&EPA
United States
Environmental Protection
Agency
EPA/600/R-13/354
December 2013
www.epa.gov/ord
A Review of Health Impact
Assessments in the U.S.: Current
State-of-Science, Best Practices, and
Areas for Improvement
I Office of Research and Development
' National Exposure Research Laboratory
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EPA/600/R-13/354
December 2013
www.epa.gov/ord
A Review of Health Impact Assessments in the
U.S.: Current State-of-Science, Best Practices,
and Areas for Improvement
Justicia Rhodus1, Florence Fulk2, Bradley Autrey2, Shannon O' Shea3, Annette Roth2
1 CSS-Dynamac
c/o U.S. Environmental Protection Agency
Cincinnati, OH 45268
2 U.S. Environmental Protection Agency
National Exposure Research Laboratory
Cincinnati, OH 45268
3 Contractor, U.S. Environmental Protection Agency
National Exposure Research Laboratory
Research Triangle Park, NC 27709
National Exposure Research Laboratory
Office of Research and Development
U.S. Environmental Protection Agency
Cincinnati, OH 45268
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Notice
The U.S. Environmental Protection Agency through its Office of Research and Development
funded and managed the research described here under contract EP-D-11-073 to Dynamac
Corporation. It has been subjected to the Agency's external and administrative reviews and has
been approved for publication as an EPA document.
Author Contributions and Acknowledgements
J. Rhodus (HIA Review Lead) - developed and managed the HIA Review process (including
review framework and database), reviewed HIAs, implemented the QA Review and corrective
actions, compiled and managed the final review database, performed final quality check on
review database, synthesized the results of the HIA Review, and authored this synthesis report.
F. Fulk (Principal Investigator) - managed implementation of the HIA Review in the context of
other related Agency research, provided input during conceptualization of the HIA Review
process, reviewed HIAs, and reviewed this synthesis report.
Brad Autrey (HIA Review Team) - provided input during conceptualization of the HIA Review
process, reviewed HIAs, and reviewed this synthesis report.
Shannon O' Shea (HIA Review Team) - reviewed HIAs and reviewed this synthesis report.
Annette Roth (HIA Review Team) - reviewed HIAs and reviewed this synthesis report.
The authors would also like to thank Ellen D'Amico (CSS-Dynamac) for GIS support and Bruce
Mintz (EPA-NERL), Aaron Wernham (Health Impact Project), Celia Harris (Human Impact
Partners), and Steve White (Oregon Public Health Institute) for providing critical review of this
synthesis report.
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A systematic review of health impact assessments (HIAs) from the U.S. was conducted to obtain
a clear picture of how HIAs are being implemented nationally and to identify potential areas for
improving the HI A community of practice. The review was focused on HIAs from the four
sectors that the U.S. Environmental Protection Agency's (EPA's) Sustainable and Healthy
Communities Research Program has identified as target areas for empowering communities to
move toward more sustainable states. These four sectors are Transportation, Housing/Buildings/
Infrastructure, Land Use, and Waste Management/Site Revitalization.
The review systematically documented organizations involved in conducting the HIAs; funding
sources; the types of community-lev el decisions being made; data, tools, and models used; self-
identified data needs; methods of stakeholder engagement; pathways and endpoints;
characterization of impacts; decision-making outcomes and recommendations; monitoring and
follow-up measures; prioritization methods employed; HIA defensibility and effectiveness;
attainment of the Minimum Elements of HIA; areas for improvement; and identification of best
practices. The results of the HIA reviews were synthesized to identify the state of the HIA
practice in the U.S., best practices in HIAs, and areas in the overall HIA process that could
benefit from enhanced guidance, strategies, and methods for conducting community-based risk
assessments and HIAs.
While HIAs have helped to raise awareness and bring health into decisions outside traditional
health-related fields, the effectiveness of HIAs in bringing health-related changes to pending
decisions in the U.S. varies greatly. The review found that there are considerable disparities in
the quality and rigor of HIAs being conducted. This, combined with the lack of monitoring,
health impact management, and other follow-up in the HIAs could be limiting the overall
utilization and effectiveness of this tool in the U.S. However, a number of best practices were
identified in the review, which (if implemented) could help advance the HIA field of practice,
reduce disparities in the quality and rigor of HIA, and improve the overall effectiveness of the
tool.
HIA is a relatively new and rapidly emerging field in the U.S. Understanding the current state
and applicability of HIAs in the U.S., as well as best practices and areas for improvement, will
help to advance the HIA community of practice in the U.S., improve the quality of assessments
upon which stakeholder and policy decisions are based, and promote healthy and sustainable
communities.
in
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The U.S. Environmental Protection Agency's (EPA's) National Exposure Research Laboratory
(NERL) conducts human and ecological exposure research that provides the tools necessary for
EPA to carry out its mission. Critical to the success of the NERL research program is
communication and utility of its research to influence and impact decisions aimed towards
protecting human health and the environment.
Health impact assessments (HIAs) are becoming a more commonly used tool in the U.S. for
incorporating health considerations into the decision-making process of plans, projects,
programs, and policies. The review of HIAs in the Transportation, Housing/Buildings/
Infrastructure, Land Use, and Waste Management/Site Revitalization sectors was conducted to
inventory the types of community-level decisions being made and to assess the data, tools, and
models currently used in HIAs in these four sectors. This information will aid in promoting
existing EPA tools, methods, and models that can support HIAs, identifying potential research
focus areas to support and improve the HIA community of practice, and discovering what the
ecological assessment community of practice could draw from HIAs and vice versa in order to
promote healthy and sustainable communities.
IV
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Table of Contents
Notice ii
Author Contributions and Acknowledgements ii
Executive Summary iii
Foreword iv
Introduction 1
Health Impact Assessment: The Tool 2
HIA Defined 2
HIA Steps 2
Hi story of HIA 2
HIA Standards and Guidelines for the Americas 3
Health Impact Assessment Review 4
Preliminary Literature Search 4
Pilot Review 6
Review Framework and Database 6
Final Literature Search 9
Full-scale Review 9
Quality Assurance 11
Review Documentation 12
Health Impact Assessment Review Synthesis 13
General HIA Characteristics 13
Implementation and Outcomes of the HI A Process 14
Screening 15
Need for HIA to Inform Decision-making 15
Decisions Assessed inHIAs 15
Types ofHIAs Conducted 16
HIA Funding 18
Scoping 19
Composition of HIA Teams 19
HIA Level of Rigor 20
Stakeholder Involvement 21
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Types of Impacts Identified for Assessment 23
Pathways of Impact 26
HIA Scope and General Approach 30
Assessment 30
Sources ofEvidence and Data Types 30
Literature/Policy Review 32
Data Sources 33
Primary Data Collection 34
Stakeholder/Community Engagement 35
Geospatial Analysis 35
Data Gaps 35
Baseline Profile 37
Health Endpoints Assessed 37
Evidence Defensibility 39
Impact Characterization 39
Recommendations 41
Prioritization of Recommendations 41
Implementation Plan or Strategy 42
Reporting 42
Transparent Documentation of HIA 43
Communication of HIA Results 43
Monitoring and Evaluation 44
Process Evaluation 44
Impact/Outcome Evaluation 44
Assessment of HI A Process-Defensibility, Compliance, and Effectiveness 45
HIA Defensibility 45
HIA Compliance with Minimum Elements of HIA 46
HIA Effectiveness 47
Sector Snapshots 49
Transportation Snapshot 49
Housing/Buildings/Infrastructure Snapshot 58
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Land Use Snapshot 65
Waste Management/Site Revitalization 76
Current State-of-Science inHIA Community of Practice 78
HIA Implementation 78
Use of HIA to Inform Decision-making 78
Implementation of the HI A Process 78
Stakeholder/Community Engagement 82
HIA and Environmental Impacts 83
Adherence to Minimum Elements and Practice Standards 84
Effectiveness of HIA 84
Best Practices 85
Areas for Improvement 101
Adherence to Minimum Elements and Practice Standards 101
Establishment of Baseline Conditions 101
Characterization of Impacts 101
Stakeholder and Community Engagement 101
Transparency in Documentation 102
Monitoring and Evaluation 102
Use of HIA to Inform Decision-making at All Levels 102
Consistency in HIA Terminology 102
Broader Utilization of Existing Tools and Resources in HIAs 103
Identifying and Closing the Data Gaps in HIA 104
Conclusions 105
References 105
Appendix A - Health Impact Assessment Review Guidelines A-l
Appendix B - Master List of HI As Reviewed B-l
Appendix C - Quality Assurance Review Documentation C-l
Appendix D - Data Sources Used in Reviewed HIAs D-l
Appendix E- Tools and Models Used in Reviewed HIAs E-l
Appendix F - Identified Data Gaps and Additional Data Needs F-l
Appendix G- Sector Snapshots: Select Data from HIAs in Each Sector G-l
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Appendix H-Rules of Engagement Memo H-l
Appendix I -Opportunities for Stakeholder Involvement in Each Step of HIA 1-1
Appendix J-Risk Assessment Technique for Impact Prioritization J-l
Tables
Table 1. HIA Review Framework 7
Table 2. Types of Decisions Informed by HIAs at Different Decision-making Levels 16
Table 3. Bibliographic Resources Used in HIA Literature Reviews 32
Table 4. Special Collection Methods Used in Reviewed HIAs 34
Table 5. Data Gaps Identified in Reivewed HIAs 35
Table 6. Health Impacts Evaluated in Reviewed HIAs 38
Table 7. Transportation Decisions Informed by Reviewed HIAs 50
Table 8. Housing/Buildings/Infrastructure Decisions Informed by Reviewed HIAs 58
Table 9. Land Use Decisions Informed by Reviewed HIAs 65
Table 10. Waste Management/Site Revitalization Decisions Informed by Reviewed HIAs 76
Table 11. Best Practices in HIA 85
Table 12. Additional Tools and Models Useful for the HIA Community of Practice 104
Figures
Figure 1. Sources used in our literature search to identify HIAs for review 5
Figure 2. Inconsistencies in sector terminology 5
Figure 3. Pilot review HI As 6
Figure 4. HIA Review data entry form 10
Figure 5. Year of report publication for reviewed HIAs 13
Figure 6. Number of reviewed HI As completed by state and sector 14
Figure 7. Number of review HIAs conducted at each decision-making level 15
FigureS. HIA typology descriptions 17
Figure 9. Types of HIA conducted 17
Figure 10. Funding sources of reviewed HI As 18
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Figure 11. Types of organizations involved in conducting the reviewed HIAs 19
Figure 12. Levels of HI A 20
Figure 13. Rigor of reviewed HIAs 21
Figure 14. Ladder of Citizen Participation inHIA 22
Figure 15. Determinants of health 23
Figure 16. Methods used to prioritize impacts in reviewed HIAs 24
Figure 17. Impacts/endpoints assessed in reviewed HIAs 25
Figure 18. Environmental and ecosystem impacts assessed in reviewed HIAs 26
Figure 19. Pathways between housing and health 27
Figure 20. Logic framework showing pathways between road pricing and health 28
Figure 21. Pathways of impact assessed in two or more reviewed HIAs 29
Figure 22. Sources of evidence used in reviewed HIAs 31
Figure 23. Data types used in reviewed HIAs 32
Figure 24. Most common resources drawn upon in reviewed HIAs for data, tools, and models.34
Figure 25. Most common health impacts/endpoints evaluated in reviewed HIAs 39
Figure 26. Deficiencies in evidence defensibility in reviewed HIAs 40
Figure 27. Characterization of impacts in reviewed HIAs 41
Figure 28. Minimum Elements missing or deficient in reviewed HIAs 47
Figure 29. Effect of reviewed HIAs on the decision and decision-making process 48
Figure 30. Dashboard of summary statistics for reviewed HIAs in the Transportation sector 56
Figure 31. Tool spotlight: Health Economic Assessment Tool (HEAT) 56
Figure 32. Model HIAs from the Transportation sector 57
Figure 33. Dashboard of summary statistics for reviewed HIAs in the Housing/Buildings/
Infrastructure sector 63
Figure 34. Tool spotlight: Traffic Noise Model (TNM) and Noise Annoyance Relationship 63
Figure 35. Model HIA from the Housing/Buildings/Infrastructure sector 64
Figure 36. Dashboard of summary statistics for reviewed HIAs in the Land Use sector 74
Figure 37. Tool spotlight: Walk Score 75
Figure 38. Model HIAs from the Land Use sector 75
Figure 39. Dashboard of summary statistics for reviewed HIAs in the Waste Management/Site
Revitalization sector 77
IX
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Figure 40. Tool spotlight: Living Wage Calculator 77
Figure 41. Best Practice: Documentation of Screening and Scoping - a scoping worksheet 91
Figure 42. Best Practice: Communication/Reporting Plan - methods of communication 92
Figure 43. Best Practice: Transparent Literature Search/ Review Documentation - a tabular
summary of literature review results 92
Figure 44. Best Practice: Quality of Evidence Evaluation- a hierarchy of evidence 93
Figure 45. Best Practice: Identification of Data Gaps - key data gaps by health effect
category 93
Figure 46. Best Practice: Detailed Documentation of Data and Methodology - key input data..94
Figure 47. Best Practice: Detailed Documentation of Data and Methodology - a detailed
description of data analysis methodology 94
Figure 48. Best Practice: Impact Pathways/Logic Frameworks - exposure pathways to
contaminants 95
Figure 49. Best Practice: Clear Summary of Impact Assessment - a summary of differential
impacts of analyzed alternatives 95
Figure 50. Best Practice: Clear Summary of Impact Assessment - a summary of health impact
assessment findings 96
Figure 51. Best Practice: Confidence Estimates/Assessments of Uncertainty - characterization
and management of uncertainty in assessment 97
Figure 52. Best Practice: Prioritization Process for Recommendations - qualitative ranking
system to prioritize health effect categories for action 97
Figure 53. Best Practice: Implementation Plan for Recommendations - recommendation
strategies and decision-makers 98
Figure 54. Best Practice: Implementation Plan for Recommendations - recommendation
summary and indicators 98
Figure 55. Best Practice: Clear/Transparent HIA Report - transparent documentation of a
stage of the HI A process 99
Figure 56. Best Practice: Monitoring Plan -impact and outcome evaluation 100
Figure 57. Inconsistencies in sector terminology among various organizations promoting and/
or reporting HIAs 103
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A systematic review of health impact assessments (HIAs) from the United States (U.S.) was
conducted to obtain a clear picture of how HIAs are being implemented nationally and to
identify potential areas for improving the HIA community of practice. The review was focused
on HIAs from four sectors that the U.S. Environmental Protection Agency's (EPA's) Sustainable
and Healthy Communities Research Program (SHCRP) has identified as targets for empowering
communities to move toward more sustainable states: Transportation, Housing/Buildings/
Infrastructure, Land Use, and Waste Management/Site Revitalization.
A review framework was developed to systematically document:
organizations involved in conducting the HIAs;
funding sources;
the types of community-lev el decisions being made;
data, tools, and models used;
self-identified data needs;
methods of stakeholder engagement;
pathways and endpoints;
characterization of impacts;
decision-making outcomes and recommendations;
monitoring and follow-up measures;
prioritization methods employed;
HIA defensibility and effectiveness;
attainment of the Minimum Elements of HIA;
areas for improvement; and
identification of best practices.
The results of the systematic HIA reviews were recorded in a Microsoft Access database and
these results were synthesized to identify the state of the HIA practice in the U.S., best practices
in HIAs, and potential areas for improvement.
This report will provide background information on the HIA community of practice, sectors
chosen for examination, and methodology employed in the HIA Review, as well as a synthesis of
the results of the review and a discussion of what those results mean for the HIA community of
practice. In an effort to improve the quality of assessments upon which stakeholder and policy
decisions are based and promote healthy and sustainable communities, possible steps to advance
the HIA community of practice in the U.S. (e.g., the use of existing tools, methods, and models)
will also be identified.
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HIA Defined
The National Research Council (2011) defines HIA as:
...a systematic process that uses an array of data sources and analytic
methods and considers input from stakeholders to determine the potential
effects of a proposed policy, plan, program, or project on health of a
population and the distribution of those effects within the population. HIA
provides recommendations on monitoring and managing those effects.
This definition is an adaption of the definition developed by the International Association of
Impact Assessment (IAIA; Quigley et al. 2006) and is based on a review of HIA definitions,
practices, guidance, and peer-reviewed literature.
HIA Steps
There are typically six steps in conducting an HIA (North American HIA Practice Standards
Working Group 2010; Bhatia 2011; National Research Council 2011; Human Impact Partners
2011,2012).
1. Screening - Determine whether an HIA is needed and the value added.
2. Scoping - Identify which health effects to consider and set the HIA parameters.
3. Assessment - Collect qualitative and quantitative information to create a profile of existing
health conditions, and identify, evaluate, and prioritize the potential health impacts of the
decision.
4. Recommendations - Identify alternatives to the decision and/or strategies for promoting
the positive health impacts and/or mitigating the adverse health impacts.
5. Reporting - Write a final report and communicate the results of the HIA to decision-
makers and other stakeholders for implementation/action.
6. Monitoring and Evaluation - Evaluate the processes involved in the HIA, the impact of
the HIA on the decision-making process, and the impacts of the decision on health.
History of HIA
The HIA community of practice has long been established in Europe, but is a rather young and
emerging field in the U.S. While the 1969 National Environmental Policy Act (NEPA) was not
an impetus for HIA, it recognized early on the need to consider the health consequences of
decision-making. NEPA requires the U.S. government to give consideration to environmental
and human health effects prior to undertaking any major federal action (e.g., proposals to adopt
rules and regulations, formal plans that direct future actions, programs, and specific projects) that
significantly affects the quality of the human environment. The NEPA requirement has helped
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to generate a great number of Environmental Impact Assessments (EIAs), but historically health
impacts have not been adequately addressed in these EIAs (Bhatia and Wernham 2008; see HIA
and Environmental Impacts for a more in-depth discussion of health considerations in El A).
More recently, health practitioners, scientists, and decision-makers have recognized that the
health of an individual is determined not only by the health care they receive, but also by the
natural, social, physical, economic, and political environment in which they live and work. As
such, decisions outside of traditional health-related fields can and often do, in fact, influence an
individual's health. The recognition that human health can be directly and indirectly impacted
by these various factors points to the need for health considerations in decision-making (National
Research Council 2011).
In 1986, the World Health Organization (WHO) held the first international conference on health
promotion, The Ottawa Charter for Health Promotion, and in December 1999 issued the
Gothenburg Consensus Paper (WHO 1999), which outlined the main concepts and suggested
approaches to conducting HIAs.
The first HIA in the U.S. was conducted in San Francisco in 1999 (Bhatia and Katz 2001) and by
2007, twenty-seven (27) HIAs had been completed nationwide (Danneberg et al. 2008).
According to the Health Impact Project (2013), the number of HIAs conducted in the U.S. has
increased more than eight-fold in the past five and a half years, from 27 HIAs in 2007 to over
225 in early 2013. Health impact assessments have not only became more prominent in the U.S.
since 2000 (National Research Council 2011; Health Impact Project 2013), but also worldwide
as the World Bank began requiring HIAs for large projects (World Bank Group 2006) and major
industries such as oil, gas, and mining (IPIECA/OGP 2000; ICMM 2010) began incorporating
HIAs into best business practices. A number of organizations in the US have begun promoting
the use of HIAs as well, including the Centers for Disease Control and Prevention (CDC),
Association of State and Tribal Health Officials (ASTHO), National Association of County and
City Health Officials (NACCHO), National Network of Public Health Institutes (NNPHI), the
National Research Council (NRC), and others.
Health impact assessment has been promoted worldwide as a tool for protecting and promoting
public health because of its applicability in a broad range of decision-making arenas,
consideration of beneficial and adverse health consequences, stakeholder and community
engagement, and potential to advance health equity (National Research Council 2011).
HIA Standards and Guidelines for the Americas
In 2008, HIA practitioners from Habitat Health Impact Consulting (Canada), the San Francisco
Department of Public Health, Human Impact Partners, and the Alaska Native Tribal Health
Consortium organized and held the first North American Conference on Health Impact
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Assessment. A set of practice guidelines for HIAs was developed by a working group
established at that conference, and in 2010, an updated version of those guidelines was issued.
The Minimum Elements and Practice Standards for Health Impact Assessment identifies
essential (i.e., minimum) elements that constitute an HIA and benchmarks (i.e., practice
standards) for how best to conduct an HIA (North American HIA Practice Standards Working
Group 2010).
In addition to the Minimum Elements and Practice Standards and a plethora of existing
international guidance, a number of other guides have been developed to inform and direct the
HIA practice in the U.S. In recent years, the U.S. has also seen HIA courses popping up in
graduate school curriculums, the emergence of HIA technical assistance and training providers,
and the dissemination of tools and templates to be used in HIA. Below is a small selection of the
guides available to inform HIAs in the U.S.
Improving Health in the United States: The Role of Health Impact Assessment (National
Research Council 2011)
A Health Impact Assessment Toolkit: A Handbook to Conducting HIA, 3rd edition
(Human Impact Partners 2011)
Health Impact Assessment: A Guide for Practice (Bhatia 2011)
HIA Summary Guides (Human Impact Partners 2012)
Rapid HIA Toolkit (Design for Health 2008)
Technical Guidance for Health Impact Assessment (HIA) in Alaska (Alaska Department
of Health and Human Services 2011)
Health Impact Assessment Review
Preliminary Literature Search
A preliminary literature search was performed in early 2012 via the internet to identify HIAs
conducted in the U.S. in each of the four chosen sectors: Transportation, Housing/Buildings/
Infrastructure, Land Use, and Waste Management/Site Revitalization. Five primary sources
were used in the search (Figure 1). Note that although Figure 1 denotes the WHO website, this
was not a fruitful source for our purposes, since most of the HIAs it lists were performed in
Europe and our scope was limited to HIAs in the U.S.
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HEALTH IMPACT
P R 0 J L C 1
Health Impact Pro jeer
v.h e altliimpactproj ect.org
H£P
MLMIWLMWInwtNIk-.
Human Impact-Partners
?,-mv.hum animpa ct.org
BITH IMPACT /BSESSMENI CLEARINGHOUSE
LEARNINGS INFORMATION CENTER
UCLAHLVCLIC
www.hi a. guide. org
-^ The HIA Gateway--^
Public Health Eugland-
HIA Gateway
\wwv.apho.orff.uk defsuit.^5px^OX=P TTTA
j World Health
g Organization
WHO
www.who.inr.hia en
Figure 1. Sources used in our literature search to identify HIAs for review.
With the exception of Human Impact Partners, each of these sources assigns a sector designation
for the HIAs included on their website. While searching these sources, it was discovered that the
terminology for several of the sectors (defined by EPA 2011 and) targeted for this review did not
align with the sector terminology used by the organizations. As shown in Figure 2, the sector
terminology used among the organizations themselves was also inconsistent. Because of these
inconsistencies, searching the sources by sector was not an option. For a more detailed
discussion of sector terminology in HIA, see Consistency in HIA Terminology.
Health Impact Assessment (HIA) Title Location
6th Avenue East Duluth HIA Duluth, MN
A Health Impact Assessment of Mixed Use Lincoin, NE
Redevelopment Nodes and Corridors in Lincoln,
Nebraska.
Arctic Outer Continental Shelf Oil and Gas Multiple Alaska
Lease Sale Environmental Impact Statement
Atlanta Beltline Atlanta, 6A
Baltimore Comprehensive Zoning Code Rewrite Baltimore, MD
Baltimore Red Line Transit Project Baltimore, MD
Battlement Mesa Battlement Mesa,
CO
Benton Accessory Dwelling Units Benton County, OR
Bernal Heights Preschool San Francisco, CA
Buford Highway and NE Plaza Redevelopment Atlanta, GA
Child Health Impact Assessment of Energy Costs and Massachusetts
the Low Income Home Energy Assistance Program
(LIHEAP)
Child Hearth Impact Assessment of the Massachusetts Massachusetts
Rental Voucher Program
Health Impact Project
Built Environment
Natural Resources and
Energy
Built Environment
Built Environment
Transportation
Natural Resources and
Energy
Housing
Built Environment
Transportation
Natural Resources and
Energy
Housing
HIA Gateway
Planning/Transport
Industry
Regeneration
UCLA HIA Clearinghouse
Transport
Housing/Inequalities
Figure 2. Inconsistencies in sector terminology.
AHY
Land Use Planning
Land Use Planning
Land Use
Planning/Transportation
Mining, Petro, Other
Extractive Industry
Transportation
Utilities
Housing
The title and description, if provided, of the HIAs in each of the sources identified in Figure 1
were examined to determine if the HIAs seemed to fall within one of the four sectors, as defined
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in the Sustainable and Health Communities Research Program (SHCRP) Draft Research
Framework (EPA 2011). For a description of the four SHCRP sectors, see Appendix A (pgs A-9
through A-14\ If the HI A seemed to fall within one of the four sectors, the HIA was included in
the preliminary literature search results. Using this approach, 78 completed, 2 draft, 66 in-
progress, and 3 HIAs of undetermined status were identified in the four sectors. Based on those
preliminary results, it was estimated that there could be between 80 and 150 HIAs to review.
Pilot Review
A pilot review of four HIAs (Figure 3), one from each sector, was completed in early spring
2012, following the preliminary literature search. Through this process, the information to be
recorded in the HIA Review was refined and the review framework and database were
developed.
Transportation
Honsing/Bnildings/Infrastructnre
Land Use
Pathways to a Healthy Decatur
A R sip s HeiHh Impact A»»»iwit
oT me City eT DflcMur Community TrjnaportJtlon Flan
Affordable Housing and Child Health
AMd Health Impact Asessmmt of the
Masadwttts SmBl vuudier Ftogram
honed bid* Mi HuM IwlttttaGn*
Health Impact Assessment
DERBY REDEVELOPMENT
HEIOBC COMMERCE CITY, CCtCKADQ
Waste Management/Revitallzation
Kkahh Impact Assessment on NMR] -
1'u-nirt.l Ilif the Bcnulilki Count>
Plannini: Commission
April roil] Hearing
Figure 3. Pilot review HIAs.
Review Framework and Database
Based on the review of the four HIAs in the pilot review, the goals of the project, and the designs
of existing HIA databases, a list of proposed data entry fields were developed for inclusion in the
review framework.
The Minimum Elements and Practice Standards for Health Impact Assessment (North American
HIA Practice Standards Working Group 2010) and a number of other ancillary sources were
chosen from the broad body of existing HIA guidance to guide the HIA Review. The Practice
Standards identified in the 2010 guidance document, like much of the available HIA guidelines,
do not represent "rigid requirements (for implementation of HIA), but rather reflect an ideal of
practice" (from National Research Council 2011). The flexibility offered in this and other HIA
guidance acknowledges the diversity of conditions and settings in which HIAs are being
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performed in the U.S. (i.e., the broad range of decisions being considered and the resource,
capacity, and expertise constraints present in implementation). However, the North American
HIA Practice Standards Working Group (2010) also acknowledges that there are certain
Minimum Elements that HIAs must include to distinguish them from other forms of assessment.
While there may not be consensus within the field of practice that these elements must be
achieved in every HIA, the Minimum Elements do provide an ideal of practice, and as such,
provided a benchmark against which the HIAs in this review were evaluated.
Following review by the project team, the list of fields in the review framework was finalized
and a description of the data to be entered into each field was added to create consistency among
the reviews (Table 1).
Table 1. HIA Review Framework Gray highlights indicate specific terms and/or formatting to be used in
data entry
Database Field
ID
Title
Year
Location
Decision-making Level
Organization(s) Involved
Organization Type
Contact
Organization/HIA Website
Funding
Status
Sector(s)
HIA Type
HIA Rigor
Scope/Summary
Source of Evidence
Data Types
Major Data Sources
Local Data Available or
Obtained?
Description/Examples
(Automatically generated in Access database)
Full title of HIA Report
Year of publication
Where HIA was conducted- city, county, state, etc. (as applicable)
Local, county, state, federal
Organizations involved in conducting/publishing/sponsoring the HIA
Educational institution, Government agency, Non-profit, Other,
Undetermined
Name and contact info for HIA point-of-contact (if available) in format:
name, email / Undetermined
Identify website dedicated to or highlighting the HIA (if applicable) / N/A
Identify financial sponsors (if named) / Undetermined
Complete, In progress, etc.
Transportation, Housing/buildings/infrastructure, Land use, Waste
management/site revitalization (as defined by SHCRP)
Mandated (by what/whom), decision support, advocacy, community-led '
Desk-based, rapid, intermediate, comprehensive2
Question/problem faced, proposed policy/plan examined
Literature review, community consultation, policy review, special
collection (interviews, surveys, focus groups, risk assessment,
demographics analysis, modeling, etc.)2
Models, literature (published, peer-reviewed, grey lit, government
documents, policy), websites, data
Specific models, agency (e.g., CDC, HUD, Census Bureau*) or community
data, bibliographic resources (Medline, Pub Med, Web of Science, Science
Direct, etc.), databases, websites, internet gateways/search engines (e.g.,
Google), surveys, focus groups/forums, entities interviewed/consulted (e.g.,
stakeholders, technical experts), etc.
*Note: Note the type, year, and geographic scale of census (and other) data used.
(If yes) Identify data / No
1 Harris-Roxas and Harris (2011)
Harris, Harris-Roxas, Harris, and Kemp (2007)
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Table 1. Continued
Database Field
Description/Examples
Additional Data Needed (Self-
Identified)
(If yes) Identify data / No
Stakeholder/Community
Involvement?
Impacts/Endpoints
Health Endpoints
Pathway of Impact
Characterization of Impact*
*Note: Originally labeled Quantification
of Impact, but characterization of
impacts is both qualitative and
quantitative.
Decision-making Outcome
(If yes) Identify stakeholder groups* / No
*Note: Per the Quality Assurance Review, avenue of involvement to be noted as well.
Health (physical, mental, developmental), environmental/ecosystem,
behavioral, economic, infrastructure, services, demographic, other
Identify health endpoints examined in HIA
Air quality, community/household economics, education, exposure to
hazards, healthcare access/insurance, housing, infectious disease, land use,
lifestyle, mental health, mobility/access to services, noise pollution,
nutrition, parks and recreation, physical activity, public health services,
safety (personal, traffic, etc.) and security, social capital, soil quality, water
quality, etc.
Direction (positive, negative, unclear, no effect), permanence, magnitude,
likelihood (definite, probable, speculative, unlikely, uncertain), distribution/
equity,2'3 etc.
HIA Report
Describe the general outcome of the HIA, including recommendations,
mitigations, etc.
(Attach HIA Report)
Prioritization Methods*
*Note: Originally labeled Impact
Prioritization, but methods for
prioritizing impacts and
recommendations both recorded.
Defensibility/P rocess
Evaluation
Effectiveness of HIA
Follow-up Measures
What methods/data were used to prioritize the impacts to be considered [and
the recommendations to be developed]?
Describe the quality of evidence and methodology; identify assumptions,
limitations, barriers; etc.
Impact evaluation (direct, general, opportunistic, none4), health outcome
evaluation (predictive accuracy, health impacts) / Undetermined
Note: The effectiveness of the HIA cannot be determined by review of the HIA Report; this
must be determined based on an internet/lit search.
Monitoring, health impact management, or other follow-up measures called
for in the HIA/N/A
Minimum Elements of HIA
Met? If no, what's missing
Yes /No - identify what's missing
CIS Used?
(If yes) Describe use - Illustrative, GIS analysis, etc. / No
Environmental/Ecosystem
Impacts Considered?
(If yes) Identify impacts / No
2 Harris, Harris-Roxas, Harris, and Kemp (2007)
3 Human Impact Partners (2011)
4 Wismar, Blau, Ernst, and Figueras (2007)
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Table 1. Continued
Database Field Description/Examples
Potential Improvements Identify what could have potentially improved the HIA and/or its
effectiveness. (Perhaps consult the HIA Practice Standards5)
Question to Consider: How are the HIAs different and what could have been done to close the
gap?
For example, quantification of impacts (including costing); consideration of environmental/
ecosystem impacts; additional information; use of GIS/spatial analysis; broader utilization of
existing tools/models/resources (C-FERST/T-FERST, BenMAP, National Atlas of Ecosystem
Services, EJ View, MyEnvironment, UCLA Health Impact Decision Support Tool, etc.);
consistency in conducting and reporting HIAs (e.g., sector terminology, enhanced guidance/
methodology, transparent/publicly-accessible documentation); clear reporting of
recommendations and mitigations; identification of evaluation and follow-up measures; etc.
Best Practices
Identify portions of the HIA process, report, etc. that stand out and describe
these best practices.
For example, tabular summary of potential impacts, including direction, extent, and populations
most affected; defensibility of process; transparency of process documentation; etc.
*Potentially identify a set of HIAs within each sector representing the best of the best.
North American HIA Practice Standards Working Group (2010)
A Microsoft Access database was created using these finalized data entry fields to document the
HIA Review. Included in this HIA Review Database was a table, a data entry form used to
record the review of each HIA (Figure 4), and a report template that allowed database entries to
be printed for review.
Final Literature Search
The preliminary literature search was updated in late spring 2012 to identify completed HIAs in
the four sectors. A total of 91 completed HIAs were identified in this final literature search,
however only 88 HIAs were available for review.
Full-scale Review
A team of five reviewers was enlisted to complete the full-scale review. HIA Review guidelines
(Appendix A) were developed to provide the reviewers background on the project and more
detailed guidance on review documentation and data entry. Prior to the start of the full-scale
review, a training session was held to review the guidelines and prepare reviewers for the task.
-------
^H Data Entry Fonn
^1 HIA Review
V
ID:
Title:
Year:
Location:
Decision-making Level:
Organ ization(s) Involved:
Organization type:
Contact:
Organization/Hi A Website:
Funding:
Status:
Sectors):
HI A Type:
HIA Rigor:
Scope/Su m mary :
Source of Evidence:
Data Types:
Major Data Sources:
Local Data Available or Obtained?:
Record: M 1 of 1 * M t *
^^^^^^M
1
^^^^^^^M
Additional Data Needed (Self-Identified}:
Stakeholder/Community Involvement:
Impacts/End points:
Health Endpoints:
Pathway of Impact:
Quantification of Impact:
Impact Prioritization:
Decision- ma king Outcome:
HIA Report:
Defensibility/Process Evaluation:
Effectiveness of HIA:
Follow-up Measures:
Minimum Elements of HIA Met? If no, what's
missing:
CIS Used?:
Environmental/Ecosystem Impacts Considered?:
Potential Improvements:
Best Practices:
^^^^^^M
Search
Figure 4. HIA Review data entry form.
Each of the five reviewers was assigned a set of HIAs to review and provided a copy of the
Microsoft Access database for recording the results of the reviews. Data entry was based on
each reviewer's independent review of the HIA and the guidance provided in the Health Impact
Assessment Review Guidelines (Appendix A). Reviewers entered data directly into the data entry
form of their database to populate the HIA Review Table; each HIA record was given a unique
ID number.
10
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fflAs
Identified for review: 91
Unavailable for download: 3
Determined to be a duplicate: 1
Determined not to be an HIA: 3
Without standalone HIA report: 3
Final Number of fflAs
Reviewed: 81
Of the 88 HIAs obtained for review, 7 were removed from the
review; 1 was found to be a duplicate of another HIA, 3 were
found to not be true HIAs (i.e., one was a report on pedestrian
collision modeling, one was a report on existing conditions, and
one was a coordinated public transit-human services
transportation plan), and 3 were Environmental Impact
Assessments (EIAs) that did not report health impact
assessment in a manner that allowed for analysis within the
HIA Review framework (i.e., the HIA was integrated into the
environmental impact statement [EIS] without a standalone
HIA report). For further discussion on HIA and environmental
impact assessment, including the integration of HIAs into EISs,
see HIA and Environmental Impacts. At final count, 81 HIAs
were reviewed from the Transportation, Housing/Buildings/
Infrastructure, Land Use, and Waste Management/Site
Revitalization sectors - 4 in the pilot review and 77 in the full-
scale review. See Appendix B for a list of the 81 HIAs
reviewed and their respective sectors.
Quality Assurance
Quality Assurance (QA) measures were taken for both locating applicable HIAs for review and
reviewing those HIAs. Following the preliminary literature search, an individual not previously
involved in the project was asked to conduct a search for HIAs in the four designated sectors.
The goal of this additional search was to determine whether any previously undiscovered,
relevant HIAs existed. This review did not uncover any additional HIAs for review.
During the full-scale review, 10% of the HIAs underwent QA review to ensure consistency in the
information being recorded. This QA review entailed select HIAs undergoing a second review
by a person not involved in the initial review of the HIA and any discrepancies between the two
reviews being examined and discussed. The QA review was conducted at the beginning of the
full-scale review to set a standard for the remaining reviews. Eight HIAs across the four chosen
sectors were designated for QA review and assigned a second reviewer.
Data entry from the initial and QA reviews of each of the eight selected HIAs was reviewed to
ensure compliance with the database field descriptions, specific terminology, and/or formatting
requirements established in the Review Guidelines, as well as general agreement in overall
evaluation of the HIA. Some level of differences was expected in the evaluations due to
subjectivity and level of detail used in recording the review. Data entry discrepancies between
the initial review and the QA review of each HIA were identified and the discrepancies
collectively reviewed to identify overall trends. Considerable discrepancies in data entry were
11
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found during the QA review, which could have been due, in part, to the unfamiliarity of the
reviewers with HIAs in general, inexperience in applying the principles of the review process, or
the implementation of the QA review early in the overall review process, as the HIAs in the QA
review were the first HIAs examined in the full-scale review.
As a corrective action, a meeting was held with reviewers to discuss areas for improvement;
challenges, questions, and lessons learned from the QA review; and the path forward. Areas for
improvement included: use and consistency of specified terminology in designated fields and
consistency in data entry, level of detail presented, and subjective evaluations. These areas for
improvement are described in greater detail in Appendix C, along with feedback to reviewer
challenges, questions, and lessons learned.
Reviewers were provided meeting notes documenting the proceedings of the corrective action
meeting (Appendix C) and the initial and QA data entries for the HIAs they reviewed in the QA
review. Reviewers were encouraged to go back and revise data entry for the HIAs in the QA
review, as warranted. Midway through the full-scale review, one additional HIA was selected
for QA review and reviewed by all five reviewers. The results of this second QA review showed
marked improvement in data entry consistency.
It should be noted, however, that differences were still present in data entry, as was expected
given that multiple people performed the reviews. To minimize these differences, a final QA
check was conducted of all 81 data entry forms (see Review Documentation).
Review Documentation
At the completion of the full-scale review, the individual reviewer databases were compiled to
form a single master database, and any duplicate data entry from the QA review was
consolidated to provide one entry per HIA. Minor changes were made to the review framework
during finalization of the master HIA Review Database to aid in analysis and more accurately
reflect actual conditions. These changes included identifying a single (primary) sector for any
HIAs originally identified by more than one sector; changing the "Quantification of Impact"
field to "Characterization of Impact," since impacts in HIAs can be judged both qualitatively or
quantitatively; and changing the "Impact Prioritization" field to "Prioritization Methods," since
prioritization of impacts and recommendations were both recorded. A final QA check was
conducted of each of the 81 data entry forms and edits made as needed to ensure compliance
with the Review Guidelines and consistency in content, format, and level of detail throughout the
database. This final HIA Review Database was subsequently analyzed to produce a synthesis of
the HIA Review.
The final HIA Review Database will be available at: http://www.epa.gov/research/
healthscience/health-review-hia.htm.
12
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Health Impact Assessment Review Synthesis
The master HIA Review Database was analyzed to identify the general characteristics of the
HIAs reviewed, the implementation and outcomes of the HIA process, and snapshots of HIAs in
each sector.
General HIA Characteristics
This section of the synthesis examines the general
characteristics of the reviewed HIAs, including status, title,
year, location, and sector. The HIAs included in the HIA
Review were those that fell within one of the four
identified sectors, were complete, and had an HIA Report
available for review (See Appendix B for a list of the HIAs
reviewed).
General HIA Characteristics
Applicable Database Fields
Status
Title
Location
- Year
- Sector
The reviewed HIAs were completed between 2005 and spring 2012, when the HIA Review
began (Figure 5), at locations throughout the nation (Figure 6). Consistent with the overall trend
noted by Health Impact Project (2013), the number of HIAs completed in these sectors is on the
rise (Figure 5). Of the 81 reviewed HIAs, 48.2% were in the Land Use sector, 25.9% were in the
Transportation sector, 21.0% were in the Housing/Buildings/Infrastructure sector, and 4.9% were
in the Waste Management/Site Revitalization sector (Figure 6). The state of California has
clearly been a leader in the HIA efforts in these four sectors, with over one-third of the reviewed
HIAs being conducted there.
Year
Figure 5. Year of report publication for reviewed HIAs.
13
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# of HIAs completed in select sectors*
0 1 2 3 4 5 8 11 24
1 federal HIA
Figure 6. Number of reviewed HIAs completed by state and sector.
Transportation
Housing/Buildings/lnfrastructure
Land Use
Waste Management/Site
Revitalization
Implementation and Outcomes of the HIA Process
This section of the synthesis examines the HIAs in light of the six steps of the HIA process. The
typical tasks involved in each HIA step are outlined in text boxes throughout the section using
guidance from the North American HIA Practice Standards Working Group (2010) and the
National Research Council (2011). Database fields related to each step were analyzed to provide
a picture of the implementation and outcomes of those steps in the 81 HIAs reviewed. Note that
some database fields are applicable to more than one step.
14
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Screening
The screening step of the HIA process was
not well documented in the HIAs that were
reviewed. In fact, less than half of the HIAs
(n=39) described undertaking the screening
process at all.
Need for HIA to Inform Decision-making
When embarking on the HIA process, one of
the first matters is to identify decisions under
consideration by decision-makers and
determine whether there is a need for HIA in
those decisions. HIAs should be initiated
when there is the potential for the HIA to add
value to the decision-making process (e.g.,
where health is not already being considered, where disproportionate health consequences are
likely, etc.) and should be initiated with enough time for the completed HIA to inform the
decision. Of the 81 HIAs reviewed, 3 were not initiated to inform a specific decision under
consideration by decision-makers and 1 was initiated in advance of a decision, but was not
completed in time to provide input into the decision-making process.
Decisions Assessed in HIAs
The majority (56.8%) of the reviewed HIAs were used as part of local, community-level
decisions, but many others were conducted to inform county, state, and federal decision-making
processes (Figure 7). Table 2 identifies the general types of decisions that the HIAs informed at
each of these decision-making levels. A more in-depth discussion of these decisions and their
outcomes can be found in the Sector Snapshots.
Screening
Determine whether an HIA is needed and the value
added. Tasks include:
Defining the decision and its alternatives
Evaluating the value of performing an HIA
Assessing the feasibility of conducting the HIA
given the timeframe and available resources
Determining the willingness of partners and
stakeholders to participate in the HIA
Applicable Database Fields
- Decision-making Level - HIA Type
- Scope/Summary - Funding
Local County State Federal
Decision-making Level
Unknown
Figure 7. Number of review HIAs conducted at each decision-making level.
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Table 2. Types of Decisions Informed by HIAs at Different Decision-making Levels
Local
- Transportation plans and policies
- Redevelopment/restoration of historic districts
- Alcohol policies
- Land use policies and projects
- Zoning controls and zoning code rewrites
- Redevelopment/master plans
- Mass transit/transit-oriented design
- Pedestrian bridge projects
- Siting of recreational centers and schools
- Comprehensive plans
- Growth policies
- Road construction, redesigns, and infrastructure
improvements
- Rezoning plans and land repurposing
- Remodels or expansion of community
institutions (e.g., airports, hospitals, farmers
markets)
- Neighborhood/sub-area planning studies
- Land use projects
- City planning practices
- Building demolition
- Road pricing scenarios
- Affordable housing siting
- Port growth
- Redevelopment of distressed public housing
- Siting of special uses (e.g., dirty materials recovery
facility, biosolids storage facility)
- County bicycle and pedestrian master plans
- Placement and maintenance of community gardens
- Growth alternatives
- County plans and policies (e.g., agriculture, open-air
burning)
- Accessory dwelling unit (ADU) policies
- Land zoning variances
- Sub-area plans for revitalizing highways and
surrounding neighborhoods
- Bridge replacement projects
- Proposed industry (e.g., coal-fired electric plants)
- Natural gas development and production
- Comprehensive/general plans and plan updates
State
- Mass transit and highway and bridge design
- Housing and energy assistance programs
- Comprehensive planning and growth policies
- Energy programs and natural resource management,
including fossil fuel exploration and development, and
renewable energy and water management policies
Federal
- Oil and gas leases/developments (NEPA/EIS)
- Federal housing policies
Types of HIAs Conducted
The HIAs were categorized into one of four types of assessment - decision-support, advocacy,
mandated, or community-led - based on the details given in the HIA report and the descriptions
provided for each of these typologies by Harris-Roxas and Harris (2011). As shown in Figure 8,
decision-support HIAs are those conducted by or with agreement of the project proponents
and/or decision-makers in order to improve the decision-making process; advocacy HIAs are
those conducted by organizations that are neither part of the project nor the deciding body in
order to bring under-recognized health concerns to light; mandated HIAs are those conducted to
meet a statutory or regulatory requirement; and community-led HIAs are those conducted by the
potentially-affected populations (Harris-Roxas and Harris 2011). With exception of five of the
reviewed HIAs, all were either advocacy or decision-support HIAs (Figure 9); the remaining
HIAs were mandated by legislative directive or NEPA (n=3) or were community-led (n=2).
16
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Forms of health imp*:! assessment
Mind,) ted
Decision-support
Advocacy
Community-led
Purpose
Occurs in the context
of an env ironnten ul
impact assess ment
(EIA), integrated
impact assessment (UA)
or. environmental, social
arid health impact
assessment (ESHIA) and
is done to meet a
regulatory or statutory
requirement
- Meeting a regulatory or
statutory requirement
Minimising negative
health impacts
Origins
Role of values
and judgements
Conducted by
Resourced by
Overseen by
Role of stakeholders
TVpe of learning
Environmental health
Almost no role for values
in assessment, judgements
often not acknowledged
Consultants
Proponents
Proponents
Providing technical
information
Technical
Conducted voluntarily by.
u with the agreement of,
organisations responsible
for a proposal, with the
goal of improving
decision-making
and implementation
- Improving
decision-making
and implementation
Minimising negative
liL'ilth impacts
* Maximising positive
health impacts
Environmental health,
social view of health,
health equity
Implied role for values
and judge menu
Government agencies.
constants
Government agencies
Government agencies
Informing the assessment
Ti.-i.liiiiiil.'Curicepfual
Conducted by organisations
or groups who are neither
proponents or decision-
makers, with goal of
influencing decision-
making and
implementation
Ensuring under-recognised
health concerns are
addressed in design, decision-
nuking and implementation
Minimising negative
health impacts
Maximising positive
health impacts
Social view of health,
health equity
More explicit role for
values and judgements
Non-governmental
organisations (NCOs),
universities, other
agencies
Varied
Varied
Guiding the assessment
Conceptual.'social
Figure 8. HIA typology descriptions (Source: Harris-Roxas and Harris 2011).
Conducted by potentially
affected communities on
issues or proposals that
are of concern
- Ensuring the community's
health-related cancel us ii v
identified and addressed
Enabling greater
part icipa Dun :jf
communities in decisions
that affect them
Minimising negative
health impacts
Maximising positive
health impacts
Social view of health,
health equity
Driven by communiy
values and judgements
Communities, often aided
by HIA practitioners in
NGOs, universities 01
other agencies
Communities themselves
Communities themselves
Controlling and conducting
the assessment
Social
Decision support
Advocacy Mandated
Type of HIA
Community-led
Figure 9. Types of HIA conducted.
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HIA Funding
Sources of funding were unable to be determined for approximately 30% (n=24) of the HI As
reviewed, which could indicate that either: a) funding sources were not adequately documented,
b) the HI As were conducted within the scope of normal work activities (i.e., without any external
funding), or c) the HIAs were performed by volunteers (e.g., a working group). Other HIAs
were conducted with funding from one or more of these entities: the Centers for Disease Control
and Prevention (CDC), the Robert Wood Johnson Foundation (RWJF), the Association of State
and Territorial Health Officials (ASTHO), The California Endowment, the Health Impact
Project, Human Impact Partners, the National Association of County and City Health Officials
(NACCHO), Blue Cross/Blue Shield, the National Network of Public Health Institutes (NNPHI),
the Northwest Health Foundation (NWHF), or others (Figure 10).
°
Funding Source
Figure 10. Funding sources of reviewed HIAs (CDC- Centers for Disease Control and Prevention; RWJF-
Robert Wood Johnson Foundation; ASTHO- Association of State and Tribal Health Officials; NACCHO-
National Association of County and City Health Officials; NNPHI- National Network of Public Health
Institutes; NWHF- Northwest Health Foundation).
