely to be successful? What are the barriers? Are there legal or regulatory levers that would allow implementation of health recommendations. Do you have the resources to do the HIA? 12

Conference on Foundations: Group HIA screening exercise Participants please consider: What are your organization s primary policy interests & initiatives? From these, please choose 1-2 that might benefit from using a health lens, and which could be appropriate targets for HIA. We will select 4-6 policy targets, and in groups, work through the screening questions on the previous slide

Discussion?