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Scoping
Scoping
Identify which health effects to consider and set the HIA parameters. Tasks include:
Determining the individuals/team that will conduct the HIA, as well as a plan for stakeholder
involvement
Examining stakeholder concerns and pathways and potential impacts of the decision on population
health, including population and vulnerable groups likely to be affected
Setting the scope and goals of the HIA, including the analytic plan, research questions, and impacts to
be considered
Determining methods, sources of evidence, and data types that will be used in assessment
Applicable Database Fields
- Organization(s) Involved - Prioritization Methods
- Organization Type - Impacts/Endpoints
- HIA Rigor - Environmental/Ecosystem
- Stakeholder/Community Involvement Impacts Considered?
Pathway of Impact
Scope/Summary
Composition of HIA Teams
A number of different types of organizations were involved in conducting the reviewed HIAs
(Figure 11), such as educational institutions, government agencies, non-profit groups, and others
(e.g., consultants, research organizations, for-profit companies, health care companies,
partnerships, working groups, etc.). Over half of the HIAs (n=44) were conducted by two or
more of these entities. Of those 44 HIAs, almost 40% (n=16) were conducted by two
government agencies or a combination of government agencies and non-profit organizations.
Government Non-profit Educational
Agency Institution
Organization Type
Other Undetermined
Figure 11. Types of organizations involved in conducting the reviewed HIAs.
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Of the 37 HIAs conducted by a single organization, 20 were conducted by a government agency.
State or local government health agencies were the most common organizations involved in
conducting the HIAs, having their hand in 37 of the 81 HIAs. Human Impact Partners, a national
non-profit involved in promoting health and equity in decision-making, conducted or was a
partner in 13 of the HIAs reviewed.
HIA Level of Rigor
Part of the scoping process involves determining the rigor or level of HIA that will be conducted,
including the number of impacts that will be assessed, the depth of assessment (e.g., extent of
data collection, stakeholder involvement, sources of evidence, etc.), and the length of time that is
available to complete the HIA. The rigor of the reviewed HIAs was judged using the definitions
of four levels of HIA provided by Harris et al. (2007). These levels, listed from least to most
rigorous (and least to most resource-intensive), are: desk-based, rapid, intermediate, and
comprehensive (Figure 12). Figure 13 shows a breakdown of the number of HIAs performed at
each level of HIA. It should be noted that reviewers also recorded in the database whether the
rigor designation they assigned the HIA differed in any way from how the authors classified the
assessment. There were ten cases of divergent classification, seven of which involved a rapid
HIA being classified by reviewers as an intermediate HIA.
DESK BASED
No more than three
impacts, assessed in
tess detail
Provides a broad
overview of potential
hearth impacts
Is an 'off the shelf exercise
based on coSecting and
analysing existing
data.
2-6 weeks for one person
full time1.
RAPID
No more than three
impacts, assessed in
more detail
Provides a more detailed
overview of potential
hearm impacts
lnvoh
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Desk-based
Rapid
Intermediate Comprehensive
Least
Rigor
Level of HIA
Most
Rigor
Figure 13. Rigor of reviewed HIAs.
Stakeholder Involvement
The rigor of the HIA determines the overall extent to which stakeholders will be involved
throughout the HIA process. When establishing a plan for stakeholder involvement, it is
important to consider not only who should be invited to participate in the process (e.g., residents,
community-based organizations, decision-makers, government leaders and representatives,
business and industry, advocacy organizations, academic institutions, policy and subject matter
experts, etc.), but also the level of engagement and methods of stakeholder participation to be
used (North American HIA Practice Standards Working Group 2010; National Research Council
2011). The level of stakeholder engagement can range from input to empowerment, as described
in the Ladder of Citizen Participation (Arnstein 1969; Figure 14), and methods of stakeholder
participation can include avenues such as steering or advisory groups, needs assessments,
community listening sessions, public comment periods, interviews, surveys, project meetings,
focus groups, expert consultations, and forums or workshops, among other things (Stakeholder
Participation Working Group 2010).
Sixty-six (66) of the 81 HIAs had some type of stakeholder and/or community involvement
component. This is not surprising given that stakeholder engagement and community
empowerment are objectives of HIA (North American HIA Practice Standards Working Group
2010; National Research Council 2011; Human Impact Partners 2012).
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Rung
Citizen Control &
Delegated Power
Partnership
Placation
Informing &
Consultation
Manipulation &
Therapy
Arnstein's (1969) Description
Vulnerable populations* most impacted obtain
majority decision-making power.
Vulnerable populations can negotiate and
engage in trade-offs with power holders.
Allows vulnerable populations to advise, but
power holders have right to decide.
Citizens can offer input and be heard, with no
assurance their views will be taken into account.
Power holders -educate or -cure citizens
participation is not encouraged.
Applied to HIA Practice
HIA stakeholders, including vulnerable
populations, decide on the HIA scope and
recommendations, have final approval of HIA
report, and decide on the communications
strategy.
Stakeholders impact the direction of HIA (scope)
and reporting, but decisions are made equally with
project team.
Stakeholders offer input that may shape the HIA,
but the project team make all decisions.
Stakeholders offer input but it does not
necessarily shape the HIA.
Telling stakeholders what is happening without
soliciting input. Saying stakeholder voices matter
but not acting on input. Not giving out all relevant
information or giving different information to
different stakeholders.
* Authors took liberty to change Arnstein's use of the term "have not" and replace it with "vulnerable population."
Figure 14. Ladder of Citizen Participation in HIA (Source: Stakeholder Participation Working Group 2010).
In fact, HIA guidance calls not only for the participation of the community and stakeholders
affected by the decision, but also the decision-makers themselves. Although the HIA Review
recorded, to the extent possible, the stakeholders involved in each HIA and the method(s) of
engagement and/or participation, it did not specifically examine the inclusion of decision-makers
as stakeholders in the HIA process. Nevertheless, reviewers explicitly identified decision-
makers as stakeholders in a handful of HIAs (n=3). Decision-makers may have been engaged as
stakeholders in additional HIAs as well, but this was not evident from a cursory review of the
HIA Review Database.
Among the HIAs with a stakeholder or community involvement component, the level and quality
of stakeholder participation varied greatly. In many of these HIAs, stakeholder input was
solicited via interviews, surveys, public meetings, community forums and workshops, and/or
other special collection methods to inform the scoping step (e.g., identify issues of interest and
areas of concern for the community and stakeholders, identify populations and vulnerable groups
that might be affected by the decision, etc.) and gather local knowledge regarding community
health and existing conditions to inform the assessment step of the process. Public or project
meetings were not only used for soliciting input from stakeholders, but were also a common
method used for communicating the results of the assessment and recommendation steps of the
HIA process to stakeholders and in some instances, soliciting their feedback and comments.
Often, stakeholders were only minimally engaged in the process (i.e., not involved in the actual
HIA decision-making), but there were a number of HIAs (n=15) that engaged stakeholders in the
22
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decision-making process, usually via a role on an advisory or steering committee, although other
methods were also used (e.g., stakeholder panels and councils, meetings, and forums). In a
handful of HIAs (n=4; two community-led HIAs and two advocacy HIAs), stakeholders actually
oversaw or guided the HIA process and were engaged as decision-makers in equal partnership
with the HIA team or as the primary decision-makers in the process.
Of the 15 HIAs with no stakeholder and/or community involvement, ten were desk-based HIAs,
which by definition do not include stakeholder or community involvement, and the remaining
HIAs incorporated stakeholder and/or community input gathered outside of the actual HIA
process (i.e., there was no stakeholder or community involvement in the HIA itself, because the
HIA used previously-collected stakeholder data).
Types of Impacts Identified for Assessment
Another important part of the scoping process involves determining what impacts will be
assessed in the HIA. This is often first accomplished by determining the impact the decision
could have on known determinants of health, such as individual factors; individual behaviors;
public services and infrastructure; living and working conditions; and social, economic, and
political factors (Figure 15). These determinants of health are factors known to directly or
indirectly impact an individual's health. Oftentimes, it is not feasible, or even possible, to
examine all of the impacts of a decision (i.e., perform a comprehensive HIA). In these cases, a
determination needs to be made as to which impacts to include in the HIA. While this decision
is usually established early in the scoping process by the HIA team and/or stakeholders, the
impacts chosen to be examined can be revised through stakeholder input later in the scoping step
and even through research, stakeholder input, and analysis in the assessment step of the HIA
process.
Social, Economic
& Political Factors
Living & Working
Conditions
Public Services
& Infrastructure
$b
Sff<3 '
fy?
fyo
i
Individual
Behaviors
Figure 15. Determinants of health (Source: Human Impact Partners 2011).
23
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Prioritization of impacts can be based on a number of factors, including stakeholder/community
input; distribution/equity of impacts; literature/research; impact on health; direction of impact;
duration/timing of impact; geographic extent of impact; relevance to project/decision interests;
likelihood, magnitude, and permanence (i.e., severity) of impacts; measurability of impact; data
availability/data gaps; quality of evidence; consultation with experts; population affected; or
specific prioritization criteria or ranking systems implemented for the project. Figure 16 shows
the methods identified most frequently in the reviewed HIAs (i.e., in ten or more of the HIAs) for
prioritizing impacts.
Prioritization Method
Figure 16. Methods used to prioritize impacts in reviewed HIAs.
The impacts (or endpoints) assessed in each HIA were classified by reviewers into one of the
following categories: health (physical, mental, developmental), environmental/ecosystem (e.g.,
impacts on the natural environment; air, water, and soil quality; noise pollution), behavioral,
economic, infrastructure (e.g., built environment), services, demographic, or other (Figure 17).
These categories relate to the generally-accepted determinants of health shown in Figure 15.
24
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X ^
^ /" cP* ^
V.P0 <^ ^
/
-------
Environmental/Eco Impacts
Figure 18. Environmental and ecosystem impacts assessed in reviewed HIAs.
Pathways of Impact
To determine the potential health endpoints or outcomes of the impacts assessed in HIAs, the
pathways through which those impacts will occur must be identified. Pathway diagrams are a
common tool used to illustrate the links between chosen health determinants and expected health
outcomes. Figure 19 is a detailed depiction from the HOPE VI to HOPE SF San Francisco
Public Housing Redevelopment HIA (UCBHIG 2009) showing the pathways between housing
and health at the social, macroenvironmental, and microenvironmental scales. Logic frameworks
can also be developed to show the various, interconnected pathways of impact for a decision,
since the health impacts of a decision are not likely to occur through a single pathway. Figure
20, taken from the Health Effects of Road Pricing in San Francisco HIA (SFDPH 2011) shows
the various pathways through which road pricing policies may affect health.
26
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Housing
Social
Macroenvironmental
Microenvironmental
D
I
J-.
3
B
I
Deprivation
AffcnLibijty
NKsfrba
LvULZlE
Overcrowding
Economic
trads-cffj
disease
Poet DutntiiHi
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4
Crime aDiviclsiiii
Traffic
Access to liealriiv
amenuies
Collective efficacy
4
4
m
Noise
Air pollution
iidewilki.
ere^nspace.
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m
Mortilin'
Depression.
iDfectioas disease
Poor numrioE
Design
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U'acer supply
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Figure 19. Pathways between housing and health (Source: HOPE VI to HOPE SF San Francisco Public
Housing Redevelopment HIA).
27
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Policy Decision
Direct Impacts
Mediating
Impacts
Environmental/
Behavioral Impacts
Health
Impacts
Costs
Equity Impacts:
i, Han6ft-d0pwd8rt populations
youth, seniors, and sensitive populations
LEGEND
Pathways from Direct Impacts:
[Trip Impacts - Local: ^
Trip Impacts -Regional: - ->
Time Impacts: >>
Economic Impacts: ^
Pathways to Health Impacts;
Quantified In HIA: *
Not Quantified in HIA: *
Figure 20. Logic framework showing pathways between road pricing and health (Source: Health Effects of
Road Pricing In San Francisco, California: Findings from a Health Impact Assessment).
The pathways examined in the reviewed HIAs ranged from common pathways with well-studied
human health effects, such as safety and security, mobility/access to services, physical activity,
social capital, air quality, community and household economics, nutrition, exposure to hazards,
land use, noise, housing, parks and recreation, education, healthcare access, and water quality, to
less common pathways, such as culture, climate change, visual effects, habitat, and public
participation (Figure 21).
28
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re
+-
re
Q.
Equity
Habitat
Visual Effects
Climate Change
Public Participation
Livability
Culture/Spiritual
Environmental Stewardship
Soil Quality
Public Health Services
Infectious Disease
Education
Healthcare Access/Insurance
Water Quality
Lifestyle
Parks and Recreation
Mental Health
Housing
Noise
Exposure to Hazards
Nutrition
Land Use
Community/Household Economics
Air Quality
Social Capital
Physical Activity
Mobility/Accessto Services
Safety and Security
10
20
30 40 50 60
Number of HIAs
70
80
Figure 21. Pathways of impact assessed in two or more reviewed HIAs.
29
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Like sector terminology, this is another area of the HIA practice that lacks an established set of
terminology. Several common pathways examined in HIA have considerable overlap and/or
subtle differences between them, leading to the terminology for these pathways being used
interchangeably at times (e.g., transportation vs. mobility/access to services or land use vs. built
environment or infrastructure). In this HIA Review, the mobility/access to services pathway was
used to examine transportation-related impacts, and the land use pathway was used to examine
impacts from both land use planning (e.g., zoning and siting of land uses) and physical land use
(e.g., agriculture, industry, development, built environment/infrastructure, etc.).
HIA Scope and General Approach
In addition to identifying the organizations to be involved in the HIA, the rigor of the HIA, the
level of stakeholder involvement, and potential impacts and pathways, the scope of the HIA (i.e.,
HIA research questions and goals) is also established in this step of the HIA process, as well as
the general approach and depth of assessment that will be undertaken.
The scope of each of the HIAs reviewed is shown in its respective Sector Snapshot. The
approach and depth of assessment to be undertaken takes into consideration the timeline for the
HIA, resource availability, potential data sources and data gaps, and sources of evidence (i.e.,
methods). Sources of evidence can vary from literature and policy reviews to more resource-
intensive community consultation (i.e., gathering information on community concerns) and
special collection methods (e.g., expert consultation, forecasting, interviews, focus groups,
modeling, risk assessment, and new data collection and analysis), as defined in Harris et al.
(2007). The sources of evidence employed in the reviewed HIAs are identified in the
Assessment section that follows (see Sources of Evidence and Data Types).
Assessment
The assessment step of the HIA process involves using data, tools, and methods to create a
profile of existing health conditions and characterize the potential impacts of the decision.
Sources of Evidence and Data Types
Figure 22 shows the sources of evidence employed in the reviewed HIAs. The data types
obtained through those sources included literature, existing and new data, websites, and models
(Figure 23).
30
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Assessment
Collect qualitative and quantitative information to create a profile of existing health conditions, and
identify, evaluate, and prioritize the potential health impacts of the decision. Tasks include:
Gathering existing data and collecting new data as needed; utilizing diverse sources
Using data and existing tools and methods to profile existing conditions and evaluate potential
health impacts of the decision
Considering direction, magnitude, severity, likelihood, and distribution/equity of impacts via
qualitative and quantitative analysis
Describing data sources and methods used, including documentation of stakeholder engagement
Acknowledging assumptions, strengths, and limitations of data and methods used
Applicable Database Fields
Sources of Evidence
Data Types
Major Data Sources
Local Data Available or Obtained?
Additional Data Needed
(Self-Identified)
Stakeholder/Community Involvement
- CIS Used?
- Health Endpoints
- Characterization of Impact
- Defensibility/Process Evaluation
0 +-
Literature Review Policy Review
Least
Resources
Community
Consultation
Special Collection
Source of Evidence
Most
Resources
Figure 22. Sources of evidence used in reviewed HIAs (as defined in Harris et al. 2007).
-------
Literature
Data Websites
Data Types
Models
Figure 23. Data types used in reviewed HIAs.
Literature/Policy Review
As evidenced by Figures 22 and 23, gathering information from the existing literature is a
significant component of HIAs. Table 3 shows the bibliographic resources identified in the
reviewed HIAs for gathering evidence on pathways, health impacts, and endpoints.
Table 3. Bibliographic Resources Used in HIA Literature Reviews (resources shown in italics are publicly
available, although access to actual publications varies by resource)
Bibiographic
Resource
Cochrane
Library
FirstSearch/
WorldCat
Google Scholar
Human Impact
Partners (HIP)
Evidence Base
JSTOR
LexisNexis
Academic
Description
A collection of databases containing medicine and healthcare-
related information.
Available at a cost and offers web access to full-text articles,
electronic books and journals, digitized special collections, etc.
Databases are also visible at no cost through WorldCat.org,
which allows users to search library collections around the
world for an item of interest and then locate a nearby library that
owns it.
Provides a search of scholarly literature across many disciplines
and sources, including theses, books, abstracts, and articles.
A searchable database that includes research evidence and
citations linking social determinants, the built environment, and
health.
A digital library of more than 1,500 academic journals, books,
and primary sources.
Provides access to government and legal information, including
government and political news, legal news, law reviews, and
state and federal statutes and case law.
Source
http://www.thecochranelibra
ry . co m/view/0/index. html
http://www.oclc.org/firstsea
rch.en.html:
http://www.worldcat.org/
http://scholar.google.com/
http://www.humanimpact.or
g/evidencebase
http://www.jstor.org/
https://www.lexisnexis.com/
hottopics/lnacademic/
32
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Table 3. Continued
Bibiographic
Resource
MEDLINE/
PubMed
Ovid/Ovid
MEDLINE
ProQuest
(formerly CSA
niumina)
PsycINFO
Science Direct
Scopus
TRID/TRIS
(Transportation
Research
Information
Services)
Web of
Knowledge/
Web of Science
Description
Contains journal citations and abstracts for biomedical
literature from around the world. PubMed provides free
access to MEDLINE and links to full text articles when
possible.
Ovid is a medical research platform that allows users to
search content and productivity tools. Ovid MEDLINE is
a comprehensive biomedical database that is updated daily
and offers access to bibliographic citations and author
abstracts from more than 5,500 biomedicine and life
sciences journals.
Provides citations and abstracts for peer-reviewed journal
articles, books, chapters and essays, dissertations, and
more. Users can select a subject area or search across all
subjects.
An abstracting and indexing database of peer-reviewed
literature in the behavioral sciences and mental health.
A full-text scientific database offering access to journal
articles and book chapters.
World's largest abstract and citation database of peer-
reviewed literature and includes tools that track, analyze,
and visualize research.
An integrated database that combines the records from the
Transportation Research Board's (TRB's) Transportation
Research Information Services (TRIS) Database and the
Organisation for Economic Cooperation and
Development's (OECD's) International Transport
Research Documentation (ITRD) Database. Provides
access to transportation research worldwide.
Can be used to access journal articles, patents, websites,
conference proceedings, and Open Access materials in the
sciences, social sciences, arts, and humanities. Web of
Science can be found within Web of Knowledge and
offers access to journal articles in the sciences, social
sciences, and arts and humanities.
Source
http://www.ncbi.nlm.nih. gov/pub
med
http://www.ovid.com
http://search.proquest.com/
http://www.apa.org/pubs/database
s/psycinfo/index.aspx
http://www.sciencedirect.com/
http://www.scopus.com/
http://trid.trb.org/
http://apps.webofknowledge.com/
Data Sources
Data, tools, and models used in the assessment phase of the reviewed HIAs were gathered from a
variety of resources. The U.S. Census Bureau was the primary resource used in the HIAs for
demographics and background data (e.g., social, economic, housing, and educational attainment
data), while health data was most commonly gathered from state, county, or local health
departments or one of the various health surveys conducted by the CDC. Figure 24 shows the
most commonly used resources (i.e., the resources and/or organizations drawn upon in
approximately one-quarter or more of the reviewed HIAs).
33
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Resource
Figure 24. Most common resources drawn upon in reviewed HIAs for data, tools, and models
(CDC- Centers for Disease Control and Prevention; EPA- Environmental Protection Agency)
The data utilized from these and other resources can be found in Appendix D. This list is not
comprehensive, but does identify national data sources used in the HIAs and examples of data
sources that may be available at the state, county, or local level. The data sources are organized
into five categories: Demographics and Background Info, Health Data, Other Supporting Data,
Benchmarks, and Indicators. Tools and models utilized in the HIAs can be found in Appendix E,
including a description of the tool or model and its source.
Primary Data Collection
In addition to utilizing existing data, tools, and models, a variety of special collection methods
were used in the HIAs to acquire new data, often at the "local" level or level of the project or
decision. Table 4 shows a list of special collection methods used in the reviewed HIAs.
Table 4. Special Collection Methods Used in Reviewed HIAs
Special Collection includes:
accessing unpublished data
advisory committee
aerial photography
air quality study
applicant information
community forums/workshops
demographics analysis
expert consultations
field visits/site observations
focus groups
food audit/retail food availability survey
Geographic Information Systems (GIS) and photo mapping
Healthy Development Measurement Tool (HDMT)
health surveys
mediation group
modeling/forecasting
Photo Voice/community photography
public/project meetings
residents panel
risk assessment
stakeholder interviews
community/stakeholder surveys
threshold scoring
traffic assessment/counts
walkability audits
windshield surveys/tours
34
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Stakeholder/Community Engagement
Of the utilized special collection methods, community forums/work shops, expert consultations,
focus groups, health surveys, community photography, public/project meetings, residents'
panels, stakeholder interviews, and community/stakeholder surveys were used most often as a
means to involve and/or solicit information from stakeholders and the community.
Geospatial Analysis
GIS and other mapping techniques were also utilized quite frequently, not only for visualizing
geographically-referenced data, but also in analysis to reveal geospatial relationships, patterns,
and trends. Of the 54 HIAs that employed this special collection method, 42 utilized GIS in an
illustrative capacity to display data and 29 utilized GIS in actual geospatial analysis.
Data Gaps
While all of the HIAs were able to obtain some type of local data for use in their analyses, there
were instances where certain data were not available at the desired geographic scale or not
available at all. In many instances, the authors of the HIA reports acknowledged these data gaps
and identified the additional data needs. A summary of those data gaps is shown in Table 5,
grouped by data category (i.e., baseline, employment sector/economic, environmental, health,
causality, infrastructure/services, miscellaneous, program, local/small geographic scale,
temporal, permit/application/plan, and tools) and a complete list of the HIAs' self-identified data
needs is compiled in Appendix F.
Table 5. Data Gaps Identified in Reviewed HIAs
Data Gaps
Baseline Data
- Data on current health status of communities
surrounding site
- Baseline health and environmental data
- Baseline data on vulnerable populations
- Demographics
- More detailed baseline health data
Employment Sector/Economic Data
- Psycho-social attributes of jobs (physical work
conditions, job security, access to health insurance
through employment, lack of control over work,
lack of participation in decision-making, time spent
at work, work environment, work balance)
- Data to estimate impact to customer bills
- Wind energy impacts on jobs, income and other
economic indicators
- Retail effects
- Agriculture, forestry, fishing, hunting, mining,
quarrying, and oil and gas extraction industry
average annual wages
- Eligibility requirements for employment and degree
to which those positions are fulfilled by residents
Environmental Data
- Locally-placed air monitors to assess air pollution
- Noise assessment
- Specific PM2.5 data
- Analysis of potential dust/diesel emissions
- Visual effects analysis
- Off-site terrain noise modeling
- Risks of groundwater contamination
- Soil testing results indicating whether pesticide
chemical residues exist in the soil
- Air quality measures other than PM2.5
- Water quality data
Health Data
- Consistently reported health behavior data for
Wisconsin youth
- Local data on youth alcohol use and effects of
underage drinking
A study on children and adolescent health
35
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TableS. Continued
Causa
Data Gaps
Causality Literature/Data
- Sufficient research to identify the relative
importance of the community design features that
promote physical activity
- Supplementary research to show causality between
elements of the built environment and chronic
disease
- Parental, social, and environmental factors affecting
selection of childcare and school locations (e.g.,
commute times, etc.)
- Local health data (e.g., morbidity/mortality) linked
to built environment data
- More data on the proximate impacts of markets
- Literature that takes socioeconomic status into
account when looking at the health impacts of the
built environment
- Longitudinal studies or randomized controlled trials
that further delineate the relationship between the
built environment and health
- Epidemiological data on the impact of climate
change
- Health impact data for ozone exposure
- More research in the areas of nearby recreation, trail
system development and health outcomes in both
urban and rural settings
- Epidemiological studies on sound, shadow flicker,
amplitude modulation, and indoor low frequency
sound impacts
- Effectiveness of particular interventions for
reducing pedestrian injuries
- Data related to human consumption of subsistence
resources to accurately assess the affects of
nutrition changes
- Accident rates due to driver distraction
Infrastructure/Services Data
- Data on the quality of public services/infrastructure
- Qualitative data on existing bicycle and pedestrian
infrastructure
- Comprehensive inventory of pedestrian facilities
- Additional mapping to fully understand the
County's bike network and recreational amenities
and their connections to residential areas and other
services
- Maintenance and repair requirements of transit
village
- Qualitative data on existing bicycle and pedestrian
infrastructure
- Comprehensive inventory of pedestrian facilities
- Quality of pedestrian environment (PEQI)
- Quality of parks and open space
- Accessory dwelling unit (ADU) literature for rural
areas
Local/Small-Geographic Scale Data
- City-scale health data (county data used instead)
- Vehicle-to-vehicle and vehicle-to-pedestrian
accident data
- Physical activity data for the quarter-mile radius
around the bridge
- Identification of pollutant sources in the
neighborhood
- Mortality and morbidity data by neighborhood
- Data on physical activity by neighborhood
- Poverty data at a small geographic scale
- Overweight/obesity data by zip code
- More locale-specific data on the prevalence of
pertinent risk factors
- Neighborhood-level data on gross per capita water
usage and annual per capita waste disposal
- Neighborhood-level data on proportion jobs paying
self-sufficiency wage and filled by residents,
households living on income below self-sufficiency
standard, occupational injury, jobs providing health
insurance, and proportion locally-owned businesses
- Neighborhood-level data on planned parking
pricing strategies and traffic calming interventions
- Neighborhood-level data on public transit access to
public school and proportion children attending
neighborhood schools
- Neighborhood-level data on access to produce
stores and food markets, and neighborhood
completeness indicator for key public/retail services
- Neighborhood-level data on tree canopy and
sidewalks with adequate lighting
- Neighborhood-level data on volunteerism
- Precise data on displacement
- Qualitative data of neighborhood changes to
identify communities receiving displaced persons
- Income at the block level
- Demographic and resources data below zip code
level
- Record-level local health data (morbidity/mortality)
linked to built environment data
- Updated subsistence data/analysis
Miscellaneous Data
- Adequate information available to apply the HDMT
development target checklist
- Data on racial/ethnic disparities (due to small
numbers)
- Quantitative data to replace qualitative data
collected at community/advisory panel meetings
- Bike and pedestrian safety data
- A more comprehensive study of truck counts and
activity
- Data on unincorporated areas
36
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TableS. Continued
Perm!
Data Gaps
Permit/Application/Plan Data
More complete/consistent applicant information
(data on types, numbers, and age of fleet vehicles;
information on type of waste transport and waste
transport routes; waste volume, waste origin, and
waste characterization; consistent traffic
projections)
Quantitative data on number of ADU permits to be
requested
Air permit application
Information about park and trail design, entry
points, and changes to the surrounding environment
to allow a more accurate assessment of access
Details on construction equipment to be used to
allow for air pollution and noise impacts during
construction to be assessed
More specific implementation strategies
Information to assess compliance with existing
housing law
Cost of the project housing
More details to support Sustainable and Safe
Transportation and Public Infrastructure and
Healthy Economy elements
Program Data
- Department of Community and Housing
Development data on program participants and
program utilization
- Availability of detailed, accurate information on the
expenditures of the School Food Services Branch
- Further evaluation of impacts of short-term ODOT
solution to safe highway accessibility
- Actual impacts of funding cutbacks on transit
services
- Utility company data on arrearages and shut-offs in
Massachusetts
Temporal Data
- Current household level survey data for the
potentially affected communities and data for years
2009-2011
- Accident and injury data for years 2009-2011
- More current data than the 2000 and 2006 census
2010 census data for updated population map
Tools
- A mechanism for predicting potential health
impacts of proposed land use and policy decisions
- Traditional and Local Knowledge survey
- Community (citizen) surveys (as study relied on
unstructured public comment and literature about
community opinions and perceptions)
- Estimation of social cohesion and level of physical
activity
Baseline Profile
The data gathered in the HIAs from existing sources and new data acquisitions were used, in
most cases, to create a profile of existing health conditions and evaluate the potential health
impacts of the decision being considered. The profile of existing conditions is used to a) predict
future conditions due to impacts of the decision assessed in the HIA and b) compare with future
conditions, should the decision be enacted (i.e., for impact monitoring). This baseline profile
includes data about the health determinants and outcomes, demographics (e.g., ethnicity, age,
gender), and socioeconomic status (e.g., income, poverty, education level, housing value; North
American HIA Practice Standards Working Group 2010; National Research Council 2011;
Human Impact Partners 2012) of the affected population. Of the 81 HIAs reviewed, 63 created
some sort of baseline profile.
Health Endpoints Assessed
As for evaluation of potential health impacts, although the decision was usually made early in the
scoping process as to which impacts would be examined, this decision was at times revised as a
result of the evidence collected in the assessment step of the HIA process. Table 6 shows the
37
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variety of health impacts evaluated in the reviewed HIAs, with the most common health
endpoints (i.e., those evaluated in one-quarter or more of the reviewed HIAs) presented in Figure
25.
Table 6. Health Impacts Evaluated in Reviewed HIAs
Health Endpoints
attention deficit disorder
(ADD)/attention deficit
hyperactivity disorder (ADHD)
alcoholism/substance abuse
allergies
anemia
anxiety
arthritis
asthma
behavioral health/development
birth defects
bronchitis
cancer
carbon monoxide poisoning
cardiovascular/circulatory health
central nervous system function
childhood growth/development
cholesterol
chronic disease
chronic obstructive pulmonary
disease (COPD)
cognitive function
communicable disease
depression
diabetes
diarrhea
disability
dyslipidemia
emphysema
endocrine disorders
eye/nose/throat/lung irritation
fatigue
food-borne illness
gallbladder disease
genotoxicity
gynecological/reproductive health
headaches
hearing loss/impairment
heart attack
heart disease
heat/cold related illnesses
hypertension/high blood pressure
immune system/function
infection
infectious disease
inflammation/inflammatory
response
injury
irregular heart beat
kidney disease/disorder
lead poisoning
learning disabilities/reduced
learning
life expectancy
liver disease/health
low birth weight
lung disease/health
malnutrition
mental health
metabolic disorder/disease
morbidity
mortality/death/fatality
musculoskeletal/bone & joint
myocardial infarction
nausea
neurological health
nutrition
obesity/weight
osteoporosis
overall/general health
physical health
physiological health
pneumonia
psychological health
rape
respiratory health
sexually transmitted disease
sick building syndrome
sleep apnea
sleep disturbance
stress
stroke
suicide
ulcers
vector borne illness
water borne illness/water toxics
exposure
38
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Health Impacts/Endpoints
Figure 25. Most common health impacts/endpoints evaluated in reviewed HIAs.
Evidence Defensibility
Predicting the health impacts of a decision with complete certainty is impossible; however, the
HIA guidance does call for the use of best available evidence; acknowledgement of assumptions,
strengths, and limitations; and transparent synthesis of evidence (North American HIA Practice
Standards Working Group 2010; Minimum Elements 2.4, 2.5). Figure 26 shows that not all of
the HIAs met these measures for evidence defensibility; however, some HIAs went above and
beyond, evaluating and documenting, for instance, the quality of evidence used as the basis for
impact assessment (n=9). See Best Practices for further discussion on including evaluations of
evidence quality in HIAs.
Impact Characterization
In addition to identifying potential health impacts, the assessment step in the HIA process also
includes judging the direction, magnitude, likelihood, distribution (i.e., equity), and permanence
of impacts via qualitative and quantitative analysis. One trend that became very apparent when
reviewing the HIAs was that quantification of impacts was lacking; most HIAs qualitatively
characterized impacts. Of the 81 HIAs reviewed, a little more than one-quarter (n=23) employed
quantitative analysis in the characterization of impacts. While stakeholder and community input
lend themselves to qualitative analysis, many times qualitative analysis was warranted for other
reasons as well (e.g., due to lack of available scientific research, unavailability of local data, time
limitations, limited resources, etc.) However, there were instances when the use of best available
39
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data may have allowed impacts to be quantified. See Implementation of the HIA Process for
further discussion on the benefits and challenges of quantitative characterization and Best
Practices for more on the use of best available evidence (both qualitative and quantitative) for
health impact characterization.
Supporting Synthesis of Quality of Assumptions
Evidence Not Evidence Not Evidence Marginal and/or Limitations
Clear/Cited Transparent Not Identified
Defensibility Deficiency
Figure 26. Deficiencies in evidence defensibility in reviewed HIAs.
The characterization of impacts employed by each of the reviewed HIAs is shown in the
respective table in Appendix G, but Figure 27 provides an overview of how impacts were
characterized in the HIAs collectively. As can be seen from the figure, characterization of
impacts primarily involved considerations of direction (e.g., positive, negative, unclear, or no
effect) and distribution/equity (i.e., identification of disproportionate or equal impacts on the
population). Of the 77 HIAs that characterized impacts, 97% included judgement of direction
and 88% included judgement of distribution/equity; judgement of likelihood, magnitude, and
permanence were each considered in less than half of the reviewed HIAs.
40
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Impact Characterization
Figure 27. Characterization of impacts in reviewed HIAs.
Recommendations
Once the available data were analyzed and
the potential impacts of the decision
identified, the next step in the HIA process
involved developing recommendations.
Recommendations can include support for or
opposition to the decision, alternatives or
modifications to the decision (e.g., to
promote positive health impacts or minimize
negative health impacts), or merely
mitigations of negative health impacts.
Prioritization of Recommendations
Oftentimes in HIAs, a prioritization process
will take place to identify the impacts for
which recommendations will be offered
and/or identify which of the developed
recommendations to offer or prioritize for
action. Prioritization can be based on a
number of factors, including stakeholder/
community input; distribution/equity of
impacts; literature/research; funding
availability; cost/economics; impact on health;
Recommendations
Identify strategies for promoting the positive
health impacts and/or mitigating the adverse health
impacts. Tasks include:
Developing recommendations (e.g., alternatives
to the decision, modifications to the proposed
policy/project, mitigation of adverse health
impacts)
Prioritizing recommendations, if desired
Developing an implementation plan for
developed recommendations (e.g., responsible
party for implementation, timeline, link to
indicators that can be monitored)
Applicable Database Fields
- Prioritization Methods
- Decision-making Outcome
41
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viability/feasibility of recommendation implementation; quick fixes or initiatives (e.g., that
indicate commitment to and lay the foundation for future actions); measurability of impact;
quality of evidence; consultation with experts; population affected; or specific prioritization
criteria or ranking systems implemented for the project.
Two HIAs implemented unique ranking techniques to classify the health impacts and prioritize
recommendations for action. One was a qualitative ranking system that took into consideration
four parameters - stakeholder concern, data gaps, potential impact for both positive and negative
health effects, and likelihood - to prioritize health effect categories for action by decision-
makers, and the other was a four-step risk assessment technique developed by Winkler et al.
(2010) that ranks the significance of identified health impacts and prioritizes actions based on the
duration, magnitude, extent, likelihood, nature (e.g., direct, indirect, cumulative), and direction
of impact. For more details on these unique prioritization approaches, see Best Practices.
Summarized decision-making outcomes for each HIA, including final recommendations offered
in the HIA Report, are identified in the respective table in Appendix G.
Implementation Plan or Strategy
In the Recommendations stage of the HIA process, it is also suggested that an implementation
plan be developed for the recommendations that includes information such as parties responsible
for implementation, timeline, and link to indicators that can be monitored (National Research
Council 2011; Human Impact Partners 2012). Implementation plans or strategies for
recommendations were found in less than 10% of the HIAs reviewed (n=8).
Reporting
Reporting and communicating the
results of the HIA is crucial to
informing the decision being
evaluated. During the preliminary
literature search, there were several
instances in which HIA Reports
were not publicly accessible,
precluding the HIA from being
included in the HIA Review. Of
the HIAs identified in the final
literature search, three were later
dropped from the review because
the HIA Reports were not
available.
Reporting
Write a final report and communicate the results of the HIA
to decision-makers for implementation/action. Tasks
include:
Developing a transparent, publicly-accessible HIA Report
that documents the process, methods, findings, funding,
and participants of the HIA
Determining the method of communicating HIA findings
and recommendations to stakeholders and decision-makers
Preparing communication materials and communicating
the results of the HIA to inform stakeholders and decision-
makers
Applicable Database Fields
- HIA Report
Minimum Elements of HIA Met?
Contact
Organization/HIA Website
42
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Transparent Documentation of HIA
Not only does the reporting step of the HIA process call for a final report to be prepared that
documents the HIA and its results, but the guidelines call for that documentation to be
transparent (North American HIA Practice Standards Working Group 2010; National Research
Council 2011; Human Impact Partners 2012). Of the 81 HIAs reviewed, over 35% of the HIAs
(n=29) lacked transparent documentation of the process, methods, findings, sponsors, funding
source(s), and/or participants and their respective roles. Of those 30 HIAs, 22 lacked
transparency in funding for the HIA and 6 lacked transparency in identifying an HIA point-of-
contact. In contrast, there were a number of HIAs that went above and beyond to ensure that the
documentation was transparent, including detailed documentation of assessment methodologies,
techniques, and models; criteria for data aggregation; geographic units of analysis (i.e.,
geographic area and scale); software packages used in analysis; confidence estimates; and
supporting documentation, such as screening and scoping worksheets, sources of information
used to develop research questions, and methodology, tools, and results of community
information gathering (e.g., walkability assessments, interviews, surveys, focus groups, and
community and stakeholder meetings).
Communication of HIA Results
In addition to preparing the HIA Report, reporting also involves communicating and
disseminating the findings and recommendations of the HIA to inform stakeholders and
decision-makers. Only 4 of the 81 HIAs reviewed, made mention of or included in the HIA
Report a communication plan or strategy for reporting and disseminating the results of the HIA
to the appropriate audiences, although communication plans could have been developed and
documented separately from the HIA Report. Methods for communicating the HIA results to
decision-makers and stakeholders took many forms in the reviewed HIAs, including
dissemination of the HIA Report and/or factsheets, inclusion of HIA documentation in an
EIS/EIS public comment period, presentations, press releases, public and/or stakeholder
meetings, public testimony in hearings related to the decision, lobbying, Listservs, and personal
communication (e.g., letters, emails, phone calls). Secondarily, results of some HIAs were also
made available on public websites or published in peer-reviewed journals or regional magazines.
For more on the importance of reporting, see Best Practices and Areas for Improvement.
43
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Monitoring and Evaluation
The monitoring and evaluation step of HIA
involves three main forms of evaluation - process
evaluation, impact evaluation, and outcome
evaluation. Process evaluation involves examining
how the HIA process was carried out, including
who was involved, strengths and weaknesses of the
HIA, successes and challenges, effectiveness in
meeting HIA objectives and established practice
standards, engagement and communication with
stakeholders, and lessons learned. Impact and
outcome evaluations are both carried out after
completion of the HIA and involve monitoring the
impacts of the HIA on the decision and decision-
making process (i.e., impact evaluation) and the
impacts of the decision implementation on health
determinants and outcomes (i.e., outcome
evaluation). All three forms of evaluation were
lacking in the reviewed HIAs, which unfortunately
is not a trend unique to this subset of HIAs
(Wismar et al. 2007; National Research Council
2011).
Process Evaluation
Process evaluation, which can be thought of as an
evaluation of HIA defensibility and quality, was
only found in 5 of the 81 HIAs reviewed, although
process evaluations may have been performed
separately from these HIAs and not included in the reports.
Impact/Outcome Evaluation
Proposed plans for impact and/or outcome evaluation were present in only 29 of the HIAs. The
National Research Council (2011) notes that outcome evaluation is infeasible in many cases,
given the length of time between implementation of the decision and changes in health
outcomes, as well as the presence of multiple confounding factors contributing to many of the
health outcomes. However, in cases when impact and/or outcome evaluation is not feasible, the
HIA should discuss the limitations preventing the evaluation from occurring.
In addition to proposals for impact and outcome evaluation, other follow-up and monitoring
measures were also identified in the reviewed HIAs. These included securing funding,
Monitoring and Evaluation
Evaluate the processes involved in the HIA, the
impact of the HIA on the decision-making
process, and the impacts of the decision on
health. Tasks include:
Evaluating how the HIA process was carried
out, who was involved, how smoothly the
assessment proceeded, and how effective the
HIA was in meeting its stated objectives and
established practice standards (i.e., process
evaluation)
Monitoring decision implementation and the
effect the HIA had on the decision-making
process (i.e., impact evaluation)
Monitoring health determinants and outcomes
to determine the accuracy of health impact
predicted in the HIA (i.e., outcome
evaluation), when feasible
Applicable Database Fields
- Defensibility/Process Evaluation
- Effectiveness of HIA
- Follow-up Measures
- Minimum Elements of HIA Met?
44
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establishing health baselines and targets for improvement, monitoring specified indicators,
performing environmental monitoring (e.g., drinking water supply, emissions, noise, carbon
footprint, and air quality monitoring), conducting research to address the information gaps in the
HIA, implementing traffic safety monitoring, performing educational outreach, conducting
additional HIAs, monitoring complaint systems, monitoring agreements made by developers to
ensure they are maintained, disseminating tools developed through the HIA, and modifying
existing tools for applicability.
For more on the need for increased monitoring and evaluation in HIA, see Best Practices and
Areas for Improvement.
Assessment of HIA Process - Defensibttity, Compliance, and Effectiveness
HIA Defensibilitv
As part of the HIA Review, reviewers conducted an evaluation of process and defensibility for
each HIA. This evaluation took into account the quality of the process undertaken (i.e., evidence
and methodology; assumptions, limitations, and barriers; successes and challenges; lessons
learned) and the documentation of that process, using the Minimum Elements and Practice
Standards for Health Impact Assessment (North American HIA Practice Standards Working
Group 2010) as a benchmark. Considerations used in the evaluation included, among other
things, the questions below.
Was the supporting information and methodology sound and clearly
documented in the report (e.g., adequate literature, data etc. collected; sources
of data acknowledged; clear description of data and methodology used;
identification of participants and their roles, funding, etc.)?
Was the scope of the HIA and process undertaken clearly documented?
Was stakeholder input solicited and utilized?
- Were the recommendations based on transparent, context-specific synthesis of
evidence (e.g., impacts/conclusions well supported by the data, literature, etc.
presented in the report) or was it not clear how the authors reached the
conclusions (e.g., evidence presented only spoke to general health impacts and
not the specific impacts examined)?
Were assumptions, limitations, and barriers present and identified by the
authors?
Was the documentation of the process, methods, findings, sponsors,
participants, etc. transparent and publicly-accessible?
45
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HIA Compliance with Minimum Elements ofHIA
In addition to the evaluation of process and defensibility, reviewers also evaluated each HIA
against the Minimum Elements of HIA developed by the North American HIA Practice Standards
Working Group (2010). These minimum elements are given below.
"A health impact assessment (HIA) must include the following minimum elements,
which together distinguish HIA from other processes. An HIA:
1. Is initiated to inform a decision-making process, and conducted in advance of
a policy, plan, program, or project decision;
2. Utilizes a systematic analytic process with the following characteristics:
2.1 Includes a scoping phase that comprehensively considers potential
impacts on health outcomes as well as on social, environmental, and
economic health determinants, and selects potentially significant issues
for impact analysis;
2.2 Solicits and utilizes input from stakeholders;
2.3 Establishes baseline conditions for health, describing health outcomes,
health determinants, affected populations, and vulnerable sub-
populations;
2.4 Uses the best available evidence to judge the magnitude, likelihood,
distribution, and permanence of potential impacts on human health or
health determinants;
2.5 Rests conclusions and recommendations on a transparent and context-
specific synthesis of evidence, acknowledging sources of data,
methodological assumptions, strengths and limitations of evidence and
uncertainties;
3. Identifies appropriate recommendations, mitigations and/or design alternatives
to protect and promote health;
4. Proposes a monitoring plan for tracking the decision's implementation on
health impacts/determinants of concern;
5. Includes transparent, publicly-accessible documentation of the process,
methods, findings, sponsors, funding sources, participants, and their
respective roles."
Of the 81 HIAs reviewed, only 13 met all the Minimum Elements of HIA. Figure 28 shows the
frequency in which each Minimum Element was not met (i.e., all of the aspects of the Minimum
Element were not met or the Minimum Element was missing completely).
46
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\ ^ -°3 .« .*>
Minimum Element Deficiency
Figure 28. Minimum Elements missing or deficient in reviewed HIAs.
HIA Effectiveness
As described previously, impact evaluation involves monitoring the effect of the HIA on the
decision-making process and final decision (e.g., how decision-making changed as a result of the
HIA, modifications made to the decision as a result of the HIA, and adoption of HIA
recommendations and/or mitigations). Because impact evaluation is carried out after completion
of the HIA, this measure of effectiveness is not documented as part of the HIA Report. As a
result, reviewers subjectively evaluated the effectiveness of each HIA in influencing the outcome
of the decision being considered. These evaluations were based on information obtained via
internet searches and used four measures of effectiveness as defined by Wismar et al. (2007) -
direct effectiveness, general effectiveness, opportunistic effectiveness, and none (i.e., no
effectiveness). Direct effectiveness entails the decision being dropped, modified, or postponed
as a result of the HIA. General effectiveness, in contrast, involves the HIA being considered by
decision-makers, but not resulting in modifications to the proposed decision. One frequent
benefit of general effectiveness is often raised awareness of health among decision-makers and
stakeholders. In opportunistic effectiveness, the HIA is conducted because it is assumed that the
assessment will support the proposed decision; that is, the decision would be carried out
regardless of the HIA. In some cases, the HIA is ignored and not taken into account at all by
decision-makers; these HIAs have no effectiveness (i.e., none).
Figure 29 shows that it was difficult to discern, via publicly-accessible documentation on the
internet, the influence the HIAs had on the decision-making process. While effectiveness could
not be discerned for 31 of the reviewed HIAs, of those HIAs for which measures of effectiveness
47
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could be obtained (n=50), 60% show direct effectiveness, 32% showed general effectiveness, 6%
showed no effectiveness, and 2% showed opportunistic effectiveness. Of the 30 HIAs shown to
have a direct effect on the decision, seven required additional testimony or lobbying of decision-
makers above and beyond implementation of traditional communication methods.
It should be noted that the measures of effectiveness noted in Figure 29 are subjective and may
not reflect the true effect of the HIA on the decision being considered. For instance, the timing
of the evaluation of effectiveness may have been such that the full impact of the HIA was not yet
realized, or the documentation upon which the measure of effectiveness was based may not have
clearly depicted changes in the decision and/or the impetus for those changes.
Effectiveness
Figure 29. Effect of reviewed HIAs on the decision and decision-making process (based
on a subjective evaluation performed by the HIA reviewers).
While 30 of the 81 HIAs reviewed showed direct effectiveness, it is unrealistic to expect that
HIAs will influence every decision-making outcome (National Research Council 2011).
Decision-makers have to weigh a number of different factors when coming to a decision, and
health is but one consideration. Beyond influencing the decision-making outcome, a number of
other measures of effectiveness were observed in the reviewed HIAs. These included raised
awareness of health and related issues; the introduction of health into discussions where health
was typically absent (i.e., informing decision-making); engagement of community members and
stakeholders in decisions that affect them; interdepartmental, interagency, and even intersector
collaborations; and relationship and capacity building within the community.
48
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While examining the health impacts of implementation of the 81 decisions assessed in the
reviewed HIAs was beyond the scope of the HIA Review, during internet searches conducted
throughout the review, it became evident that little to no documentation of outcome evaluation is
available. This may be due to the lag in time between decision implementation and health
outcome changes, the inability to discern whether changes to a specific health outcome is the
result of the decision when multiple confounding factors and pathways exist, and the lack of time
and resources needed for the long-term research commitment (National Research Council 2011).
Sector Snapshots
This section of the synthesis includes snapshots of the HIAs conducted in each of the four sectors
(i.e., Transportation, Housing/Buildings/Infrastructure, Land Use, and Waste Management/Site
Revitalization) to identify the types of decisions being assessed in those sectors and the outcomes
of the HIAs on those decisions. In addition, each sector snapshot includes a dashboard of
summary statistics for the HIAs in that sector; identifies sources of evidence, tools, or methods
primary to the sector; and highlights one or two model HIAs from the sector that meet the
Minimum Elements of HIA and exemplify HIA best practices. Summary tables of select data
from the HIA Review Database are provided in Appendix G for each of the HIAs.
Transportation Snapshot
The 21 HIAs in the Transportation sector were conducted to assess the impacts of a variety of
transportation-related projects, plans, programs, and policies (Table 7). As described previously,
the effectiveness of these HIAs in influencing the decisions at hand was evaluated by the HIA
reviewers using four measures of effectiveness defined by Wismar et al. (2007) and information
obtained via an internet search. As such, the measures of effectiveness noted in Table 7 are
subjective and may not reflect the true effect of the HIA on the decision-making process.
Likewise, the measures of effectiveness noted in the table, do not necessarily reflect the overall
effectiveness of the HIA, but rather the HIA's effect on the decision. For a more detailed
discussion of the four measures of effectiveness utilized here and measures of overall HIA
effectiveness, see HIA Effectiveness.
49
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Table 7. Transportation Decisions Informed by Reviewed HIAs
ID
1
5
9
11
Title
Pathways to a
Healthy Decatur:
A Rapid Health
Assessment of the
City of Decatur
Community
Transportation
Plan
The Red Line
Transit Project
Health Impact
Assessment
Spokane
University District
Pedestrian/
Bicycle Bridge
Health Impact
Assessment
The Impact of
U.S. Highway 550
Design on Health
and Safety in
Cuba, New
Mexico: A Health
Impact
Assessment
Decision-
making
Level
Local
State
Local
State
Decision
TVIIA
J r ^
Plan
Project
Project
Project
HIA Scope/Summary
Examine the health impacts of
the City of Decatur Community
Transportation Plan that aims to
make Decatur a healthy place to
live and work, maintain a high
quality of life, and increase
opportunities for alternative
modes of transportation.
Examine current health
conditions for the population
living in the Red Line corridor,
illustrate links between
transportation and health in
Baltimore, and recommend
specific design features and
mitigation strategies to
maximize the Baltimore Red
Line Project's capacity to
achieve better health.
Inform decision makers about
potential health impacts that
development of a pedestrian
bridge in the University District
will have on the current and
projected population who will
live, work, and recreate within a
quarter-mile radius of the
bridge.
Provide information on how the
design of U.S. Highway 550
could impact the health and
safety of Cuba area residents
and visitors.
HIA Rigor
Rapid
Intermediate
Intermediate
Desk-based
Effect of HIA
on Decision-
making
General
effectiveness
assumed at a
minimum
General
effectiveness
at a minimum,
although
direct
effectiveness
possible
Undetermined
General
effectiveness
at a minimum,
although
direct
effectiveness
possible
50
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Table?. Continued
ID
14
17
27
Title
Comprehensive
Health Impact
Assessment: Clark
County Bicycle
and Pedestrian
Master Plan
Health Impact
Assessment, June
20, 2011:Duluth,
Minnesota's
Complete Streets
Resolution,
Mobility in the
Hillside
Neighborhoods
and the Schematic
Redesign of Sixth
Avenue East
Mass Transit
Health Impact
Assessment:
Potential Health
Impacts of the
Governor's
Proposed
Redirection of
California State
Transportation
Spillover Funds
Decision-
making
Level
County
Local
State
Decision
ype
Plan
Project
Program/
Policy
HIA Scope/Summary
Examine the likely health
impacts of the Clark County
Bicycle and Pedestrian Master
Plan, whether to adopt the
Master Plan or not, and how
elements of the Plan could be
prioritized to maximize health
impacts
The purpose of the HIA was to
determine the potential health
impacts of the Sixth Avenue
East Schematic Redesign
Study, if the redesign was
embracing Duluth's Complete
Streets Resolution, and how the
redesign study could be
improved to provide additional
health benefits to users of the
corridor.
Synthesize and communicate
research evidence on how
proposed cuts in state funding
of mass transit may impact the
public's health and inform
pending transportation funding
decisions in California and
illustrate how public policies
outside the public health and
health care sectors can affect
public health.
HIA Rigor
Rapid
Rapid
Rapid
Effect of HIA
on Decision-
making
Direct
effectiveness
Undetermined
General
effectiveness
51
-------
Table?. Continued
ID
32
42
46
51
53
Title
HI A of the
Still/Lyell
Freeway Channel
in the Excelsior
District
Columbia River
Crossing Health
Impact
Assessment
The Sellwood
Bridge Project: A
Health Impact
Assessment
Rapid Health
Impact
Assessment,
Crook County/
City of Prineville,
Bicycle and
Pedestrian Safety
Plan
SR 520 Health
Impact
Assessment: A
Bridge to a
Healthier
Community
Decision-
making
Level
Local
State
(interstate)
County
Local
State
Decision
TVIIA
J r ^
Project
Project
Project
Plan
Project
HIA Scope/Summary
Examine the health impacts
associated with past
construction of the 1-280
Freeway and high-traffic
surface streets in the Excelsior
District of San Francisco after
concerns surfaced that residents
of that community were being
disproportionately exposed to
traffic-related exposures,
including air pollution, and
suffering the health
consequences.
Examine the Columbia River
Crossing (CRC) Draft
Environmental Impact
Statement (EIS) through a
public health lens to understand
the scope and magnitude of the
potential health effects of the
four bridge alternatives being
considered.
Assess how the proposed
Sellwood Bridge redesign may
affect human health during both
the construction and operational
phases of the project.
Evaluate the current pedestrian
and bicycle situation in
Prineville, Oregon and provide
recommendations to be
incorporated into the updated
Bicycle and Pedestrian Safety
Plan.
Ensure health consequences
were considered in the
decision-making process for the
SR 520 Bridge Replacement
and HOV Project and help
decision makers evaluate the
alternatives based upon their
potential health effects.
HIA Rigor
Intermediate
Desk-based
Rapid
Intermediate
Intermediate
Effect of HIA
on Decision-
making
Direct
effectiveness
Undetermined
Undetermined
Undetermined
Opportunistic
effectiveness
52
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Table?. Continued
ID
54
55
56
62
Title
A Health Impact
Assessment on
Policies Reducing
Vehicle Miles
Traveled in
Oregon
Metropolitan
Areas
Health Effects of
Road Pricing hi
San Francisco,
California:
Findings from a
Health Impact
Assessment
Santa Monica
Airport Health
Impact
Assessment
Health Impact
Assessment on
Transportation
Policies in the
Eugene Climate
and Energy
Action Plan
Decision-
making
Level
State
Local
Local
Local
Decision
ype
Program/
Policy
Program/
Policy
Project
Plan
HIA Scope/Summary
Assess how vehicle miles
travelled (VMT) reduction
strategies being considered by
Oregon's six metropolitan
regions would bring about
changes in air quality, physical
activity, and car accident
rates and what impact that
would have on the public's
health.
Examine a future road pricing
scenario being studied by the
San Francisco County
Transportation Authority
(SFCTA) that would charge $3
during AM/PM rush hours to
travel into or out of the
northeast quadrant of San
Francisco (which includes a
concentration of San
Francisco's currently congested
downtown streets).
Organize, analyze, and evaluate
existing information and
evidence regarding Santa
Monica Airport's (SMO's)
impact on three issue areas:
lack of an airport buffer zone,
noise, and air quality.
Examine the positive and
negative impacts of
transportation policies within
the Eugene Climate and Energy
Action Plan (CEAP). The HIA
examined seven transportation
objectives/ recommendations
and summarized the scientific
evidence that links those
policies to health issues in
Eugene.
HIA Rigor
Intermediate
Comprehensive
Rapid
Intermediate
Effect of HIA
on Decision-
making
Undetermined
Undetermined
General
effectiveness
Direct
effectiveness
53
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Table?. Continued
ID
65
66
75
Title
Health Impact
Assessment (HIA)
of Proposed
"Road Diet" and
Restriping Project
on Daniel Morgan
Avenue in
Spartanburg,
South Carolina
Treasure Island
Community
Transportation
Plan
Interstate 75
Focus Area Study
Health Impact
Assessment
Decision-
making
Level
State
Local
Local
Decision
TVriA
± J'JJC
Project
Plan
Plan
HIA Scope/Summary
Assess what the expected effect
of the proposed Daniel Morgan
Avenue (DMA) Road Diet and
Restriping Project would be on
the safety of motorists,
bicyclists, and pedestrians;
opportunities for physical
activity; opportunities for
improved access to goods and
services; and air quality.
Evaluated whether the Treasure
Island Transportation Plan met
the health needs of its
neighborhood residents, using
the HDMT assessment tool and
focused on ways the
transportation system could be
designed and implemented to
maximize opportunities for
active modes of transportation -
such as walking and cycling -
and minimize the risk of
injuries.
Review the final
recommendations of the Revive
Cincinnati: Neighborhoods of
the Mill Creek Valley
Comprehensive Plan and assess
the health impacts of proposed
Interstate-75 infrastructure
improvements to select
neighborhoods adjacent to 1-75.
Due to time constraints, this
HIA only examined health
impacts to two of the four focus
areas in the study.
HIA Rigor
Intermediate
Rapid
Desk-based
Effect of HIA
on Decision-
making
Undetermined
Direct
effectiveness
Undetermined,
but general
effectiveness
assumed
54
-------
Table?. Continued
ID
79
81
Title
Lake Oswego to
Portland Transit
Project: Health
Impact
Assessment
Health Impact
Assessment of the
Port of Oakland
Decision-
making
Level
Local
Local
Decision
TVriA
± yjJC
Project
Project
HIA Scope/Summary
Complement the Draft
Environmental Impact
Statement (DEIS) and more
fully assess the health impacts
of the three transit alternatives
of the Lake Oswego to Portland
Transit Project - no-build,
enhanced bus service, and
streetcar.
Evaluate the cumulative
impacts of on-going Port of
Oakland growth on the health
of residents in West Oakland
through multiple inter-related
pathways.
HIA Rigor
intermediate
Comprehensive
Effect of HIA
on Decision-
making
Undetermined
Undetermined
Appendix G, Table G-l provides a more detailed look at each of these HIAs, including sources of
evidence, impacts/endpoints, pathways of impact, characterization of impacts, decision-making
outcome, evidence of HIA effectiveness, and evaluation of whether the Minimum Elements of
HIA were met. Figure 30 provides a dashboard of summary statistics for the HIAs in this sector
and Figure 31 highlights one of the tools utilized in analysis.
55
-------
Decision-making Level
Local
County
State
HIA Type
HIA Rigor
Advocacy
Decision support
Community-led
Mandated
Desk-based
Rapid
Intermediate
Comprehensive
Organizations Involved
Other
Educational
Non-profit
GovtAgency
13
0 5 10
Number of HIAs
15
HIA Effectiveness
Sources of Evidence
Special Collection [ \ ] 20
Literature Review I ' ] 20
Policy Review ] . 12
Community Consultation
10 20
Number of HIAs
Minimum Elements of HIA Met
30
1
4 5
11
General
Undetermined
Direct
Opportunistic
*
Yes
No
Figure 30. Dashboard of summary statistics for reviewed HIAs in the Transportation sector.
In the
Spotlight
Health Economic Assessment Tool (HEAT)
HEAT was used in the Health Effects of Road Pricing in San Francisco HIA to calculate
the number of lives saved by predicted increases in walking and bicycling under business
as usual and the proposed road pricing scenario. Using the EPA value of statistical life,
the HIA was able to provide an economic valuation of the mortality averted by active
walking and biking. When compared to the economic valuation of the adverse health
effects, the HIA found that the cost savings estimated from active transportation via
walking and biking were slightly greater than the estimated adverse health costs in each
scenario. HEAT is available at: http://www.heatwalkingcvcling.ore/.
Figure 31. Tool spotlight: Health Economic Assessment Tool (HEAT).
56
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Of the 21 HIAs in the Transportation sector, 15 examined environmental impacts or endpoints
(almost exclusively via the air quality pathway), 13 utilized GIS, and 9 utilized modeling (e.g.,
travel forecasting and traffic noise and emissions modeling). Sources of evidence and data
sources primary to the Transportation sector, included expert consultation, data on vehicle miles
travelled, and data from the National Transit Database and National Household Travel Survey/
Nationwide Personal Transportation Survey.
Model HIAs from the Transportation sector are shown in Figure 32. These HIAs meet the
Minimum Elements ofHIA and exemplify HIA best practices.
Health Effects of Road Pricing
In San Francisco, California
Health Effects of Road Pricing In San Francisco, California:
Findings from a Health Impact Assessment
Strengths
adherence to HIA standards and methodology
clearly described screening and scoping phases, including factors
used in screening
detailed logic framework (identifying direct, mediating,
environmentaybehavioral, health and equity impacts; scale of
impact; and whether judgement of impact was qualitative or
quantitative)
pathway diagrams showing impacts and data used for each
impact type
sources of evidence and methodology sound and of high quality
detailed documentation of data sources, geographic units of
analysis, and how data was utilized in the HIA
detailed documentation of assessment methods/models and
software packages used
quantitative evaluation, including economic valuation
detailed caveats, limitations, and assumptions of assessment
identified uncertainty factors, assessment approach, and
summary confidence level for identified health impacts
Health Impact Assessment (HIA) of Proposed "Road Diet"
and Restriping Project on Daniel Morgan Avenue in
Spartanburg, South Carolina
Strengths
adherence to HIA standards and methodology
identified factors considered in screening
included scoping worksheet showing research questions,
indicators, data sources, and data collection methods in the HIA
sources of evidence and methodology sound and of high quality
provided causal pathways
tabular summary of impacts, including direction, magnitude,
likelihood, significance, and distribution
Figure 32. Model HIAs from the Transportation sector.
57
-------
Housing/Buildings/Infrastructure Snapshot
The 17 HIAs in the Housing/Buildings/Infrastructure sector were conducted to assess the impacts
of a variety of Built Environment projects, plans, programs, and policies (Table 8). As described
previously, the effectiveness of these HIAs in influencing the decisions at hand was evaluated by
the HIA reviewers using four measures of effectiveness defined by Wismar et al. (2007) and
information obtained via an internet search. As such, the measures of effectiveness noted in
Table 8 are subjective and may not reflect the true effect of the HIA on the decision-making
process. Likewise, the measures of effectiveness noted in the table, do not necessarily reflect the
overall effectiveness of the HIA, but rather the HIA's effect on the decision. For a more detailed
discussion of the four measures of effectiveness utilized here and measures of overall HIA
effectiveness, see HIA Effectiveness.
Table 8. Housing/Buildings/Infrastructure Decisions Informed by Reviewed HIAs
ID
\>
8
12
Title
Affordable
Housing and Child
Health: A Child
Health Impact
Assessment of the
Massachusetts
Rental Voucher
Program
Health Impact
Assessment:
South Lincoln
Homes, Denver
CO
Community
Health
Assessment:
Bernal Heights
Preschool - An
Application of the
Healthy
Development
Measurement
Tool (HDMT)
Decision-
making
Level
State
Local
Local
Decision
ype
Program/
Policy
Plan
Project
HIA Scope/Summary
Evaluate the implications of the
Massachusetts Rental Voucher
Program (MRVP), a housing
assistance and homelessness
prevention program, and
proposed MRVP changes for
FY2006, for children's health
and well-being.
Examine the redevelopment
master plan for the Denver
Housing Authority's South
Lincoln Homes community in
Downtown Denver for potential
impacts the redevelopment may
have on health and wellbeing of
the South Lincoln
neighborhood.
Inform decision making
processes related to the choice
among three potential future
locations of the Bernal Heights
Preschool.
HIA Rigor
Intermediate
Comprehensive
Rapid
Effect of HIA
on Decision-
making
Direct
effectiveness
Direct
effectiveness
Undetermined
58
-------
TableS. Continued
ID
23
28
30
35
Title
Health Impact
Assessment of
Modifications to
the Trenton
Farmer's Market
(Trenton, New
Jersey)
The Rental
Assistance
Demonstration
Project - A Health
Impact
Assessment
Jack London
Gateway Rapid
Health Impact
Assessment: A
Case Study
A Health Impact
Assessment of
Accessory
Dwelling Unit
Policies in Rural
Benton County,
Oregon
Decision-
making
Level
Local
Federal
Local
County
Decision
ype
Project
Program/
Policy
Project
Program/
Policy
HIA Scope/Summary
Examine several proposed
changes to a farmers market in
Trenton, New Jersey, including
two being considered by the
market's executive board (i.e.,
minor cosmetic changes and a
major remodel) and a third
suggestion (i.e., a market
outreach strategy) and their
impacts on patrons' nutrition
and physical activity patterns,
as well as the potential
economic and social capital
benefits for vendors and the
surrounding community.
Examine the impacts of a
proposed federal housing policy
designed to address some of the
systemic funding issues related
to public housing on a number
of health determinants that
remained unanswered in
legislative debates; and ensure
that the evaluation of this pilot
project comprehensively
considered the health impacts
of public housing-related policy
decisions
Examine a planned retail
expansion and low-income
senior housing development
and address community
concerns about air quality,
noise, safety, and retail
planning
Examine the impacts of five
accessory dwelling unit policy
options, ranging from
restricting currently permitted
uses to allowing construction of
a complete accessory unit.
HIA Rigor
Intermediate
Comprehensive
Rapid
Comprehensive
Effect of HIA
on Decision-
making
Undetermined,
but no
effectiveness
assumed
General
effectiveness
Direct
effectiveness
Direct
effectiveness
59
-------
TableS. Continued
ID
36
40
48
Title
The Health Impact
Assessment (HIA)
of the
Commonwealth
Edison (ComEd)
Advanced
Metering
Infrastructure
(AMI)
Deployment
Unhealthy
Consequences:
Energy Costs and
Child Health -A
Child Health
Impact
Assessment of
Energy Costs and
the Low Income
Home Energy
Assistance
Program
A Rapid Health
Impact
Assessment of the
City of Los
Angeles' Proposed
University of
Southern
California Specific
Plan
Decision-
making
Level
State
State
Local
Decision
TVriA
± J'JJC
Program/
Policy
Program/
Policy
Plan
HIA Scope/Summary
Identify the impact of advanced
metering infrastructure (AMI)
deployment on the health of
residential customers in the
Commonwealth Edison
(ComEd) service territory in
Illinois, particularly vulnerable
customers - the very young
(birth to age 5), older
individuals (age 65+),
individuals with functional
disability status including those
with temperature sensitive
conditions, individuals who are
socially isolated, and
individuals with limited English
proficiency or literacy.
Evaluate impacts of both home
heating and total home energy
(including electricity, water
heating, and cooking) costs and
a federally-funded energy
assistance program - the Low
Income Home Energy
Assistance Program (LIHEAP)
-on the health of children.
Examine how the proposed
University of Southern
California (USC) Specific Plan
would impact measures of
housing, gentrification, and
displacement and lead to
changes in health for the
communities around the USC
campus, particularly low-
income and vulnerable
populations.
HIA Rigor
Comprehensive
Intermediate
Rapid
Effect of HIA
on Decision-
making
Direct
effectiveness
Direct
effectiveness
Direct
effectiveness
60
-------
TableS. Continued
ID
50
52
57
61
Title
Anticipated
Effects of
Residential
Displacement on
Health: Results
from Qualitative
Research
29th St. / San
Pedro St. Area
Health Impact
Assessment
Lowry Corridor,
Phase 2 Health
Impact
Assessment
Hospitals and
Community
Health HIA: A
Study of
Localized Health
Impacts of
Hospitals
Decision-
making
Level
Local
Local
Local
Local
Decision
TVriA
i^pe
Project
Project
Project
Project
HIA Scope/Summary
Examine the Trinity Plaza
Redevelopment, which
proposed to demolish an older
apartment building with over
360 rent-controlled units and
replace it with 1,400 market-
rate condominiums and the
potential effects of eviction on
health and well-being of
tenants.
Ensure that health impacts were
considered in the development
plan for The Crossings at 29th
Street -an 11.6-acre
development that included
affordable housing and retail
and community space - and in
the broader policies impacting
redevelopment in the area.
Analyze the potential health
effects of Phase 2 development
of the Lowry Avenue Corridor
Project, a five-mile
thoroughfare located north of
downtown Minneapolis.
Built upon the Atlanta BeltLine
HIA to retrospectively examine
the localized health impacts of
Piedmont Hospital - one of the
major anchor institutions along
the Peachtree Corridor in
Atlanta, Georgia - and
prospectively examine how
plans for future growth could
change those impacts.
HIA Rigor
Rapid
Intermediate
Desk-based
Comprehensive
Effect of HIA
on Decision-
making
Direct
effectiveness
Direct
effectiveness
Direct
effectiveness
General
effectiveness
61
-------
TableS. Continued
ID
70
76
80
Title
Pathways to
Community
Health: Evaluating
the Healthfullness
of Affordable
Housing
Opportunity Sites
Along the San
Pablo Avenue
Corridor Using
Health Impact
Assessment
A Rapid Health
Impact
Assessment of the
Long Beach
Downtown Plan
HOPE VI to
HOPE SF San
Francisco Public
Housing
Redevelopment: A
Health Impact
Assessment
Decision-
making
Level
Local
Local
Local
TVrija
lype
Plan
Plan
Program/
Policy
HIA Scope/Summary
Assess the health impacts
associated with the San Pablo
Avenue Specific Plan for three
sites proposed to be included in
a campaign for affordable
housing, and encourage the
healthfulness of the San Pablo
Area Specific Plan and eventual
site development
Ensure decisions in the City of
Long Beach Downtown Plan
and Long Beach Downtown
Plan Environmental Impact
Report account for impacts to
low-income and vulnerable
populations in the areas of
housing and employment.
Explore the positive and
negative health impacts of past
Housing Opportunities for
People Everywhere (HOPE) VI
redevelopment at two sites -
Bernal Dwellings and North
Beach Place - with the aim of
finding opportunities to address
existing problems and
informing future public housing
redevelopment in the HOPE SF
Program.
HIA Rigor
Intermediate
Rapid
Intermediate
Effect of HIA
on Decision-
making
Undetermined,
but general
effectiveness
assumed
None
General
effectiveness
at a minimum,
but direct
effectiveness
assumed
Appendix G, Table G-2 provides a more detailed look at each of these HIAs, including sources of
evidence, impacts/endpoints, pathways of impact, characterization of impacts, decision-making
outcome, evidence of HIA effectiveness, and evaluation of whether the Minimum Elements of
HIA were met. Figure 33 provides a dashboard of summary statistics for the HIAs in this sector
and Figure 34 highlights one of the tools utilized in analysis.
62
-------
Decision-making Level
Local
County
State
Federal
HIA Type
HIA Rigor
Advocacy
Decision support
Community-led
Desk-based
Rapid
Intermediate
Comprehensive
Organizations Involved
Non-profit
Other
Educational
Govt Agency
Sources of Evidence
Literature Review
Special Collection
Policy Review
Community Consultation
2 4 6 8 10
Numberof HIAs
11
10
I 17
16
10
Numberof HIAs
20
HIA Effectiveness
General
Undetermined
Direct
None
Minimum Elements of HIA Met
I Yes
No
Figure 33. Dashboard of summary statistics for reviewed HIAs in the Housing/Buildings/Infrastructure
sector.
In the
Spotlight
Traffic Noise Model (TNM) and Noise Annoyance Relationship
The TNM was used to estimate traffic noise levels at two potential affordable housing
development sites in the HIA Evaluating the Healthfulness of Affordable Housing
Opportunity Sites Along the San Pablo Avenue Corridor. This data was used in
combination with the Miedema and Oudshoorn Noise Annoyance Relationship to
estimate the percentage of population that would be highly annoyed by the road traffic
noise at these two sites. The TNM is available at: http://www.fhwa.dot.gov/
environment/noise/traffic noise model/: and the Noise Annoyance Relationship is
available at:
000409.pdf
http://www.ncbi.nlm.nih. gov/pmc/articles/PMC1240282/pdf/ehp0109-
Figure 34. Tool spotlight: Traffic Noise Model (TNM) and Noise Annoyance Relationship.
63
-------
Of the 17 HIAs in the Housing/Buildings/Infrastructure sector, 8 were conducted in California
and 1 was a nationwide HIA; five (5) HIAs examined environmental impacts or endpoints, 10
utilized GIS, and 4 utilized modeling (e.g., traffic noise and emissions modeling). Data sources
and tools primary to the Housing/Buildings/Infrastructure sector included HUD, the American
Housing Survey, and the American Community Survey.
A model HIA from the Housing/Buildings/Infrastructure sector is shown in Figure 35. This HIA
meets the Minimum Elements of HIA and exemplifies HIA best practices.
The Rental Assistance Demonstration Project - A Health
Impact Assessment
Strengths
adherence to HIA standards and methodology
documentation of each step of the HIA process, including
screening
included scoping worksheet, housing/health survey questions,
and focus group moderator's guide in the HIA
sources of evidence and methodology sound and of high quality
used case study cities to focus and ground findings for
nationwide HIA
included a section in the HIA Report identifying the most
challenging limitations
provided pathway diagrams, research questions, empirical
analysis, predicted impacts, and recommendations for each
determinant of health
tabular summary identifying direction, magnitude, and severity
of impacts, evidence strength, and uncertainties for each health
determinant
Figure 35. Model HIA from the Housing/Buildings/Infrastructure sector.
64
-------
Land Use Snapshot
The 39 HIAs in the Land Use sector were conducted to assess the impacts of a variety of land
use-related projects, plans, programs, and policies (Table 9). As described previously, the
effectiveness of these HIAs in influencing the decisions at hand was evaluated by the HIA
reviewers using four measures of effectiveness defined by Wismar et al. (2007) and information
obtained via an internet search. As such, the measures of effectiveness noted in Table 9 are
subjective and may not reflect the true effect of the HIA on the decision-making process.
Likewise, the measures of effectiveness noted in the table, do not necessarily reflect the overall
effectiveness of the HIA, but rather the HIA's effect on the decision. For a more detailed
discussion of the four measures of effectiveness utilized here and measures of overall HIA
effectiveness, see HIA Effectiveness.
Table 9. Land Use Decisions Informed by Reviewed HIAs
~~l
ID Title
1
3
6
7
Health Impact
Assessment -
Deiby
Redevelopment,
Historic
Commerce City,
Colorado
Health Impact
Assessment
Report: Alcohol
Environment -
Village of Weston,
WI
Eastern
Neighborhoods
Community
Health Impact
Assessment Final
Report
Decision-
making
Level
Local
Local
Local
Decision
ype
Project
Program/
Policy
Project
HIA Scope/Summary
Evaluate potential impact of
Derby's redevelopment on
physical activity and nutrition
behaviors of the population of
historic Commerce City.
Assess the impact of an alcohol
policy on the community's
health, specifically underage
drinking and drinking and
driving behaviors. While there
was no specific policy under
review at the onset of the
project, the potential impacts of
a retail outlet density policy,
specifically a limit on future
Class A alcohol licenses, on
community health and
development were assessed.
Assess the health benefits and
burdens of development, land
use plans, and zoning controls
in several San Francisco
neighborhoods, including the
Mission, South of Market, and
Portero Hill.
HIA Rigor
Rapid
Intermediate
Comprehensive
Effect of HIA
on Decision-
making
General
effectiveness
assumed at a
minimum
Undetermined
General
effectiveness
at a minimum,
but direct
effectiveness is
assumed
65
-------
Table 9. Continued
ID
10
13
15
16
Title
Health Impact
Assessment: An
Analysis of
Potential Sites for
a Regional
Recreation Center
to Serve North
Aurora, Colorado
St. Louis Park
Comprehensive
Plan - Health
Impact
Assessment
Health Impact
Assessment: Key
Reco mmendations
of the Northeast
Area Plan
Yellowstone
County/City of
Billings Growth
Policy Health
Impact
Assessment
Decision-
making
Level
Local
Local
Local
Local
Tvnp
iype
Program/
Policy
Plan
Plan
Program/
Policy
HIA Scope/Summary
Inform a policy decision about
the specific location of a
regional recreation center in
North Aurora, identify impacts
to health, and provide
recommendations for the
Aurora Residents for
Recreation Task Force
(ARRTF), City Planners, and
City Council.
Assess the St. Louis Park
Comprehensive Plan to ensure
that public health is considered
within the plan.
Evaluate the six key
recommendations of the City of
Columbus Northeast Area Plan
with respect to physical activity
for the residents of the
Northeast area.
Take a retrospective look at the
Growth Policy that was adopted
in 2003 in order to identify
ways to make health a part of
the decision making process
regarding community growth
by predicting health
consequences, informing
decision makers and the public
about health impacts, and
providing realistic
recommendations to prevent or
mitigate negative health
outcomes.
HIA Rigor
Rapid
Desk-based
Desk-based
Intermediate
Effect of HIA
on Decision-
making
Undetermined
General
effectiveness
at a minimum,
but possibly
direct
effectiveness
Undetermined
Direct
effectiveness
66
-------
Table 9. Continued
ID
18
19
20
21
Title
Knox County
Health
Department
Community
Garden Health
Impact
Assessment:
Reco mmendations
for Lonsdale,
Inskip and Mascot
Alaska Outer
Continental Shelf
- Beaufort Sea and
Chukchi Sea
Planning Areas,
Oil and Gas Lease
Sales 209, 212,
217, and 221 Draft
Environmental
Impact Statement;
Appendix J -
Public Health
Divine Mercy
Development
Health Impact
Assessment
Fort McPherson
Rapid Health
Impact
Assessment:
Zoning for Health
Benefit to
Surrounding
Communities
During Merim
Use
Decision-
making
Level
County
Federal
State
Local
TVrija
lype
Program/
Policy
Project
Plan
Project
HIA Scope/Summary
Mo rm policy decisions related
to the placement and
maintenance of community
gardens in Knox County,
Tennessee and to objectively
present the facts surrounding
community gardens and why
zoning code should be changed
if needed in order to support
their placement within
residential and nonresidential
communities
Examine the health impacts of
the proposals for oil and gas
leasing in the Beaufort and
Chukchi seas, as well as the 10
alternatives to these proposed
actions addressed in the EIS.
Mo rm recommendations on
incorporating health and
climate change indicators into
the Minnesota Environmental
Assessment Worksheet (EAW)
used in the environmental
review process.
As part of a project to bring a
Health in all Policies (HiAP)
perspective into the baseline
realignment and closure process
for Fort McPherson and
assessed the zoning provisions
that govern permitted uses of
land, green space, and
transportation to gauge their
effect on health.
HIA Rigor
Desk-based
Mermediate
Desk-based
Rapid
Effect of HIA
on Decision-
making
Direct
effectiveness
General
effectiveness
assumed
Undetermined
General
effectiveness
at a minimum,
but possibly
direct
effectiveness
67
-------
Table 9. Continued
ID
22
24
26
29
31
Title
Re: November
10th Merced
County General
Plan Update
(MCGPU)
Preferred Growth
Alternative
Decision
SE 122nd Avenue
Planning Study
Health Impact
Assessment
Health Impact
Assessment:
Hawai'i County
Agriculture
Development Plan
Case Study:
Bloomington Xcel
Energy Corridor
Trail Health
Impact
Assessment
Health Impact
Assessment for
Proposed Coal
Mine at Wishbone
Hill, Matanuska-
Susitna Borough
Alaska
Decision-
making
Level
County
Local
County
Local
State
TVrija
lype
Plan
Project
Plan
Project
Project
HIA Scope/Summary
Examine the two growth
alternatives being considered
for the Merced County General
Plan Update - one that focused
development in existing urban
areas and another that would
allow for the creation of new
towns in the county - and
associated health impacts.
Evaluate both the health
impacts of the SE 122nd
Avenue Pilot Project
recommendations themselves,
as well as the health impacts of
the 20-minute neighborhood
form
Evaluate the potential positive
and negative impacts of three
Agriculture Plan policies -
institutional buying (farm-to-
school programs), commercial
expansion of food agriculture,
and home production -on the
health of Hawaii Island
residents.
Assess potential health impacts
and obstacles to the proposed
Xcel recreational trail corridor
and support for including the
Xcel trail corridor in the
Alternative Transportation Plan
Review potential positive and
negative human health impacts
related to the proposed
Wishbone Hill Mine (WHM) -
a surface coal mine located in
the Matanuska-Susitna valley
near Sutton, Alaska.
HIA Rigor
Desk-based
Intermediate
Intermediate
Rapid
Intermediate
Effect of HIA
on Decision-
making
None
Undetermined,
but general
effectiveness
assumed at a
minimum
Direct
effectiveness
General
effectiveness
Undetermined
68
-------
Table 9. Continued
ID
34
37
38
39
Title
City of Ramsey
Health Impact
Assessment
Atlanta Beltline
Health Impact
Assessment
Zoning for a
Healthy
Baltimore: A
Health Impact
Assessment of the
Transform
Baltimore Zoning
Code Rewrite
Hood River
County Health
Department
Health Impact
Assessment for
the Barrett
Property
Decision-
making
Level
Local
Local
Local
County
TVrija
lype
Plan
Project
Project
Project
HIA Scope/Summary
Assess the potential health
impacts of current city planning
practices, set goals for
improvement, and develop
future policy directions in
conjunction with the 2008 City
of Ramsey Comprehensive Plan
update.
Make health a part of the
Atlanta BeltLine decision-
making process by predicting
health consequences, informing
decision makers and the public
about health impacts, and
providing realistic
recommendations to prevent or
mitigate negative health
outcomes.
Evaluate the impacts of
Baltimore's comprehensive
zoning code rewrite, TransForm
Baltimore, to maximize the
potential for the zoning recede
to prevent obesity and other
adverse health outcomes and
reduce inequities in these
outcomes among children and
adolescents in Baltimore.
Investigate the potential health
benefits of turning a former
orchard into a community park
with open play fields, trails, and
community gardens and the
potential health risks for users
of the property from exposure
to residual pesticide chemicals.
HIA Rigor
Desk-based
Comprehensive
Intermediate
Intermediate
Effect of HIA
on Decision-
making
Direct
effectiveness
Undetermined
Undetermined
Undetermined
69
-------
Table 9. Continued
ID
41
43
44
45
Title
Technical Report
9: Highway 99
Sub-Area Plan
Health Impact
Assessment
Inupiat Health and
Proposed Alaskan
Oil Development:
Results of the
First Integrated
Health Impact
Assessment/
Environmental
Impact Statement
for Proposed Oil
Development on
Alaska's North
Slope
Page Avenue
Health Impact
Assessment
Pittsburg Railroad
Avenue Specific
Plan Health
Impact
Assessment
Decision-
making
Level
County
Federal
Local
Local
TVrija
lype
Plan
Project
Project
Plan
HIA Scope/Summary
Support the Sub -Area Plan
vision (to apply land use
planning to build a healthy
community) by using an
established socio-ecological
model of health promotion to
validate the plan's health
promoting features.
Developed as part of a
supplemental Environmental
Impact Statement (EIS) to
examine health impacts of oil
and gas development in the
Teshekpuk Lake Special Area
of the Northeast National
Petroleum Reserve (NPR)-A
(North Slope Bureau, Alaska).
Provide an impartial assessment
of the health impacts of the
Page Avenue Redevelopment
on individuals, youth, and
families living primarily in
Pagedale, Missouri as well as
surrounding communities in
University City and Wellston.
Determine the health impacts of
the Pittsburg Railroad Avenue
Specific Plan - a transit-
oriented design plan to build a
new train station, new
residential and commercial
uses, public space, and
pedestrian and bicycle
improvements.
HIA Rigor
Rapid
Intermediate
Comprehensive
Comprehensive
Effect of HIA
on Decision-
making
Direct
effectiveness
Direct
effectiveness
Undetermined
Direct
effectiveness
70
-------
Table 9. Continued
ID
47
49
58
59
60
63
Title
The East Bay
Greenway Health
Impact
Assessment
Taylor Energy
Center Health
Impact
Assessment
Battlement Mesa
Health Impact
Assessment (2nd
Draft)
Douglas County
Comprehensive
Plan Update
Health Impact
Assessment
The Executive
Park Subarea Plan
Health Impact
Assessment: An
Application of the
TT _ _1 J-1-
Healthy
Development
Measurement
Tool (HDMT)
Oak to Ninth
Avenue Health
Impact
Assessment
Decision-
making
Level
Unknown
County
County
County
Local
Local
TVrija
lype
Project
Project
Project
Plan
Plan
Project
HIA Scope/Summary
Highlight potential positive
impacts of the Greenway
pedestrian and bike trail could
have on health and to uncover
and suggest mitigations for
potential barriers that would
hinder the project from
reaching its full positive health
impact.
Analyze the impact of a
proposed coal-fired electric
plant, including risks from air
pollution and benefits to health
from employment by the plant
and the "community
contribution"
Address citizen concerns about
health impacts of natural gas
development and production in
the Battlement Mesa Planned
Unit Development (PUD).
Evaluate updates to the Douglas
County Comprehensive Plan,
which provides a framework
and policy direction for future
land use, transportation, natural
resource and park/open space
decisions.
Summarize the results from the
first application of San
Francisco's Healthy
Development Measurement
Tool to the Executive Park
Subarea Plan, which proposes
to build 2,800 units of new
residential housing on a 71 -acre
area in the southeastern corner
of San Francisco.
Assess the influence of the Oak
to Ninth Avenue development
project - a waterfront mixed-
use neighborhood - on
determinants of human health.
HIA Rigor
Rapid
Rapid
Comprehensive
Intermediate
Comprehensive
Intermediate
Effect of HIA
on Decision-
making
Direct
effectiveness
Undetermined
Direct
effectiveness
Direct
effectiveness
Undetermined
Direct
effectiveness
71
-------
Table 9. Continued
ID
64
67
68
69
Title
A Health
Assessment of
Mixed Use
Redevelopment
Nodes and
Corridors in
Lincoln, Nebraska
Healthy Tumalo
Community Plan:
A Health Impact
Assessment on the
Tumalo
Community Plan;
A Chapter Of The
20-Year
Deschutes County
Comprehensive
Plan Update
Strategic Health
Impact
Assessment on
Wind Energy
Development in
Oregon (Public
Review Draft)
Impacts on
Community
Health of Area
Plans for the
Mission, East
SoMa, and
Potrero
Hill/Showplace
Square: An
Application of the
Healthy
Development
Measurement
Tool
Decision-
making
Level
County
County
State
Local
TVrija
lype
Plan
Plan
Project
Plan
HIA Scope/Summary
Analyze the nodes and
corridors proposal in the
Comprehensive Plan to
determine whether the proposed
changes would truly generate
health benefits in Lincoln.
Evaluate the draft Tumalo
Community Plan in the context
of community health and
support county planners by
providing recommendations
that could be incorporated into
the final plan.
Assess ways that wind energy
developments in Oregon might
affect the health of individuals
and communities where they
are built and maintained,
develop evidence-based
recommendations for future
facility siting decisions, engage
community and stakeholders,
and assess the utility of HIA for
specific wind farm siting
decisions.
Use the Healthy Development
Measurement Tool (HDMT) to
examine potential health
implications of the Eastern
Neighborhoods Area Plans,
using 26 of 27 community
health objectives within six
healthy city vision elements -
environmental steward-ship,
sustainable and safe
transportation, social cohesion,
public infrastructure/access to
goods and services, adequate
and healthy housing, and
healthy economy.
HIA Rigor
Rapid
Intermediate
Comprehensive
Comprehensive
Effect of HIA
on Decision-
making
None
Direct
effectiveness
Undetermined
Direct
effectiveness
72
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Table 9. Continued
ID
71
72
73
77
78
Title
MacArthur BART
Transit Village
Health Impact
Assessment
Healthy Corridor
for All: A
Community
Health Impact
Assessment of
Transit-oriented
Development
Policy in St. Paul
Minnesota
Health Impact
Assessment Point
Thomson Project
Humboldt County
General Plan
Update Health
Impact
Assessment
Rapid Health
Impact
Assessment:
Vancouver
Comprehensive
Growth Manage-
ment Plan 20 11
Decision-
making
Level
Local
Local
Federal
County
Local
TVrija
lype
Project
Program/
Policy
Project
Plan
Plan
HIA Scope/Summary
Examine the health impacts of
the MacArthur BART Transit
Village - a proposed
redevelopment of the
MacArthur Bay Area Rapid
Transit Station parking lot and
adjacent property into a mixed
use village.
Examine the rezoning
ordinance that would lay the
foundation for the
implementation of transit-
oriented development (TOD)
along the Central Corridor to
understand the impacts of the
light rail line and subsequent
land use changes on community
health, health inequities, and
underlying conditions that
determine health.
Identify human health impacts
associated with each of the five
proposed design alternatives of
the proposed oil and gas
development in Alaska's remote
Point Thomson area.
Evaluate six key areas of the
Humboldt County General Plan
Update (GPU) to identify how
indicators of healthy
development would change as a
result of the three alternatives
being considered - denser
development in urban areas,
limited growth to exurban
areas, and unrestricted growth
across the county.
Examine the 2011 Vancouver
Comprehensive Plan and its
impact on two key determinants
of health - physical activity and
access to healthy food.
HIA Rigor
Comprehensive
Comprehensive
Intermediate
Intermediate
Rapid
Effect of HIA
on Decision-
making
Undetermined
General
effectiveness
at a minimum,
but direct
effectiveness
assumed
General
effectiveness
Direct
effectiveness
Undetermined
73
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Appendix G, Table G-3 provides a more detailed look at each of these HIAs, including sources of
evidence, impacts/endpoints, pathways of impact, characterization of impacts, decision-making
outcome, evidence of HIA effectiveness, and evaluation of whether the Minimum Elements of
HIA were met. Figure 36 provides a dashboard of summary statistics for the HIAs in this sector
and Figure 37 highlights one of the tools utilized in analysis.
Of the 39 HIAs in the Land Use sector, 9 were conducted in California and 6 were conducted in
Minnesota; twenty-six (26) HIAs examined environmental impacts or endpoints, 28 utilized GIS,
and 15 utilized modeling (e.g., travel forecasting and urban emission, air pollutant dispersion,
economic, food availability, and parking demand modeling). Data sources and tools primary to
the Land Use sector, included zoning data, data from the Bureau of Labor Statistics, and the
CALINE3/CAL3QHC/CAL3QHCR models (for predicting pollutant dispersion from traffic).
Decision-making Level
Local
County
State
Federal
Unknown
HIA Rigor
HIA Type
Desk-based
Rapid
Intermediate
Comprehensive
Advocacy
Decision support
Mandated
Organizations Involved
GovtAgency
Non-profit
Educational
Other
Undetermined
Sources of Evidence
Literature Review
Special Collection
Policy Review
Community Consultation
136
36
26
22
10 20
Number of HIAs
HIA Effectiveness
20
Numberof HIAs
40
General
Undetermined
Direct
None
Minimum Elements of HIA Met
I Yes
No
Figure 36. Dashboard of summary statistics for reviewed HIAs in the Land Use sector.
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Walk Score
Walk Score was used in the Rapid HIA of the 2011 Vancouver Comprehensive Growth
In the Management Plan to measure the existing density of land use mix and overall walkability
Spotlight in Vancouver and its neighborhoods. The walkability scores/maps were then compared
with measures of connectivity (i.e., connected node ratio), retail development density (i.e.,
floor area ratio), socioeconomic status (SES), race/ethnicity, and age to identify
correlations between walkability and these measures. These correlations, in combination
with existing literature, were used to evaluate the impacts of proposed policy, planning,
and zoning changes. The HIA found that the changes in the Comprehensive Plan would
promote greater walkability and increased access to healthy food. Walk Score is available
at: http://www.walkscore.com/
«. >
Figure 37. Tool spotlight: Walk Score.
Model HI As from the Land Use sector are shown in Figure 38. These HI As meet the Minimum
Elements of HIA and exemplify HIA best practices.
Atlanta BeltLine
Health Impact Assessment
HEALTHY CORRIDOR FOR ALL
A COMMUNITY HEALTH IMPACT ASSESSMENT
OF TRANSIT CHWNTED DEVELOPMENT PCUCY
IN SAINT PAUL MINNESOTA
FolkyLnk
Atlanta Beltline Health Impact Assessment
Strengths
adherence to HIA standards and methodology
included description of screening process in the HIA
provided logic model framework
assessed comprehensive health endpoints
sources of evidence and methodology sound and of high quality
included survey and results in the HIA
tabular summary of HIA showing key findings, affected
populations, recommendations, and the categories of health
impacts attributed to each recommendation
identified lessons learned
Healthy Corridor for All: A Community Health Impact
Assessment of Transit-oriented Development Policy in St.
Paul Minnesota
Strengths
adherence to HIA standards and methodology
identified core values that guided the HIA
included a description of methodology used at each step of the
HIA, including screening
provided a logic model framework
used a Rules of Engagement Memo
sources of evidence and methodology sound and of high quality
provided a detailed description of data sources, including
geographic scale of the data, and methodology used in data
analysis
Figure 38. Model HIAs from the Land Use sector.
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Waste Management/Site Revitalization
The four HIAs in the Waste Management/Site Revitalization sector were conducted to assess the
impacts of a number of waste-related projects and policies (Table 10). As described previously,
the effectiveness of these HIAs in influencing the decisions at hand was evaluated by the HIA
reviewers using four measures of effectiveness defined by Wismar et al. (2007) and information
obtained via an internet search. As such, the measures of effectiveness noted in Table 10 are
subjective and may not reflect the true effect of the HIA on the decision-making process.
Likewise, the measures of effectiveness noted in the table, do not necessarily reflect the overall
effectiveness of the HIA, but rather the HIA's effect on the decision. For a more detailed
discussion of the four measures of effectiveness utilized here and measures of overall HIA
effectiveness, see HIA Effectiveness.
Table 10. Waste Management/Site Revitalization Decisions Informed by Reviewed HIAs
ID
4
25
33
74
Title
Health Impact
Assessment of
NRMTs Request
for a Special Use
Permit
Concord Naval
Weapons Station
Reuse Project
Health Impact
Assessment
Neenah-Menasha
Sewerage
Commission
Biosolids Storage
Facility,
Greenville, WI
Assessment of
Open Burning
Enforcement in La
Crosse County
Decision-
making
Level
County
Local
County
County
Decision
Type
Project
Project
Project
Program/
Policy
HIA Scope/Summary
Address the health impacts of
the proposed dirty materials
recovery facility.
Analyze how the alternatives
being considered for the CNWS
Reuse Project would help
realize health and well being
benefits or potentially lead to
negative health outcomes.
Review potential health
concerns and propose methods
to reduce those risks with the
building of a biosolids storage
facility.
Determine the potential health
impacts of creating a uniform
open air burning policy within
La Crosse County.
HIA Rigor
Intermediate
Intermediate
Rapid
Rapid
Effect of HIA
on Decision-
making
Direct
effectiveness
Direct
effectiveness
Undetermined
Undetermined
Appendix G, Table G-4 provides a more detailed look at each of these HIAs, including sources of
evidence, impacts/endpoints, pathways of impact, characterization of impacts, decision-making
outcome, evidence of HIA effectiveness, and evaluation of whether the Minimum Elements of
HIA were met. Figure 39 provides a dashboard of summary statistics for these HIAs and Figure
40 highlights one of the tools utilized in analysis.
76
-------
Decision-making Level
HIA Type
HIA Rigor
Advocacy
Decision support
Rapid
Intermediate
Organizations Involved
GovtAgency
Non-profit
Sources of Evidence
Literature Review I ' |4
Special Collection | . ]4
Policy Review | \ ]4
Community Consultation
0 0.5 1 1.5 2 2.5
Numberof HIAs
0
2 4
Numberof HIAs
HIA Effectiveness
Direct
Undetermined
Minimum Elements of HIA Met
I Yes
No
Figure 39. Dashboard of summary statistics for reviewed HIAs in the Waste Management/Site Revitalization
sector.
In the
Spotlight
Living Wage Calculator
The Living Wage Calculator was used in the Concord Naval Weapons Station Reuse
Project HIA to calculate the living wage for the city of Concord and compare this with
the wages of current jobs in the area, as well as the wages of jobs likely to be created by
the project. Using this tool, the HIA was able to showthat over 50% of the created jobs
would pay workers less than the living wage and that the amount of affordable housing
proposed in the project alternatives would not meet the demand created by these wages.
This led to recommendations to 1) adopt a Living Wage Ordinance that ensures that
new jobs pay residents enough for them to live in Concord and have a reasonable
quality of life, and 2) match the cost of new housing to the projected wages of new jobs
to meet the affordable housing need. The Living Wage Calculator is available at:
http://livingwage.mit.edu/
Figure 40. Tool spotlight: Living Wage Calculator
77
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All 4 HIAs in the Waste Management/Site Revitalization sector examined environmental
impacts or endpoints, 3 examined economic endpoints, and 3 utilized GIS.
None of the HIAs in the Waste Management/Site Revitalization sector met the Minimum
Elements of HIA, so no model HIAs are provided for this sector.
Current State-of-Science in HIA Community of Practice
Based on the HIAs reviewed, conclusions can be drawn about the current state-of-science in the
HIA community of practice, including the implementation of HIAs, best practices, and areas for
improvement.
HIA Implementation
The HIA Review revealed several trends in implementation of HIAs within the four chosen
sectors that can be safely extrapolated to the greater community of practice.
Use of HIA to Inform Decision-making
Based on the HIAs reviewed, it is evident that HIAs are being used with increased frequency to
bring health to the decision-making process. This trend is consistent with trends seen in the
overall community of practice (i.e., the use of HIAs in the U.S. is on the rise; Health Impact
Project 2013). While the reviewed HIAs were implemented consistently across the four sectors
to inform decisions at the local level, they were used less frequently to inform decisions at the
county, state, and federal level.
Implementation of the HIA Process
Implementation of the six-step HIA process varied greatly among the reviewed HIAs, leading to
large disparities in rigor and quality.
Screening - Documentation of the screening process was lacking throughout the HIAs
reviewed, making it difficult to discern what factors went into making the decision to
conduct the HIA. This is consistent with trends seen in the overall community of practice
(National Research Council 2011). But as the National Research Council (2011) notes, while
the reasons for proceeding with an HIA are often unclear, still less is known about the
reasons that lead to decisions not to proceed with an HIA.
Scoping - Documentation of the scoping process was not consistent among HIAs and often
lacked details of the overall HIA plan (including research questions to be answered and
rationale for issues selected for inclusion in the HIA), despite readily-available guidance and
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even scoping templates developed by Human Impact Partners (http://www.human!mpact.org/
component/idownloads/fmish/13/5) and others.
Organizations involved in conducting HIAs vary, although state and local government health
agencies were most commonly involved in carrying out the assessments included in the HIA
Review. While HIAs are typically successful in bringing health to the table in decisions
outside of traditional health-related fields, the HIA field of practice could be advanced with
successful implementation of HIAs by non health-related organizations.
The rigor of the HIAs vary drastically due to the scale and complexity of the decisions being
assessed, the timing of the HIA relative to the decision-making process, and disparities in the
breadth of the HIA scope (i.e., the number of impacts to assess), depth of impact assessment,
extent of data collection and analysis (including input from stakeholders), time and resources
allocated to complete the HIA, and likely the skills and expertise of the HIA team, although
the latter was not assessed in the HIA Review.
It is often infeasible to examine all the impacts of a decision, making it necessary to prioritize
the impacts to be considered in the HIA. Prioritization can be based on a number of factors,
but those used most frequently in the reviewed HIAs included stakeholder/community input,
literature and research, impact on health and relevance to project/decision interests, and
equity of impacts. While considerable evidence exists regarding the various pathways
through which health can be affected and the value added of logic frameworks and pathway
diagrams in identifying links between proposed decisions and health, these tools were
inconsistently applied in the scoping process of the HIAs.
Assessment - The depth and defensibility of the evidence used in HIA is crucial to the
effectiveness of impact assessment. Existing data, tools, and models used in the assessment
step of the reviewed HIAs were gathered from a variety of resources. The U.S. Census
Bureau was the primary resource used in the HIAs for demographics and background data
(e.g., social, economic, housing, and educational attainment data), while health data were
most commonly gathered from state, county, or local health departments or one of the
various health surveys conducted by the CDC.
In addition to the use of existing data, tools, and models, collection of primary data is also a
critical component of HIA. A variety of special collection methods were used in the HIAs to
acquire new data, often at the "local" level (i.e., the level of the project or decision). Of the
special collection methods utilized, those that involved and/or solicited information from
stakeholders or the community and GIS or other mapping techniques were used most often.
Several deficiencies were found in the HIAs related to evidence defensibility. These include:
lack of clear/cited supporting evidence, marginal or moderate quality of evidence, no
identification of assumptions and/or limitations of the assessment, and lack of transparency
in the synthesis of evidence.
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A critical component of the assessment process is developing a profile of baseline conditions
that includes data on health outcomes and determinants of health. These baseline conditions
are necessary in order to identify disparities in existing conditions and predict future
conditions if the decision is implemented, yet the extent of the profiles created in some of the
HIAs was very limited and in others, it was missing completely (n=18).
Overall, the potential health impacts from decisions in the 81 reviewed HIAs were extensive,
but on the individual HIA level, the depth of health impacts considered in assessment varied
greatly. In addition to identifying potential health impacts, the assessment step in the HIA
process also includes characterizing the direction, magnitude, likelihood, distribution (i.e.,
equity), and permanence of impacts via qualitative and quantitative analysis. However, the
HIA Review found that impact characterization rarely considered likelihood, magnitude, or
permanence; characterization of impacts primarily involved considerations of direction and
di stributi on/equity.
In addition, most HIAs qualitatively characterized impacts; the use of quantitative analysis
was lacking. The participatory research aspects of HIA (i.e., stakeholder and community
involvement) lend themselves to qualitative analysis, and in HIA, unlike other forms of risk
assessment, impacts that are able to be characterized qualitatively can often be more relevant
to the decision at hand than those impacts that are able to be quantified (National Research
Council 2011). While qualitative characterization is acceptable, and many times warranted
due to a lack of available scientific research, local data, time, and resources, there is also
value added in the use of quantitative estimates when the process allows. When empirical
research exists linking a health determinant to a specific health outcome and the data, time,
and resources are available, quantification of health impacts via modeling, forecasting, and
other tools (e.g., exposure-response relationships) can provide depth and defensibility to the
impact assessment, allowing estimates of magnitude of impact and in some cases,
permanence (or severity) of impact when compared against established threshold values
(National Research Council 2011).
Recommendations - Recommendations provided in HIA typically include alternatives or
modifications to the decision to promote positive health impacts or minimize negative health
impacts, and/or direct mitigations for negative health impacts; in some cases, support for or
opposition to the decision being assessed is also offered. In most cases, HIAs also include
some sort of prioritization process to identify impacts for which recommendations will be
offered and/or identify which of the developed recommendations to offer or prioritize for
action.
In the recommendations stage of the HIA process, it is suggested that an implementation plan
be prepared for the developed recommendations that includes information such as parties
responsible for implementation, timeline, and links to indicators to be monitored. However,
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implementation plans or strategies for recommendations were found in only 10% of the HIAs
reviewed.
Reporting - Reporting and communicating the results of HIA are crucial to informing the
decision being evaluated, yet only 4 of the 81 reviewed HIAs made mention of or included in
the HIA report a communication plan or strategy for reporting and disseminating the findings
and results to the appropriate audiences, although communication plans could have been
developed and documented separately from the HIA Report.
Preparation of a publicly-accessible HIA report documenting the HIA and its results is one
component of the reporting phase. When identifying HIAs for inclusion in the HIA Review,
there were multiple instances of HIA reports not being readily accessible, which precluded
those HIAs from the review. The reporting phase of the HIA process not only calls for the
HIA report to be publicly accessible, but also transparent. Of the 81 HIAs reviewed, over
35% lacked transparent documentation of the processes, methods, findings, sponsors, funding
source(s), and/or participants and their respective roles. There were a number of HIAs,
however, that went above and beyond to ensure that the documentation was transparent,
including detailed documentation of assessment methodologies, techniques, and models;
criteria for data aggregation; geographic units of analysis (i.e., geographic area and scale);
confidence estimates; and supporting documentation in the HIA report.
In addition to preparing the HIA report, reporting also involves communicating and
disseminating the findings and recommendations of the HIA to inform stakeholders and
decision-makers. Methods for communicating the HIA results to decision-makers and
stakeholders took many forms in the reviewed HIAs, including dissemination of the HIA
Report, factsheets, presentations, press releases, public and/or stakeholder meetings, public
testimony, lobbying, personal communication, and publication on websites and peer-
revi ewed j ournal s.
Monitoring and Evaluation - This step of the HIA process was almost completely lacking in
the 81 HIAs reviewed. Unfortunately, this is not a trend unique to this subset of HIAs
(Wismar et al. 2007; National Research Council 2011). Of the three forms of evaluation
called for in the monitoring and evaluation phase of HIA (i.e., process evaluation, impact
evaluation, and outcome evaluation), process evaluation was found in only 5 HIAs (although
process evaluation could have been performed and reported separately) and proposed plans
for impact and/or outcome evaluation were present in only 29 of the HIAs.
Because both impact evaluation (i.e., monitoring the effect of the HIA on the decision-
making process and final decision) and outcome evaluation (i.e., monitoring the effect of
decision implementation on health) are carried out after completion of the HIA, these
measures are not documented as part of the HIA Report. During internet searches conducted
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throughout the duration of the HI A Review, little to no documentation of these evaluations
were found. Monitoring and evaluation is a definite area for improvement in the HIA
community of practice.
Stakeholder/Community Engagement
The engagement of stakeholders and the community in the HIA process varied greatly in the
HIAs. While stakeholder and community engagement in each step of the HIA process is ideal,
this was rarely witnessed in the HIA Review. In fact, of the 81 HIAs, almost 20% (n=l 5) did not
engage stakeholders or the community at all in the HIA process. Of those HIAs with no
stakeholder and/or community involvement, ten were desk-based HIAs, which by definition do
not include stakeholder or community involvement, yet stakeholder engagement and community
empowerment are objectives of HIA (North American HIA Practice Standards Working Group
2010; National Research Council 2011; Human Impact Partners 2012). Engagement of the
community, and in particular vulnerable populations, is critical to ensuring equity is promoted in
HIA and can help illuminate issues and existing conditions that might not be readily apparent to
those outside the community. Engagement of decision-makers as stakeholders in the process is
also beneficial and ensures that the recommendations offered are realistic, practical, and able to
be implemented within the purview and authority of the decision-makers.
Among the HIAs with a stakeholder or community involvement component, the level and quality
of stakeholder participation varied greatly. In many of these HIAs, stakeholder input was
solicited to inform the scoping and assessment steps of the process (e.g., identify issues of
interest and areas of concern for the community and stakeholders, identify populations and
vulnerable groups that might be affected by the decision, gather local knowledge regarding
community health and existing conditions, etc.), but the stakeholders themselves were not
involved in the actual HIA decision-making. However, there were a number of HIAs (n=15) that
did engage stakeholders in the decision-making process, usually via a role on an advisory or
steering committee, and in a handful of HIAs (n=4), stakeholders actually oversaw or guided the
HIA process and were engaged as decision-makers in equal partnership with the HIA team or as
the primary decision-makers in the process.
Due to the variety of decision contexts, capacities, and stakeholder groups that could potentially
be involved in HIA, there is no single approach to engaging stakeholders in the process,
however, HIA guidance does call for HIA practitioners to employ "deliberative methods" of
stakeholder engagement (North American HIA Practice Standards Working Group 2010;
National Research Council 2011). Deliberative stakeholder engagement "makes a difference, is
transparent, has integrity, is tailored to the circumstances, involves the right number and types of
people, treats participants with respect, gives priority to participants' discussions, is reviewed
and evaluated to improve practice, and keeps participants fully informed" (Warburton et al.
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2008). Increased rigor in the engagement of stakeholders and the community in the HIA process
is an area for improvement that could help advance the HIA community of practice.
HIA and Environmental Impacts
Characterization of environmental or ecosystem impacts was present in 50 of the 81 HIAs
reviewed, but with the exception of the 5 HIAs conducted in support of environmental impact
assessments, these HIAs primarily examined impacts via the air quality pathway. Increased
consideration of environmental impacts via other pathways could help advance the effectiveness
of HIA in predicting health impacts. For example, the consideration of impacts on soils, water
quality, water quantity (e.g., stormwater runoff, flooding, groundwater and drinking water
recharge, etc.), vegetation and green space, habitat (e.g., habitat quality, loss, fragmentation),
wildlife (e.g., aquatic and terrestrial species), sustainability and stewardship, and temperature and
climate change (e.g., the urban heat island effect, greenhouse gases) could, in some instances,
contribute to a more robust impact assessment. The EPA's Eco-Health Relationship Browser
(http://www.epa.gov/research/healthscience/browser/introduction.html) illustrates some of the
scientific evidence linking human health to some of these ecosystem services (i.e., benefits
supplied by nature).
In addition to broader consideration of environmental and ecosystem impacts in HIAs, HIA can
also be used as a tool for incorporating health considerations into environmental impact
assessments. As mentioned previously, NEPA requires the U.S. government to consider
environmental and human health effects prior to undertaking any major federal action that will
significantly affect the quality of the human environment, but historically the examination of
health effects in EIA is rare and narrowly focused (Bhatia and Wernham 2008). The EIA and
HIA processes are similar in many regards. Like HIA, EIA examines potential effects of the
decision under consideration, provides opportunity for stakeholder involvement, and develops
recommendations to minimize risks and maximize benefits. If health effects were considered in
EIA to the same extent that environmental effects are considered, the resulting health effects
analysis would be consistent with conducting an HIA (National Research Council 2011).
Therefore, HIA can potentially provide a means of complying with the NEPA requirement to
include human health considerations (i.e., direct, indirect, and cumulative human health effects)
in analysis, and in fact, HIAs have been successfully incorporated into the EIA process in the
U.S. on multiple occasions (Bhatia and Wernham 2008; National Research Council 2011).
When health effects have not been adequately considered in the EIA process, HIA has provided a
means of bringing those issues to light and informing the EIA. In other cases, rather than
performing the HIA separately from the EIA, it has actually been integrated into the EIA
process. In these integrated El A/HI As, health expertise is included on the team conducting the
EIA and health is integrated throughout the EIA process (e.g., stakeholder involvement, analysis
of impacts, development of recommendations, and reporting). Whether it results in a separate
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standalone report or is integrated into the EIS, HIA can improve the consideration of health in
EIA.
Adherence to Minimum Elements and Practice Standards
Less than 20% (n=13) of the HIAs examined met all the Minimum Elements of HIA. Elements
most often missing in the HIAs included complete characterization of impacts (direction,
magnitude, likelihood, distribution, and permanence), inclusion of a plan for monitoring, and
transparency in documentation. Adherence to these Minimum Elements and Practice Standards
is crucial for advancing the use of HIAs in the U.S and is a definite area for improvement in the
HIA community of practice overall.
Effectiveness of HIA
As part of the HIA Review, evaluations of HIA effectiveness were conducted by the reviewers
using information able to be obtained via an internet search. As such, it should be noted that
these evaluations of effectiveness are subjective and may not reflect the true effectiveness of the
reviewed HIAs. In many cases it was difficult to discern from the internet, the effectiveness an
HIA had in influencing the decision at hand. Effectiveness could not be determined for almost
40% (n=31) of the reviewed HIAs, but for those HIAs for which measures of effectiveness were
made, 60% showed direct effectiveness (i.e., the decision was dropped, modified, or postponed
as a result of the HIA), 32% showed general effectiveness (i.e., the HIA was considered, but did
not result in modification to the decision), 6% showed no effectiveness, and 2% showed
opportunistic effectiveness (i.e., the decision was going to be carried out regardless of the HIA).
While the high degree of direct effectiveness seems to support the use of HIA in decision-
making, one could hypothesize that effectiveness could not be determined for the 31 HIAs
because there was no direct effect on the decisions in those cases (i.e., documentation of the
decision-making process available on-line did not attribute any portion of the final decision to
the HIA). Beyond influencing the decision-making outcome, a number of other measures of
effectiveness were observed in the reviewed HIAs. These included raised awareness of health
and related issues; the introduction of health into discussions where health was typically absent
(i.e., informing decision-making); engagement of community members and stakeholders in
decisions that affect them; interdepartmental, interagency, and even intersector collaborations;
and relationship and capacity building within the community. If HIA practitioners are to make
the case for the use of HIA in decision-making, the value and effectiveness of this tool in
informing decisions and protecting and promoting human health needs to be established.
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Best Practices
Best practices were identified within various HIAs in the HIA Review and are compiled here for
future use, in an attempt to advance the HIA field of practice and reduce disparities in the quality
and rigor of HIA. A list of these best practices is provided in Table 11, and where appropriate,
the best practices are supported by examples from the reviewed HIAs in the figures that follow.
Table 11. Best Practices in HIA
Best Practice
Adherence to Minimum Elements and
Practice Standards for Health Impact
Assessment (North American HIA
Practice Standards Working Group
2010) or similar criteria developed by
the National Research Council (2011)
Description
Adherence to the Minimum Elements ensures the elements that distinguish
HIA from other assessment processes are met (i.e., screening; scoping;
stakeholder engagement; establishment of baseline conditions; judgement
of impact direction, magnitude, likelihood, distribution, and permanence
using best available evidence; transparent and context-specific synthesis of
evidence, including assumptions, strengths, limitations, and uncertainties;
identification of recommendations that promote health; monitoring plan
proposal; and transparent, publicly-accessible documentation). Adherence
to the Practice Standards allows benchmarks for effective HIA practice,
rigor, and quality to be met. While the National Research Council (2011)
criteria and Practice Standards are intended to reflect an ideal of practice
rather than rigid requirements for HIA implementation, the need and
rationale for deviations from these should be clearly articulated.
HIA as a Tool for Environmental
Impact Assessment
Use of HIA in the environmental impact assessment process can provide a
means of meeting the NEPA requirement to include human health effect
considerations. Whether it results in a separate standalone report or is
integrated into the EIS, HIA can improve the consideration of health in
EIA
Note: If the HIA was completed separately from the Environmental Impact
Statement (EIS), the HIA Report should be included as an appendix to the
EIS, with appropriate health information incorporated into the body of the
EIS, as needed for transparency in documentation.
Equity Promotion
Promotion of equitable health outcomes and empowerment of vulnerable
communities is central to HIA. hi addition to judging the distribution and
equity of predicted health impacts in the HIA process, equity can be
promoted in a number of other ways (Heller et al. 2013):
employing HIA to inform decisions that are identified by, or relevant to,
vulnerable populations;
promoting community ownership and participation in the HIA;
engaging vulnerable populations in the decision-making process;
identifying recommendations that result in equitable health outcomes;
communicating findings and recommendations of the HIA to the
community; and
monitoring the impacts of implemented decisions on community health.
85
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Table 11. Continued
Best Practice
Description
Documentation of Screening and
Scoping
Clear documentation of the selection process for the HIA, including
screening criteria/factors that went into making the decision to perform the
HIA; and HIA scope, including participants and their roles, the issues
prioritized for inclusion (and the rationale), research questions to be
answered, methods to be employed, and the timeline for completion. The
National Research Council (2011) provides an excellent summary of the
recommended outputs for both of these steps in the HIA process.
See Figure 41 for an excerpt of the Scoping Worksheet from the Daniel
Morgan Road Diet and Restriping HIA.
Rules of Engagement Memo/
Memorandum of Understanding
A Rules of Engagement Memo or Memorandum of Understanding
establishes groundrules for HIA participants, and outlines expected
outcomes, participant responsibilities, and protocols for information sharing
throughout the project.
See Appendix H for the Rules of Engagement Memo from the St. Paul
Healthy Corridors for All HIA.
Communication/Reporting Plan
Communicating the findings and recommendations of the HIA is crucial to
informing the decision being evaluated. Identification and documentation
of communication and reporting strategies (e.g., types of communication,
methodology, audience, and timing) early on, helps to ensure effective
communication throughout the HIA process.
See Figure 42 for the communication methods used in the HIA on Wind
Energy Development.
Stakeholder Involvement
Stakeholders, including decision-makers and the community, should be
engaged at every step of the HIA process to inform and provide input into
the findings and results of the HIA. Stakeholders may also play a more
substantial role in the HIA process and actually conduct the HIA, such as in
the case of community-led HIAs. No matter the level of stakeholder
involvement, HIA practitioners should employ "deliberative methods" to
engage stakeholders in the process. The principles of deliberative
stakeholder engagement are that "the process:
makes a difference;
is transparent;
has integrity;
is tailored to the circumstances;
involves the right number and types of people;
treats participants with respect;
gives priority to participants' discussions;
is reviewed and evaluated to improve practice; and
that participants are kept informed." (Warburton et al. 2008)
See Appendix I for a summary of stakeholder involvement opportunities in
each step of the HIA process, and the St. Paul Healthy Corridors for All
HIA for an example of deliberative stakeholder engagement.
86
-------
Table 11. Continued
Best Practice
Description
Transparent Literature Search/
Review Documentation
Clear, thorough description of the literature review process, including
search terms and bibliometric databases searched. Documentation may also
include identification of the number of articles yielded by the literature
search and the final number of articles used as evidence base.
See Figure 43 for a tabular summary of literature review results from the
HIA of the Transform Baltimore Zoning Code Rewrite, hi addition to this
summary, a quality review of the literature was also conducted (see Quality
of Evidence Evaluation best practice) and the terms used in the literature
search documented in the HIA Report.
Use of Best Available Data
(Qualitative & Quantitative)
The use of best available data - both qualitative and quantitative - is
necessary to provide a strong evidence base on which to predict potential
health impacts. When empirical research exists linking a health
determinant to a specific health outcome and the data and time are
available, quantification of health impacts via modeling, forecasting, and
other tools (e.g., exposure-response relationships) can provide depth and
defensibility to the impact assessment, allowing estimates of magnitude
and, in some cases, permanence (or severity) of impacts. Regardless of
whether qualitative or quantitative analysis is utilized, the methodology and
analytical approach should be clear and rigorous.
Quality of Evidence Evaluation
An evaluation of the quality or strength of evidence on which the impact
assessment is made provides transparency and defensibility in HIA.
Documentation of that evaluation includes identification of criteria used in
making the determinations of quality/strength and reporting the results of
the evaluation.
The quality review conducted in the HIA of the Transform Baltimore
Zoning Code Rewrite, for example, was based on whether the papers used
an appropriate study design, whether they adequately controlled for
confounding by socioeconomic status, and whether they used self-reported
as opposed to externally measured variables; studies were then categorized
into one of three quality groups - good, fair, or poor -based on these
criteria (see Figure 43).
Other HIAs have used ratings based on the number and strength of studies
used as evidence (e.g., < 5 studies and claim consistent with public health
principles, 5 or more studies of weak or moderate quality, 5-10 strong
studies and/or data analysis, 10+ strong studies).
See Figure 44 for the hierarchy of evidence used in the HIA on Wind
Energy Development.
Identification of Data Gaps
Clear identification of data gaps in the HIA report, especially as a stand-
alone presentation (e.g., section or table) provides transparency in
reporting.
See Figure 45 for data gaps identified by health effect category in the HIA
for the Proposed Coal Mine at Wishbone Hill.
Use of Existing Tools, Methods,
Standards, and Metrics
There is no need to start from scratch. Use of existing tools, methods,
standards, and metrics provides efficiency and consistency in HIA.
87
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Table 11. Continued
Best Practice
Description
Adaptation of Existing Tools and
Methods
While use of existing tools and methods is ideal, there may be the need to
tailor these items for the problem at hand.
For instance, Humboldt County modified the existing Healthy Development
Measurement Tool (HDMT). which was created for an urban environment,
to create a version of the tool that allows health to be considered in
development decisions in rural environments.
Detailed Documentation of Data and
Methodology
Detailed documentation of the data (e.g., key input data, data variables, data
sources, geographic scale, etc.) and methodologies used in analysis provide
transparency and defensibility in the HIA.
See Figure 46 for a description of key input data from the Health Effects of
Road Pricing in San Francisco HIA; See Figure 47 for a detailed description
of data analysis methodology from the St. Paul Healthy Corridors for All
HIA.
Geographic Information Systems
(CIS)
GIS allows geographically-referenced data to be displayed in visually-
pleasing maps, but can also be used to analyze and interpret geographically-
referenced data to reveal relationships, patterns, and trends. GIS can be
used to identify spatial disparities in health outcomes, evaluate health
determinants and outcomes in a geographic context (e.g., evaluate
proximity measures identified for health determinants), identify
environmental justice (EJ) communities, link health and environmental data
in geographical modeling and analysis, and even combine incompatible
spatial data (Gotway and Young 2002; Young et al. 2009; AAG 2012;
Deganian and Thompson 2012).
Impact Pathways/Logic Frameworks
The use of impact pathways and logic frameworks to identify links between
the proposed decision and health is value added. Of additional value is
clear identification of pathways of exposure to contaminants and pollutants.
See Figure 19 for a pathway diagram from the HOPE VI to HOPE SF HIA;
See Figure 20 for a logic framework from the Health Effects of Road
Pricing in San Francisco HIA showing pathways between road pricing and
health; See Figure 48 for identified exposure pathways from the Beaufort
Sea and Chukchi Sea Oil and Gas Lease HIA.
Clear Summary of Impact
Assessment
While characterization of impacts is essential in HIA, the use of tables and
graphics to summarize the findings of impact assessment provides added
transparency. Summaries of impact direction, magnitude, likelihood,
permanence, and distribution can be provided, as well as summaries of
differential impacts between alternatives being analyzed.
See Figure 49 for a summary of differential impacts of alternatives in the
Trenton Farmers Market HIA; See Figure 50 for a summary of health
impact assessment findings from the Daniel Morgan Road Diet and
Restriping HIA.
88
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Table 11. Continued
Best Practice
Description
Confidence Estimates/Assessments
of Uncertainty
Confidence estimates assess uncertainties in the assumptions, parameters,
and methodologies on which the health impact characterization is based.
Uncertainties can include limitations, gaps, or weaknesses in individual
evidence sources used in characterization, considerations of whether
measures used in assessment are reliable proxies for the intended factor,
whether an existing model or tool from the literature can be generalized to
the study area or population of interest, etc. Confidence estimates can
entail qualitatively identifying the uncertainty, explaining how the data
inputs used in analysis may vary from actual (be over- or under-estimated),
and describing the influence of that variation on the health impact
conclusions, or quantitatively assessing uncertainty using methods such as
sensitivity analysis (Bhatia 2011, National Research Council 2011).
Characterization and management of uncertainty in assessment provides
transparency and defensibility.
See Figure 51 for uncertainty factors and confidence estimates from the
Health Effects of Road Pricing in San Francisco HIA.
Prioritization Process for
Recommendation
Development/Action
A prioritization or ranking process can be used to identify which impacts
require recommendations and/or which of the developed recommendations
to offer for action. Prioritization can be based on a number of factors, but
prioritization methods commonly used include stakeholder/community
input, literature and research, impact on health and relevance to
project/decision interests, and equity of impacts.
See Figure 52 for a ranking process used in the HIA for the Proposed Coal
Mine at Wishbone Hill and Appendix J for a unique risk assessment
technique used to prioritize impacts for management actions in the Point
Thomson Project HIA.
Recommendations That Meet
Established Feasibility Criteria
Human Impact Partners
recommendations:
Responsive to predicted impacts
Specific and actionable
Experience-based and effective
Enforceable
Able to be monitored and enforced
Technically feasible
(2012) provides the following criteria for
Politically feasible
Economically efficient
Do not introduce additional
negative consequences
Relative to the authority of
decision-makers
Implementation Plan for
Recommendations
Recommendations identified in HIAs are only effective if they are
implemented. Development of an implementation plan for identified
recommendations identifies information such as parties responsible for
implementation, audience for the recommendation, timeline for
implementation, and links to indicators that can be monitored.
See Figure 53 for a summary of recommendation strategies and decision-
makers from the Page Avenue HIA; See Figure 54 for a summary of
recommendations and indicators from the Highway 99 Sub-Area Plan HIA.
89
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Table 11. Continued
Best Practice
Description
Clear/Transparent HIA Report
Clear, transparent documentation of the HIA process should include
documentation of sponsors; funding sources; timelines; participants and
their roles; what tasks and activities were undertaken at each step of the
process; data and methodologies; results of analysis; conclusions and
findings; recommendations; and assumptions and limitations. Tables and
figures should be used in the body of the report to illustrate key information
and appendices used to detail supporting documentation.
See Figure 55 for an example of transparent documentation of one stage in
the Eastern Neighborhoods Community HIA.
Process Evaluation
Process evaluation involves an evaluation of HIA quality and defensibility
and should examine how the HIA process was carried out, including who
was involved, strengths and weaknesses of the HIA, successes and
challenges, effectiveness in meeting HIA objectives and established
practice standards, engagement and communication with stakeholders, and
lessons learned. During the scoping phase, steps should be taken to
consider how process evaluation can be built into the HIA process.
Example evaluation questions are available from Human Impact Partner
(2012).
Monitoring Plan - Impact and
Outcome Evaluation
Impact and outcome evaluation are both carried out after completion of the
HIA; however, the HIA should include or, at a minimum, acknowledge
plans for monitoring the impacts of the HIA on the decision and decision-
making process (i.e., impact evaluation) and the impacts of the decision
implementation on health determinants and outcomes (i.e., outcome
evaluation), rf impact and/or outcome evaluation is infeasible, the HIA
should discuss the limitations that are preventing monitoring from
occurring (e.g., the length of time between implementation of the decision
and changes in health outcomes, the presence of multiple contributing
factors to health outcomes, etc.).
Per Human Impact Partners (2012), the essential elements of a monitoring
plan include:
Goals
Resources to conduct and report monitoring
Identification of the outcomes, processes, impacts, and indicators to be
monitored
Process for collecting meaningful and relevant information (e.g., baseline
and long-term data)
Defined roles for individuals or organizations involved in monitoring
Criteria or triggers for action, if agreed upon mitigations or
recommendations are not met
Process for reporting monitoring (methods and results) and making them
publicly available
Process for learning, adapting, and responding to monitoring results
See Figure 56 for a monitoring plan from the Rental Assistance
Demonstration Project HIA.
90
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APPENDIX B: SCOPING WORKSHEET
Project: Road Diet/Re-Striping of Daniel Morgan Avenue (DMA), Spartanburg, SC
Health Determinant: Traffic Safety
Geographic Scope: Stretch of DMA included in proposed project
Existing Conditions Impact Research Questions Indicators Data Sources Methods
What is the existing traffic
count on DMA?
How many pedestrians and
bicyclists travel on DMA each day?
What is the current motor vehicle
collision rate on DMA?
What is the current Bicycle Level of
Service (BIOS) on DMA?
What is the average rate of
speed on DMA?
How will the new pedestrian and
bicycle lanes affect the number of
cars on DMA?
What is the anticipated change
in the number of bicyclists and
pedestrians?
How will the proposed
-------
Audience
General Public
General Public
Communications
Announcement of meetings, report
release
Description of process,
announcement of meetings,
updates, invitations to provide
feedback, links to electronic
versions of report
Public meetings
General Listserv
Steering Committee Listserv
Personal Communications
Genera! Public in North
Opportunity for community
Central/ Eastern Oregon members to share thoughts,
questions, concerns
Interested parties
Steering committee
Interested parties
Announcement of meetings, survey,
progress updates, report release
Meeting logistics, announcement of
meetings, training opportunities,
information sharing
Response to individual calls,
emails, and letters
Figure 42. Best Practice: Communication/Reporting Plan - methods of
communication (Source: HIA on Wind Energy Development in Oregon).
TABLE 6-1: LITERATIM
ENVIRONMENT FEATURE
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MMMJ*.
Blalr«tal,mi"
B ra FHS « tat . zrjro *'
in...-. n bw
f)V HEA
4-
<
LTHOU
t
t
t
t
X*
rcowE!
t
t
J
"x
OF IHT
J.
4-
4-
«
4-
4
S-"
*c
X
EREST
t
Figure 43. Best Practice: Transparent Literature Search/ Review Documentation - a tabular summary
of literature review results (Source: HIA of the Transform Baltimore Zoning Code Rewrite).
92
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Population-based Measured
Peer-review Journals
Public health/medical
Risk assessment Validated model reports
Publications by public
Case series/ case Non-validated health authorities
reports model
Publications by other
groups (Industry,
Animal studies community members)
Other: Wei) sites, news
articles, opinions, etc.
Figure 44. Best Practice: Quality of Evidence Evaluation - a hierarchy of
evidence (Source: HIA on Wind Energy Development in Oregon).
Table 34 Key Data Gaps by Health Effect
HEC 1 Social Determinants of Health
(SDH)
HEC 2: Accidents and Injuries
HEC 3 Exposure to potentially Hazardous
Materials
Category
Current household level survey data for the PACs is not
available.
Data sets do not include years 2009-2011.
Data sets do not include data from the ATR for years 2009-
2011.
No offsite residential monitoring well data are available for
review.
Fish/Aquatics data set may not fully capture all of the recent
restoration efforts.
There are no site specific PM25 data.
There is no air permit application available for review
There is no analysis of potential dust/diesel emissions in Point
MacKenzie.
Visual effects analysis is not available.
Complex off-Site terrain noise modeling has not been
performed.
Figure 45. Best Practice: Identification of Data Gaps - key data gaps by health effect category
(Source: HIA for the Proposed Coal Mine at Wishbone Hill).
93
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V,ri,ble
importation and Land Use Conditions: 2005
City Lots, Building Heights, Zoning
Designation
Pedestrian Environmental Quality
Traffic Volume by Vehicle Type, Time of Day,
Traffic Speed (Free Flow and Congested
Conditions), Bus Volumes
Trips, Travel Mode by Age Category
Walk and Bike Trips, Travel Time
Data Source
, 2015 BAU, 2015 KP
SF Planning
PEQI Data Collection
SFCTA Model
BATS
SFCTA Model
Geographic Unit of Analysis
Lot
Street Segment, Intersection
Street Segment
Bay Area Region
Transportation District
HIA Analyses
AO, Noise
Ped Inj
AQ, Noise, Cyclist Inj,
Ped Inj, Equity
Active Transport
Active Transport, Cyclist
Inj
Socio-demographic Conditions: 2005 and 2015
Resident Age
Average Household Income
Resident Population Data
ACS Inc. Estimates
ABAC Estimates
ABAG Estimates
Census Block
Transportation Analysis Zone
Transportation Analysis Zone
All
Equity
All
Health Outcomes and Behaviors: 2005 Existing Conditions
Mortality
Myocardial Infarction, Hospital Admission
Vehicle-Pedestrian Injury Collisions, Vehicle
Cyclist Injury Collisions
CDPH (Vital Statistics)
CDPH (OSHPD)
SWITRS
County
County
Intersection, Census Tract, County
AQ, Active Transport
Noise
Ped Inj, Cyclist Inj
Figure 46. Best Practice: Detailed Documentation of Data and Methodology - key input
data (Source: Health Effects of Road Pricing in San Francisco HIA).
Indicator
Number of employees
byindustry^forall
geographies
Average wages by
industry for all
industries
Number of employed
residents by industry
Number of jobs in the
CC by place of worker
residence
Number of employed
residents in the Corridor
by place of work
Educational attainment
of workers by industry
Educational attainment
distribution overall and
by race, age
Data Source
US Census LEND
Workplace Area
Characteristics, 2008
BLS Quarterly Census
of Employment and
Wages, 2009
US Census LEHD
Resident Area
Characteristics, 2008
US Census LEHD
Origin-Destination
Employment Statistics,
2008
US Census LEHD
Origin-Destination
Employment Statistics,
2008
Census Equal
Employment
Opportunity data set,
2000
US Census 1990, 2000;
American Community
Survey 2005-2009 5-
year estimates
Methodology
Aggregated total workers in each block by industry
for the Central Corridor (CC), Saint Paul, and Ramsey
County in SPSS
At QCEW web site, downloaded average annual pay
by 2-digit NAICS code for all industries, total
covered ownerships, all establishment sizes, and all
employees in Ramsey County. For Public
Administration, took average of the average annual
pay for local, state, and federal government
Aggregated total workers in each block in the CC by
industry in SPSS
In SPSS, selected all blocks with jobs in Ramsey
County; from those blocks, selected all blocks with
workers in Ramsey County. Coded those blocks to
identify those for workers that reside in Saint Paul in
theCC
In SPSS, selected all blocks with residents who live in
the CC. Coded those blocks to identify those who
work in the CC, Saint Paul, and Ramsey County
Downloaded Educational Attainment (5 levels) by
Census Occupational Codes by worksite for Ramsey
County, Downloaded Employment by Census
Occupational Codes and Industry by worksite for
Ramsey County, Used Access to relate the data sets
and calculate the percentage of workers with less
than high school education, a high school diploma,
some college or an Associate's, Bachelor's, and
Master's degree or greater by industry
Aggregated educational attainment for all residents
and by race for all block groups in the CC;
aggregated educational attainment by age for all
census tracts in the CC (2005-2009 data only);
downloaded educational attainment overall and by
race/age for Saint Paul and Ramsey County on US
Census Bureau's American FactFinder
Figure 47. Best Practice: Detailed Documentation of Data and Methodology -
a detailed description of data analysis methodology (Source: St. Paul Healthy
Corridors for All HIA).
94
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The main potential exposure pathways to contaminants produced by regional oil and gas
activities for residents of the region would include:
1) Consumption of tainted subsistence resources: pollutants from oil and gas
operations could contaminate local subsistence resources, and expose individuals
to contaminants when the harvested resource is consumed.
2) Inhalation: emissions from combustion associated with exploration and
production activities could be entrained in the local airshed, and inhaled by
residents; subsistence hunters travelling near combustion sites, and residents
nearest major emissions sources would be at greatest risk. It is important to
recognize that even projects complying with NAAQS standards may produce
levels of pollutants that are harmful to human health, particularly vulnerable
groups such as infants, elders, and people with underlying chronic illnesses
(U.S. EPA 2006; U.S. EPA Region DC 2008; U.S. EPA 2008).
3) Direct contact with skin (as could occur in the case of an oil spill).
4) Contaminated drinking water: Drinking water in the NSB is generally taken
from surface water bodies, which could become contaminated through local oil
and gas activities.
Figure 48. Best Practice: Impact Pathways/Logic Frameworks - exposure pathways to
contaminants (Source: Beaufort Sea and Chukchi Sea Oil and Gas Lease HIA).
Table 8: Summary of expected health impacts from modification of the Trenton Farmers' Market
Patlnvav j
Nutrition
(e.g. consumption of
fresh fruits and
vegetables)
Direct
Economics
Effects
(e.g. increased
income for vendors t
S econd- order
economic
effects
(e.g. neighborhood
economic expansion
and development)
Physical
Activity
(e.g. walking and
biking to the market)
Social Capital
(e.g. opportunities to
socialize with other
residents, develop
social networks)
Preventive
lifilih services
(e.g. health
education and
screening services on
site)
Alternative 1: No-change minor
change
Q Changes to the market too small to
significantly impact food access
and consumption
Some small increase in patronage
and revenues could occur as a
result of minor cosmetic changes to
facility
Any increase in revenue would be
f. unlikely to be large enough to
generate secondary economic
impacts.
Changes to the market too small to
0 change patterns of physical
activity.
Clianges to the market too small to
change community social capital.
,-. No additional preventive services
planned under this alternative
Alternative 2\ Full implementation of
PPS recommendations: major remodeling
Patronage and sales may increase, bur these
changes would probably Dot change
0 consumption patterns, since there's no
indication that changes would affect
individuals with poor food access
Expansion of the market and increasing
market activities during rhe low season.
+ coupled with improved visibility will likely
lead to a substantial increase in sales with
subsequent increases in income for vendors.
Increased patronage and sales are likelv to
generate secondary economic benefits
through "recycling" of income, by attracting
customers to other nearby businesses, and by
stimulating neighborhood redevelopment
efforts.
Redevelopment in surrounding
neighborhood could improve
walkabilitv bikeability and induce more
people to walk -bike to the market.
Improvements in bus service, coupled with
outreach to transit-dependent populations
could increase walking associated with bus
trips to the market
Increases in market patronage, using market
facilities for community meetings and
+ events, and subsequent redevelopment could
all contribute to improved community social
capital.
Impacts on preventive health services
- available at the market contingent on
agencies and organizations deciding to bring
such services to the market.
Alternative 3: Market outreach.1'
satellite markets
Satellite markets would target
+ neighborhoods and populations with
limited access to fresh produce.
Expansion of outlets, broadening of
customer base will likelv increase
-j- sales and income to vendors, but
probably not as much as in
Alternative 2.
Modest expansion of sales potential
under this option would probably be
0 insufficient :o yield second-order
economic impacts on the
surrounding community.
Bringing the market to people
would minimize travel distance.
thus walking trips to the market
0 would not increase. This alternative
by itself would not be sufficient to
spur neighborhood redevelopment
Could benefit community social
capital. Depends on reaching new
patrons and providing events that
draw residents. May also improve
sjense of community of it becomes
seen as neiehborhood asset.
Satellite market at the Capital
Health Systems hospital would
-1- 0 facilitate tie-in to various health
services. Contingent on hospital
and health department decisions.
"0" (no change)- "-" (potentially benebcial). "-" (potentially tunafi.il)
Figure 49. Best Practice: Clear Summary of Impact Assessment - a summary of
differential impacts of analyzed alternatives (Source: Trenton Farmers Market
HIA).
95
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Table 1: HIA Analysis Summary of Findings
Health Determinant
Direction Magnitude Impact
Significance
Likelihood
Distribution
Traffic Safety
Physical Activity
Access to Goods and Services
Air Quality
?>
t
t
t
High
Medium
Medium
Low
High
Medium/High
Medium/High
Low
Very Likely
Very Likely
Very Likely
Possible
Affects whole
community
relatively equally
Impacts neighboring vulnerable
community and whole community
via expanded access
Disproportional effect
on low income, transit-dependent
communities around DMA
Affects whole
community
relatively equally
Legend:
Direction of Impact:
Positive = Changes that may improve health
Negative = Changes that may detract from health
Uncertain = Unknown how health will be impacted
No effect = No effect on hedth
Magnitude of Impact: {realizing the proposed project is a 2.1 mite
stretch of road, so the comparison or point of perspective is those
who currently use DMA)
Low = Causes impacts to no or very few people
Medium = Causes impacts to wider number of people
High = Causes impacts to many people
Note that this is relative to population size
Significance of Impact:
Low= Causes negative impacts that can be quicklyand easily
managed or do not require treatment or causes positive
impacts that are not serious/significant
Medium = Causes negative impacts that necessitate treatment
or medical management and are reversible or positive
impacts that provide opportunity for improved health
High = Causes or prevents death or serious illness
likelihood of impact:
Very Likely = it is very likely that impacts will occur as a result
of the proposal
Likely = it is likely that impacts will occur as a result of the
proposal
Possible = it is possible that impacts will occur as a result of the
proposal
Unlikely = it is unlikely that impacts will occur as a result of the
proposal
Uncertain = it is unclear if impacts will occur as a result of the
proposal
Distribution of Impact:
The community surrounding DMA has a large minority
population (37.4% in the 29303 zip code and 70,8% of
the population in the 29306 zip code). When it comes to
economic characteristics, in the293Q3 zip code 18,1% of
individuals live belowthe poverty line and in 29306 28,8% of
individuals live belowthe poverty line.
Figure 50. Best Practice: Clear Summary of Impact Assessment - a summary of health
impact assessment findings (Source: Daniel Morgan Road Diet and Restriping HIA).
96
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Uncertainty Factors Regarding the Magnitude of Estimated Health Effects
for Lives Saved from Active Transportation via Walking and Cycling
Changes in walking and cycling trips and time for
transportation based on model outputs from the
SFCTA model at a district level, the smallest area
level with reliable estimates. Used BATS (2000) data
to estimate trips by age, assuming the proportion of
the population travelling during the average
weekday and average number of daily trips are the
same within San Francisco as the rest of the Bay
Area. Does not include leisure walking and cycling
trips, or walking trips to transit. Likely an
underestimate of walking and cycling, overall.
Moderate
Mortality Rate: County-level data from vital statistics
for people aged 25-64.
High
Health Economic Assessment Tool (HEAT) for
walking and cycling approach. Estimate for walking
based on meta-analysis of nine studies. Estimate for
cycling based on three studies and expert consensus.
A threshold approach, though evidence for an
inverse-linear relationship, which could result in an
underestimate of overall benefits. Overall health
benefits underestimated given tool focus on adults,
mortality only.
Moderate
Figure 51. Best Practice: Confidence Estimates/Assessments of Uncertainty-
characterization of uncertainty in assessment (Source: Health Effects of Road Pricing in
San Francisco HIA).
Parameter Ranking for Priootiring HEC*
Bank
LOW
Medium
Hich
Stakeholder
Concern
MIC not
mentioned b?
«ak*boid*ri
HEC mentioned
by stakeholders,
somewhat
important
HEC highly
important to
stakeholders
Daacapi
NO data gaps
cmt forth*
HEC
Data gaps einst
for the HEC but
would pro v*de
Utt4 adORKMUti
nformation if
fifed
Data gaps east
for the HEC and
represent
critically
important
Hvotmation
Potential impact
HtC rtvww reveals no
pcttnt>a! impact! or minor
pOHtiv* or Mfitivt impact!
only, easy adaptation
Modest increase (or
decrease- n miid to
moderate disease events;
effectme mitigation
strategies exist
Substantial increase [or
decrease) n moderate to
severe morbidity or
mortarlitv events;
adaptation with assistance
Utehnood
unl**l> HfCtfl«ctJ,
not typicatty obMrvcd
in similar H«SBfS or
hav« n*vtr b**n
observed m similar
strung*
Possible At =esa
some of the hearth
effects in this KEC
have occurred m
similar settings and
could occur given
proper conditions or
design features
Probable At least
some of the health
effects in the HEC are
known to be common
HI similar settings and
wril most likely occur
Figure 52. Best Practice: Prioritization Process for Recommendations - qualitative ranking
system to prioritize health effect categories for action (Source: HIA for the Proposed
Coal Mine at Wishbone Hill).
97
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Summary of Recommendations
EMPLOYMENT
Policy
Design
Program
Education
1. Recruit businesses that prioritize employ-
ing local residents.
2, Incentivize Pagedale employers to offer a Liv-
ing Wage at a minimum of $8.30/hr.
3. Incentivize employment of residents
in new retail and to fund workforce
development programs with a develop-
ment agreement or community benefits
agreement.
4. Design buildings for mixed use.
5. Provide space for a community marketplace to
support local microenterprises.
6. Increase entrepreneurship training and
business management support to job train-
ing services to improve the employabtlity of
residents.
7. Inform residents of potential job
opportunities offered by new enterprises.
8. Provide information about job training
and job application.
Decision-maker Sou of Relation to Top 1
Recommendation Recommendations 1
Beyond Housing;
City of Pagedale
City of Pagedale
City of Pagedale;
Developers
Beyond Housing
City of Pagedale;
UMSL Extension
Social service
agencies
Social service
agencies
Social service
agencies
Community
Research
Research
Research
Key Informant
Key Informant
Community
Community
3
3
3
Figure 53. Best Practice: Implementation Plan for Recommendations - recommendation strategies
and decision-makers (Source: Page Avenue HIA)
RECOMMENDATIONS FOR A MIXED USE, MIXED INCOME COMMUNITY
\Health Promoting \Potential Health Impacts
Access to Public Transit Transit Benefits tor Individuals: Almost one-third of
Americans who commute to work via public transit
meet their daily requirements for physical activity (30
or more minutes per day) by walking as part of their
daily life, including to and from the transit stop (Besser
& Dannenberg, 2005)
Transit Use by Proximity: Proximity to public transit
helps determine travel choices {Ewing 2006).
For every % mile increase in distance to public transit
from homes, there was an associated 16% decrease
in transit use. (Lawrence Frank & Company, 2005)
Transit Benefit and Environment: increased public
transit use directly results in decreased air pollution
from passenger vehicles (Ewing 2006).
Affordable Housing Benefits of Affordable Housing: More equitable.
affordable housing increases social cohesion,
decreases displacement and homelessness,
decreases stress, increases overall health (SFDPH
2004).
The National Low Income Housing Coalition classifies
people as severely cost-burdened if more than 50% of
their household's income is spent on housing costs
(UieHDMT.org).
Lack of affordable housing can increase poverty.
crowding, displacement, and homelessness all of
which result in poor health outcomes (SFDPH 2004;
Hood, 2005).
Benefits of Relocation: Relocating residents from
public housing projects into neighborhoods with
lower concentrations of poverty has been associated
with weight loss and a decline in reported stress levels
among adults, and reduced rates of injurv among
male youths (Orr et al, 2QD3; SFDPH. 2004).
Equity Issues
Currently 70% of sub-area residents live within
1/4 mile of transit stop. Less served areas are
predominantly lighter residential and higher
income.
Access to transit by elderly needs to be
facilitated by ensuring close proximity to transit
stops.
Gentrifi cation can push out low-income and
ethnic minority residents, whose housing
stability and health outcomes will be affected
adversely by increases in housing prices.
Housing planning can also result in segregation.
which has adverse impacts for health of African
Americans, in the Highway 99 area, Hispanics
would be the largest ethnic group and most likely
to be affected.
Summary
tf achieved ~.
A Physical Activity
A Use of transit
A Health equity
/'not jcnieved
Status Quo
A Social Cohesion
A Social Equity
T Stress
T Homelessness
T Obesity
T injury
If not achieved:
A Poverty
A Crowding
A Homelessness
A Cost burden
Design Indicators
Transit Routes.
Access to transit stops.
Access to employment.
goods, and services.
Stability of housing values
Availability of affordable
housing in proportion to local
household incomes and
demand
Displacement rates
Relocation planning and
assistance
Mixed age, ethnicity, income
levels
Figure 54. Best Practice: Implementation Plan for Recommendations - recommendation summary
and indicators (Source: Highway 99 Sub-Area Plan HIA).
98
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Stage 5: Generating Measurable Indicators and Element Profiles
(April 200^August 2005)
SUMMARY:
In this stage, the ENCH1A process worked to identify indicators of community
health that could help measure how well the City was performing with respect
to the ENCHIA Healthy City Vision and Community Health Objectives. Council
subgroups and ENCHIA staff gathered a significant amount of data to generate
baseline data profiles. Staff also completed qualitative research on how develop-
ment was impacting specific population subgroups underrepresented on the
Community Council as well as on the relationship of health to psycho-social
employment attributes.
KEY OUTCOMES/ACHIEVEMENTS:
Gathered data on over 100 measurable community health indicators
Generated five Element Profiles using quantitative data on selected indicators
Completed study and report titled: Tales of the City's Workers: A Work and
Health Survey of San Francisco's Workforce
Completed study and report titled: Eastern Neighborhood Community
Health Impact Assessment Results from a Community Assessment of Health
and Land Use
TASKS/ACTIVITIES:
Conducted research on characteristics of good indicators
Subgroups collected and reviewed baseline data on selected indicators
Disaggregated indicators by variables of interest such as race/ethnicity.
income, and geography
Presented data to the larger Council to get feedback on selected indicators
and ideas for new indicators
Conducted numerous focus groups and key informant interviews to complete
qualitative studies
Figure 55. Best Practice: Clear/Transparent HIA Report - transparent documentation
of a stage of the HIA process (Source: Eastern Neighborhoods Community HIA).
99
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In the case of RAD, we propose the following monitoring plan:
Monitoring the impact of this H IA on the decision: National People's Action
will be responsible for tracking the progress of RAD to monitor if RAD has
been amended according to this HIA's recommendations, and whether
this HIA had any influence on the thinking of policy-makers in terms of the
evaluation of RAD and the expansion of RAD beyond the pilot period into a
permanent policy.
Monitoring decision implementation: RAD's evaluation process should
include a Conversion Oversight Committee made up of resident
organizations, public housing advocates, and elected officials to monitor
RAD's implementation. Their monitoring will include tracking selection
criteria for public housing complexes chosen for conversion, how decisions
about selection are made, and allocation of funding for conversion,
relocation counseling, and other programming or support services related
to policy implementation. This information shall be reported out semi-
annual ly for two years. If a Conversion Oversight Committee is not created,
NPA and Advancement Project will try to work with HUD to report out
these indicators semi-annually for two years.
Monitoring determinants of health: If RAD's evaluation process includes a
Conversion Oversight Committee, the Committee will obtain information
from HUD regarding the number of housing complexes and number of
units "converted" from HUD ownership to another entity's ownership;
the number of units that remain available for very low- and low-income
residents; the number of management systems changed from public
to private management; the number of any lost units; the number of
evictions; and, the number of vouchers created and used. Impacts on
health will be assessed via impacts on these changes. Longer-term impacts
on health and tracking of impacts on residents will be monitored, ideally,
via HUD evaluation of RAD implementation, or pending further funding.
Figure 56. Best Practice: Monitoring Plan -impact and outcome evaluation (Source: Rental
Assistance Demonstration Project HIA).
100
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Areas for Improvement
There are ample areas for improvement in the HIA community of practice. Addressing these
will help to improve the overall quality and rigor of HIAs, advance the community of practice,
and improve overall utilization and effectiveness of HIAs in the U.S. Areas for improvement
include: adherence to the Minimum Elements and Practice Standards, use of HIA to inform
decision-making at all levels, consistency in terminology, broader utilization of existing tools
and resources, and identification and closing of data gaps.
Adherence to Minimum Elements and Practice Standards
Adherence to the Minimum Elements and Practice Standards for Health Impact Assessment
(North American HIA Practice Standards Working Group 2010) or similar criteria developed by
the National Research Council (2011) is undoubtedly the single most important factor for
advancing HIAs in the U.S. The Practice Standards provide HIA benchmarks or best practices
that HIA practitioners should strive to meet when performing HIAs. If these standards were
implemented more consistently, the results would be extraordinary. Consistent implementation
of the Minimum Elements (or National Research Council criteria) across the HIA community of
practice would ensure the essential components of HIA are put into practice that help distinguish
HIA from other practices and methods, and would result in marked increases in rigor, quality,
defensibility, and effectiveness. Essential components of HIA that are particularly lacking and
should be targeted for improvement are given below.
Establishment of Baseline Conditions
A profile of baseline conditions is necessary in order to identify disparities in existing conditions,
predict future conditions if the decision is implemented, and compare with future conditions
should the decision be enacted (i.e., for impact monitoring).
Characterization of Impacts
Consistency in judging direction, magnitude, likelihood, distribution, and permanence of impacts
and increased use of quantitative evaluation methods, when warranted, would increase the
defensibility and effectiveness of HIA considerably. Due to the current lack of consideration in
impact assessment of likelihood, magnitude, permanence, and quantification, further guidance or
methodology may be needed for the HIA field of practice to reach a state of consistency in this
area.
Stakeholder and Community Engagement
Stakeholder engagement is central to the HIA field of practice, yet it is lacking in many HIAs.
Enforcing the need for deliberative engagement of the community, decision-makers, and other
stakeholders in the HIA process will lead to greater depth in the evidence base, promote equity,
empower communities, and ensure that the recommendations offered are relevant to the
community and feasible, practical, and able to be implemented within the purview and authority
of the decision-makers.
101
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Transparency in Documentation
Effective communication of HIA results is crucial to informing the decision-making process, and
effective communication of HIA processes, strategies, methodologies, and lessons learned
(including some components of the HIA process that may be documented separate from the
traditional HIA Report, such as communication plans and monitoring and evaluation efforts) are
crucial for advancing the HIA community of practice; both of these can best be achieved through
clarity and transparency in developed reporting materials. Following the guidance provided in
the Minimum Elements and Practice Standards would result in more consistent transparency and
quality in HIA documentation.
Monitoring and Evaluation
Monitoring and evaluation is an area that is considerably lacking in the HIA practice.
Monitoring (i.e., impact evaluation and outcome evaluation) is crucial for improved utilization
and effectiveness of HIAs because it establishes baselines and trends for accountability, builds a
better understanding of the value of HIA, and validates the accuracy of health impact predictions.
Further research should be conducted on developing strategies and methodologies to minimize
the challenges that exist in implementing monitoring measures.
While monitoring can be challenging to implement, process evaluation is an element that could
be easily incorporated into the HIA process. Process evaluation can be used not only to
document the defensibility of a conducted HIA, but also results in valuable information (e.g.,
successes, challenges, lessons learned, etc.) that can be used to help refine methods and
approaches used in HIA and advance the HIA community of practice.
In addition to the value of implementing monitoring and evaluation for individual HIAs, there is
considerable potential for these efforts to advance the HIA community of practice. However, the
value of monitoring and evaluation for the practice as a whole will not be realized if the
documentation of those efforts (e.g., plans for and results of monitoring and evaluation) are kept
internally and not made available to the community of HIA practitioners.
Use of HIA to Inform Decision-making at All Levels
HIA is commonly implemented to inform local decisions; however, strategies should be
developed for applying HIA more readily to decisions at all levels, including county, state, and
federal decisions.
Consistency in HIA Terminology
Inconsistencies exist in the sector terminology used by the organizations utilized in the
preliminary literature search for the HIA Review. Figure 57 shows the inconsistencies in sector
terminology among these various organizations, which are responsible for promoting and/or
reporting HIAs. During the HIA Review, inconsistencies were also noted in pathway
102
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terminology. Like transparency, consistency in terminology will help to advance HIA reporting
and rigor.
HEALTH IMPACT The HIA Gateway
p f-
Agriculture and Food
Built Environment
Climate Change
Economic Policy
Education
Gambling
Housing
Labor and Employment
Natural Resources and Energy
Physical Activity
Transportation
Water
Agricultural Industry
Air Transport
Crime
Economic Policy
Education
Employment
Greenspace
Health Services
Housing
Tl
Industry
Inequalities
Leisure
Planning
Regeneration
Roads
Sustainable development
Transport
Urban Areas
Waste
lm\ World Health
*£5/ Organization
Agriculture
Air
Culture
Development
Energy
Environment
Housing
Integrated impact assessment
Mining
Noise
Other subjects
Overview
Recreation
Social welfare
Tourism
Transport and
communications
Waste
Water
HEALTH IMPACT ASSESSMENT CLEARINGHOUSE
LEARNING & INFORMATION CENTER
Agriculture
Communications, Media
Community Planning
Economic Policy
Education
Environmental Protection
Food Processing, Distribution, Sales
Housing
Labor, Workplace
Land-Use Planning
Mining, petroleum, other extractive industry
Parks & Recreation
Public Safety
Taxation
Transportation
Utilities
Workplace
Figure 57. Inconsistencies in sector terminology among various organizations promoting and/or reporting
HIAs.
Broader Utilization of Existing Tools and Resources in HIAs
Broader utilization of existing tools and resources could contribute to a more robust impact
assessment and help to close some of the data gaps found in HIA. A comprehensive inventory of
tools, models, and methodologies that can be used in HIA would greatly benefit the HIA
community of practice. An effort is currently underway to develop an HIA Roadmap for
incorporation into the Community-Focused Exposure and Risk Screening Tool (C-FERST) under
development by the EPA. This HIA Roadmap is envisioned to include an inventory of models,
tools, and other resources for use in HIA. Table 12 highlights C-FERST and a few other tools
and models not utilized in the reviewed HIAs, but that could be of benefit in the HIA practice.
103
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Table 12. Additional Tools and Models Useful for the HIA Community of Practice
Tool/Model
AirData
Benefit Mapping and
Analysis Program
(BenMAP)
Co-Benefits Risk
Assessment (COBRA)
Community-Focused
Exposure and Risk
Screening Tool
(C-FERST)
Comparative
Quantification of
Health Risks
Eco-Health
Relationship Browser
MyEnvironment
ParkScore
Regional Vulnerability
Assessment (REVA)
Environmental
Decision Toolkit
Description
Provides access to the EPA's Air Quality System (AQS) Data Mart which is updated
each week night with air quality data collected at outdoor monitors across the U.S. One
can get criteria pollutant and air quality index (AQI) data in multiple forms, including
reports, graphs, maps, and other visualization forms.
A GIS-based computer program used to estimate the health impacts and associated
economic value experienced with changes in air quality.
A free tool that estimates the health and economic benefits of air quality policies.
Allows users to estimate and map the air quality, human health, and related economic
benefits (excluding energy cost savings) of clean energy policies or programs; and
approximate the outcomes of clean energy policies that change emissions of paniculate
matter (PM25), sulfur dioxide (SO2), nitrogen oxides (NOX), ammonia (NH3), and
volatile organic compounds (VOCs) at the county, state, regional, or national level.
A one-stop community mapping, information access, and assessment tool designed to
help assess risk and assist in decision making within communities. The addition of an
HIA Roadmap to this tool will make C-FERST a very useful resource for those that are
new to HIA.
Quantifies risk factor exposure and effects for 26 major health risks and identifies
population exposure distributions, evidence for causality, and estimates of disease-
specific hazards associated with each level of exposure.
Illustrates the linkages between human health and ecosystem services (i.e., benefits
supplied by nature). This tool provides information about several major ecosystems in
the U.S. (i.e., agro-ecosystems, forests, urban ecosystems, and wetlands), the services
they provide, and how those services, or their degradation and loss, may affect people.
Integrates data from EPA and other sources, including air, water, energy, and health
data, to provide a quick picture of local environmental conditions.
Provides measures of how well the 40 largest U.S. cities meet their need for parks.
Using advanced GIS, ParkScore identifies neighborhoods and demographics that are
underserved by parks, and the number of people able to reach a park within a ten-
minute walk. It also provides in-depth data to guide local park improvement efforts.
A web-based application that provides a means for visualizing and exploring data about
current conditions, possible future conditions, and integrating stressors and conditions.
The objective of Re V A is to assist decision-makers in making more informed decisions
and in estimating the large-scale changes that might result from their actions.
Source
Environmental Protection Agency;
http://www.epa.gov/airdata/
Environmental Protection Agency;
http://www.epa. gov/air/benmap
Environmental Protection Agency;
http://www. epa. gov/statelocalclimate/resourc
es/cobra.html
Environmental Protection Agency;
http://www.epa.gov/heasd/c-ferst
World Health Organization;
http ://www. who . int/healthinfo/global burden
disease/cra/en/
Environmental Protection Agency;
http://www.epa.gOv/research/healthscience/b
rowser/introduction. html
Environmental Protection Agency;
http://www.epa.gov/myenvironment
Trust for Public Land;
http://parkscore.tpl.org/
Environmental Protection Agency;
http://amethyst.epa.gov/revatoolkit/Welcome
.isp
104
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Identifying and Closing the Data Gaps in HIA
Identification of data gaps is important to transparency in HIA reporting, but it can also be useful
in helping to refine methods and approaches used in HIA and identify areas for future research.
Closing identified data gaps and maximizing the evidence available for use in HIA will result in
more robust assessments and improved efficiency in predicting health impacts.
Conclusions
While HIAs have helped to raise awareness and bring health into decisions outside traditional
health-related fields, the effectiveness of HIAs in bringing health-related changes to pending
decisions in the U.S. varies greatly. This review found that there are considerable disparities in
the quality and rigor of HIAs being conducted. This, combined with lack of monitoring, health
impact management, and other follow-up in HIAs could be limiting the overall utilization and
effectiveness of this tool in the U.S.
Understanding the current state and applicability of HIAs in the U.S., as well as best practices
and areas for improvement, will help to advance the HIA community of practice in the U.S.,
improve the quality of assessments upon which stakeholder and policy decisions are based, and
promote healthy and sustainable communities.
References
AAG. 2012. Annals of the Association of American Geographers Special Issue: Geographies of
Health. Philadelphia, PA: Taylor & Francis Group.
Alaska Department of Health and Human Services. 2011. Technical Guidance for Health
Impact Assessment (HIA) in Alaska. Juneau, AK: Alaska Department of Health and Human
Services.
Arnstein, S.R. 1969. A ladder of citizen participation. Journal of the American Institute of
Planners 35(4):216-224.
Bhatia, R. 2011. Health Impact Assessment: A Guide for Practice. Oakland, CA: Human
Impact Partners.
Bhatia, R. and M. Katz. 2001. Estimation of health benefits from a local living wage ordinance.
American Journal of Public Health 91:1398-1402.
Bhatia, R. and A. Wernham. 2008. Integrating human health into environmental impact
assessment: an unrealized opportunity for environmental health and justice. Environmental
Health Perspectives 116(8):991-1000.
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Danneberg, A.L., R. Bhatia, B.L. Cole, S.K. Heaton, J.D. Feldman, and C.D. Rutt. 2008. Use of
health impact assessment in the U.S.: 27 case studies, 1999-2007. American Journal of
Preventive Medicine 34(3):241-256.
Deganian, D., and J. Thompson. 2012. Patterns of Pollution: A Report on Demographics and
Pollution in Metro Atlanta. Atlanta, GA: GreenLaw.
Design for Health. 2008. Rapid Health Impact Assessment Toolkit, Version 3.0. Minneapolis,
MN: University of Minnesota.
EPA. 2011. Draft Research Framework: Sustainable and Healthy Communities Research
Program. Washington, DC: U.S. Environmental Protection Agency.
Gotway, C.A, and LJ. Young. 2002. Combining incompatible spatial data. Journal of the
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Harris, P., B. Harris-Roxas, E. Harris, and L. Kemp. 2007. Health Impact Assessment: A
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(CHETRE).
Harris-Roxas, B. andE. Harris. 2011. Differing forms, differing purposes: Atypology of health
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Trusts. Available at: http://www.pewhealth.org/reports-analysis/data-visualizations/the-rise-of-
hias-in-the-united-states-85 899464695.
Heller, J., S. Malekafzali, L.C. Todman, and M. Wier. 2013. Promoting Equity through the
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Human Impact Partners. 2011. A Health Impact Assessment Toolkit: A Handbook to
Conducting HIA, 3rd edition. Oakland, CA: Human Impact Partners.
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ICMM. 2010. Good Practice Guidance on Health Impact Assessment. London, UK:
International Council on Mining and Metals.
IPIECA/OGP. 2000. A Guide to Health Impact Assessments in the Oil and Gas Industry.
London, UK: International Petroleum Industry Environmental Conservation Association/
International Association of Oil & Gas Producers.
National Research Council. 2011. Improving Health in the United States: The Role of Health
Impact Assessment. Washington, D.C.: The National Academies Press.
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North American HIA Practice Standards Working Group (Bhatia, R., J. Branscomb, L. Farhang,
M. Lee, M. Orenstein, and M. Richardson). 2010. Minimum Elements and Practice Standards
for Health Impact Assessment, Version 2. Oakland, CA: North American HIA Practice
Standards Working Group.
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Assessment International Best Practice Principles. Special Publication Series No. 5. Fargo, ND:
International Association for Impact Assessment.
SFDPH. 2011. Health Effects of Road Pricing In San Francisco, California: Findings from a
Health Impact Assessment. San Francisco, CA: San Francisco Department of Public Health,
Program on Health, Equity, and Sustainability.
Stakeholder Participation Working Group. 2010. Best Practices for Stakeholder Participation in
Health Impact Assessment, Version 1.0. Oakland, CA: Stakeholder Participation Working Group
of the 2010 HIA in the Americas Workshop.
UCBHIG. 2009. HOPE VI to HOPE SF San Francisco Public Housing Redevelopment: A
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Warburton, D., L. Colbourne, K. Gavelin, and R. Wilson. 2008. Deliberative Public
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WHO. 1999. Health Impact Assessment: Main Concepts and Suggested Approach; Gothenburg
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Assessing health impacts in complex eco-epidemiological settings in the humid tropics:
Advancing tools and methods. Environmental Impact Assessment Review 3 0(1):52-61.
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Appendix A - Health Impact Assessment Review Guidelines
HEALTH IMPACT ASSESSMENT
REVIEW GUIDELINES
May 30, 2012
(Annotated July 2012, August 2013)
Compiled By: Justicia Rhodus, Dynamac Corporation
A-l
-------
HEALTH IMPACT ASSESSMENT REVIEW
BACKGROUND
SCOPE
A systematic review is being conducted of health impact assessments (HIAs) from the U.S. to obtain a
clear picture of how HIAs are being implemented nationally and to identify potential areas for
improving the HI A community of practice. The review is focused on HIAs from four sectors that the
U.S. Environmental Protection Agency's (EPA's) Sustainable and Healthy Communities Research
Program has identified as targets for empowering communities to move toward more sustainable states -
transportation, housing/buildings/infrastructure, land use, and waste management/revitalization.
A pilot review of four HIAs - one from each sector - has been completed to date. Through this process,
the project team has been able to refine the information to be recorded from the HIA reviews.
The hope is that the HIA Review will aid in identifying EPA products and research that could enhance
the HIA community of practice and discovering what the ecological assessment community of practice
could draw from HIAs (and vice versa).
PRODUCTS
The products of this HIA Review will be two-fold:
an Access database documenting the review of available HIAs in the four identified sectors; and
a report synthesizing the results of the review to identify the state of the HIA practice in the U.S.
and areas in the overall HIA process that could benefit from enhanced guidance, strategies, and
methods.
TIMELINE
The HIA reviews are expected to be complete in early August 2012, with release of the report to follow
in September 2012.
* NOTE (July 2012): The timeline for completion of the review has been delayed. It is expected that
the report will be issued mid-late 2013.
A-2
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HEALTH IMPACT ASSESSMENT REVIEW
WHAT IS HIA?
HIA DEFINED
Health impact assessment (HIA) is commonly defined as:
a combination of procedures, methods, and tools which systematically judges the
potential, and sometimes unintended, effects of a policy, program, or project on
the health of a population and the distribution of those effects within the
population.
* NOTE (August 2013): This definition is from the International Association of Impact Assessment
(Quigley et al. 2006); an updated definition was developed by the National Research Council in 2011.
Health impact assessment
identifies and evaluates public health consequences of a plan, project, or policy,
suggests actions to minimize adverse health impacts and optimize beneficial ones, and
provides recommendations intended to shape the final proposal.
Health impact assessment is:
a way to factor health considerations into the decision-making process
a structured process that uses scientific data, professional expertise, and stakeholder input
conducted and communicated in advance of a decision
both a health protection and health promotion tool that identifies health hazards and health
benefits
HIA STEPS
The major steps in conducting an HIA* include:
1. Screening - identify proj ects or policies for which an HIA would be useful
2. Scoping - identify which health effects to consider and setting the parameters of the HIA
3. Identification - collect information to identify potential health impacts
4. Assessment - synthesize and critically assess the information to prioritize health impacts,
identify which people may be affected, and how they may be affected
5. Decision Making/Recommendations - make decisions to reach a set of final action-oriented
recommendations that promote positive health effects and/or mitigate adverse health effects;
write a final report to present the results of the HIA to decision-makers for
implementation/action.
6. Evaluation and Follow-up - evaluate the processes involved in the HIA, including the
effect/impact of the HIA, and set up impact monitoring and a health impact management plan.
* NOTE (July 2012): The steps outlined here and noted in the figure on page A-5 and the table on pages
A-7 and A-8 were taken from Harris, Harris-Roxas, Harris, and Kemp (2007). It should be noted that the
standardized steps for HIAs conducted in the U. S. vary slightly from these and include: Screening,
Scoping, Assessment, Recommendations, Reporting, and Monitoring and Evaluation.
A-3
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HEALTH IMPACT ASSESSMENT REVIEW
HIA LITERATURE SEARCH
PRELIMINARY LITERATURE SEARCH
Health Impact Assessment (HIAfTitle
&th Avenue East Dulutn HIA
A Health Impact .Assessment of Mixe-d Use
Redevelopment Nodes and Corridors in Lincoln,
Nebraska.
Arctic Outer-Continental Shelf Oil and Gas Multiple
Lease Sale Environmental Impact Statement
Atlanta Beltline
Baltimore Comprehensive Zoning Co-da Rewrite
Baltimore Red Line Transit Project
Barrett Park Property
Battlement Mesa
Benton Accessory Dwelling Units
Bernal Heights Preschool
Buford Highway and NE Plaza Redevelopment
Child Health Impact .Assessment of Energy Casts and
the Low Income Home Energy Assistance Program
(LIHEAPJ
Child Health ImpactAssessmentofthe
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Lincoln., NE
Alaska
Atlanta, GA
Baltimore, MD
Baltimore, MD
Hood River, OR
Battlement Mesa,
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Benton County, OR
San Francisco, CA
Atlanta, GA
Massachusetts
Massachusetts
Status SHCRPSecti
Completed
Completed
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Human Impact
iris} Health Impact Project HIA Gateway UCLA HIA Clearinghouse Other
Partners
Built Environment
Planning/Transport
Natural Resources and Industry
Energy
Built Environment Regeneration Land Use Planning
Built Environment Land Use Planning
Transportation Land Use
Planning/Transportation
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For planning purposes, it was estimated in late March 2012 that there were between 80 and 150 HIAs to review in the four identified sectors; this
includes the four HIAs in the pilot review: 78 Completed 2 Draft 66 In Progress 3 Undetermined
LITERATURE SEARCH RESULTS
The literature search results were updated in May 2012 and available HIA reports downloaded for review. A total of 89 completed HIAs
obtained.
were
HEALTH IMMCT
PROJECT
http://www.healthimpactproject.org
The HIA Gateway-^
http://www.hiagateway.org.uk/
A.> HEALTH IMPACT ASSESSMENT CLEARINGHOUSE
LEARNINGS INFORMATION CENTER
http://www.hiaguide.org/
HUMAN IMPACT PARTNERS
http: //www. humani mpact. org/
World Health
Organization
http: //www. who. int/hia/en/
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HEALTH IMPACT ASSESSMENT REVIEW
REVIEW PROCESS
DOCUMENTATION OF REVIEWS
An Access database has been created to record the results of the systematic HIA reviews. An Access
2007 database containing a Data Entry Form will be transmitted to each reviewer. This form, which
allows data entry directly into the HIA Review database, will be used to record the results of your HIA
Review.
HIA REVIEW
Each reviewer will be assigned a set of HIAs to review. The HIA reports are located on the network at:
L:\Public\NERL-PUB\Health Impact AssessmentAHIA Review Materials\HIA Reports
Review each assigned HIA report for the information requested in the Data Entry Form shown below.
Database fields are defined in more detail on pages 6-7 and expanded upon even further in subsequent
pages.
HIA Review
ID:
Title:
Year:
Location:
Decision-making Level:
Organization(s) Involved:
Organization Type:
Contact:
Organization/HIA Website:
Find ing
Status:
Sector(s):
HIA Type:
HIA Rigor:
Scope/Summary:
Source of Evidence:
Data Types:
Major Data Sources:
Local Data Available or
Obtained?:
Additional Data Needed
(Self-identified):
Stakeholder Involvement:
Impacts/Endpoints:
Health Endpoints:
Pathway of Impact:
Quantification of Impact:
mpact Prioritization:
Decision-making Outcome:
HIA Report:
Defensibility/Process Eval:
Effectiveness of HIA
-ollow-up Measures:
Minimum Elements of HIA
Met? If no, what's missing:
GIS Used?:
Environmental/Ecosystem f
Impacts Considered?:
Potential Improvements:
Best Practices:
HIA
Step
Scoping
Identification
Assessment
Decision/Recommend
Evaluation/
Follow-up
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Data entry should be based on your independent review of the HIA Report and the guidance provided in
this document. Some of the requested data will not be directly available in the reports, however - they
either require your assessment of the HIA to some extent (HIA Rigor, Defensibility/Process Evaluation,
Minimum Elements of HIA Met, Potential Improvements, Best Practices) or request ancillary data,
which can be obtained (if available) via an internet search (Organization Type, Effectiveness of HIA).
Please note that some fields have specific terminology or formatting that should be used for data entry;
these are highlighted in gray in the database field descriptions on pages 6-7.
Note: If you are having trouble gathering some of the data from the HIA Report, the HIA databases/
clearinghouses identified at the bottom of page 3 can be referenced to gather some of the data (e.g.,
point of contact, funding, websites, rigor, summary, recommendations, effectiveness of HIA, etc.),
although data entries should be based on your review of the HIA to the extent possible*.
* HIA guidelines point to having transparent, publicly-accessible documentation. So, for instance, if you
cannot discern the funding sources from the HIA Report, but this information is included in the
clearinghouses/databases, do not include it in the HIA Review database; instead, enter "Undetermined."
(Note: In the Potential Improvements field, you could enter improved transparency in documentation.)
Likewise, if the information you gather from the HIA Report contradicts information contained in the
clearinghouses/databases, enter the information based on your review of the HIA Report and the
guidance included here, noting the discrepancy. See this data entry example, noting the discrepancy in
HIA Rigor: Intermediate (Listed by Human Impact Project as rapid, but more than three impacts
assessed).
Materials referenced throughout these guidelines are located on the network at:
L:\Public\NERL-PUB\Health Impact AssessmentXHIA Review Materials\Background Materials
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HEALTH IMPACT ASSESSMENT REVIEW
DATABASE FIELDS*
These headings are placed in the overall context of the HIA Process (screening, scoping, identification, assessment, decision
making and recommendations, evaluation and follow-up), as applicable. The table cells highlighted in gray give specific
terms and/or format that must be used for data entry.
Database Field
ID
Title
Year
Location
Decision-making Level
Organization(s) Involved
Organization Type
Contact
Organization/HIA Website
Funding
Status
Sector(s)
HIA Type
HIA Rigor
Scope/Summary
Source of Evidence
Data Types
Major Data Sources
Local Data Available or
Obtained?
Additional Data Needed
(Self-Identified)
Stakeholder/Community
Involvement?
Impacts/Endpoints
Health Endpoints
Description/Examples
(Automatically generated in Access database)
Full title of HIA Report
Year of publication
Where HIA was conducted- city, county, state, etc. (as
applicable)
Local, county, state, federal
Organizations involved in conducting/publishing/
sponsoring the HIA
Educational institution, Government agency, Non-profit,
Other, Undetermined
Name and contact info for HIA point-of-contact (if
available) in format: name, email / Undetermined
Identify website dedicated to or highlighting the HIA (if
applicable) / N/A
Identify financial sponsors (if named) / Undetermined
Complete, In progress, etc.
Transportation, housing/buildings/infrastructure, land use,
waste management/revitalization (as defined by SHCRP)
Mandated (by what/whom), decision support, advocacy,
community-ledl :
Desk-based, rapid, intermediate, comprehensive 2
Question/problem faced, proposed policy/plan examined
Literature review, survey, community consultation, policy
review, special collection (interviews, surveys, focus
groups, risk assessment, demographics analysis, modeling,
etc.) 2
Models, literature (published, peer-reviewed, grey lit,
government documents, policy), websites, data
Specific models, agency (e.g., CDC, HUD, Census
Bureau*) or community data, bibliographic resources
(Medline, Pub Med, Web of Science, Science Direct, etc.),
databases, websites, internet gateways/search engines
(e.g., Google), surveys, focus groups/forums, entities
interviewed/consulted (e.g., stakeholders, technical
experts), etc.
* Note: It has been brought to our attention that it would be useful to
note the type, year, and geographic scale of census (and other) data used.
(If yes) Identify data / No
(If yes) Identify data / No
(If yes) Identify stakeholder groups / No
Health (physical, mental, developmental), environmental/
ecosystem, behavioral, economic, infrastructure, services,
demographic, other
Identify health endpoints examined in HIA
HIA Step
Addtl Info
*NOTE (August 201 3):
Changes were made to several
Database Fields and
Descriptions over the course of
the HIA Review to refine the
review framework. See Table
I in the body of the report for
an updated version of this
table.
Scoping
Scoping
Scoping
Scoping/Identification
Identification
Identification
Identification
Identification
Assessment
Assessment
8-12
13
14
15
15
1 Harris-Roxas and Harris (2011)
2 Harris, Harris-Roxas, Harris, and Kemp (2007)
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Database Field
Description/Examples
HIA Step
Addtl Info
on Page(s)
Pathway of Impact
Quantification of Impact
Impact Prioritization
Decision-making Outcome
HIA Report
Defensibility/Process
Evaluation
Effectiveness of HIA
Follow-up Measures
Minimum Elements of
HIA5 Met? If no, what's
missing
CIS Used?
Environmental/Ecosystem
Impacts Considered?
Potential Improvements
Best Practices
Air quality, community/household economics, education,
exposure to hazards, healthcare access/insurance, housing,
infectious disease, land use, lifestyle, mental health,
mobility/access to services, noise pollution, nutrition,
parks and recreation, physical activity, public health
services, safety (personal, traffic, etc.) and security, social
capital, soil quality, water quality, etc.
Direction (positive, negative, unclear, no effect),
permanence, magnitude, likelihood (definite, probable,
speculative, unlikely, uncertain), distribution/equity,2'3etc.
What methods/data were used to prioritize the impacts?
Note: Prioritization of impacts often used to determine the impacts for
which recommendations/mitigations will be developed. Direction,
permanence, magnitude, likelihood, distribution/equity of impacts may
be used in prioritization (see Quantification [Characterization] of Impact)
Describe the general outcome of the HIA, including
recommendations, mitigations, etc.
Assessment
16
Assessment
17
(Attach HIA Report)
Describe the quality of evidence and methodology;
identify assumptions, limitations, barriers; etc.
Impact evaluation (direct, general, opportunistic, none4),
health outcome evaluation (predictive accuracy, health
impacts) /Undetermined
Note: The effectiveness of the HIA cannot be determined by review of
the HIA Report; this must be determined based on an internet/lit search.
Monitoring, health impact management, or other follow-
up measures called for in the HIA / N/A
Assessment
17
Decision/Recommend
Decision/Recommend
Evaluation / Follow-up
Evaluation / Follow-up
18
19
Yes / No - identify what's missing
(If yes) Describe use - Illustrative, GIS analysis, etc. / No
(If yes) Identify impacts / No
Identify what could have potentially improved the HIA
and/or its effectiveness. (Perhaps consult the HIA Practice
Standards 5)
Question to Consider: How are the HIAs different and what could have
been done to close the gap?
For example, quantification of impacts (including costing); consideration
of environmental/ecosystem impacts; additional information; use of
GIS/spatial analysis; broader utilization of existing
tools/models/resources (C-FERST/T-FERST, BenMAP, National Atlas
of Ecosystem Services, EJ View, My Environment, UCLA Health Impact
Decision Support Tool, etc.); consistency in conducting and reporting
HIAs (e.g., sector terminology, enhanced guidance/methodology,
transparent/publicly-accessible documentation); clear reporting of
recommendations and mitigations; identification of evaluation and
follow-up measures; etc.
Evaluation / Follow-up
20
21-24
Identify portions of the HIA process, report, etc. that stand
out and describe these best practices.
For example, tabular summary of potential impacts, including direction,
extent, and populations most affected; defensibility of process;
transparency of process documentation; etc.
* Potentially identify a set of HIAs within each sector representing the
best of the best.
3 Human Impact Partners (2011)
4 Wismar, Blau, Ernst, and Figueras (2007)
5 North American HIA Practice Standards Working Group (2010)
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HEALTH IMPACT ASSESSMENT REVIEW
SECTORS
Observation: Sector terminology is not consistent between the various organizations promoting and/or
reporting HIAs.
Resolution: The sectors to be analyzed will be defined using the terminology found in the Sustainable
and Healthy Communities Research Program Draft Research Framework, June 1, 2011
(excerpts below).
* NOTE (August 2013): The HIA Review was conducted as part of the EPA's Sustainable and Healthy
Communities Research Program and therefore utilized the sectors and sector descriptions identified for that
research program It should be noted that these sector descriptions do not necessarily reflect the sector
descriptions typically utilized in the HIA field of practice.
TRANSPORTATION
Many communities find themselves in a transportation construct imposed by past generations' priorities,
which doesn't easily fit more sustainable transportation models , imposes a high demand on fossil fuels
and imposes an economic burdens on individuals and communities. In order to adequately transition to
new transportation forms, decision makers must fully understand the full and long-term implications of
new and transitional options. For example, many people think of mass transit alternatives only in terms
of economic cost. However, there are many indirect economic and health benefits of mass transit that are
relevant for decisions. It encourages better health by increasing walking, it raises adjacent property
values, it lessens need for more destructive road building, decreases road congestion and so emissions,
increases social capital and psychological health by enabling more incidental social interactions, and
makes more jobs accessible to people who cannot afford cars. Also, adequate comparisons of
transportation issues need to be placed in the proper context of alternatives, for example, two options for
meeting commuting demand could be building a new highway lane or buying 50 buses for critical routes
and creating incentives for ridership. The economic, environmental and social costs of these two
alternatives are quite different, so tradeoffs should be clear.
Transportation issues also vary between rural and urban communities. Large, urban centers are usually
growing, with increasing need for transportation capacity. However, they are also striving to decrease
vehicles miles traveled (VMT) in cars by facilitating public transportation, walking and bicycling.
Alternatively, rural residents are highly dependent on cars to access job centers and services. Most rural
communities have a very limited public transportation infrastructure. While they recognize the value of
public transportation from a sustainability perspective, it is less feasible for them because of cost,
limited ridership, and the complexity of setting up regional partnerships with neighboring
counties/cities. In addition, social and economic considerations affect transit use.
Illustrative Science Questions:
1. How can we assess a full accounting of environmental, economic and social effects of alternative
transportation modes and fuels decisions on the sustainability and resilience of communities?
2. What new and existing community, state, and national policy options, incentives, interventions,
or communication strategies can be used to improve transportation effects on community
sustainability and resilience?
3. What suite of transportation options improves community sustainability and resilience most
effectively and economically?
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4. What associated land use and development designs can increase the use of public transportation
systems?
5. How do transportation choices made in suburban and exurban areas affect overall community
sustainability and resilience and the distribution of costs and benefits?
6. How can transportation design and choices affect a community's ability to adapt to climate
change?
7. How can we communicate the full costs and benefits of transportation choices in a way that
effectively informs decisions and changes behavior?
Health Impact Assessment (Pilot Review):
Pathways to a Healthy Decatur: A Rapid Health Assessment of the City of Decatur Community Transportation Plan
Location: Decatur, Georgia
Decision Making-Level: Local
Organization(s): Georgia Tech Center for Quality Growth and Regional Development
Housing is a pivotal consideration for communities. Housing shortages (e.g., middle- or low-income,
accommodations for families of local employers) have some communities focused on building more
homes to attract new members to the community and to meet existing residents' needs. Other
communities are driven by a desire to expand the tax base by renovating existing housing and
commercial property. Still other communities suffer from abandoned buildings as their economy shrinks
and people move away. Rising energy costs have made energy efficiency a top priority both for
communities looking to cut costs in their subsidized housing programs and residents looking to make
their money go farther, but "green" building is still a niche market and extensive energy retrofitting of
existing homes can have a long payback. In addition, communities are making strides to revitalize their
downtowns, but are challenged to address the cost and impact of sprawl caused by development.
Communities are increasingly developing land use plans and zoning decisions with sustainability goals
in mind, but these can be undone easily by ad hoc rezoning or variances for specific buildings or
developments the municipality thinks are economically justified or desired, based on the limited
cost/benefit information available. Such decisions have long-term implications and can be made without
the community participatory process that usually accompanies planning efforts. Roads will replace
greenfield acreage, with the accompanying ecological services impacts. Other infrastructure will
similarly displace vegetation, create impervious surfaces and impose long term costs. Buildings may be
considered more expendable, and so not as permanent a decision, but seldom are buildings replaced by
green space. So, unless a building is designed to be flexible for future use, unproductive buildings are
often torn down, and embodied energy in buildings and materials are wasted.
With this kind of economic cost and environmental implications, community decisions that affect new
development and infrastructure are best made with well-informed foresight, with sufficient information
to allow accurate and timely comparison of long-term cumulative costs and benefits. In addition, there is
significant new experience in retrofitting sprawl, dead malls and other underperforming sites into
denser, mixed use, transit-oriented development, and full-cost accounting evaluation of these
redevelopments would be useful. An accurate full cost/benefit evaluation comparing existing
development, redevelopment and green field development implications would significantly benefit
community decision making and could highlight significant economic opportunities.
Infrastructure evaluations also need to be made with full implications considered. There are many
assumptions in infrastructure design that are being called to question by anecdotal evidence that can
result in counterproductive decisions. For example, narrower streets in neighborhoods will better support
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walking, biking and a more protected feel, but wider streets are sometimes required to support larger fire
trucks and allow faster response. An unforeseen consequence is that more firefighters are being killed in
traffic accidents en route to fires than fighting fires. Such anecdotes highlight the need to evaluate the
assumptions which underpin costly infrastructure decisions. An additional infrastructure issue raised by
a community is that of transitioning from "grey" to "green" infrastructure. Making decisions on new
infrastructure more easily incorporates comprehensive information than decisions on retrofitting green
infrastructure or low impact development models into an existing built environment. But repair and
retrofit decisions are regularly made in cities and would benefit from a comprehensive evaluation of
gains and losses from different options.
Another example of the need for understanding the full implication of aging infrastructure issues is
underground storage tanks for fuels. Ethanol can expand benzene plumes generated from leaking tanks,
endangering groundwater supplies and causing vapor intrusion in buildings. A recent ORD analysis has
shown that there is a significant population surrounding urban cores that have a higher vulnerability due
to the co-location of gas stations and water supply wells. The SHCRP infrastructure, land use,
transportation and site remediation research can significantly contribute to resolution of this issue.
Illustrative Science Questions:
1. What are the effects of the design, condition and maintenance practices of housing and other
built environments (e.g. schools, office spaces, retail spaces, etc.) on human health and
wellbeing? What are the best practices and products that communities can employ to minimize
health risks (or promote wellness) from indoor exposures?
2. How can homes and infrastructure be designed and built to be more resilient to climate change
and major environmental events that may be exacerbated by climate change (e.g. flooding,
hurricanes, etc.)?
3. What type and mix of housing best promote the well-being of individuals and communities?
4. How does the distribution and type of built infrastructure affect the delivery of ecosystem
services?
5. How can safe, affordable and healthful housing be distributed such that communities are better
integrated and individuals have equitable access to the benefits associated with such housing
(including community benefits such as access to transportation, education, healthy food, medical
services and cultural amenities)?
6. How can building and infrastructure choices affect a community's ability to adapt to climate
change?
7. What are the cumulative benefits of green practices implemented at the individual level (e.g. rain
barrels, roof gardens, compact fluorescent bulbs, low VOC paint) in terms of improved health
and well-being and increased delivery of ecosystem services? Which green practices contribute
most to these benefits?
Health Impact Assessment (Pilot Review):
A Child Health Impact Assessment of the Massachusetts Rental Voucher Program
Location: Massachusetts
Decision Making-Level: State
Organization(s): Boston University Child HIA Working Group
LAND USE
According to the participants in the community outreach efforts, many communities have developed
"sustainability" plans, but these are often driven by more traditional long-standing planning practices
that have mixed results. In addition, planning can take place without inclusive, well-informed
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discussions with community members and key stakeholders like local businesses and neighborhood
associations. Rural communities are especially interested in ways to conduct planning that maintains
their individual identities and land uses that sustain the rural economy (from agriculture to nature-based
tourism on protected lands). Given the array of needs that must be considered (e.g., buildings,
greenways, infrastructure), communities are challenged to know which sustainability practices and
projects will serve them best. Communities are also interested in integrating land uses that promote
healthy and safe lifestyles (e.g., greenways, trails, parks); however they are unclear about the benefits
compared to impacts of their choices.
A holistic, cumulative assessment of all the costs and benefits of local decisions will allow
fully-informed comparison of options and transparency of tradeoffs imposed by policy makers. For
example, in attempts to increase their property tax base and create jobs, communities often permit big
box stores on city fringes. However, a recent case study on tax values for different kinds of properties
showed that infrastructure costs for big box stores would not be paid back by the expected revenue for
decades, while urban mixed use midrise development payback was nearly 100 times greater per acre.
Thus, a decision to permit a big box store may not have been made were the real costs and payback
known. At the same time, there are unintended impacts and long term costs imposed by sprawl
development that are not quantified, and so, not considered in such decisions, e.g. stormwater runoff
pollution, heat island exacerbation, spreading of associated sprawl because of extended infrastructure,
increased vehicle miles travelled (VMT) and mobile emissions, loss of green space or farmland and
traffic problems.
Just as there are unaccounted costs in typical community decision making, there are also cumulative
benefits for sustainable urbanism actions that are usually unrecognized or unquantified for decision
making. For example, green space in a streetscape can treat stormwater, create walkable places for
increased healthy lifestyles, feed biophilia and a feeling of well-being, increase social interactions and
social capital, increase adjacent land values, support wildlife and pollinators, create activity-related jobs
and increase customer traffic at adjacent businesses.
Besides the obvious parameters, planning and zoning decisions will affect traffic volume, viability of
transit, feasibility of transportation alternatives like walkability and bikeability, proximity of services,
proximity of green space, etc. These parameters of urban form affect health by affecting, for example,
the amount of air pollution, the ability to incorporate exercise into daily living, safety (e.g. traffic
accidents and crime) and the psychological benefits of increased social capital and freedom of mobility
without a car. Communities are especially interested in the assessment of full costs and benefits of
sprawl forms of growth compared to smart growth options. It is important that this be done with
appropriate metrics for effective comparison. For example, GHG emissions per acre show a much
different picture than GHG per capita, which demonstrates the energy efficiency of cities. Similarly,
quantifying impervious surfaces in a dense, mixed use scenario may seem worse than in a diffuse
suburban scenario, but comparing these scenarios on a common denominator of capacity basis (such as,
"per 100,000 people" or "per 100 acres") will give a more realistic comparison of the ecosystem
services impacts.
Community decision-making is often confounded by things that happen outside their boundaries and
ability to control. Understanding what these processes are and how they factor into community problem
solving is crucial for communities to move towards sustainable futures. For example, many communities
in the Southeast share a common water supply and recent droughts have created "water wars" among
communities. Communities also often export problems, e.g. the state of South Carolina's most impaired
water body is located just downstream of Charlotte, NC.
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Illustrative Science Questions:
1. What are the impacts of building density, mix (e.g., residential versus commercial/industrial),
and location on the environmental, economic, and social health of a community?
2. What are the impacts of non-urban land use management (e.g., local versus distant agriculture,
chemical use, crops and rotations, timber harvest), on the environmental, economic, and social
health of a community?
3. How do a variety of land uses (e.g., community agriculture, parks, and urban services) contribute
to community health and well-being and economic vitality?
4. What social and judicial levers or emerging information technology could compel behavior
change related to land use at the individual and community levels?
5. How can we quantify the values of ecosystem services provided by a landscape and integrate
those values with other social and economic parameters for improved decision making?
6. How do regional-scale processes (e.g. development outside community boundaries, air pollution
transport, and shared water supplies) affect community-scale sustainability and how can these
processes be factored into community decision-making?
Health Impact Assessment (Pilot Review):
Derby Redevelopment Health Impact Assessment
Location: Historic Commerce City, Colorado
Decision Making-Level: Local
Organization(s): Tri-County Health Department
Communities may make decisions about waste management and disposal and site remediation and reuse
options that are unsustainable because they lack the decision support tools needed to do comparative
analysis of the short- and long-term costs and benefits in the life cycle of the various materials
management options. Comprehensive analysis would incorporate elements such as, cumulative human
exposures, carbon footprint, environmental justice, impairment of ecosystem services, transportation
options and land use.
All communities are faced with managing a steady stream of municipal solid waste (MSW), the majority
of which is managed in landfills. The per capita generation rates grew from 1960 to 1990 and remained
in the range of 4.3 to 4.7 Ib/person/day through 2009, when there was an apparent slight decline. Less
than two-thirds of yard waste, aluminum cans and tires are recycled and less than a third of glass
containers. Almost two-thirds of the entire MSW stream is organic materials that contain energy values,
which are lost if the waste is disposed in a conventional landfill. Communities need to be able to
evaluate the full costs and benefits of MSW recycling and management options in order to build the
right infrastructure and set disposal fees and incentives in ways that meet costs and provide for future
sustainable management. But even well-founded initiatives can fail if compliance by residents is easily
circumvented. Bans on certain objects in landfills have been known to result in more of those objects
thrown onto the roadside. Understanding motivations for non-compliance and incentives for compliance
will assist communities to design and implement successful programs.
In addition to routine wastes, many communities periodically have to manage high volumes of debris
from natural disasters, such as earthquakes, tornadoes, and flooding, often when infrastructure and
communications are already strained. As an example, after a tornado ravaged Joplin, MO, the
community needed support in managing the large volumes of debris that were generated. ORD was
asked about comparative trade-offs in considering various risk management options, including
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landfilling and combustion. A decision support tool that identified the life cycle impacts of potential
human health and ecosystem services of the various reuse/treatment/disposal options could have
provided support in the recovery of the community. Additionally, these events (likely more frequent
with climate change) create significant surges in materials that have the potential to create long-term
environmental and/or human health impacts. Technological options and advance planning would allow
communities to mobilize options that have the least impact on land resources, ecological resources, and
human populations, particularly populations that are more susceptible or already disproportionally
exposed to environmental stressors. Other man-made debris, such as building and demolition discards
and roadbuilding and maintenance wastes, could also be recycled and disposed of more sustainably with
the right technologies, planning, ordinances, and pricing schedules.
Communities have more blighted properties following the recent economic recession. Some of these,
particularly defunct commercial and industrial properties, are suspected of being contaminated by
hazardous constituents. Brownfields grants and other voluntary programs can help communities assess
and redevelop properties. Added focus on the full costs and benefits of redevelopment alternatives (park,
green space, urban agriculture, business park, small business, residential, green energy) could maximize
sustainability gains. Redevelopment also offers opportunities to rectify conditions faced by
disadvantaged populations.
This research will be integrated with the Office of Solid Waste and Emergency Response's (OSWER)
advice to individuals and communities for managing MSW
(http://www.epa.gov/wastes/nonhaz/municipal/) and activities on Brownfields and land revitalization.
Note that this objective is complemented by research in Objectives 3a and 3b. Whereas Objective le
research focuses on community decision-making, the focus of the Theme 3 objectives is more on the
R&D to ensure that environmental regulations involving waste and materials management and site
remediation are based on sound science and engineering.
Illustrative Science Questions:
1. What are the most important decisions facing communities in the area of waste disposal,
materials management, and site remediation?
2. How can we improve the decision process to assist communities in managing debris after
extreme weather events?
3. What are the direct, indirect, and cumulative effects of the most commonly faced decisions about
waste disposal, materials management, and site remediation options on human health (including
children and the elderly) and ecosystem services?
4. What are the likely economic consequences of these options, including economic multipliers,
lost resources, and changes in property valuation, economic stability and job creation?
5. What are the likely social consequences of these effects, including social acceptance of possible
actions, effect on social capital and environmental justice of actions and outcomes?
Health Impact Assessment (Pilot Review):
Health Impact Assessment of NRMT's Request for a Special Use Permit
Location: Bernalillo County, New Mexico
Decision Making-Level: County
Organization(s): Bernalillo County Place Matters Team, New Mexico Health Equity Working Group
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HEALTH IMPACT ASSESSMENT REVIEW
HIA TYPE
Forms of health impact assessment
Mandated
Decision-support
Advocacy
Community-led
Description
Purpose
Origins
Role of values
and judgements
Conducted by
Resourced by
Overseen by
Role of stakeholders
type of teaming
Occurs in the context
of in environmental
impact assessment
(EW), integrated
impact assessment (UA)
at environmental, social
and health impact
assessment (ESHtA) and
is done to meet a
regulatory or statutory
requirement
« Meeting a regulatory or
statutory requirement
* Minimising negative
health impacts
Environtnenbl health
Almost no role for values
in assessment judgements
often not acknowledged
Consultants
Proponents
Proponents
Providing technical
information
Technical
Conducted voluntarily by,
or with the agreement of,
organisations responsible
fa- a proposal, with the
goal of improving
decision-making
and implementation
improving
deck ion-making
and implementation
Minimising negative
health impacts
Maximising positive
health impacts
Environmental health,
soda I view of health,
health equity
Implied role for values
and judgements
Government agencies,
consultants
Government agencies
Government agencies
Informing the assessment
Technical/canoe ptual
Conducted by organisations
of groups who Mt neither
proponents or decision-
makers, with goal of
influencing decision-
making and
implementation
Ensuring under-recognised
health concerns are
addressed in design, dedsion-
making and Implementation
Minimising negative
health impacts
«Maxiniisirtg positive
health impacts
Social view of health,
health equity
More explicit rule for
va b es a rid judge merits
Nort-fwerruiierttal
organisations! (NGOs),
universities, other
agencies
Varied
Varied
Hie assessment
Conducted by potentially
affected communities on
issues or proposals that
are of concern
Coriee ptua l/social
Ensuring the community's
health-related concerns are
identified and addressed
Enabling greater
participation of
communities in decisions
that affect them
Minimising negative
health impacts
Maximising positive
health impacts
Social view of health,
health equity
Driven by community
values and judgements
Communities, often aided
by HIA practitioners to
NGQs, universities or
oner agencies
Communities themselves
Communities themselves
Controlling and conducting
the assessment
Social
Taken from Harris-Roxas and Harris. 2011. Differing forms, differing purposes: A typology of health impact assessment
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HEALTH IMPACT ASSESSMENT REVIEW
HIA RIGOR
DESK BASED
2-6 weeks for ore person
full time'.
RAPID
6 to 12 weeks for one
person full tine.
INTERMEDIATE
12 weeks to 6 months
for one person full time.
COMPREHENSIVE
6 to 12 months for one
person full time.
Provides a broad overview
of potential health impacts.
Provides a more detaled
overview of potential
hearth impacts.
Provides a more thorough
assess|7ient of potential
health impacts, and more
detail on specific predicted
impacts.
Provides a comprehensive
assessment of potential
health impacts.
Could be used where time
and resources are Emited.
Could be used where time
and resources are limited.
Requires significant time
and resources.
Requires significant time
and resources.
Is an 'off the she)f exercise
based on cdecting and
analysing existing accEssfc4e
data.
invokes cdecting and
analysing existing data with
limited input from experts
and key stakeholders
invokes collecting and
analysing existing data
as well as gathering new
qualitative data from
stakeholders and key
informants.
involves collecting and
analysing data from multiple
sources (qualitative and
quantitative}
Activities indude accessing
off the shelf resources and
synthesising and appraising
information.
Activities indude accessing
resouras, hosting and
supporting meetings, and
synthesising and appraising
information.
rf capacity does not exist
in-house, consideration
should be given to
commissioning external
assessors.
Activities include accessing
resources, hosting and
supporting meetings,
identifying stakeholders and
key informants, gathering
and analysing qualitative
and quantitative data, and
synthesising and appraising
information.
rf capacity does not exist in-
house, consideration should
be given to commissioning
external assessors.
Activities include accessing
resources, hosting and
supporting meetings,
identifying stakeholders and
key informants, gathering
and analysing qualitative
and quantitative data, and
synthesising and appraising
information.
If capacity does not exist
fi-house, consideration
should be given to
commissioning external
assessors.
LESS IMPACTS
MORE IMPACTS
The time invoted v> il vay depending on the lunber cT people actnely invoked in undertaking HIA tasks. For examp4e 2 compehenswe assessment may take
3 team at TDU peopt tfiree months to coinptet.
DESK BASED
No more than three
impacts, assessed in
tess detail
RAPID
No rnoie than three
impacts, assessed in
more detail
Three to ten impacts,
assessed in detail
All potential impacts,
assessed in detai
Provides a broad
overview of potential
hearth rmparts
Provides a more detailed
overview of potential
health impacts
Provides a more thorough
assessment of potential
health impacts, and more
detail on specific predicted
impacts
Provides a comprehensive
assessment of potential
hearth impacts
Taken from Harris, Harris-Roxas, Harris, and Kemp. 2007. Health Impact Assessment: A Practical Guide.
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HEALTH IMPACT ASSESSMENT REVIEW
DATA TYPES/MAJOR DATA SOURCES
Data types are general categories of information - models, literature, websites, and data.
It is not necessary to list all data sources, journals, authors, etc. referenced in the HIA, but the
major sources of data utilized in analysis, must be identified by name and where applicable, type
of data.
If identified, enter the year, scale, and type of data; see below for example:
HUD American Housing Survey, HUD 2005 Fair Market Rent, HUD
Special Tabulations of Households (by income, tenure, age of
householder, and housing conditions; 2005), City of Boston Homeless
Census (2004)
A common data source used in HIA comes from the U.S. Census Bureau. See the types of census
data and the various scales at which the data are reported below:
Types of Census Data - Age, agriculture, births, business establishments, communications,
construction, cost of living, crime, deaths, education, elections, employment, energy, finance,
government, health, households, housing, immigration, income, manufactures, marriages and
divorces, media, natural resources, population, poverty, race and Hispanic origin, residence,
retail sales, science and engineering, social services, tourism, transportation, veterans, etc.
Scale of Census Data - National, regional, state, metropolitan area, county (or equivalent),
city/township, school district, census block, etc.
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HEALTH IMPACT ASSESSMENT REVIEW
PATHWAY OF IMPACT
The pathway of impact is the pathway through which the proposed policy, program, or project is
expected to affect health.
Below is a list of common pathways used in HIAs. To the extent possible, use this terminology
when identifying the pathways of impact; additional description can be added in parentheses for
more general pathways. If a pathway of impact was examined in an HIA and is not included in
this list, be sure to include it in the data entry, being consistent in terminology across HIAs (if
applicable).
Air quality
Community/household economics
Education
Exposure to hazards (pollutants, health hazards, etc.)
Healthcare access/insurance
Housing (physical housing conditions, affordability, housing instability, etc.)
Infectious disease
Land use
Lifestyle
Mental health
Mobility/access to services
Noise pollution
Nutrition
Parks and recreation/green space
Physical activity
Public health services
Safety and security
Social capital
Soil quality
Traffic safety
Water quality
Descriptions of many of these pathways and their common downstream health endpoints/effects
are available at: http://www.hiaguide.org/sectors-and-causal-pathways/pathways
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HEALTH IMPACT ASSESSMENT REVIEW
QUANTIFICATION OF IMPACT/IMPACT PRIORITIZATION
* NOTE (August 2013): In the final master database, the Quantification of Impact field will be
revised to Characterization of Impact to more accurately reflect the actual process of impact
assessment, which can involve both qualitative and quantitative characterization.
DIRECTION
Positive = Changes that may improve health
Negative = Changes that may detract from health
Unclear = Unknown how health will be impacted
No effect = No effect on health
PERMANENCE (severity)
Low = Causes impacts that can be quickly and easily managed or do not require treatment
Medium = Causes impacts that necessitate treatment or medical management and are reversible
High = Causes impacts that are chronic, irreversible or fatal
MAGNITUDE (relative to population size)
Low = Causes impacts to no or very few people
Medium = Causes impacts to wider number of people
High = Causes impacts to many people
LIKELIHOOD
Definite = impacts will occur as a result of the proposal
Probable = it is likely that impacts will occur as a result of the proposal
Speculative = it is possible that impacts will occur as a result of the proposal
Unlikely = it is unlikely that impacts will occur as a result of the proposal
Uncertain = it is unclear if impacts will occur as a result of the proposal
DISTRIBUTION/EQUITY OF IMPACT
Name subpopulation impacted more (e.g., "low-income residents impacted more";
"Blacks impacted more") or "equal impacts"
Taken/adapted from Human Impact Partners. 2011. A Health Impact Assessment Toolkit: A handbook to
conducting HIA (3rd edition).
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HEALTH IMPACT ASSESSMENT REVIEW
HIA REPORT
Attach the reviewed HIA Report to the database record using the following steps:
1. Double-click in the HIA Report field of the Data Entry Form.
2. In the Attachments dialog box that pops up, click on the "Add" button at the top right.
3. Navigate to the HIA Reports located on the network:
L:\Public\NERL-PUB\Health Impact AssessmentXHIA Review Materials\HIA Reports
4. Click on the appropriate HIA Report so that the file name is highlighted, and then click
on the "Open" button at the bottom right of the window.
Note: The HIA Report file should now show up in the Attachments dialog box.
5. Click the "OK" button at the bottom of the dialog box and the file should display in the
HIA Report field of the Data Entry Form.
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HEALTH IMPACT ASSESSMENT REVIEW
EFFECTIVENESS OF HIA
Direct effectiveness - a decision is dropped or modified as a result of the HIA.
General effectiveness - the assessment was considered adequately by the decision-makers,
but does not result in modifications to the proposed decision.
Opportunistic effectiveness - the HIA is conducted because it is assumed that it will support the
proposed decision.
None (ineffectiveness) - decision-makers do not take account of the assessment
Health/equity/
community
adequately
acknowledged
Modification of pending decisions according
to heatth/equity/community aspects and inputs
yes
Wo
Yes
Direct effectiveness
HIA-related changes
in the decision
due to the HIA the
project was dropped
« decision was
postponed
General effectiveness
* reasons provided for not
following HIA recommendations
» health consequences are
negligible or positive
HIA has raised awareness
anong policy-makers
No
Opportunistic effectiveness No effectiveness
the decision would have « the HIA was ignored
made anyway
* the HIA v/as dismissed
Taken from Wismar, Blau, Ernst, and Figueras. 2007. The Effectiveness of Health Impact
Assessment: Scope and Limitations of Supporting Decision-making in Europe.
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HEALTH IMPACT ASSESSMENT REVIEW
MINIMUM ELEMENTS OF HIA
A health impact assessment (HIA) must include the following minimum elements, which
together distinguish HIA from other processes. An HIA:
1. Is initiated to inform a decision-making process, and conducted in advance of a policy,
plan, program, or project decision;
2. Utilizes a systematic analytic process with the following characteristics:
2.1 Includes a scoping phase that comprehensively considers potential impacts on
health outcomes as well as on social, environmental, and economic health
determinants, and selects potentially significant issues for impact analysis;
2.2 Solicits and utilizes input from stakeholders;
2.3 Establishes baseline conditions for health, describing health outcomes, health
determinants, affected populations, and vulnerable sub-populations;
2.4 Uses the best available evidence to judge the magnitude, likelihood,
distribution, and permanence of potential impacts on human health or health
determinants;
2.5 Rests conclusions and recommendations on a transparent and context-specific
synthesis of evidence, acknowledging sources of data, methodological
assumptions, strengths and limitations of evidence and uncertainties;
3. Identifies appropriate recommendations, mitigations and/or design alternatives to protect
and promote health;
4. Proposes a monitoring plan for tracking the decision's implementation on health
impacts/determinants of concern;
5. Includes transparent, publicly-accessible documentation of the process, methods,
findings, sponsors, funding sources, participants and their respective roles.
Taken from North American HIA Practice Standards Working Group. 2010. Minimum Elements and
Practice Standards for Health Impact Assessment.
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HEALTH IMPACT ASSESSMENT REVIEW
POTENTIAL IMPROVEMENTS/BEST PRACTICES
To identify areas of potential improvements and even best practices, it may be helpful to consult
the HI A Practice Standards.
Taken from North American HIA Practice Standards Working Group. 2010. Minimum Elements and Practice
Standards for Health Impact Assessment
Adherence to the following standards is recommended to advance effective HIA practice:
1. General standards for the HIA process
1.1 An HIA should include, at a minimum, the stages of screening, scoping, assessment,
recommendations, and reporting described below.
1.2 Monitoring is an important follow-up activity in the HIA process. The HIA should
include a follow-up monitoring plan to track the outcomes of a decision and its
implementation.
1.3 Evaluation of the HIA process and impacts is necessary for field development and
practice improvement. Each HIA process should begin with explicit, written goals that
can be evaluated as to their success at the end of the process.
1.4 HIA should respect the needs and timing of the decision-making process it evaluates.
1.5 HIA requires integration of knowledge from many disciplines; the practitioner or
practitioner team must take reasonable and available steps to identify, solicit and utilize
the expertise, including from the community, needed to both identify and answer
questions about potentially significant health impacts.
1.6 Meaningful and inclusive stakeholder participation (e.g., community, public agency,
decision-maker) in each stage of the HIA supports HIA quality and effectiveness. Each
HIA should have a specific engagement and participation approach that utilizes available
participatory or deliberative methods suitable to the needs of stakeholders and context.
1.7 HIA is a forward looking activity intended to inform an anticipated decision; however,
HIA may appropriately conduct or utilize analysis, or evaluate an existing policy, project
or plan to prospectively inform a contemporary decision or discussion.
1.8 Where integrated impact assessment is required and conducted, and requirements for
impact assessment include responsibility to analyze health impacts, HIA should be part of
an integrated impact assessment process to advance efficiency, to allow for
interdisciplinary analysis and to maximize the potential for advancing health promoting
mitigations or improvements.
1.9 HIA integrated within another impact assessment process should adhere to these practice
standards to the greatest extent possible.
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2. Standards for the screening stage
2.1 Screening should clearly identify all the decision alternatives under consideration by
decision-makers at the time the HIA is considered.
2.2 Screening should determine whether an HIA would add value to the decision-making
process. The following factors may be among those weighed in the screening process:
2.2.1 The potential for the decision to result in substantial effects on public
health, particularly those effects which are avoidable, involuntary,
adverse, irreversible or catastrophic
2.2.2 The potential for unequally distributed impacts
2.2.3 Stakeholder and decision-maker concerns about a decision's health effects
2.2.4 The potential for the HIA to result in timely changes to a policy plan,
policy or program
2.2.5 The availability of data, methods, resources and technical capacity to
conduct analyses
2.2.6 The availability, application, and effectiveness of alternative opportunities
or approaches to evaluate and communicate the decision's potential health
impacts
2.3 Sponsors of the HIA should document the explicit goals of the HIA and should
notify, to the extent feasible, decision-makers, identified stakeholders, affected
individuals and organizations, and responsible public agencies on their decision to
conduct an HIA.
3. Standards for the scoping phase
3.1 Scoping of health issues and public concerns related to the decision should include
identification of: 1) the decision and decision alternatives that will be studied; 2) potential
significant health impacts and their pathways (e.g., a logic model); 3) research questions
for impact analysis; 4) demographic, geographical and temporal boundaries for impact
analysis; 5) evidence sources and research methods expected for each research question
in impacts analysis; 6) the identity of vulnerable subgroups of the affected population; 7)
an approach to the evaluation of the distribution of impacts; 8) roles for experts and key
informants; 9) the standards or process, if any, that will be used for determining the
significance of health impacts; 10) a plan for external and public review; and 11) a plan
for dissemination of findings and recommendations.
3.2 The scoping process should establish the individual or team responsible for conducting
the HIA and should define their roles.
3.3 Scoping should include consideration of all potential pathways that could reasonably link
the decision and/or proposed activity to health, whether direct, indirect, or cumulative.
3.4 The consideration of potential pathways should be informed by the expertise and
experience of assessors as well as perspectives of the affected communities, health
officials and decision-makers. The assessment team should solicit input from public
health officials and local medical practitioners to ensure adequate representation by the
A-24
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entities responsible for and knowledgeable about health conditions. The assessment team
should solicit input from members of affected communities or representative
organizations via public meetings, written comments, or interviews to understand their
views and concerns. The assessment team should solicit input from decision-makers to
understand their views on the decision's relationship to health.
3.5 The final scope should focus on those impacts with the greatest potential significance,
with regards to factors including but not limited to magnitude, certainty, permanence,
stakeholder priorities, and equity.
3.6 The scope should include an approach to evaluate any potential inequities in impacts
based on population characteristics, including but not limited to age, gender, income,
place (disadvantaged locations), and race or ethnicity.
3.7 The HIA scoping process should identify a mechanism to incorporate new, relevant
information and evidence into the scope as it becomes available, including through expert
or stakeholder feedback.
4 Standards for the assessment phase
4.1 Assessment should include, at a minimum, a baseline conditions analysis and
qualified judgments of potential health impacts:
4.1.1 Documentation of baseline conditions should include the documentation
of both population health vulnerabilities (based on the population
characteristics described above) and inequalities in health outcomes
among subpopulations or places.
4.1.2 Evaluation of potential health impacts should be based on a synthesis of
the best available evidence, as qualified below.
4.1.3 To support determinations of impact significance, the HIA should
characterize health impacts according to characteristics such as direction,
magnitude, likelihood, distribution within the population, and permanence.
4.2 Judgments of health impacts should be based on a synthesis of the best available
evidence. This means:
4.2.1 Evidence considered may include existing data, empirical research,
professional expertise and local knowledge, and the products of original
investigations.
4.2.2 When available, practitioners should utilize evidence from well-designed
and peer-reviewed systematic reviews.
4.2.3 HIA practitioners should consider published evidence, both supporting
and refuting particular health impacts.
4.2.4 The expertise and experience of affected members of the public (local
knowledge), whether obtained via the use of participatory methods,
collected via formal qualitative research methods, or reflected in public
testimony, is potential evidence.
A-25
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4.2.5 Justification for the selection or exclusion of particular methodologies and
data sources should be made explicit (e.g., resource constraints).
4.2.6 The HIA should acknowledge when available methods were not utilized
and why (e.g., resource constraints).
4.3 Impact analysis should explicitly acknowledge methodological assumptions as well
as the strengths and limitations of all data and methods used.
4.3.1 The HIA should identify data gaps that prevent an adequate or complete
assessment of potential impacts.
4.3.2 Assessors should describe the uncertainty in predictions.
4.3.3 Assumptions or inferences made in the context of modeling or predictions
should be made explicit.
4.4 The lack of formal, scientific, quantitative or published evidence should not preclude
reasoned predictions of health impacts.
5. Standards for the recommendations phase
5.1 The HIA should include specific recommendations to manage the health impacts
identified, including alternatives to the decision, modifications to the proposed policy,
program, or project, or mitigation measures.
5.2 Where needed, expert guidance should be utilized to ensure recommendations reflect
current effective practices.
5.3 The following criteria may be considered in developing recommendations and
mitigation measures: responsiveness to predicted impacts; specificity; technical
feasibility; enforceability; and authority of decision-makers.
5.4 Recommendations may include those for monitoring, reassessment, and adaptations
to help manage uncertainty in impact assessment.
6. Standards for the reporting phase
6.1 The responsible parties should complete a report of the HIA findings and
recommendations.
6.2 To support effective, inclusive communication of the principal HIA findings and
recommendations, a succinct summary should be created that communicates findings
in a way that allows all stakeholders to understand, evaluate, and respond to the
findings.
6.3 The full HIA report should document the screening and scoping processes and
identify the sponsor of the HIA and the funding source, the team conducting the HIA,
and all other participants in the HIA and their roles and contributions. Any potential
conflicts of interest should be acknowledged.
6.4 The full HIA report should, for each specific health issue analyzed, discuss the
available scientific evidence, describe the data sources and analytic methods used for
the HIA including their rationale, profile existing conditions, detail the analytic
results, characterize the health impacts and their significance, list corresponding
A-26
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recommendations for policy, program, or project alternatives, design or mitigations,
and describe the limitations of the HIA.
6.5 Recommendations for decision alternatives, policy recommendations, or mitigations
should be specific and justified. The criteria used for prioritization of
recommendations should be explicitly stated and based on scientific evidence and,
ideally, informed by an inclusive process that accounts for stakeholder values.
6.6 Distribute HIA and/or findings to stakeholders that were involved in the HIA. The
HIA reporting process should offer stakeholders and decision-makers a meaningful
opportunity to critically review evidence, methods, findings, conclusions, and
recommendations. Ideally, a draft report should be made available and readily
accessible for public review and comment. The HIA practitioners should address
substantive criticisms either through a formal written response or HIA report
revisions before finalizing the HIA report.
6.7 The final HIA report should be made publicly accessible.
7 Standards for the monitoring phase
7.1 The HIA should include a follow-up monitoring plan to track the decision outcomes
as well as the effect of the decision on health impacts and/or determinants of concern.
7.2 The monitoring plan should include: 1) goals for short- and long-term monitoring; 2)
outcomes and indicators for monitoring; 3) lead individuals or organizations to
conduct monitoring; 4) a mechanism to report monitoring outcomes to decision-
makers and HIA stakeholders; 5) triggers or thresholds that may lead to review and
adaptation in decision implementation; and 6) identified resources to conduct,
complete, and report the monitoring.
7.3 Where possible, recommended mitigations should be further developed and integrated
into an HIA (or other) management plan, which clearly outlines how each mitigation
measure will be implemented. Management plans commonly include information on:
deadlines, responsibilities, management structure, potential partnerships, engagement
activities and monitoring and evaluation related to the implementation of the HIA
mitigations. For greater effectiveness, HIA management plans should be developed in
collaboration with, or at least with the input from, the entity responsible for
implementing the plan. Management plans are living documents that will need to be
revised and improved on an on-going basis.
7.4 When monitoring is conducted, methods and results from monitoring should be made
available to the public.
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A-28
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Appendix B - Master List of HIAs Reviewed
ID
1
2
o
J
4
5
|6
7
8
|9
10
11
12
13
14
fflA Title
Pathways to a Healthy Decatur: A Rapid Health Assessment of the City of Decatur
Community Transportation Plan
Affordable Housing and Child Health: A Child Health Impact Assessment of the
Massachusetts Rental Voucher Program
Health Impact Assessment - Derby Redevelopment, Historic Commerce City,
Colorado
Health Impact Assessment of NRMT's Request for a Special Use Permit
The Red Line Transit Project Health Impact Assessment
Health Impact Assessment Report: Alcohol Environment - Village of Weston, WI
Eastern Neighborhoods Community Health Impact Assessment Final Report
Health Impact Assessment: South Lincoln Homes, Denver CO
Spokane University District Pedestrian/Bicycle Bridge Health Impact Assessment
Health Impact Assessment: An Analysis of Potential Sites for a Regional Recreation
Center to Serve North Aurora, Colorado
The Impact of U.S. Highway 550 Design on Health and Safety in Cuba, New
Mexico: A Health Impact Assessment
Community Health Assessment: Bernal Heights Preschool - An Application of the
Healthy Development Measurement Tool (HDMT)
Sector
Transportation
Housing/Buildings/
Infrastructure
Land Use
Waste Management/
Site Revitalization
Transportation
Land Use
Land Use
Housing/Buildings/
Infrastructure
Transportation
Land Use
Transportation
Housing/Buildings/
Infrastructure
St. Louis Park Comprehensive Plan - Health Impact Assessment |Land Use
Comprehensive Health Impact Assessment: Clark County Bicycle and Pedestrian
Master Plan
Transportation
15 [Health Impact Assessment: Key Recommendations of the Northeast Area Plan |Land Use
16 [Yellowstone County/City of Billings Growth Policy Health Impact Assessment |Land Use
17
18
19
20
21
22
23
24
25
Health Impact Assessment, June 20, 2011: Duluth, Minnesota's Complete Streets
Resolution, Mobility in the Hillside Neighborhoods and the Schematic Redesign of
Sixth Avenue East
Knox County Health Department Community Garden Health Impact Assessment:
Recommendations for Lonsdale, Inskip and Mascot
Alaska Outer Continental Shelf - Beaufort Sea and Chukchi Sea Planning Areas, Oil
and Gas Lease Sales 209, 212, 217, and 221 Draft Environmental Impact Statement;
Appendix J - Public Health
Divine Mercy Development Health Impact Assessment
Fort McPherson Rapid Health Impact Assessment: Zoning for Health Benefit to
Surrounding Communities During Interim Use
Re: November 10th Merced County General Plan Update (MCGPU) Preferred
Growth Alternative Decision
Health Impact Assessment of Modifications to the Trenton Farmer's Market
(Trenton, New Jersey)
SE 122nd Avenue Planning Study Health Impact Assessment
Concord Naval Weapons Station Reuse Project Health Impact Assessment
Transportation
Land Use
Land Use
Land Use
Land Use
Land use
Housing/Buildings/
Infrastructure
Land Use
Waste Management/
Site Revitalization
B-l
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ID
|26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
|44
|45
46
|47
48
49
50
51
52
53
54
fflA Title
Health Impact Assessment: Hawai'i County Agriculture Development Plan
Mass Transit Health Impact Assessment: Potential Health Impacts of the Governor's
Proposed Redirection of California State Transportation Spillover Funds
The Rental Assistance Demonstration Project - A Health Impact Assessment
Case Study: Bloomington Xcel Energy Corridor Trail Health Impact Assessment
Jack London Gateway Rapid Health Impact Assessment: A Case Study
Health Impact Assessment for Proposed Coal Mine at Wishbone Hill, Matanuska-
Susitna Borough Alaska (DRAFT)
Sector
Land Use
Transportation
Housing/Buildings/
Infrastructure
Land Use
Housing/Buildings/
Infrastructure
Land Use
HIA of the Still/Lyell Freeway Channel in the Excelsior District [Transportation
Neenah-Menasha Sewerage Commission Biosolids Storage Facility, Greenville, WI
City of Ramsey Health Impact Assessment
A Health Impact Assessment of Accessory Dwelling Unit Policies in Rural Benton
County, Oregon
The Health Impact Assessment (HIA) of the Commonwealth Edison (ComEd)
Advanced Metering Infrastructure (AMI) Deployment
Atlanta Beltline Health Impact Assessment
Zoning for a Healthy Baltimore: A Health Impact Assessment of the Transform
Baltimore Zoning Code Rewrite
Hood River County Health Department Health Impact Assessment for the Barrett
Property
Unhealthy Consequences: Energy Costs and Child Health - A Child Health Impact
Assessment of Energy Costs and the Low Income Home Energy Assistance Program
Technical Report 9: Highway 99 Sub-Area Plan Health Impact Assessment
Columbia River Crossing Health Impact Assessment
Inupiat Health and Proposed Alaskan Oil Development: Results of the First
Integrated Health Impact Assessment/Environmental Impact Statement for Proposed
Oil Development on Alaska's North Slope
Page Avenue Health Impact Assessment
Pittsburg Railroad Avenue Specific Plan Health Impact Assessment
Waste Management/
Site Revitalization
Land Use
Housing/Buildings/
Infrastructure
Housing/Buildings/
Infrastructure
Land Use
Land Use
Land Use
Housing/Buildings/
Infrastructure
Land Use
Transportation
Land Use
Land Use
Land Use
The Sellwood Bridge Project: A Health Impact Assessment [Transportation
The East Bay Greenway Health Impact Assessment |Land Use
A Rapid Health Impact Assessment of the City of Los Angeles' Proposed University
of Southern California Specific Plan
Housing/Buildings/
Infrastructure
Taylor Energy Center Health Impact Assessment |Land Use
Anticipated Effects of Residential Displacement on Health: Results from Qualitative
Research
Rapid Health Impact Assessment, Crook County/City of Prineville, Bicycle and
Pedestrian Safety Plan
29th St. / San Pedro St. Area Health Impact Assessment
SR 520 Health Impact Assessment: A Bridge to a Healthier Community
A Health Impact Assessment on Policies Reducing Vehicle Miles Traveled in
Oregon Metropolitan Areas
Housing/Buildings/
Infrastructure
Transportation
Housing/Buildings/
Infrastructure
Transportation
Transportation
B-2
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ID
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
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fflA Title
Health Effects of Road Pricing In San Francisco, California: Findings from a Health
Impact Assessment
Santa Monica Airport Health Impact Assessment
Lowry Corridor, Phase 2 Health Impact Assessment
Battlement Mesa Health Impact Assessment (2nd Draft)
Douglas County Comprehensive Plan Update Health Impact Assessment
The Executive Park Subarea Plan Health Impact Assessment: An Application of the
Healthy Development Measurement Tool (HDMT)
Hospitals and Community Health HIA: A Study of Localized Health Impacts of
Hospitals
Health Impact Assessment on Transportation Policies in the Eugene Climate and
Energy Action Plan
Oak to Ninth Avenue Health Impact Assessment
A Health Assessment of Mixed Use Redevelopment Nodes and Corridors in Lincoln,
Nebraska
Health Impact Assessment (HIA) of Proposed "Road Diet" and Restriping Project on
Daniel Morgan Avenue in Spartanburg, South Carolina
Treasure Island Community Transportation Plan
Healthy Tumalo Community Plan: A Health Impact Assessment on the Tumalo
Community Plan; A Chapter Of The 20-Year Deschutes County Comprehensive Plan
Update
Strategic Health Impact Assessment on Wind Energy Development in Oregon
(Public Review Draft)
Impacts on Community Health of Area Plans for the Mission, East SoMa, and
Potrero Hill/Showplace Square: An Application of the Healthy Development
Measurement Tool
Pathways to Community Health: Evaluating the Healthfulness of Affordable Housing
Opportunity Sites Along the San Pablo Avenue Corridor Using Health Impact
Assessment
MacArthurBART Transit Village Health Impact Assessment
Healthy Corridor for All: A Community Health Impact Assessment of Transit-
oriented Development Policy in St. Paul Minnesota
Health Impact Assessment Point Thomson Project
Assessment of Open Burning Enforcement in La Crosse County
Interstate 75 Focus Area Study Health Impact Assessment
A Rapid Health Impact Assessment of the Long Beach Downtown Plan
Humboldt County General Plan Update Health Impact Assessment
Rapid Health Impact Assessment: Vancouver Comprehensive Growth Management
Plan 20 11
Lake Oswego to Portland Transit Project: Health Impact Assessment
HOPE VI to HOPE SF San Francisco Public Housing Redevelopment: A Health
Impact Assessment
Health Impact Assessment of the Port of Oakland
Sector
Transportation
Transportation
Housing/Buildings/
Infrastructure
Land Use
Land Use
Land Use
Housing/Buildings/
Infrastructure
Transportation
Land Use
Land Use
Transportation
Transportation
Land Use
Land Use
Land Use
Housing/Buildings/
Infrastructure
Land Use
Land Use
Land Use
Waste Management/
Site Revitalization
Transportation
Housing/Buildings/
Infrastructure
Land Use
Land Use
Transportation
Housing/Buildings/
Infrastructure
Transportation
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Appendix C - Quality Assurance Review Documentation
Health Impact Assessment QA Review
Follow-up/Preliminary Corrective Action Meeting Notes
July 3, 2012
Summary
There were considerable discrepancies in data entry for the health impact assessments (HIAs)
designated for quality assurance (QA) review. This may be due, in part, to the unfamiliarity of
the reviewers with HIAs in general, inexperience in applying the principles of the review
process, as well as the timing of the QA Review implementation in the overall review, as the
HIAs in the QA Review were the first three HIAs reviewed by the reviewers.
Data entry discrepancies between the initial review and the QA Review of each HIA were
identified and the discrepancies collectively reviewed to identify overall trends. The areas for
improvement (shown below); challenges, questions, and lessons learned from the QA Review;
and the review pathforward will be discussed.
I. Areas for Improvement
1) Use specified terminology (HIA Review Guidelines, pages 6-7; highlighted in gray}
Decision-making Level HIA Rigor Quantification of Impact
Organization Type Source of Evidence Effectiveness of HIA*
Contact Data Types CIS Used?
Sector(s) Impacts/Endpoints
HIA Type Pathway of Impact
* NOTE (August 2013): In the final master database, the Quantification of Impact field will be
revised to Characterization of Impact to more accurately reflect the actual process of impact
assessment; impacts in HIAs can be judged qualitatively or quantitatively.
2) Consistency in use of specified terminology
Sector(s) - see SHCRP definitions in HIA Review Guidelines, pages 8-12
HIA Type - see HIA Review Guidelines, page 13
Advocacy vs. Decision Support - "Outagamie County Public Health first learned of the proposed biosolids
storage facility and the concerns of the community... Outagamie County Public Health Division has no regulatory
authority for biosolids production, transport, storage or use. Outagamie County Public Health Division's sole
interest in this project is to review potential health concerns and propose methods to reduce those risks.. M was
also concluded that the HIA would provide a background that could serve as a base to address citizen inquiries
and complaints that local agencies may encounter if the storage facility is built." - Advocacy
HIA Rigor - see HIA Review Guidelines, page 14; three main factors - number of impacts assessed, level/depth of
assessment, and length of time (but time involved will vary depending on the number of people and effort actually
involved; times noted are for one full-time person)
Desk-based vs. Rapid - "The impact assessment was completed and presented to the community in less than
one month. Outagamie County Public Health staff attended both meetings to learn more about the health
concerns being raised. In order to narrow the focus on the most significant potential health impacts... the
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following activities were completed: interviews with existing biosolids storage facilities in Outagamie County..." -
Rapid
Intermediate vs. Comprehensive - "This assessment does not use all the indicators from each of the six HDMT
elements, but rather focuses on four elements that captured the possible impacts of AD Us in Benton County. The
elements used are healthy housing, access to goods and services, social and family cohesion, and transportation
and mobility. Accessory dwelling units likely have impacts related to the other unused impact elements of
environmental stewardship, public infrastructure and healthy economy. However, because of the scope and intent
of the assessment the most relevant and impactful indicators were used." - Intermediate
Intermediate vs. Rapid - "the HIA in the Village of Weston to review local alcohol policies was performed as a
"rapid" HIA over the course of 6 months.... The advisory committee for the Village of Weston HIA includes
(stakeholders) the Village Administrator; the Everest Metro Chief of Police, the Village Clerk and Marathon
County Health Department Staff... .The advisory committee has generated a list of potential stakeholders (Village
residents, Village Board members, license holders, youth, etc.) to contact to provide further information on
existing conditions within the village and feedback relating to the policy itself... Further research such as focus
groups, community surveys and stakeholder interviews were considered in order to gather qualitative data from
Village residents, business owners and leaders...."- Intermediate
- use the specified terminology, with the term "data" encompassing anything beyond models, literature,
and websites (e.g., datasets, surveys, focus groups, consultations, interviews, etc.)
- use specified terminology for impacts assessed; any impacts that don't fit the specified
terminology, enter "other"
- use specified terminology for the pathways or causes of the assessed impacts; details can be
added in parentheses after the specified terminology [e.g., lifestyle (alcohol use, binge drinking, drunk driving,
underage drinking)] or if any pathways don't fit the specified terminology, enter the name of the pathway
- use the specified terminology and identify the impacts; for likelihood, look for
quantifiers such as likely, could, may, definitely when describing impacts; example:
Direction of impacts (positive impacts on health - increased opportunity for physical activity, improved safety, better
access to health promoting goods and services, and enhanced social capital, as well as a slight reduction in car use
and its negative health impacts; negative impacts on health - pedestrian and bicycle safety); likelihood of impacts
(definite impacts - increased physical activity, enhanced social capital, better access; probable impacts - negative
impacts related to pedestrian and bicycle safety; speculative impacts - reduction in car use and its negative health
impacts)
- when describing the impact of the HIA on the policy, plan or project, use the terms direct,
general, opportunistic, or none, along with a more detailed explanation; effectiveness can also include the accuracy
of the HIA in predicting health impacts; must be determined by an internet search
3) Consistency in data entry (clarification of database fields)
- title of the HIA Report, exactly as it appears on the report cover (including any subtitles)
- of policy, project, or plan being evaluated by the HIA (not of the HIA itself)
- lead organization(s), conducting and publishing the HIA; not all organizations involved
- type of organization for each of the organizations identified; this will likely need to be
identified via an internet search
- name and/or email (if available), otherwise enter "Undetermined"; no need to enter organization name,
because entered in previous field
- if there is not a website dedicated to or highlighting the HIA, enter "N/A"; no need to
enter organization's general website if no info available on HIA; this will likely need to be identified via an internet
search
- only enter financial sponsors if specifically named in report (i.e., do not assume based on organizations
involved); if unsure or not identified, enter "Undetermined"
- major data sources are highlighted in the text and/or presented in tables, charts, or figures;
name the specific organization/agency and data type, year, and geographic scale (if presented); examples: U.S.
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Census Bureau 2009 (city- and county-level demographics and socio-economic status), New Mexico Department of
Health (Hispanic rate of death and leading causes of death; city and county),
- name the local data obtained (e.g., health data; locations of vehicle
accidents, vulnerable populations, etc.; zoning ordinances; demographics; income; life expectancy; transportation;
population; crime; socioeconomic data; specific survey data; etc.)
- name the self-identified data needs
- identify the stakeholders involved AND avenue of involvement
(interviews, focus groups, surveys, etc.)
- name the general and/or specific health effects identified in the HIA (e.g., physical health,
mental health, developmental health, asthma, cardiovascular disease, injury, fatality/mortality, chronic diseases,
obesity/weight, infectious disease, headaches, malnutrition, etc.)
- describe how was it determined which pathways/impacts would be focused on (e.g.,
community input, equity/distribution of impacts, funding availability, synthesis of literature and data, magnitude of
the impact, likelihood of the impact, permanence of the impact, etc.); if it is not clear from the report how this was
done, enter "Undetermined" and if no prioritization took place (i.e., all impacts were assessed), enter "N/A; all
impacts assessed")
- the results reported in the HIA - conclusions, recommendations, mitigations, etc. -
NOT the effect the HIA had on the plan, project, or decision; this should be entered in "Effectiveness of HIA" field
- your evaluation of the quality of the process undertaken (evidence,
methodology, assumptions, limitations, and barriers) and the documentation of that process, using the HIA practice
standards (included in the Review Guidelines) as a benchmark; if authors documented a process evaluation, note this
as well (e.g., identified successes, challenges, and lessons learned)
1. Quality of Evidence and Methodology
- Was the supporting information and methodology sound and clearly documented in the report (e.g., adequate
literature, data etc. collected; sources of data acknowledged; clear description of data and methodology used;
identification of participants and their roles, funding, etc.)?
- Was the scope of the HIA and process undertaken clearly documented?
- Was stakeholder input solicited and utilized?
- Were the recommendations based on transparent, context-specific synthesis of evidence (e.g., impacts/conclusions
well supported by the data, literature, etc. presented in the report) or was it not clear how the authors reached the
conclusions (e.g., evidence presented only spoke to general health impacts and not the specific impacts examined)?
2. Assumptions, Limitations, and Barriers
- Note any assumptions, limitations, and barriers identified in the report
- Identify assumptions, limitations, and barriers you saw in the HIA, that were not identified by the authors (e.g.,
data gaps, assumptions, etc.)
3. Documentation
- Is the documentation of the process, methods, findings, sponsors, participants, etc. transparent and publicly-
accessible?
- monitoring, health impact management, or other follow-up measures called for in the HIA
- If all aspects of the 5 elements (and sub-elements) are
not met, the answer is no; enter "No;" and identify what elements or aspects of the elements are missing (e.g., No;
Element 4 is missing and documentation of funding sources (Element 5) is not transparent)
- if yes, describe how GIS was used (e.g., illustrative maps of site locations, used in spatial analysis to
evaluate proposed bike routes and existing traffic safety conditions)
4) Consistency in level of detail presented
- Use pilot HIA reviews as a benchmark
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5) Consistency in subjective evaluations
Review of an exemplary HIA (often one that involved Human Impact Partners, Robert E. Wood Foundation, or
Health Impact Project) will provide a benchmark for subjective evaluations (h: :; n il.ilJi. J n r- !' ,-iJn,-iin n,
C'i li'miriJ liiii'ii. :,:Vi,!]i , Hi' 11 ,-,k HI. . ) and allows for consistency in these evaluations
II. Reviewer Feedback - Challenges, Questions, and Lessons Learned
Primary factors in determining HIA rigor are the number of impacts assessed and level/depth of
assessment - Duration of the HIA will vary depending on the number of people involved and the
actual level of effort (PT or FT) and, therefore, is the least accurate criteria.
Internet searches can be used to gather data for three fields only - Organization Type,
Organization/Hi A Website, and Effectiveness of HIA.
Reason: One of the HIA standards is transparent documentation of the process, methods, findings,
sponsors, funding, participants, etc. If this information is not clearly documented in the HIA Report,
then we need this noted as such in order to accurately reflect the state of HIAs in these sectors and
areas for improvement.
Source of evidence, data types, and major data sources fields are used together to paint the data
picture - Source of evidence is the method used to collect the data, data types is the general type of
data used (models, literature, websites, and data), and major data sources defines the source and type
of data [e.g., US Census Bureau 2009 (city- and county level demographics and socioeconomic
status)].
It is difficult to determine how to accurately categorize the HIAs (e.g., Decision-making Level, HIA
Type, HIA Rigor, etc.) - In general, this will become easier as more HIAs are reviewed, but the
HIAs are not always going to be black and white; in those cases, best judgement should be used in
data entry and/or the specified terminology that best fits chosen.
- Typical health endpoints (morbidity/mortality) are not used and impacts are not quantified - The
health endpoints in HIA are not typical toxicity study endpoints, although mortality (or fatality) may
be an endpoint. Health endpoints are general and/or specific health effects, such as physical health,
mental health, asthma, chronic disease, injury, obesity, malnutrition, etc.
Impacts are not typically quantified as they are in scientific research, but by a more qualitative
assessment. This can be due to a number of factors, including lack of available scientific research,
unavailability of local data, time limitations, limited resources, etc.
Determining the appropriate level of detail is difficult - Use the pilot HIA reviews as a benchmark,
but in some cases, the depth of information provided in the HIA (for quantification of impacts or
recommendations/mitigation, for example) makes it ineffective to enter information at that level of
detail; in those cases, it is acceptable to summarize the information.
- Subjective evaluations of defensibility, potential improvements, and best practices are difficult -
Review of an exemplary HIA (often one that involved Human Impact Partners, Robert E. Wood
Foundation, or Health Impact Project) will provide a benchmark for subjective evaluations, but be
sure to compare apples to apples - a rapid HIA will not have the same level of effort or detail that an
intermediate or comprehensive HIA will have.
III. Review Pathforward
Next review deadline: July 13 -Half of the HI A reviews complete
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Given the discussion and the details provided in this document, it is acceptable (and likely
warranted) to go back and revise data entry for the previous HIA reviews.
For reference, each reviewer will be provided the primary and Q A data entry for the HIAs they
reviewed in the Q A Review. Upon examination, if there are any questions, feel free to discuss with
the other reviewer.
One additional HIA will be selected in mid-July and reviewed by all five reviewers as part of a
secondary Q A Review.
Toward the end of the HIA Review, reviewers will be asked to share their three most difficult HIA
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Appendix D - Data Sources Used in Reviewed HIAs
Resource/Organization
Data Source
Description
Website
Demographics and Background Info
U.S. Census Bureau
American FactFinder
Decennial Census
American Community
Survey (ACS)
American Housing
Survey (AHS)
Economic Census
Provides access to data about the U.S., Puerto Rico, and the Island
Areas from multiple U.S. Census Bureau censuses and surveys,
including: Decennial Census, American Community Survey (ACS),
American Housing Survey (AHS), Economic Census, Census of
Governments, Population Estimates Program, and more.
Provides demographic, social, and economic data at state, county,
city, zip code, census tract, block group, and block levels, every 10
years.
An on-going survey that releases results each year. Instead of
actual counts, it provides estimates based on a random sample of
the population. It is used to collect data on demographic, social,
and economic characteristics at state, county, and sometimes
smaller levels (e.g., zip code tabulation area) depending on the
year; for example: age, sex, race, family and relationships, income
and benefits, health insurance, and education.
A national housing sample survey that gathers information on the
number and characteristics of U.S. housing units, as well as the
households that occupy those units.
Provides a profile of national and local economies every five years.
http : //factf inder2 . census . go v/
General information:
http : //www. census . go v/
Data: http://factfmder2.census.gov/
General information:
http ://www. census . gov/acs/www/
Data: http://factfmder2.census.gov/
General information:
http : //www. census . go v/housing/ahs/
Data: http://factfmder2.census.gov/
General information:
http ://www. census . gov/econ/census/
Data: http://factfmder2.census.gov/
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Resource/Organization
Data Source
Description
Website
Demographics and Background Info (Cont.)
U.S. Department of
Housing and Urban
Development (HUD)
U.S. Department of
Labor
Oregon Employment
Department
HUD USER
Fair Market Rents
Special Tabulations of
Households
Bureau of Labor
Statistics (BLS)
Oregon Labor Market
Information System
Provides access to Fair Market Rents data, Special Tabulations of
Households, and many other original HUD datasets.
Gross rent estimates that include the shelter rent plus the cost of all
tenant-paid utilities, except telephones, cable or satellite television
service, and internet service. Used to determine how much rent
should be covered through Section 8 for individuals with low
income.
Produces tabular statistical summaries of counts of households by
income, tenure, age of householder, and housing conditions for
select geographic areas in the U.S.
Databases, tables, and calculators on essential economic
information such as labor market activity (e.g., employment or
unemployment), working conditions (e.g., pay and benefits), and
price changes. Data are available at the state, county, and
sometimes smaller geographic scales.
Provides statewide information on unemployment, employment by
industry, wages, personal income and cost of living, consumer price
index, and employer-provided benefits (e.g., health, retirement,
leave, other), as well as regional economic and occupational
profiles.*
^similar labor statistics may be available for other states
http://www.huduser.org/portal/pdrdatas_l
anding.html
http://www.huduser.0rg/portal/datasets/f
mr.html
http://www.huduser.org/portal/datasets/sp
ectabs.html
http://www.bls. gov/home.htm
http://www.qualitvinfo.org/olmisj/Olmis
Zine
Health Data
U.S. Centers for Disease
Control and Prevention
(CDC)
Behavioral Risk Factor
Surveillance System
(BRFSS)
World's largest, on-going telephone health survey. This survey,
which is run by CDC and conducted by individual state health
departments, examines behavioral risk factors in the U.S.
http://www.cdc.gov/brfss/index.htm
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Resource/Organization
Data Source
Description
Website
Health Data (Cont.)
U.S. Centers for Disease
Control and Prevention
(CDC)
National Center of
Health Statistics
(NCHS)
National Health and
Nutrition
Examination Survey
(NHANES)
National Health
Interview Survey
(NHIS)
Youth Risk Behavior
Surveillance System
(YRBSS)
Provides access to data, documentation, and questionnaires for
various national health surveys, such as the National Health
Interview Survey (NHIS), National Health and Nutrition
Examination Survey (NHANES), National Vital Statistics System
(NVSS), and National Immunization Survey (NIS).
A program of studies designed to assess the health and nutritional
status of adults and children in the U.S. The survey is unique in
that it combines interviews and physical examinations.
Data on a broad range of health topics are collected through
personal household interviews. For over 50 years, the U.S. Census
Bureau has been its data collection agent. Survey results have been
instrumental in providing data to track health status, health care
access, and progress toward achieving national health objectives.
Monitors six types of health-risk behaviors that contribute to the
leading causes of death and disability among youth and adults (i.e.,
behaviors that contribute to unintentional injuries and violence;
sexual behaviors that contribute to unintended pregnancy and
sexually transmitted diseases, including HIV infection; alcohol and
other drug use; tobacco use; unhealthy dietary behaviors; and
inadequate physical activity) and measures the prevalence of
obesity and asthma among youth and young adults. Includes a
national school-based survey conducted by CDC, and state,
territorial, tribal, and local surveys conducted by state, territorial,
and local education and health agencies and tribal governments.
http://www.cdc.gov/nchs/
http://www.cdc.gov/nchs/nhanes.htm
http://www.cdc.gov/nchs/nhis.htm
http://www.cdc.gOv/HealthvYouth/yrbs/i
ndex.htm
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Resource/Organization
Data Source
Description
Website
Health Data (Cont.)
Georgia Department of
Public Health
University of California
at Los Angeles
Los Angeles County
Department of Public
Health
Online Analytical
Statistical Information
System (OASIS)/
Health and Vital
Statistics Data
Repository
California Health
Interview Survey
(CHIS) / State Health
Survey
Los Angeles County
Health Survey /County
or City Health Survey
Provides access to the state's standardized health data repository*,
which includes hospital discharge, emergency room visit, arboviral
surveillance, YRBSS, BRFSS, sexually transmitted disease, motor
vehicle crash, vital statistics (i.e., births, deaths, fetal deaths,
induced terminations, pregnancies), and population data. Where
possible, data are available by age group, race, ethnicity, sex,
census tract, county commission district, county, health district,
legislative district, region, or state.
^similar health and vital statistics data may be available from other
state, county, and local health departments
A state survey conducted every two years that provides key health
statistics for adults, adolescents, and children. Data are available at
the state, county, region, and service planning area levels in
California.*
^similar health survey data may be available for other states
A periodic, population-based survey that provides information
about the health of county residents on topics such as health
outcomes, health behaviors, the built environment, and access to
medical care. Data are available for Los Angeles County and its
service planning areas and health districts.*
^similar health survey data may be available for other counties and
locales
http://oasis.state.ga. us/oasis/#
http://www.chis.ucla.edu/
http://publichealth.lacountv.gov/ha/hasur
veyintro.htm
Other Supporting Data
Denver Police
Department
Crime Statistics
The Police Department provides crime statistics and maps at the
city, neighborhood, police district, and city council district levels,
and data on sex offenders, and gang activity.*
^similar crime data may be available for other counties and locales
http://www.denvergov.org/police/Police
Depart ment/tabid/440727/Default.aspx
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Resource/Organization
Data Source
Description
Website
Other Supporting Data (Cont.)
Oregon Department of
Environmental Quality
(DEQ)
Environmental
Databases and Mapping
Applications
Provides access to environmental data, such as air quality, water
quality, wastewater permits, enforcement actions, and cleanup sites,
and provides GIS/mapping applications for capturing, managing,
analyzing, and displaying the various geographically-referenced
information.*
*similar databases and applications may be available for other
states and locales
http://www.deq.state.or.us/news/database
s.htm
U.S. Department of
Agriculture (USD A)
Food and Nutrition
Service
Provides access to various nutrition and hunger data, including data
on food security, food assistance and nutrition programs, and
Supplemental Nutrition Assistance Program (SNAP) and Summer
Food Service Program (SFSP) participation rates and economic
benefits.
http ://www. fns .usda. gov/outreach/getinv
olved/data.htm
Benton County Maps
and CIS
Maps and CIS
Repository
This GIS repository and mapping application* provides a user
interface to view and query roads, parks, tax lot, zoning, survey
documents, addressing, election maps, aerial photography,
topography, and other digital map layers.
*similar GIS data may be available for other states and locales
http://www.co.benton.or.us/maps/benton
maps.php
Oakland Parks and
Recreation (OPR)
Parks, Recreation
Facilities, and
Programming
Provides locations of parks, recreation facilities, pools, etc. in the
community, as well as information on programming.*
*similar data on parks and recreation may be available for other
states and locales
http://www2.oaklandnet.com/Governmen
t/o/opr/index. htm
Clark County Assessor
Parcel Data and
Property Records
Provides parcel data and maps, including data on roads and other
right-of-way parcels, and a property search function, which allows
users to access ownership and property value data.*
*similar parcel data and property records may be available for
other counties and locales
http://www.clarkcountynv.gov/Depts/ass
essor/Pages/default.aspx
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Resource/Organization
Data Source
Description
Website
Other Supporting Data (Cont.)
San Francisco Planning
Department
Zoning, Permits,
Planning Code
Provides the complete planning code, zoning and permit data, and
survey maps.*
*similar planning data may be available for other states and
locales
http://www.sf-planning.org/
Los Angeles Unified
School District
School Locator/School
Profile & Performance
Provides a school locator, profiles of school demographics (e.g.,
enrollment, ethnicity, graduation rate, suspensions/expulsions,
attendance rates), and school report cards (e.g., academic
performance index, English and Math proficiency).*
*similar databases and applications may be available for other
states and locales
School Locator:
http://notebook.lausd.net/schoolsearch/sel
ector.jsp
School Profile and Performance:
http://data.lausd.net/why-does-data-
matter-how-do-i-get-data
Federal Transit
Administration (FTA)
National Transit
Database
Provides monthly and annual financial and operating data on transit
agencies throughout the U.S., including expenditures, revenue
sources, service delivery, and trip length.
http://www.ntdprogram.gov/ntdprogram/
U.S. Department of
Transportation, Federal
Highway Administration
National Household
Travel Survey (NHTS)
[formerly Nationwide
Personal Transportation
Survey (NPTS)]
A national inventory of daily travel and includes information on the
purpose and means of travel, travel time, day and time of travel,
and traveler demographics.
http://nhts.ornl.gov/introduction.shtml
California Highway
Patrol
Statewide Integrated
Traffic Records System
(SWITRS)
A database of California collision data, including bicyclist and
pedestrian collisions.* Custom reports are available by criteria,
such as jurisdiction, location, or date.
*similar databases may be available for other states and locales
http://www.chp.ca. gov/switrs/index_men
u.html
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Resource/Organization
Data Source
Description
Website
Other Supporting Data (Cont.)
Oregon Department of
Transportation (DOT)
Transportation Data
Section
Provides statewide transportation data, such as pavement condition,
transportation infrastructure, traffic counts and flow, posted speed
limits, traffic congestion, transit routes, vehicle miles travelled, and
crash data, as well as mapping applications for capturing,
managing, analyzing, and displaying the various geographically-
referenced information.*
*similar databases and applications may be available for other
states and locales
http://www.oregon.gov/ODOT/TD/TDA
TA/Pages/index.aspx;
https://gis.odot.state.or.us/transgis/
Metro Transit
Transit Services
-
provides maps of transit routes, as well as service frequency,
average ridership, and fare data.*
*similar transit data may be available for other regions and locales
http ://www. metrotransit. org/
Benchmarks
U.S. Centers for Disease
Control and Prevention
(CDC)
Physical Activity
Guidelines for
Americans
Identify how much physical activity children, adults, older adults,
and healthy pregnant/ postpartum women should be getting and
provide examples of different types of activities to meet those
goals.
http://www.cdc.gov/physicalactivity/ever
vone/guidelines/index. html
U.S. Environmental
Protection Agency
(EPA)
Air Quality/Pollution
Standards
Under the Clean Air Act, EPA is responsible for setting standards.
also known as national ambient air quality standards (NAAQS), for
pollutants which are considered harmful to people and the
environment and ensuring that these air quality standards are met.
or attained through national standards and strategies to control
pollutant emissions from automobiles, factories, and other sources.
Under the Clean Air Act, federal noise regulations have also been
set, which cover standards for transportation equipment, motor
carriers, low-noise-emission products, and construction equipment.
Although EPA is not responsible for regulating indoor air quality.
as it does outdoor air quality, the Agency does conduct indoor air
quality research to examine the health risks of radon, mold, and
other indoor air pollutants and offer means by which to reduce
human exposures.
National Ambient Air Quality Standards:
http://www.epa.gov/air/criteria.html
Air Pollutants /Air Quality:
http://www.epa.gov/air/airpollutants.html
Transportation-related Air Quality
Standards: http://www.epa.gov/otaq/
Noise Pollution:
http://www.epa.gov/air/noise.html
Indoor Air Quality:
http://www.epa.gov/iaq/index.html
D-7
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Resource/Organization
Data Source
Description
Website
Benchmarks (Cont.)
Robert Wood Johnson
Foundation and the
University of Wisconsin
Population Health
Institute
Transportation Research
Board / National
Cooperative Highway
Research Program
National Crime
Prevention Council
World Health
Organization (WHO)
U.S. Department of
Health and Human
Services
County Health
Rankings & Roadmaps
Crash Reduction
Factors
Crime Prevention
Through Environmental
Design (CPTED)
Health Initiatives,
Strategies, and
Guidelines
Healthy People
Using data available for each county in all 50 states, measure the
overall health of each county based on factors that influence health,
such as health behaviors, clinical care, social and economic factors,
and the physical environment. Users can see specific county-level
data and state benchmarks for various measures used in the
rankings.
This State-of-Knowledge Report summarizes the current status of
crash reduction factors for a variety of treatments and provides a
summary of the best available crash reduction factors.
A multi-disciplinary approach to deterring criminal behavior
through environmental design implementations in the built
environment.
Initiatives and evidenced-based strategies and guidelines for
various health and development topics, including community noise.
A set of science-based, ten-year national health objectives.
http://www.countyhealthrankings.org/
http://onlinepubs.trb.org/onlinepubs/nchr
p/nchrp rrd 299.pdf
http://www.ncpc.gov.sg/pdf/CPTED%20
Guidebook.pdf
http ://www. who . int/topics/en/ ;
http ://www. who . int/publications/guidelin
es/en/index.html
Healthy People 2010:
http://www.healthypeople. gov/20 10/
Healthy People 2020:
http://www.healthypeople.gov/2020/defa
ult.aspx
Indicators
San Francisco
Department of Public
Health
Sustainable
Communities Index
(SCI); formerly
Healthy Development
Measurement Tool
(HDMT)
A set of measurement methods for indicators of livable, equitable,
and prosperous cities. Includes over 100 measures that can be used
to track diverse sustainability objectives for the environment,
transportation systems, community cohesion and civic engagement,
public facilities, education, housing, and economic strength, and
health systems. Where possible, methods try to represent indicators
at the neighborhood scale.
http ://www. sustainablesf . org/
D-8
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Appendix E - Tools and Models Used in Reviewed HIAs
Tool/Model
Description
Source
20-Minute
Neighborhood
Analysis
A GIS analysis of walkability and local access to services
that takes into account both the presence of local
destinations, as well as factors that impact the ability to
access these destinations (e.g., street connectivity,
sidewalks, transit service, and topography).
Portland Bureau of Planning and Sustainability;
http://efiles.portlandoregon.gov/webdrawer.dll/webdrawer/rec/4376218/
view/PP%2020-min%20neighborhood%20analvsis.PDF
AERMOD
A dispersion model used to estimate criteria pollutants.
American Meteorological Survey/Environmental Protection Agency;
http://www.epa.gov/ttn/scram/dispersion prefrec.htnrfaermod
Air Quality Index
(AQI) Scores/AirData
The AirData website allows users to display and download
monitored hourly, daily, and annual concentration data,
AQI data, and particle pollution data collected at outdoor
monitors across the U.S. Puerto Rico, and the U.S. Virgin
Islands. The data come primarily from the Air Quality
System (AQS) database.
Environmental Protection Agency; http://www.epa. gov/airdata/
Bicycle Environmental
Quality Index (BEQI)
A quantitative observational survey used to assess the
bicycle environment on roadways and evaluate what
streetscape improvements could be made to promote
bicycling.
San Francisco Department of Public Health;
http://www.sfphes.org/component/jdownloads/viewcategory/19-
beqi?Itemid=62
CALINE3/CAL3QHC
/CAL3QHCR
CALINE3/CAL3QHC are pollutant dispersion models used
for predicting carbon monoxide (CO) dispersion from
traffic. CAL3QHCR is a more refined version that requires
local meteorological data. Inputs for the model include:
roadway geometry, receptor locations, meteorological
conditions, and vehicular emission rates.
Environmental Protection Agency;
http://www.epa. gov/ttn/scram/dispersion_prefrec.htm#caline3;
http://www.epa.gov/ttn/scram/dispersion prefrec.htm#cal3qhc
E-l
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Tool/Model
CALINE4 (CAlifornia
LINE Source
Dispersion Model)
CALRoads View
Carbon Sequestration
Estimates
Childcare Supply and
Demand
Claritas BusinessPoint
(now Nielsen
BusinessPoint)
Comprehensive Plan
Review Checklist
Consumer Price Index
Description
Based on the same diffusion equation used in EPA's
CALINE3 model, CALINE4 is the standard modeling
program used by the California Department of
Transportation to predict air concentrations of CO near
roadways; the model can also handle dispersion modeling
of paniculate matter (PM) and nitrogen dioxide (NO2).
Inputs for the model include traffic characteristics
(volumes, speeds, etc.), roadway geometry, meteorological
data, and vehicle emission factors.
An air dispersion modeling package that combines the
CALINE4, CAL3QHC, and CAL3QHCR air dispersion
models into one seamless integrated graphical interface.
This package is used for predicting air pollution
concentrations of CO, NO2, and PM from traffic.
A methodology for determining possible sequestration
ability of local forest cover.
A methodology for determining childcare supply and
demand in a community, and can also be used to determine
childcare demand created by new development.
An on-line data source that matches and appends large
business databases in real time to provide detailed statistics
including sales, number of employees, primary contacts,
existing markets, and market potential.
Designed for use in reviewing comprehensive land use
plans, transportation plans, and neighborhood plans, and is
appropriate for different locations. Elements examined
include land use, transportation, water resources, parks and
open space, and urbanization/redevelopment/ economic
development.
A tool that provides monthly data on changes in the prices
paid by urban consumers for a representative basket of
goods and services.
Source
California Department of Transportation (Caltrans);
http://www.dot.ca.sov/hq/env/air/software/caline4/calinesw.htm
Lakes Environmental Software;
http://www.weblakes.com/products/calroads/7AspxAutoDetectCookieSu
EBQltl
U.S. Department of Agriculture;
http://www.fs.fed.us/ecosvstemservices/pdf/estimates-forest-tvpes.pdf
Enterprise Community Partners;
http://www.practitionerresources.org/sho wdoc.html?id=19705&topic=Re
sident%20Services&doctype=Manual
http ://www. claritas .co m/MvB estMarkets2/Default. i sp?ID=0& SubID=&p
ageName=Home
Design for Health; http ://designforhealth. net/resources/legacy/checklists/
U.S. Bureau of Labor Statistics; http ://www.bls . gov/cpi/
E-2
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Tool/Model
Description
Source
Diversity Index
A proprietary diversity index that measures diversity on a
scale fromO (no diversity) to 100 (complete diversity).
Defined as the likelihood that two persons, selected at
random from the same area, would belong to a different
race or ethnic group.
ESRI; http://www.esri.com/data/esri data/demographic-overview/
demographic
(Note: The Diversity Index is part of ESRI's 2012/2017 Updated
Demographics database.)
Emissions &
Generation Resource
Integrated Database
(eGRIDweb)
A web-based tool that displays eGRID data in a user
friendly way and allows users to export data they select; a
comprehensive source of data on the environmental
characteristics of almost all electric power generated in the
U.S. and links air emissions data with electric generation
data for U.S. power plants.
Environmental Protection Agency; http://cfpub.epa.gov/egridweb/
EMission FACtor
Model (EMFAC)
An emission inventory model used to calculate emission
rates from motor vehicles, such as passenger cars to heavy-
duty trucks, operating on highways, freeways, and local
roads in California; the emission rates are multiplied with
vehicle activity data provided by regional transportation
agencies to calculate the statewide or regional emission
inventories. Inputs required for generating an emissions
inventory are geographic area, calendar year, month or
season selection, title, model years included in the
calculation, inspection and maintenance (I/M) programs,
emission mode, and output options.
California Air Resources Board;
http://www. arb.ca. gov/msei/onroad/latest version.htm
Food Access Research
Atlas (formerly Food
Desert Locator)
An internet-based mapping tool that provides a spatial
overview of food access indicators for low-income and
other census tracts using different measures of supermarket
accessibility and pinpoints the location of food deserts
(low-income communities that lack ready access to healthy
food).
U.S. Department of Agriculture;
http://www.ers.usda.gov/data-products/food-access-research-atlas.aspx
Frank and Sallis CIS-
Based Walkability
Index
A combined measure of net residential density, road
network connectivity, retail floor area ratio, and land use
mix, and can be calculated using archival GIS data rather
than by means of intensive primary data collection efforts.
Frank L, Sallis J, Saelens B, Leary L, CainK, Conway T, et al. 2010.
The development of a walkability index: application to the neighborhood
quality of life study. British Journal of Sports Medicine 43:924-933.
E-3
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Tool/Model
Description
Source
Geographic
Information Systems
(CIS) / Mapping
Applications
GIS is a tool that allows users to visualize, analyze,
interpret, and understand geographically-referenced data to
reveal relationships, patterns, and trends. Examples include
ArcGIS (a GIS for working with maps and geographic
information), SimplyMap (a web-based mapping
application with a user-friendly interface), and Maplnfo (a
desktop-based GIS used for mapping and location
analysis).
ESRI; http://www.esri.com/software/arcgis
Geographic Research, Inc.; http://geographicresearch.com/simplvmap/
Pitney Bowes; http://www.mapinfo.com/
Google; http://maps.google.com/; http://www.google.com/earth/index.
html
Google Map/
Google Earth
Google Maps is a web mapping application that offers
street maps, a route planner for traveling by foot, car, bike,
or with public transportation, and a locator for urban
businesses in numerous countries around the world.
Google Earth combines maps and geographic information
with satellite and aerial photography, allowing the user to
view 3D imagery, terrain, and buildings. Note that Earth
View is a feature in Google Maps that allows users to see
the same high-resolution imagery, terrain, and 3D buildings
that are available in the desktop version of Google Earth.
Greenhouse Gas
(GHG) Emissions
Modeling
The Puget Sound GHG Emissions Model evaluates various
GHG models, identifies the most appropriate model for the
project under consideration, and identifies appropriate
values for key factors and components of the scenarios
being analyzed.
Puget Sound Clear Air Agency; SR520 fflA, Appendix K -
http://www.wsdot.wa.gov/NR/rdonlyres/EFDE4CC6-406F-48E4-BEFD-
EF50B2842625/0/SR520HealthImpactAssessment.pdf
Health Economic
Assessment Tool
(HEAT)
A tool designed to conduct an economic assessment of the
health benefits of walking or cycling by estimating the
value of reduced mortality that results from regular walking
or cycling.
World Health Organization; http://www.heatwalkingcvcling.org/
E-4
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Tool/Model
Description
Source
Healthy Development
Management Tool
(HDMT); now
Sustainable
Communities Index
(SCI)
A comprehensive set of measurement methods for
indicators of livable, equitable, and prosperous cities.
Includes over 100 measures that can be used to track
sustainability objectives for the environment, transportation
systems, community cohesion and civic engagement, public
facilities, education, housing, and economic strength, and
health systems and apply these metrics to planning, policy
making, and civic engagement.
San Francisco Department of Public Health;
http ://www. sustainablesf. org/
Health Impact
Predictive Function
Equations
Used to predict excess traffic-attributable PM2.5 mortality,
changes in noise-related annoyance, and noise-attributable
cases of myocardial infarction.
San Francisco Department of Public Health; Road Pricing HIA,
Appendices B & C -
http://www.sfphes.org/component/jdownloads/finish/37-congestion-
pricing/111-health-effects-of-road-pricing-in-san-francisco-california/
0?Itemid=0
HIA Threshold
Analysis
A detailed spreadsheet-based assessment that uses a point-
based scoring system to assess achievement across a wide
variety of planning-related topics, including accessibility,
air quality, environment and housing quality, food, mental
health, physical activity, safety, social capital, and water.
Design for Health; http://designforhealth.net/wp-content/uploads/2012/
12/BCBS HIAThreshold4.0 063008.pdf
Home Energy
Insecurity Scale
A tool used to quantitatively measure the extent to which an
energy assistance program improves the energy self-
sufficiency of a low-income household.
U.S. Department of Health and Human Services;
http://www.acf.hhs.gov/sites/default/files/ocs/measuring outcome O.pdf
Huff Gravity Model
(integrated into GIS)
A probabilistic retail gravity model (created by D. Huff
1963) used to predict consumer behavior among competing
retail shopping locations. From these probabilities, sales
potential can be calculated based on disposable income,
population, or other variables.
ESRI; ArcGIS 9.3: http://arcscripts.esri.com/details.asp?dbid=15999;
ArcGIS 10.0 or later: http://www.arcgis.com/home/itemhtml?id=
f4769668fc3f486a992955ce55caca!8
Input-Output Model
Shows the value of goods and services flowing among the
various economic sectors. This model provides a detailed
and complete picture of a state or region's economic
structure, including inter-industry linkages, and the
economy's dependence on different markets.
State of Hawaii*; http://files.hawaii.gov/dbedt/economic/data_reports/
2005_state_io/2005-input-output-study.pdf
*similar models may be available for other states and areas
E-5
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Tool/Model
Description
Source
Land Use Regression
Model
Utilizes monitored levels of the pollutant of interest as the
dependent variable and variables such as traffic,
topography, and other geographic variables as the
independent variables in a multivariate regression model to
characterize air pollution exposure and health effects that
vary spatially.
General information on land use regression models:
http://www.integrated-assessment.eu/guidebook/land use regression;
Review of land use regression models:
http://www.ncbi.nlmnih.gov/pmc/articles/PMC2233947/pdf/nihms3668
3.pdf
Estimates the cost of living in a community or region. Lists
typical expenses, the living wage, and typical wages for the
selected location.
Living Wage
Calculator
Poverty in America Project (Perm State); http://livingwage.mit.edu/
Location Allocation
Model
(MINDISTANCE)
A site analysis technique in GIS using location allocation to
determine potential locations for retail that optimize
proximity. Specifically computes the location and
allocation to minimize the total weighted distance traveled
from all demand points to their nearest center.
ESRI; ArcGIS Network Analyst extension
ArcGIS 9.3: http://webhelp.esri.eom/arcgisdesktop/9.3/index.cfm?
TopicName=Creating an OP cost matrix
ArcGIS 10.0 or later: http://help.arcgis.eom/en/arcgisdesktop/10.0/help/
index.html#//004700000050000000
Log-linear Risk Model
of Population
Exposure - Paniculate
Matter
Forecasts the mortality effects of exposure to paniculate
matter for a population.
World Health Organization;
http ://www. who. int/publications/cra/chapters/volume2/13 5 3 -143 4 .pdf
Mapping
Susceptibility to
Gentrification: Early
Warning Toolkit
Developed to help communities in California identify
whether their neighborhood is susceptible to gentrification.
Provides indicators to identify neighborhoods at risk of
gentrification.
U.C. Berkley Center of Community Innovations;
http://communitvinnovation.berkelev.edu/reports/Gentrification-
Report.pdf
Metropolitan Sprawl
Index
Measures and evaluates metropolitan sprawl based on four
factors: residential density; neighborhood mix of homes.
jobs, and services; strength of activity centers and
downtowns; and accessibility of the street network.
Smart Growth America;
http://www.smartgrowthamerica.org/research/measuring-sprawl-and-its-
impact/
Neighborhood
Environment
Walkability Scale
(NEWS)
A survey that assesses residents' perception of
neighborhood design features related to physical activity,
including residential density, land use mix (including both
indices of proximity and accessibility), street connectivity,
infrastructure for walking/cycling, neighborhood aesthetics,
traffic and crime safety, and neighborhood satisfaction.
http://sallis.ucsd.edu/measure news.html
E-6
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Tool/Model
Description
Source
Noise Annoyance
Relationship
Formulas used to define populations a little annoyed,
annoyed, or highly annoyed by aircraft, road traffic, and
railway noise.
http://www.ncbi.nlm.nih. gov/pmc/articles/PMC 1240282/pdf/ehpO 109-
000409.pdf
Miedema HME and Oudshoorn CGM. 2001. Annoyance from
transportation noise: relationships with exposure metrics DNL and
DENL and their confidence intervals. Environmental Health
Perspectives 109(4):409-416.
Pedestrian
Environment Data
Scan (PEDS)
An audit instrument that measures environmental features
related to walking in varied environments in the U.S.
http://planningandactivitv.unc.edu/RP 1 .htm
Pedestrian
Environmental Quality
Index (PEQI)
A quantitative observational tool used to assess the
pedestrian environment. The tool is organized into five
categories: intersection safety, traffic, street design, land
use, and perceived safety. Indicators within these
categories are aggregated to create a weighted summary
index, which can be reported as an overall index score.
San Francisco Department of Public Health; http://peqiwalksafe.com/
A primer on how to view the complex issue of
gentrification, including nationally-recognized indicators to
measure whether gentrification is occurring.
Primer on
Gentrification and
Policy Choices
Brookings Institution Center on Urban and Metropolitan Policy/
PolicyLink; http://www.policvlink.org/atf/cf/%7B97C6D565-BB43-
406D-A6D5-CA3BBF35AFO%7D/DealingWithGentrification final.pdf
Retail Food
Environment Index
(RFEI)
A tool that gives a snapshot of unhealthy versus healthy
food retail options for an area. RFEI is a ratio of fast food
restaurants & convenience stores, divided by the number of
groceries, farmer's markets, and produce stands; a higher
RFEI suggests greater concentration of unhealthy food.
California Center for Public Health Advocacy;
http://www.publichealthadvocacv.org/RFEI/presskit RFEI.pdf
Retail Gap Analysis
A technique for identifying the strengths and weaknesses of
an economy's retail sector. The technique quantifies retail
surplus and leakage (i.e., the extent to which the corridor is
capturing the spending potential of households residing in
the area).
http://pods.dasrir.okstate.edu/docushare/dsweb/Get/Document-1631/F-
917web.pdf
SF-CHAMP Travel
Forecasting Model
A regional travel demand model that is used assess
estimated changes in travel patterns in the San Francisco
Bay area under different land use, population, and
transportation system conditions.
San Francisco County Transportation Authority;
http://www.sfcta.org/modeling-and-travel-forecasting
E-7
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Tool/Model
Description
Source
Sleep Disturbance
Formula
Calculates the percent of the exposed population expected
to be awakened by single event noise exposure.
U.S. Federal Interagency Committee on Noise;
http ://www. fican. org/pdf/nai-8-92 .pdf
Smart Growth Parking
Demand Model
Estimates how many parking spaces are required in a study
area based on its demographics, current land uses, and
projected developments. Also helps tailor parking
requirements by land use for each study area, incorporating
a series of case study-specific factors such as alternative
transportation mode prevalence, the ability to share
parking, and the time period under study.
Metropolitan Transportation Commission (San Francisco Bay);
http://www.mtc.ca. gov/planning/smart_growth/parking/parking_seminar.
htm
SoundPLAN Noise
Model
Noise modeling software that can predict, analyze, and
graphically display traffic noise, occupational noise indoors
and outdoors, general industrial noise, and aircraft noise.
SoundPLAN is a standards-based program that can provide
road noise calculations in accordance with various
international standards, including the Federal Highway
Administration's STAMINA/Traffic Noise Model.
SoundPLAN International LLC and Braunstein
http://www.soundplan.eu/english
Berndt GmbH;
Store Inventory Tool
Used to inventory the availability and pricing of fresh fruit
and vegetables, snack foods, and beverages, and assess
store infrastructure.
D.C. Healthy Corner Store Program;
http://www.dchunger.org/pdf/cornerstores08_phaseone_report.pdf;
Appendix A
Student Generation
Rates for New
Residential
Development
Can be used to project public school students, by level
(elementary, middle, high), from proposed residential
development.
Oakfield Unified School District*;
http://www.ousd.kl2.ca.us/cms/lib07/CAO 1001176/Centricitv/Domain/9
5/Oakland%20USD%20-Developer%20Fees%20StudY.pdf
*similar information may be available for other states and school
districts
Traffic Congestion
Burden Index
Quantifies the combined effect of congestion and the
degree to which people are exposed to it. The index
considers measures of rush-hour traffic and travel rates with
figures for the portion of commuters who are subject to that
congestion because they drive to work.
Surface Transportation Policy Project;
http://www.transact.org/pdfs/etb report.pdf
E-8
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Tool/Model
Description
Source
Traffic Noise Model
(TNM; formerly
STAMINA)
A Windows-based model for predicting and analyzing
highway traffic noise. Inputs for the model include data on
the roadway, receivers, barriers, building rows, terrain
lines, ground zones, tree zones, contour zones, etc. This
model replaces the previous STAMINA 2.0/OPTIMA
Model.
Federal Highway Administration;
http://www.fhwa.dot.gov/environment/noise/traffic noise model/
Urban Emissions
Model (URBEMIS)
Estimates air pollution emissions in pounds per day or tons
per year for various land uses, area sources, construction
projects, and project operations. Note that URBEMIS 2007
uses California motor vehicle emission rates, which tend to
be lower than those in other states due to California's
stricter emission controls; therefore, out-of-state users
should adjust emission outputs to reflect their vehicle
fleets.)
California Air Resources Board; http://www.urbemis.com/
Vehicle-Cyclist Injury
Collision Predictive
Model Equation
Used to estimate future vehicle-cyclist injury collisions and
% change in vehicle-cyclist collisions. Model inputs are
the number of motor vehicles and the number of cyclists in
the different study scenarios.
Elvik R. 2009. The non-linearity of risk and the promotion of
environmentally sustainable transport. Accident Analysis and Prevention
41(4):849-855
Vehicle-Pedestrian
Injury Collision Model
A census-tract level model of pedestrian injury collision
frequency as a function of aggregate traffic volume
(log-transformed), street, land use and population
characteristics. The model can be used to estimate
census-tract level changes in vehicle-pedestrian injury
collisions.
San Francisco Department of Public Health;
http://www.sfphes.org/elements/24-elements/tools/108-pedestrian-injury-
model
WierM, Weintraub J, Humphreys EH, Seto E, BhatiaR. 2009. An area-
level model of vehicle-pedestrian injury collisions with implications for
land use and transportation planning. Accident Analysis and Prevention
41(1):137-145
Walk Score
A public access walkability index that assigns a numerical
walkability score to any address in the U.S., Canada, or
Australia. The Walk Score is a number between 0 (car
dependent) and 100 (walker's paradise).
Walk Score; http://www.walkscore.com/
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E-10
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Appendix F - Identified Data Gaps and Additional Data Needs
Note: The HIAs included in this Appendix were found to have self-identified additional data needs.
ID
1
2
3
4
5
6
7
8
9
12
13
fflA Title
Pathways to a Healthy Decatur: A
Rapid Health Assessment of the City of
Decatur Community Transportation
Plan
Affordable Housing and Child Health:
A Child Health Impact Assessment of
the Massachusetts Rental Voucher
Program
Health Impact Assessment - Derby
Redevelopment, Historic Commerce
City, Colorado
Health Impact Assessment of NRMT's
Request for a Special Use Permit
The Red Line Transit Project Health
Impact Assessment
Health Impact Assessment Report:
Alcohol Environment - Village of
Weston, WI
Eastern Neighborhoods Community
Health Impact Assessment Final Report
Health Impact Assessment: South
Lincoln Homes, Denver CO
Spokane University District
Pedestrian/Bicycle Bridge Health
Impact Assessment
Community Health Assessment: Bernal
Heights Preschool - An Application of
the Healthy Development Measurement
Tool (HDMT)
St. Louis Park Comprehensive Plan -
Health Impact Assessment
Location
Decatur, Georgia
Massachusetts
Historic Commerce
City, Colorado
Bernalillo County, New
Mexico
Baltimore, Maryland
Village of Weston,
Wisconsin
San Francisco,
California
Denver, Colorado
Spokane, Washington
San Francisco,
California
St. Louis Park,
Minnesota
Additional Data Needs
(Self-Identified)
Yes; city-scale health data (county data used instead)
Yes; Department of Community and Housing
Development data on program participants and
program utilization
Yes; sufficient research to identify the relative
importance of the community design features that
promote physical activity
Yes; more complete/consistent applicant information
(data on types, numbers, and age of fleet vehicles;
information on type of waste transport and waste
transport routes; waste volume, waste origin, and waste
characterization; consistent traffic projections)
Yes; locally-placed air monitors to assess air pollution
(greater air pollution predicted in communities in the
Red Line corridor as of result of increased traffic with
the No Build Option)
Yes; consistently-reported health behavior data for
Wisconsin youth; local data on youth alcohol use and
effects of underage drinking
Yes; locate more qualitative info to supplement and
inform the quantitative data collected; data gaps in
healthy economy profile - psycho-social attributes of
jobs (physical work conditions, job security, access to
health insurance through employment, lack of control
over work, lack of participation in decision making,
time spent at work, supportive work environment,
work-life balance); data on the quality of public
services and infrastructure
Yes; a study on children and adolescent health;
vehicle-to-vehicle and vehicle-to-pedestrian accident
data
Yes; physical activity data for the quarter-mile radius
around the bridge
Yes; parental, social, and environmental factors
affecting selection of childcare and school locations
(e.g., commute times, etc.); adequate information
available to apply the HDMT development target
checklist
Yes; identification of pollutant sources in the
neighborhood
F-l
-------
ID
IT
fflA Title
Location
Additional Data Needs
(Self-Identified)
Comprehensive Health Impact
Assessment: Clark County Bicycle and
Pedestrian Master Plan
Clark County,
Washington
Yes; qualitative data on existing bicycle and pedestrian
infrastructure; comprehensive inventory of pedestrian
facilities; local health data (morbidity/mortality) linked
to built environment data; data on most types of
morbidity by neighborhood; data on physical activity
by neighborhood; data on racial/ethnic disparities (due
to small numbers); poverty data at a small geographic
scale; overweight/obesity data by zip code
16
Yellowstone County/City of Billings
Growth Policy Health Impact
Assessment
Yellowstone County,
Montana
Yes; supplementary research to show causality
between elements of the built environment and chronic
disease
17
Health Impact Assessment, June 20,
2011: Duluth, Minnesota's Complete
Streets Resolution, Mobility in the
Hillside Neighborhoods and the
Schematic Redesign of Sixth Avenue
East
Duluth, Minnesota
Yes; noise assessment
19
Alaska Outer Continental Shelf -
Beaufort Sea and Chukchi Sea Planning
Areas, Oil and Gas Lease Sales 209,
212, 217, and 221 Draft Environmental
Impact Statement; Appendix J - Public
Health
Alaska
Yes; baseline health and environmental data
21
Fort McPherson Rapid Health Impact
Assessment: Zoning for Health Benefit
to Surrounding Communities During
Interim Use
Atlanta, Georgia
Yes; data on current health status of communities
surrounding Fort McPherson
22
Re: November 10th Merced County
General Plan Update (MCGPU)
Preferred Growth Alternative Decision
Merced County,
California
Yes; additional data and analysis would be required in
order to conduct a full HIA; a mechanism for
predicting potential health impacts of proposed land
use and policy decisions
23
Health Impact Assessment of
Modifications to the Trenton Farmer's
Market (Trenton, New Jersey)
Trenton, New Jersey
Yes; more data on the proximate impacts of markets
and more locale-specific data on the prevalence of
pertinent risk factors is needed for more quantitative
analysis of farmers market health impacts
26
Health Impact Assessment: Hawai'i
County Agriculture Development Plan
Hawai'i County, Hawaii
Yes; availability of detailed, accurate information on
the expenditures of the School Food Services Branch
to make sound recommendations for increasing
procurement of local food
27
Mass Transit Health Impact
Assessment: Potential Health Impacts of
the Governor's Proposed Redirection of
California State Transportation
Spillover Funds
California
Yes; actual impacts of funding cutbacks on transit
services
F-2
-------
ID
fflA Title
Location
Additional Data Needs
(Self-Identified)
31
Health Impact Assessment for Proposed
Coal Mine at Wishbone Hill,
Matanuska-Susitna Borough Alaska
Matanuska-Susitna
Borough, Alaska
Yes; Social Determinants of Health - current
household level survey data for the potentially affected
communities and data for years 2009-2011; Accidents
and Injuries - data for years 2009-2011; Exposure to
Potentially Hazardous Materials - offsite residential
monitoring well data, updated fish/aquatics data set,
site specific PM2.5 data, air permit application,
analysis of potential dust/diesel emissions, visual
effects analysis, and off-site terrain noise modeling;
Food, Nutrition and Subsistence - Traditional and
Local Knowledge survey and updated subsistence
data/analysis
33
Neenah-Menasha Sewerage
Commission Biosolids Storage Facility,
Greenville, WI
Greenville, Wisconsin
Yes; risks of groundwater contamination; community
(citizen) surveys (as study relied on unstructured
public comment and literature about community
opinions and perceptions)
35
A Health Impact Assessment of
Accessory Dwelling Unit Policies in
Rural Benton County, Oregon
Benton County, Oregon
Yes; more current data than the 2000 and 2006 census
data used; data on unincorporated areas; ADU
literature for rural areas; quantitative data on number
of permits to be requested; quantitative data to replace
the qualitative data collected at community meeting
and advisory panel meetings
36
The Health Impact Assessment (HIA) of
the Commonwealth Edison (ComEd)
Advanced Metering Infrastructure
(AMI) Deployment
Northern Illinois
(Commonwealth
Edison Utility
Territory)
Yes; data to estimate impact to customer bills
37
Atlanta Beltline Health Impact
Assessment
Atlanta, Georgia
Yes; information about park and trail design, entry
points, and changes to the surrounding environment to
allow a more accurate assessment of access
38
Zoning for a Healthy Baltimore: A
Health Impact Assessment of the
Transform Baltimore Zoning Code
Rewrite
Baltimore, Maryland
Yes; literature that takes socioeconomic status into
account when looking at the health impacts of the built
environment; longitudinal studies or randomized
controlled trials that further delineate the relationship
between the built environment and health
39
Hood River County Health Department
Health Impact Assessment for the
Barrett Property
Hood River County,
Oregon
Yes; soil testing results indicating whether pesticide
chemical residues exist in the soil
40
Unhealthy Consequences: Energy Costs
and Child Health - A Child Health
Impact Assessment of Energy Costs and
the Low Income Home Energy
Assistance Program
Boston, Massachusetts
Yes; utility company data on arrearages and shut-offs
in Massachusetts
46
The Sellwood Bridge Project: A Health
Impact Assessment
Multnomah County,
Oregon
Yes; bike and pedestrian safety data; details on
construction equipment to be used to allow for air
pollution and noise impacts during construction to be
assessed
48
A Rapid Health Impact Assessment of
the City of Los Angeles' Proposed
University of Southern California
Specific Plan
Los Angeles, California
Yes; precise data on displacement; qualitative data of
neighborhood changes to identify communities
receiving displaced persons
F-3
-------
ID
fflA Title
Location
Additional Data Needs
(Self-Identified)
49
Taylor Energy Center Health Impact
Assessment
Taylor County, Florida
Yes; epidemiological data on the impact of climate
change; health impact data for ozone exposure
54
A Health Impact Assessment on
Policies Reducing Vehicle Miles
Traveled in Oregon Metropolitan Areas
Oregon [Portland,
Eugene-Springfield,
Rogue Valley
(Medford-Ashland
area), Corvallis, Bend,
and Salem-Keizer]
Yes; baseline data for vulnerable populations
55
Health Effects of Road Pricing hi San
Francisco, California: Findings from a
Health Impact Assessment
San Francisco,
California
Yes; air quality measures other than PM2.5
56
Santa Monica Airport Health Impact
Assessment
Santa Monica,
California
Yes; demographics
59
Douglas County Comprehensive Plan
Update Health Impact Assessment
Douglas County,
Minnesota
Yes; water quality data; additional mapping to fully
understand the County's bike network and recreational
amenities and their connections to residential areas and
other services; 2010 census data for updated
population map
60
The Executive Park Subarea Plan
Health Impact Assessment: An
Application of the Healthy
Development Measurement Tool
(HDMT)
San Francisco,
California
Yes; more detailed baseline health data (baseline
conditions used mostly demographic data, less health
data); more specific implementation strategies; more
details to support Sustainable and Safe Transportation
and Public Infrastructure and Healthy Economy
elements
67
Healthy Tumalo Community Plan: A
Health Impact Assessment on the
Tumalo Community Plan; A Chapter Of
The 20-Year Deschutes County
Comprehensive Plan Update
Tumalo, Oregon
Yes; more research in the areas of nearby recreation,
trail system development, and health outcomes in both
urban and rural settings; further evaluation of impacts
of short-term ODOT solution to safe highway
accessibility
68
Strategic Health Impact Assessment on
Wind Energy Development in Oregon
(Public Review Draft)
Oregon
Yes; epidemiological studies on sound, shadow flicker,
amplitude modulation, and indoor low frequency
sound impacts; accident rates due to driver distraction;
and wind energy impacts on jobs, income, and other
economic indicators
69
Impacts on Community Health of Area
Plans for the Mission, East SoMa, and
Potrero Hill/Showplace Square: An
Application of the Healthy
Development Measurement Tool
San Francisco,
California
Yes; neighborhood-level data on gross per capita water
usage, annual per capita waste disposal, tree canopy,
proportion jobs paying self-sufficiency wage and filled
by residents, proportion households living on income
below self-sufficiency standard, occupational injury,
jobs providing health insurance, proportion locally-
owned businesses, planned parking pricing strategies,
planned traffic calming interventions, public transit
access to public school, proportion children attending
neighborhood schools, access to produce stores and
food markets, neighborhood completeness indicator for
key public and retail services, volunteerism, sidewalks
with adequate lighting
70
Pathways to Community Health:
Evaluating the Healthfulness of
Affordable Housing Opportunity Sites
Along the San Pablo Avenue Corridor
Using Health Impact Assessment
Oakland, California
Yes; mortality and morbidity data for El Cerrito
F-4
-------
ID
fflA Title
Location
Additional Data Needs
(Self-Identified)
71
Mac Arthur BART Transit Village
Health Impact Assessment
Oakland, California
Yes; information to assess compliance with existing
housing law; maintenance and repair of MBTV; cost of
the project housing; retail effects; effectiveness of
particular interventions for reducing pedestrian injuries
72
Healthy Corridor for All: A Community
Health Impact Assessment of Transit-
oriented Development Policy in St. Paul
Minnesota
St. Paul, Minnesota
Yes; agriculture, forestry, fishing, hunting, mining,
quarrying, and oil and gas extraction industry average
annual wages; income at the block level
73
Health Impact Assessment Point
Thomson Project
Alaska
Yes; data related to human consumption of subsistence
resources to accurately assess the affects of nutrition
changes
77
Humboldt County General Plan Update
Health Impact Assessment
Humboldt County,
California
Yes; demographic and resources data below the zip
code level
78
Rapid Health Impact Assessment:
Vancouver Comprehensive Growth
Management Plan 2011
Vancouver,
Washington
Yes; qualitative data on existing bicycle and pedestrian
infrastructure; comprehensive inventory of pedestrian
facilities; record-level local health data
(morbidity/mortality) linked to built environment data;
data on most types of morbidity by neighborhood; data
on physical activity by neighborhood; data on some
racial/ethnic disparities (due to small numbers)
81
Health Impact Assessment of the Port of
Oakland
Oakland, California
Yes; a more comprehensive study of truck counts and
activity; quality of pedestrian environment (PEQI);
quality of parks and open space; estimation of social
cohesion and level of physical activity; eligibility
requirements for port employment and degree to which
those positions are fulfilled by West Oakland residents
F-5
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F-6
-------
Appendix G - Sector Snapshots: Select Data from HIAs in Each Sector
Table G-l. Summary Table of Select Data from HIAs in the Transportation Sector
ID
HIA; Year;
Location
Scope/Summary
Source of
Evidence
Impacts/
1 ml points
Pathway of
Impact
Characterization of Impact
Decision-making Outcome
Effectiveness of HIA
Minimum Elements of HIA
Met? If no, what's missing
1
5
Pathways to a
Examine the health impacts
Community
Health,
Land use, lifestyle,
Direction of impacts (positive
Concluded that elements of the Community Transportation General effectiveness assumed at
No; Element 4 (monitoring plan)
Healthy Decatur: A of the City of Decatur consultation, behavioral, mobility/access to health impacts, negative health Plan, such as intersection and corridor improvements, bike a minimum- HIA was included missing; permanence of potential
Rapid Health Community Transportation literature review, infrastructure services, physical impacts); Likelihood of impacts and pedestrian facilities, and transportation and land use as an Appendix to the impacts on human health or
Assessment of the Plan that aims to make special collection
City of Decatur Decatur a healthy place to (expert
Community live and work, maintain a consultation,
Transportation high quality of life, and demographics
Plan; 2007; increase opportunities for analysis, GIS)
Decatur, Georgia alternative modes of
transportation
The Red Line
Examine current health
Literature review,
Transit Project conditions for the community
Health Impact population living in the Red consultation,
Health,
activity, safety (definite impacts, probable connections, will increase opportunities for physical activity, Community Transportation Plan health determinants (Element 2.4)
(traffic) and impacts, speculative impacts) improve safety, and provide better access to health promoting and portions incorporated into the not judged; and documentation of
security, social goods and services. Potential negative health impacts exist body of the Plan; infra-structure funding (Element 5) not
capital
Air quality,
Direction of impacts (positive
related to pedestrian and bicycle safety, but can be eliminated improvements and an Active
or mitigated by incorporating findings of the HIA in the Living Division created, but it is
design phase of the corridor and intersection improvements. unclear if this is a direct result of
transparent
Recommendations included: making traffic safety a priority, health recommendations in the
prioritizing connectivity, making intersections ADA- HIA being implemented
compliant, emphasizing the mobility of the most vulnerable
populations, supporting the bicycle community, partnering
with schools to promote childhood physical activity,
accommodating commuter and recreations users in planning
alternate transportation modes, a community- wide campaign
to promote physical activity, and making the Plan one
component of a greater health promoting strategy for the city.
Potential for some negative health impacts from construction,
General effectiveness at a
No; Element 4 (monitoring plan)
behavioral, exposure to health impacts, negative health butthe majority of health impacts are positive; the No-Build minimum, although direct missing; documentation of
environmental, hazards, land use, impacts); Equity of impacts option eliminates the potential for the benefits the Red Line effectiveness possible - HIA was funding not transparent (Element
Assessment; 2008; Line corridor, illustrate policy review, infrastructure, mental health, (demographics, populations offers. Cross-cutting Recommendations: Build the Red Line submitted to the Maryland Transit
Baltimore, links between transportation special collection services, mobility /access to sensitive to vehicle emissions using light rail, appoint a public health expert to serve on Authority as comment to the draft
Maryland
5)
and health in Baltimore, and (interviews, expert demographic services, noise and noise); Magnitude of decision-making teams, and increase green space. EIS; in 2009, Maryland Governor
recommend specific design consultation,
features and mitigation modeling health
strategies to maximize the links,
Baltimore Red Line demographics
Project's capacity to analysis)
achieve better health.
pollution, nutrition, impacts (high for some risks); Recommendations were also provided for improving access announced locally-preferred
physical activity, Likelihood of impacts (definite and safe outdoor activity and construction issues. alternative for the Red Line
safety and security, positive impact, speculative would be implemented - a light
social capital positive impacts)
rail system
G-l
-------
Table G-l. Continued
ID
HIA; Year;
Location
Spokane University
District Pedestrian/
Bicycle Bridge
Health Impact
Assessment; 2011;
Spokane,
Washington
Scope/Summary
Source of
Evidence
Impacts/
1 ml points
Pathway of
Impact
Characterization of Impact
Decision-making Outcome
Effectiveness of HIA
Minimum Elements of HIA
Met? If no, what's missing
Inform decision makers
about potential health
impacts that development of
a pedestrian bridge in the
University District will have
on the current and projected
population who will live,
work, and recreate within a
quarter-mile radius of the
bridge.
Literature review,
policy review,
special collection
(surveys,
demographics
analysis, GIS)
Health,
environmental
Safety and security,
social capital, air
quality, physical
activity, community
economics,
housing, land use
Correlative analyses of eyes on
the streets and windows on the
block to perceived safety and
perceived safety or eyes on the
street with actual crime
numbers; Direction of impacts
(positive health impacts,
negative health impacts);
Magnitude of impacts
(hypothesize a positive impact
on physical activity similar in
magnitude to London study);
Likelihood of impacts (unlikely
impacts, likely impacts); Cost of
impacts (pedestrian and bicycle
collisions)
The bridge will contribute positively to the health of the study
area and the HIA recommend that the bridge be constructed.
A number of recommendations were produced and prioritized
for implementation, including reduced on- and off-street
parking, incentives for alternative transportation and mixed-
use development, bike lanes on and to/from the bridge,
regular bus service, proper repair and maintenance of
sidewalks, maps and signage for bicycle and pedestrian
routes, traffic calming measures, and continued branding of
the University District.
Undetermined
No; Element 4 (monitoring plan)
missing; and distribution and
permanence of potential impacts
not assessed (Element 2.4)
11
The Impact of U.S.
Highway 550
Design on Health
and Safety in Cuba,
New Mexico: A
Health Impact
Assessment; 2010;
Cuba, New Mexico
Provide information on how
the design of U.S. Highway
550 could impact the health
and safety of Cuba area
residents and visitors.
Literature review,
community
consultation,
special collection
(survey,
workshop)
Health,
behavioral,
infrastructure,
economic
Land use, safety
and security,
physical activity,
social capital,
community
economics,
mobility/access to
Draws on general research about
the effects of transportation
planning on pedestrian safety,
physical activity, social
connections, and community
economics, but doesn't touch on
specific health consequences or
quantify impacts for Cuba
residents
Recommendations were provided that could increase
pedestrian safety and encourage safe walking along U.S. 550
as part of an active daily lifestyle for Cuba area residents,
including improving the pedestrian environment (adding or
upgrading sidewalks; providing lighting, shade, and benches;
and creating safe pedestrian crossings); providing a buffer
between vehicular traffic and foot traffic; signage that would
promote a safe pedestrian environment; and traffic calming
measures.
General effectiveness at a
minimum, although direct
effectiveness possible -perthe
Winter 2011 UNMPRC
Newsletter, the HIA was included
in the NMDOT's Environmental
Assessment of the Cuba sidewalk
project
No; Elements 2.2 (stakeholder
input), 2.4 (judgement of
impacts), and 4 (monitoring plan)
missing; evidence of the HIA
being initiated to inform a
decision-making process is not
clear (Element 1); documentation
of the process and methods not
very transparent (Element 5)
G-2
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Table G-l. Continued
HIA; Year; Source of Impacts/ Pathway of _ * .u «T * i /-» * r«- ^ *TTT» Minimum Elements of HIA
ID Scope/Summary Characterization of Impact Decision-making Outcome Effectiveness of HIA
Location Evidence I ml points Impact Met? If no, what's missing
14
17
Comprehensive
Examine the likely health
Literature review,
Health,
Physical activity
Projects - Direction of impacts
Concluded that the projects, policies, and programs in the Direct effectiveness - the board
Yes, although permanence of
Health Impact impacts of the Clark County special collection infrastructure, primarily; to a | (positive health impacts); | Bicycle and Pedestrian Master Plan would positively impact of County Commissioners impacts (Element 2.4) is not very
^Co^Bic chand Bicyde and Pedestrian KexPert
, , f Master Plan, whether to consultation,
Pedestricin M.cister
Plan- 2010- Clark adopt the Master Plan or demographics
County n°t> and now elements of analysis, GIS)
Washington
Health Impact
Assessment, June
the Plan could be prioritized
to maximize health impacts
The purpose of the HIA was
to determine the potential
Literature review,
policy review,
20, 201 1 : Duluth, health impacts of the Sixth community
Minnesota's Avenue East Schematic consultation,
Complete Streets Redesign Study, if the special collection
Resolution, redesign was embracing (expert
Mobility in the Duluth's Complete Streets consultation,
Hillside Resolution, and how the walkability audit,
Neighborhoods and redesign study could be GIS)
the Schematic improved to provide
Redesign of Sixth additional health benefits to
Avenue East; 201 1 ; users of the corridor.
Duluth, Minnesota
economic
Health,
infrastructure,
limited extent: Strength of evidence (limited, health by increasing opportunities for physical activity. The adopted the plan, which will be apparent
mobility/access to some, moderate, or strong); HIA identified important data inputs omitted during the incorporated into the 2014
services, parks and Magnitude of impacts planning process, which limited the ability of the plan to County Comprehensive Growth
recreation, (populations served based on maximize health benefits. Overarching recommendations Management Plan Update
nutrition, GIS analysis); Distribution/ included: updating the plan in five years; using data to
community/house-
hold economics,
safety
equity of impacts (one-way prioritize projects and track progress; and planning and
ANOVA to determine disparate providing for the needs of a continuum of users and trip types.
impacts); Permanence of Project, policy, and program recommendations were also
impacts (medium - medical provided.
treatment for obesity);
Quantification of impacts
(medical costs of obesity,
correlations between fast food
density and income, bicycle
network density);
Policies/Programs - Direction of
impact; Strength of evidence;
Mobility/access to
services, safety and
Distribution/equity of impacts
(if applicable)
Distribution/equity of impacts
(transit mobility for vulnerable
Concluded that the roadway redesign is a feasible project, that
the Comprehensive Plan has additional language to support
behavioral security, physical populations); otherwise, impacts the redesign, and with existing city policies/plans and the
activity, livability, not really documented
community
economics,
housing, social
capital, land use,
parks and
recreation
recommendations made in the HIA that the renewal of the
corridor would positively impact health and better serve the
users of and residents of Hillside. Selected recommendations
addressed accessibility and safety, physical activity, and
livability. Suggested that recommendations become an
addendum to the Redesign Study and be paired with an
upcoming traffic study.
Undetermined
No; Elements 2.3 (baseline health
conditions) and 2.4 (judgment of
impacts) missing
G-3
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Table G-l. Continued
ID
27
HIA; Year;
Location
Scope/Summary
Source of
Evidence
Impacts/
1 ml points
Pathway of
Impact
Characterization of Impact
Decision-making Outcome
Mass Transit
Health Impact
Assessment:
Potential Health
Impacts of the
Governor's
Proposed
Redirection of
California State
Transportation
Spillover Funds;
2008; California
Synthesize and
communicate research
evidence on how proposed
cuts in state funding of mass
transit may impact the
public's health and inform
pending transportation
funding decisions in
California and illustrate
how public policies outside
the public health and health
care sectors can affect
public health.
Literature review,
policy review,
special collection
(consultation with
transit advocacy
group, expert
consultation,
modeling)
Health,
economic,
environmental,
other (social)
Air quality, water
quality, noise
pollution,
community/ house-
hold economics,
land use, physical
activity, lifestyle,
social capital,
mobility/access to
Due to uncertainties, could not
predict health impacts of state
transit funding cutbacks;
provided pathways through
which transportation and transit
funding generally affect public
health
Effectiveness of HIA
Minimum Elements of HIA
Met? If no, what's missing
Concluded that getting people out of their cars and into mass
transit has the potential to benefit health in a number of ways.
Uncertainty about how the state transit funding cutbacks
would affect transit systems throughout the state and manifest
at the local level made it difficult to draw firm conclusions
about the health impacts. However, the HIA predicted cuts
were most likely to impact smaller agencies that lack other
resources to make up the funds and for transit-dependent
populations, such as the children, seniors, low-income and
disabled persons.
General effectiveness - the
budget for fiscal year 2007,
which included the Governor's
proposed re-direction of $1.3
billion in transportation
"spillover" funds to the State's
General Funds, was approved
prior to the HIA Report being
issued, but allocation of public
funds for transit at the state and
local levels continues to be a high
priority issue
No; Elements 2.4 (judgement of
impacts), 3 (recommendations
and mitigations), and 4
(monitoring plan) missing;
stakeholder input limited
(Element 2.2); although initiated
in advance of the decision, was
not completed in advance of the
decision (Element 1)
32
HIA of the
Still/Lyell Freeway
Channel in the
Excelsior District;
2008; San
Francisco,
California
Examine the health impacts
associated with past
construction of the 1-280
Freeway and high-traffic
surface streets in the
Excelsior District of San
Francisco after concerns
surfaced that residents of
that community were being
disproportionately exposed
to traffic-related exposures,
including air pollution, and
suffering the health
consequences.
Literature review,
community
consultation,
special collection
(survey,
interviews,
community
photography,
traffic counts,
modeling,
walkability audit,
demographics
analysis, GIS)
Health,
environmental
Air quality, noise
pollution, safety
and security
Quantification of impacts (air
and noise pollution impacts via
modeling, assessment of
pedestrian environment using
the Pedestrian Environmental
Quality Index); Direction of
impacts (negative health impacts
of traffic)
Air quality and noise modeling and monitoring provided
evidence that traffic contributed significantly to
environmental hazards in the Excelsior neighborhood, which
is largely composed of families with children, immigrants,
and people of color. Also found that leading causes of death
in the project zip code were illnesses associated with
increased exposure to traffic and traffic-related air pollutants
and noise, including heart disease, lung cancer, and traffic
collisions. The HIA identified solutions to the risks identified,
such as using more non-polluting (hybrid) buses, reducing
truck traffic, building a sound wall next to the freeway,
establishing a program for acoustic upgrades to building
facades and windows, ensuring safe routes to school, and
improving health care access.
Direct effectiveness - lobbied
San Francisco Board of
Supervisors to draft and adopt a
resolution to reduce the adverse
health impacts of local truck
traffic on southeast communities,
and on November 25, 2008, the
Board unanimously passed
Resolution 081397, which
requires a mitigation plan to
address the impacts of local truck
traffic on residential communities
of southeast San Francisco
No; Elements 1 (conducted in
advance of decision) and 4
(monitoring plan) are missing;
documentation of funding sources
and HIA point-of-contact not
transparent and HIA
documentation is scattered and
not easily accessible (Element 5);
magnitude, likelihood,
distribution, and permanence of
impacts not addressed (Element
2.4)
G-4
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Table G-l. Continued
HIA; Year; Source of Impacts/ Pathway of _ * .u «T * i /-» * r«- ^ *TTT» Minimum Elements of HIA
ID Scope/Summary Characterization of Impact Decision-making Outcome Effectiveness of HIA
Location Evidence Endpoints Impact Met? If no, what's missing
42
46
Columbia River
Examine the Columbia
Literature review,
Health,
Air quality,
Direction of impacts (positive
Provided six recommendations and suggested additional Undetermined - bridge project is
Crossing Health River Crossing (CRC) Draft policy review environmental/ exposure to health impacts, negative health analyses in several areas, including transportation, safety, air still under consideration
Impact Assessment, Environmental Impact ecosystem, hazards, mental impacts); Distribution/equity of quality, noise pollution, and environmental justice. The HIA
2008; Multnomah Statement (EIS) through a
County, Portland, public health lens to
Oregon understand the scope and
magnitude of the potential
health effects of the four
bridge alternatives being
considered.
behavioral,
health, mobility/ impacts (demographics, and health-based recommendations were submitted as a
economic, access to services, populations sensitive to noise, detailed comment letter during the public comment period for
infrastructure, noise pollution, transit mobility for vulnerable the draft EIS. Recommendations included use of light rail,
services
The Sellwood Assess how the proposed Literature review, Health,
Bridge Project: A Sellwood Bridge redesign special collection behavioral,
Health Impact may affect human health (GIS)
Assessment; 20 1 1 ; during both the construction
Multnomah and operational phases of
County, Oregon the project.
physical activity, populations)
safety and security
transit alignments that serve low income and minority
populations, roadway interchange improvements, safe and
accessible bike and pedestrian facilities, tolling to discourage
motor vehicle use, and alternatives that do not increas single
occupancy motor vehicle use. Suggestions for additional
analyses included travel forecasting and predicted collision
rates, analysis of cumulative air toxics exposure, analysis of
noise impacts using a lower threshold, etc.
Air quality, Direction of impacts (positive Concluded that the replacement for the current Sellwood Undetermined
exposure to health impacts, negative health Bridge is expected to be beneficial to county residents' health
infrastructure hazards, mental
impacts); Magnitude of impacts by increasing safety and opportunities for bicyclists and
health, noise (population estimates for air and pedestrians, while addressing general transportation concerns.
pollution, physical noise pollution impacts); The HIA recommended additional measures to maximize
activity, safety and Likelihood of impacts (likely safety along the corridor and maintain safe air quality and
security impacts, definite impacts); noise levels during construction. In addition, the HIA
Distribution/equity of impacts identifies potential partners for implementation of those
(increased risk for air and noise measures.
pollution impacts based on
proximity to the bridge;
populations sensitive to noise
and air quality impacts)
No; Elements 2.2 (stakeholder
input), 2.3 (baseline health
conditions), and 4 (monitoring
plan) missing; magnitude,
likelihood, and permanence of
impacts not assessed (Element
2.4); assumptions and limitations
not acknowledged (Element 2.5);
documentation of funding sources
and HIA point-of -contact not
transparent (Element 5)
No; Elements 2.2 (stakeholder
input) and 4 (monitoring plan)
missing; permanence of impacts
not assessed (Element 2.4);
scoping phase is not clear
(Element 2. 1); and documentation
of funding sources not transparent
(Element 5)
G-5
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Table G-l. Continued
ID
51
HIA; Year;
Location
Scope/Summary
Source of
Evidence
Impacts/
1 ml points
Rapid Health
Impact Assessment,
Crook County/City
of Prineville,
Bicycle and
Pedestrian Safety
Plan; 2011; Crook
County, Oregon
Evaluate the current
pedestrian and bicycle
situation in Prineville,
Oregon and provide
recommendations to be
incorporated into the
updated Bicycle and
Pedestrian Safety Plan.
Literature review,
community
consultation,
policy review,
special collection
(demographics
analysis,
windshield
survey, GIS)
Health,
behavioral,
infrastructure,
services
Pathway of
Impact
Exposure to
hazards, lifestyle,
mental health,
mobility/access to
services, noise
pollution, nutrition,
physical activity,
safety and security
Characterization of Impact
Decision-making Outcome
Effectiveness of HIA
Direction of impacts from
current conditions (negative
health impacts, positive health
impacts); Direction of
recommendation impacts
(positive health impacts);
Likelihood of recommendation
impacts (speculative impacts);
Magnitude of recommendation
impacts (affected populations
identified); Distribution/equity
of current conditions and
recommendation impacts
(populations vulnerable to
transit mobility)
Resulted in the identification of some potential negative
health impacts that could be eliminated or mitigated by
incorporating the findings and results of the HIA into future
planning. Recommendations were provided for increasing
opportunities for physical activity, improving safety, and
providing better access to health promoting goods and
services. These included: increasing connectivity of existing
sidewalks, increasing overall existence of sidewalks,
maintaining and upgrading existing bike lanes, increasing
overall amount of bike lanes, strategically reviewing speed
limit zones, and creating safe pedestrian crossing in key
traffic areas.
Undetermined
Minimum Elements of HIA
Met? If no, what's missing
Yes
53
SR 520 Health
Impact Assessment:
A Bridge to a
Healthier
Community; 2008;
King County,
Washington
Ensure health consequences Literature i
were considered in the
decision-making process for
the SR 520 Bridge
Replacement and HOV
Project and help decision
makers evaluate the
alternatives based upon
their potential health effects.
policy review,
special collection
(Mediation Group,
modeling, GIS)
Health,
environmental/
ecosystem,
behavioral,
economic,
infrastructure,
services
Air quality,
community/house-
hold economics,
education, exposure
to hazards,
healthcare access,
lifestyle, mental
health, mobility/
access to services,
noise pollution,
physical activity,
safety and security,
social capital, water
quality, land use
Direction of impacts (negative
health impacts, positive health
effects); Distribution/equity of
impacts (higher concentrations
of certain air pollutants for
individuals in proximity to SR
520); Quantification of impacts
(greenhouse gas analysis
conducted)
Indicated that choosing the right set of features for the SR 520
Project - regardless of which of the three plans under
consideration is adopted - could contribute significantly to
improving the health of people in communities adjacent to the
corridor and the livability of their neighborhoods.
Recommendations (that would be useful in any alternative)
were organized into the following critical health elements:
construction period (reduced construction pollution, increased
traffic management, noise control); transit, bicycling and
walking (improved transit service, connected walking and
bicycling facilities, way-finding system); landscaped lids and
green spaces (landscaped freeway lids, improved and
preserved green space, preserved access to the waterfront);
and design features (noise reduction, additions to the visual
character with art and design, stormwater management
practices).
Opportunistic effectiveness - SR
520 Bridge Replacement and
HOV Project would be
implemented; this HIA ensured
public health was adequately
addressed in the decision-making
process
No; Element 4 (monitoring plan)
missing; permanence, magnitude,
and likelihood of impacts not
assessed (Element 2.4); and
documentation of funding sources
not transparent (Element 5)
G-6
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Table G-l. Continued
ID
54
HIA; Year;
Location
Scope/Summary
Source of
Evidence
Impacts/
1 ml points
Pathway of
Impact
Characterization of Impact
Decision-making Outcome
A Health Impact
Assessment on
Policies Reducing
Vehicle Miles
Traveled in Oregon
Metropolitan
Areas; 2009;
Oregon [Portland,
Eugene-Springfield,
Rogue Valley
(Medford-Ashland
area), Corvallis,
Bend, and
Salem-Keizerl
Assess how vehicle miles
travelled (VMT) reduction
strategies being considered
by Oregon's six
metropolitan regions would
bring about changes in air
quality, physical activity,
and car accident ratesand
what impact that would
have on the public's health.
Literature review,
policy review,
special collection
(advisory
committee)
Health,
behavioral,
environmental/
ecosystem,
infrastructure,
services
Air quality,
exposure to
hazards, lifestyle,
mobility/access to
services, physical
activity, safety and
security, commun-
ity/ household
economics
Direction of impacts (negative
health impacts, positive health
impacts); Magnitude of impacts
(high, moderate, low, negligible,
or insufficient); Equity of
impacts (effects on vulnerable
populations); Quality of
evidence
Demonstrated that reducing VMT would have significant
health benefits overall. Examined 11 different policies that
could reduce VMT and recommended the 5 that would be the
most beneficial in terms of the public's well-being. The HIA
recommended a combination of improvements to the built
environment (e.g., mixed-use and highly-dense with good
connectivity, pedestrian and bicycle infrastructure
improvements, traffic calming measures, air infiltration
systems in buildings), increased costs (e.g., fees for employee
parking at businesses in metropolitan areas, a VMT tax,
income tax bracket-based fees/taxes), and strengthening of
public transit (e.g., increased transit coverage, public transit
with lower levels of area-specific pollution such as light rail).
While all three policies work best together to reduce adverse
health effects, built environment and strengthening public
transit were found to be more positive policies for vulnerable
populations.
Effectiveness of HIA
Minimum Elements of HIA
Met? If no, what's missing
Undetermined - HIA was
presented to seven government
decision-making bodies; while
the impact of the HIA is unclear,
the final Jobs and Transportation
Bill of 2009 and a subsequent bill
included VMT targets for the six
metropolitan areas in Oregon
No; Element 4 (monitoring plan)
missing (suggests 'Future
research,' but not specific
monitoring measures); and
permanence and likelihood of
impacts not assessed (Element
2.4)
G-7
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Table G-l. Continued
ID
55
Location
Health Effects of
Road Pricing In
San Francisco,
California:
Findings from a
Health Impact
Assessment; 2011;
San Francisco,
California
ari
Scope/Summary
n
Source of
Evidence
Impacts/
1 ml points
Pathway of
Impact
Characterization of Impact
Decision-making Outcome
Effectiveness of HIA
Examine a future road
pricing scenario being
studied by the San
Francisco County
Transportation Authority
(SFCTA) that would charge
$3 during AM/PM rush
hours to travel into or out of
the northeast quadrant of
San Francisco (which
includes a concentration of
San Francisco's currently
congested downtown
streets).
Literature review,
community
consultation,
policy review,
special collection
(demographics
analysis,
walkability audit,
modeling, GIS)
Health,
environmental/
ecosystem,
behavioral,
economic,
infrastructure,
services
Air quality,
community/house-
hold economics,
exposure to
hazards, lifestyle,
mental health,
mobility/access to
services, noise
pollution, physical
activity, safety and
security
Direction of impacts (negative
health impacts, positive health
impacts); Permanence (severity)
of impacts (high, low);
Magnitude of impacts (low, low
to medium, substantial);
Likelihood of impacts
(certain/probable impacts,
probable/speculative impacts);
Distribution/equity of impacts
(vulnerable populations
identified; equity of
transportation health effects
spatially; potential for policy to
reduce some inequitable adverse
health effects); Quantification of
impacts (estimates of PM2.5
traffic-related deaths, noise-
related annoyances, and
myocardial infarction; Health
Economic Assessment Tool;
area-level vehicle - pedestrian
injury forecasting; street/
intersection conditions using
Pedestrian Environment Quality
Index; quantified changes in
vehicle-cyclist injury collisions;
economic value of traffic-
attributable beneficial and
adverse health effects); Overall
confidence in impact assessment
(uncertainty factors regarding
magnitude)
Concluded that transportation system operation in San
Francisco has highly significant health burdens and benefits
today and that health burdens are expected to increase due to
increased motor vehicle traffic and population densities. Road
pricing could moderate, but not entirely eliminate, the
expected health burdens associated with "business as usual,"
including increased populations and traffic and no new
policies or funding to manage the transportation system.
Recommendations were developed to enhance the potential
health benefits of road pricing, support reductions in
transportation- associated health costs, and increase active
transportation and included: increasing congestion pricing
fees in circumstances likely to result in reduced health risks
(e.g., on "spare the air" days or applying specifically to more
polluting vehicles); investing in walking and biking safety
improvements in locations where injuries are greatest (e.g.,
with traffic calming along arterials in and near the
road-pricing zone); using quieter, low-emission hybrid buses
in areas where noise and air pollution are worse; investing in
walking and biking infrastructure to encourage trips by foot
and by bike into and out of the road pricing zone; monitoring
road-pricing implementation to address any unanticipated
traffic increases and health impacts; encouraging active
transportation and discouraging driving through more policies
such as demand-based parking fees, "unbundling" parking in
new development, and transportation demand management
programs.
Minimum Elements of HIA
Met? If no, what's missing
Yes
G-8
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Table G-l. Continued
ID
56
HIA; Year;
Location
Scope/Summary
Source of
Evidence
Impacts/
1 ml points
Pathway of
Impact
Characterization of Impact
Decision-making Outcome
Santa Monica
Airport Health
Impact Assessment;
2010; Santa
Monica, California
Organize, analyze, and
evaluate existing
information and evidence
regarding Santa Monica
Airport's (SMO's) impact
on three issue areas: lack of
an airport buffer zone,
noise, and air quality.
Literature review,
policy review,
special collection
(interviews, expert
consultation)
Health,
environmental/
ecosystem
Air quality,
exposure to
hazards, land use,
noise pollution
Direction of impacts (negative
health impacts)
Effectiveness of HIA
Minimum Elements of HIA
Met? If no, what's missing
Offered feasible recommendations that could be taken into
consideration to mitigate the adverse health impacts the
airport's operations have on the surrounding communities,
including eliminating or significantly decreasing the number
of jet takeoffs, installing HEPA filters in surrounding schools
and residential homes, implementing additional noise
abatement strategies, notifying residents and affected
community members of noise and air pollution risks, and
maintaining a runway buffer zone. Closure of SMO would
eliminate all health risks associated with airport air and noise
pollution.
General effectiveness - HIA
raised awareness
No; Elements 2.2 (stakeholder
involvement), 2.3 (baseline health
conditions) and 4 (monitoring
plan) missing; scoping phase did
not include impacts other than
health (Element 2.1); magnitude,
likelihood, distribution, and
permanence of impacts not
assessed (Element 2.4); and
documentation of HIA point-of-
contact not transparent (Element
5)
62
Health Impact
Assessment on
Transportation
Policies in the
Eugene Climate
and Energy Action
Plan;20W;
Eugene, Oregon
Examine the positive and
negative impacts of
transportation policies
within the Eugene Climate
and Energy Action Plan
(CEAP). The HIA examined
seven transportation
objectives/ recommend-
ations and summarized the
scientific evidence that links
those policies to health
issues in Eugene.
Literature review,
community
consultation,
policy review,
special collection
(demographics
analysis,
modeling)
Health,
environmental/
ecosystem,
behavioral,
infrastructure
Air quality, safety
and security,
physical activity
Direction of impacts (positive
health impacts, negative health
impacts); Likelihood of impacts
(speculative impacts)
Concluded that the Transportation and Land Use objectives of
the CEAP have broad benefits and should be approved. Also
provided recommendations to maximize positive impacts and
mitigate negative impacts associated with the Plan, such as
strategies to reduce greenhouse gas emissions and mitigate
negative health impacts from increased urban density;
investments in complete streets, safety improvements, and
public transit; and systems to track injuries and fatalities by
transportation mode, to evaluate plan implementation, and
systematically improve bicycle and pedestrian outcomes.
Also recommended incorporating HIA practices into
transportation and land use planning at the state and local
level.
Direct effectiveness - on
September 15th, 2010, Eugene's
City Council unanimously
endorsed Eugene's first
Community Climate and Energy
Action Plan
No; judgement of magnitude,
distribution, and permanence of
impacts not assessed (Element
2.4)
65
Health Impact
Assessment (HIA)
of Proposed "Road
Diet" and
Restriping Project
on Daniel Morgan
Avenue in
Spartanburg, South
Carolina; 2012;
Spartanburg, South
Carolina
Assess what the expected
effect of the proposed
Daniel Morgan Avenue
(DMA) Road Diet and
Restriping Project would be
on the safety of motorists,
bicyclists, and pedestrians;
opportunities for physical
activity; opportunities for
improved access to goods
and services; and air
quality.
Literature review,
policy review,
special collection
(demographics
analysis, GIS)
Health,
environmental,
infrastructure,
services
Safety and security,
physical activity,
mobility/access to
goods and services,
air quality
Direction of impacts (positive
health impacts); Magnitude of
impacts (high, medium, low);
Significance of impacts (high,
medium, low); Likelihood of
impacts (uncertain impacts,
unlikely impacts, possible
impacts, likely impacts, very
likely impacts); Distribution/
equity of impacts (whole
community, disproportionate
effects)
Findings suggested that the proposed road diet and re-striping
could not only improve the health of many people, but also
prevent death, injury, and/or serious illnesses. Recommended
that the City of Spartanburg implement the proposed road diet
and re-striping and gave particulars (turning 4-lane road into
3-lane road, shared-use paths, wider sidewalks, physically-
seperated bike lanes, etc.); also recommended expansion and
marketing of existing bicycle lending program, ample road
safety signs, implementing an educational program on rules
of the road, and offering a community cycling safety class.
Undetermined
Yes
G-9
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Table G-l. Continued
ID
HIA; Year;
Location
Treasure Island
Community
Transportation
Plan; 2009; San
Francisco,
California
Scope/Summary
Evaluated whether the
Treasure Island Transport-
ation Plan met the health
needs of its neighborhood
residents, using the HDMT
assessment tool and focused
on ways the transportation
system could be designed
and implemented to
maximize opportunities for
active modes of transport-
ation - such as walking and
cycling -and minimize the
risk of injuries.
Source of
Evidence
Special collection
(modeling,
HDMT)
Impacts/
1 ml points
Pathway of
Impact
Characterization of Impact
Decision-making Outcome
Health,
economic
Physical activity,
safety and security,
mobility/access to
services,
community
economics
Quantification of impacts
(Healthy Development
Measurement Tool Sustainable
and Safe Transportation element
development objectives, street
and intersection conduction
using Pedestrian Environmental
Quality Index/ Bicycle
Environmental Quality Index);
Direction of impacts (positive
health impact, negative health
impacts)
Effectiveness of HIA
Minimum Elements of HIA
Met? If no, what's missing
Analysis indicated that the Transportation Plan met 13 of the
20 development targets in the Sustainable and Safe
Transportation element of the HDMT. Recommendations
from the HDMT analysis included the possible construction
of a pedestrian and bicycle connection, a policy regarding
pedestrian improvements at locations with potential high
frequencies of pedestrian collisions, a policy to address
economic barriers to public transit utilization, elimination of
parking requirements, a reduction in number of residential
parking spaces per unit, targeted areas for traffic calming,
and more detail regarding potential parking pricing strategies
in final version of the plan
Direct effectiveness - some HIA
recommendations included in the
Treasure Island Transportation
Implementation Plan issued in
2011
No; Elements 2.1 (scoping), 2.2
(stakeholder input), 2.3 (baseline
health conditions), and 5
(transparent documentation)
missing from the portion deemed
the HIA; and likelihood,
permanence, magnitude, and
distribution of impacts not
assessed (Element 2.4); some of
these elements were addressed in
the overall Transportation Plan,
however
75
Interstate 75 Focus
Area Study Health
Impact Assessment;
2010; Cincinnati,
Ohio
Review the final
recommendations of the
Revive Cincinnati:
Neighborhoods of the Mill
Creek Valley
Comprehensive Plan and
assess the health impacts of
proposed Interstate-75
infrastructure improvements
to select neighborhoods
adjacent to 1-75. Due to
time constraints, this HIA
only examined health
impacts to two of the four
focus areas in the study.
Literature review,
special collection
(demographics
analysis, air
quality study,
GIS)
Health,
environmental,
other
Air quality, mental
health, safety and
security, housing,
mobility/access to
services
Direction of impacts (negative
health impacts, positive health
impacts); Likelihood of impacts
(probable impacts, definite
impacts); Distribution/equity of
impact (empowerment zone
neighborhoods identified for
assessment)
Concluded that several recommendations from the
Comprehensive Plan would have positive impacts for air
quality and public health, but concluded that the 1-75
infrastructure improvements would most likely have a
negative impact on air quality, specifically particulate matter
2.5 (PM 2.5) and volatile organic compounds (VOCs). One
overarching recommendation was to conduct an air quality
study (focused on PM 2.5 and VOCs) that included
establishment of baseline air quality levels prior to
construction, and air quality monitoring during and after
construction. Other recommendations touched on air quality,
traffic/crashes, displacement, pre-construction, construction,
and post-construction.
Undetermined, but general
effectiveness assumed -
agreement for air quality
monitoring established with the
University of Cincinnati and
baseline monitoring initiated;
work on the HIA raised
awareness among the Traffic and
Engineering Department to solicit
comments on several other
transportation projects. Lessons
learned and experience from this
HIA gave the Health Department
the confidence to undertake 3
additional HIAs in Cincinnati
No; Elements 2.2 (stakeholder
involvement) and 2.3 (baseline
health conditions) missing;
magnitude and permanence of
impacts not assessed (Element
2.4); portions of Element 2.5
(assumptions, strengths and
limitations) weak or missing, and
documentation of funding sources
not transparent (Element 5)
79
Lake Oswego to
Portland Transit
Project: Health
Impact Assessment;
2010; Portland,
Oregon
Complement the Draft
Environmental Impact
Statement (DEIS) and more
fully assess the health
impacts of the three transit
alternatives of the Lake
Oswego to Portland Transit
Project - no-build, enhanced
bus service, and streetcar.
Literature review,
special collection
(modeling/
forecasting, GIS)
Health,
environmental,
services
Air quality,
physical activity,
mobility/access to
services, parks and
recreation, safety
and security
Based on selection of build
scenario versus no-build
scenario; Direction of impacts
(positive health impacts,
negative health impacts, no
change in health); Likelihood of
impacts (definite impacts,
probable impacts); Distribution/
equity of impacts (no
disproportionate impacts)
Provided recommendations for mitigating the adverse health
impacts of either build scenario - enhanced bus service or
streetcar. Recommendations included: developing more
stringent emissions-based fleet requirements or incentives,
improving construction equipment emissions; outreach to
residents regarding construction and potential health effects;
education on how to avoid exposure to air toxics generated
during construction; and monitoring programs to assess
construction site concentrations of air toxics.
Undetermined - the Lake
Oswego to Portland Transit
Project was suspended
No; magnitude and permanence
of impacts not assessed (Element
2.4)
G-10
-------
Table G-l. Continued
HIA; Year; Source of Impacts/ Pathway of _ * .u « T * i /-» *
ID Scope/Summary Characterization of Impact Decision-making Outcome
Location Evidence I ml points Impact
81
Health Impact
Evaluate the cumulative
Literature review,
Assessment of the impacts of on-going Port of community
Port of Oakland; Oakland growth on the consultation,
Health,
Air quality,
Direction of impacts (positive
The Port of Oakland plays an important role in the movement
environmental, physical activity, health impacts, negative health of goods in the United States and can play both a positive and
economic, community/house-
2010; Oakland, health of residents in West special collection services, hold economics,
California
Oakland through multiple (interviews,
inter-related pathways. surveys,
demographic
analysis,
infrastructure healthcare
impacts); Likelihood of impacts negative role in the health of West Oakland. Multiple
(definite impacts, probable recommendations were made in each of the five areas
impacts, undetermined impacts); examined (air quality, noise, transportation, retail, and labor)
insurance, land use, Magnitude of impacts (percent to mitigate negative health impacts, and seven of those were
modeling, GIS)
mobility/access to population affected by noise identified as more cross-cutting mitigation recommendations:
services, noise pollution); Permanence of considering health impacts in future planning, roadway
pollution, parks and impacts (estimated traffic- improvements, and monitoring; exploring benefits of
recreation, safety related mortality rates); including noise emissions reductions with truck retrofits;
and security, Distribution/equity of impacts creating a commercial corridor that meets community needs
employment, social (disparate health conditions of for healthy retail services; considering air pollution and noise
capital vulnerable communities; mitigation for sensitive land uses; reducing the
disproportionate effect of diesel unemployment rate; diverting increasing tax revenue to
particulate matter on vulnerable specific community services; and improving Port operations.
populations); Quantification of
impacts (cumulative
contributions of port and area
traffic emissions using a
roadway dispersion model;
attributable mortality rate and
adjusted mortality risk based on
social position; modeled traffic
noise levels/contours; percent
population at risk of annoyance,
sleep disturbance, and cognitive
impairment, and deaths due to
myocardial infarction);
Qualitative analysis of impacts
(pedestrian environment quality/
walkability, photo document-
ation, assessment of housing
values as a proxy for retail
viability)
_, _ , . , . Minimum Elements of HIA
Effectiveness of HIA
Met? If no, what's missing
Undetermined
No; Elements 1 (informs a
decision-making process), 2. 1
(scoping), and 4 (monitoring
plan) are missing; funding
sources and sponsors were not
identified (Element 5)
G-ll
-------
Table G-2. Summary Table of Select Data from HIAs in the Housing/Buildings/Infrastructure Sector
ID
HIA; Year,
Location
Affordable Housing
and Child Health:
A Child Health
Impact Assessment
of the
Massachusetts
Rental Voucher
Program; 2005;
Massachusetts
Scope/Summar
Source of
Evidence
Evaluate the implications of Literature review,
the Massachusetts Rental
Voucher Program (MRVP),
a housing assistance and
homelessness prevention
program, and proposed
MRVP changes for
FY2006, for children's
health and well-being.
special collection
(interviews with
stakeholders, local
housing
authorities survey,
demographics
analysis)
Impacts/
1 ml points
Health,
behavioral, other
(educational
attainment)
Pathway of
Impact
Housing,
community/ house-
hold economics,
mobility/access to
services, exposure
to hazards
Characterization of Impact
Direction of impacts (negative
health impacts, positive health
impacts, health impacts
unclear); Magnitude of impacts;
Quantification of impacts
(percent increase in food
insecurity, cost implications of
educational impacts)
Decision-making Outcome
Effectiveness of HIA
The majority of proposed changes would lead to budget trade-
offs, disenrollment, and housing instability, all of which have
adverse health effects. Proposals that lead to increased
homelessness and housing instability would also result in
increased education costs. Proposals that decrease tenant rent
share decrease the need for budget trade-offs and children in
families who cannot use their mobile vouchers to move out of
high poverty areas may still experience the health benefits of
increased household resources available for other basic needs.
Direct effectiveness - provided
testimony at legislative hearing;
evidence provided was crucial to
state's decision to not move
forward
Minimum Elements of HIA
Met? If no, what's missing
No; Elements 3
(recommendations and
mitigations) and 4 (monitoring
plan) missing; and documentation
of sponsors, funding, and
interviewed stakeholders not
transparent (Element 5)
Health Impact
Assessment: South
Lincoln Homes,
Denver CO; 2009;
Denver, Colorado
Examine the redevelopment
master plan for the Denver
Housing Authority's South
Lincoln Homes community
in Downtown Denver for
potential impacts the
redevelopment may have on
health and wellbeing of the
South Lincoln
neighborhood.
Literature review,
community
consultation,
special collection
(interviews/focus
groups, survey,
health survey,
food audit, retail
food availability
survey, walk-
ability audit,
HDMT,
demographics
analysis, GIS)
Health,
environmental,
behavioral,
economic,
infrastructure,
services,
demographic
Social capital,
mental health,
cultural identity and
equity, physical
activity, land use,
nutrition, parks and
recreation, mobility
/access to services,
healthcare access,
safety and security,
air quality, noise
pollution, house-
hold/community
economics, water
quality, exposure to
hazards, socio-
economic status
Direction of impacts (positive
health impacts); Distribution/
equity of impacts (impacts on
neighborhood of low socio-
economic status); Quantification
of impacts (benchmarks of
performance; walkability
quantified using the Pedestrian
Environmental Quality Index;
resident health and availability
of healthy food quantified via
neighborhood surveys)
Concluded that the master plan included many sustainable
design concepts that focus on health and well-being of the
residents. Provided a very detailed series of recommendations
to optimize positive impacts and mitigate negative impacts in
five categories - social and mental wellbeing, natural
environment, built environment and transportation, access,
and safety. The inclusion of recommendations in the master
plan document and/or further actions to be taken were noted.
Some recommendations included improved health care
access, walkability, pedestrian and traffic safety,
infrastructure that promotes bicycling, social capital, and
access to healthy foods; reduced parking demand and
footprint; increased park and recreation spaces; and improved
environmental conditions.
Direct effectiveness - Mithun,
one of the organizations involved
in the HIA, is also the firm hired
by the Denver Housing Authority
to complete the master plan; the
HIA was included in the Final
Redevelopment Master Plan and
HIA-related changes are
incorporated in the master plan
No; permanence, magnitude and
likelihood of impacts not assessed
(Element 2.4); and documentation
of funding sources in not
transparent (Element 5)
Direction of impacts (positive
health impacts, negative health
impacts); Distribution/equity of
impacts (childcare for lower
income families/retain families)
12
Community Health
Assessment: Bernal
Heights Preschool -
An Application of
the Healthy
Development
Measurement Tool
(HDMT); 2008; San
Francisco,
California
Inform decision making
processes related to the
choice among three
potential future locations of
the Bernal Heights
Preschool.
Literature review,
special collection
(modeling,
HDMT
demographics
analysis, GIS)
Health,
behavioral,
infrastructure,
services,
demographic
Childcare, housing,
exposure to
hazards, education,
parks and
recreation, physical
activity, mobility
/access to services,
air quality, noise
pollution, demo-
graphics, social
capital, nutrition
The majority of data available in the HDMT was not
geographically specific enough to differentiate between the
three potential locations under consideration, but the key
findings point to a strong need for childcare, investment in
schools and parks, valuing of community and social
interactions, and retention of racially and socioeconomically
diverse communities in the Bernal Heights neighborhood. No
recommendations on preferred location were provided, but
HIA suggested that Option C was the only location that
allows the preschool to expand the number of children served
and keep the preschool near Cortland Avenue.
Undetermined - the Bernal
Heights Preschool has been re-
located out of the library, but it is
not evident whether this is a
temporary or permanent move
No; Element 4 (monitoring plan)
missing; magnitude, likelihood,
and permanence of impacts not
assessed (Element 2.4); and
source of funding not transparent
(Element 5)
G-12
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Table G-2. Continued
ID
23
HIA; Year,
Location
Health Impact
Assessment of
Modifications to the
Trenton Farmer's
Market (Trenton,
NewJersey);2007;
Trenton, New
Jersey
Scope/Summar
Examine several proposed
changes to a farmers market
in Trenton, New Jersey,
including two being consid-
ered by the market's execu-
tive board (i.e., minor
cosmetic changes and a
major re-model) and a third
suggestion (i.e., a market
outreach strategy) and their
impacts on patrons' nutrition
and physical activity patt-
erns, as well as the potential
economic and social capital
benefits for vendors and the
surrounding community.
Source of
Evidence
Literature review,
special collection
(interviews,
surveys, public
meetings,
demographics
analysis,
modeling)
Impacts/
1 ml points
Health,
economic,
services,
behavioral
Pathway of
Impact
Nutrition,
community
economics,
physical activity,
social capital,
preventative health
services
Characterization of Impact
Direction of impacts (impacts
under each alternative were
rated as "no change,"
"potentially beneficial," and
"potentially harmful" for each
pathway); Distribution/equity of
impacts (based on major
disparities in health status, risk
factors, and food access,
evaluated impacts to different
population segments - within 2
miles of the market, city of
Trenton, and Mercer County)
Decision-making Outcome
Market's executive board was only interested in making
limited (cosmetic) changes, which would likely not
significantly impact health; but the HIA offered
recommendations to improve the alternative (such as
equipping vendor stalls with electronic benefits transfer
machines and ensuring the prepared food vendors offer
healthy options). The HIA found that Alternative 2 (major
remodel) could yield significant health impacts (economic
and social capital), but would probably not improve
consumption of fresh fruit and vegetables; Alternative 3
(outreach strategy) by comparison, had the best likelihood for
improving nutrition. Concluded a combination of the second
and third alternatives posed the greatest potential benefit. One
overall recommendation - that the market offer nutrition
education programs and market coupons to increase
likelihood of selecting healthy options.
Effectiveness of HIA
Undetermined, but no
effectiveness assumed - based on
executive board's input on
alternative scenarios, no
effectiveness assumed
Minimum Elements of HIA
Met? If no, what's missing
No; Element 4 (monitoring plan)
missing; and magnitude,
likelihood and permanence of
impacts not assessed (Element
2.4)
28
The Rental
Assistance
Demonstration
Project - A Health
Impact Assessment;
2012; United States
Examine the impacts of a
proposed federal housing
policy designed to address
some of the systemic
funding issues related to
public housing on a number
of health determinants that
remained unanswered in
legislative debates; and
ensure that the evaluation of
this pilot project
comprehensively considered
the health impacts of public
housing-related policy
decisions
Literature review,
policy review,
special collection
(focus groups,
surveys,
demographics
analysis)
Health,
infrastructure,
behavioral,
economic
Housing, physical
activity, commun-
ity/household
economics,
mobility/ access to
goods and services,
nutrition, social
capital, safety and
security, exposure
to hazards
Direction of impacts (negative
health impacts, positive health
impacts, mixed result impact);
Magnitude of impacts (no.
people living in housing units if
the pilot project is implemented
more widely; could also impact
the lives of individuals living on
the edge of economic insecur-
ity); Magnitude of specific
impacts (negligible, minor,
moderate, or major); Severity/
Permanence of impacts (high,
moderate, or low); Likelihood of
impacts (probable impacts,
speculative impacts); Strength
of evidence (plausible but
insufficient evidence; likely but
more evidence needed; causal
relationship certain); Distribu-
tion/equity of impacts (impacts
hard-to-house populations)
Found that RAD, as currently written, would have significant
impacts on the health of public housing residents and
communities, and the impacts were more negative than
positive - especially if recommendations proposed in the HIA
were not adopted. Seven overarching recommendations were
provided (e.g., funding to improve existing public housing
stock; keeping public housing "public;" preservation of public
housing stock; funding for services and support for hard to
house; a conversion oversight committee; including local
resident association participation in review and decision
making; an assessment, monitoring, and evaluation program
to track implementation and effects of RAD); and 35 specific
recommendations, such as requiring environmentally
sustainable rehabilitation, expanding due process protections
for public housing residents, requiring just cause evictions of
residents, and limiting how far residents are relocated.
General effectiveness - 2011 bill
passed before HIA released, but
HIA elevated health in a
discussion that did not typically
include health; impact of the HIA
is on-going since RAD is a pilot
project (i.e., HIA will be used
through end of the pilot to
evaluate and monitor RAD's
effects)
Yes
G-13
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Table G-2. Continued
ID
30
HIA; Year,
Location
Jack London
Gateway Rapid
Health Impact
Assessment: A Case
Study; 2007; West
Oakland, California
Scope/Summar
Examine a planned retail
expansion and low-income
senior housing development
and address community
concerns about air quality,
noise, safety, and retail
planning
Source of
Evidence
Literature review,
community
consultation,
special collection
(demographics
analysis)
Impacts/
1 ml points
Health,
infrastructure,
services,
economic,
demographic
Pathway of
Impact
Housing, air
quality, noise,
safety and security,
social capital,
nutrition, parks and
recreation, physical
activity, mobility/
access to services,
public health
services, social
equity, household
economics/liveli-
hood, water quality,
education,
democratic process
(participation in
public decision
making)
Characterization of Impact
Direction of impacts (negative
health impacts, positive health
impacts); Distribution/equity of
impacts (senior citizens
impacted)
Decision-making Outcome
Effectiveness of HIA
Found that, without mitigations, the project could lead to
health concerns and made recommendations to mitigate
potential negative impacts (e.g., air quality monitoring,
installation of ventilation systems with modest filtration, a
noise study, noise buffering, obtaining crime statistics,
increasing private security talking with Neighborhood Crime
Prevention Council, improving walkability, implementing
traffic calming measures, creating a retail plan to meet
community needs/wishes).
Direct effectiveness - when
developer did not guarantee
implementation of mitigations,
two members of HIA Working
Group testified before the Design
Review Committee; as a result, a
central ventilation system/air
filters was installed, and building
design was modified to orient the
entryway through a noise-
buffered courtyard; developer in
discussion with the Neighborhood
Crime Prevention Council and
conducted a small survey to
evaluate interest in retail usage.
HIA also sparked additional HIA
work in area
Minimum Elements of HIA
Met? If no, what's missing
No; magnitude, likelihood, and
permanence (Element 2.4) not
directly judged; studies suggested
to further assess/quantify impact
35
A Health Impact
Assessment of
Accessory Dwelling
Unit Policies in
Rural Benton
County, Oregon;
2011; Benton
County, Oregon
Examine the impacts of five
accessory dwelling unit
policy options, ranging from
restricting currently
permitted uses to allowing
construction of a complete
accessory unit.
Literature review,
community
consultation,
policy review,
special collection
(focus groups,
interviews,
HDMT, GIS)
Health,
infrastructure,
services, other
Housing, mobility/
access to services,
land use, social
capital; secondary
pathways: house-
hold economics,
healthcare access,
lifestyle, mental
health, physical
activity, safety
Direction of impacts (positive
health impacts, negative health
impacts); Direction (positive
health impacts, negative health
impacts) and Magnitude (low to
moderate, significant) of
impacts and best/worst policy
option by assessment area
(housing, access to goods and
services, social and family
cohesion, transportation and
mobility); Distribution/equity of
impacts (population most
benefited; affordable housing in
communities that often suffer
from higher rates of poverty);
Quantification of impacts
(projected ADUs annually)
Found that two of the five policy options would have positive
health impacts - Option 3 (allowing smaller, more restrictive
ADUs) due to the family-friendly living arrangements that
ADUs encourage and Option 2 (restricting currently
permitted uses such as medical hardship trailers and satellite
bedrooms) due to restrictions on the number of dwelling units
in rural parts of the County with poor accessibility to goods,
services, and public transit options. Despite the two policies'
equal impacts, Option 3 was the more socially and politically
preferred policy option, as it clearly benefited several
vulnerable populations (disabled and elderly) and was in line
with the desires of policymakers and public stakeholders to
provide an avenue for family care. Recommended that the
Benton County Community Development Department
consider the adoption of an ADU policy similar to Option 3
and provided recommendations to ensure the positive health
benefits were optimized.
Direct effectiveness - as a result
of this HIA, Benton County's
code was amended to allow
ADUs
No; likelihood and permanence of
impacts not assessed (Element
2.4)
G-14
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Table G-2. Continued
ID
36
HIA; Year,
Location
The Health Impact
Assessment (HIA)
of the
Commonwealth
Edison (ComEd)
Advanced Metering
Infrastructure
(AMI) Deployment;
2012; Northern
Illinois
(Commonwealth
Edison Utility
Territory)
Scope/Summar
Identify the impact of
advanced metering
infrastructure (AMI)
deployment on the health of
residential customers in the
Commonwealth Edison
(ComEd) service territory in
Illinois, particularly
vulnerable customers - the
very young (birth to age 5),
older individuals (age 65+),
individuals with functional
disability status including
those with temperature
sensitive conditions,
individuals who are socially
isolated, and individuals
with limited English
proficiency or literacy.
Source of
Evidence
Literature review,
community
consultation,
policy review,
special collection
(surveys)
Impacts/
1 ml points
Health,
environmental,
behavioral
Pathway of
Impact
Air quality,
community/house-
hold economics,
housing, exposure
to hazards, health-
care access/
insurance, nutrition/
food security,
safety and security
Characterization of Impact
Direction of impacts (negative
health impacts, impact predicted
but none seen in pilot or
insufficient evidence available);
Magnitude of impacts/size of at
risk groups (all households with
AMI, % of households);
Severity/Permanence and
Likelihood of impacts (moderate
impact on few, moderate impact
on medium number or strong
impact on few, strong impact on
medium number or moderate
impact on many, strong impact
on many); Distribution/equity of
impacts (disproportionate
impacts on vulnerable
populations); Quality of
evidence
Decision-making Outcome
Effectiveness of HIA
Found that AMI implementation could result in several
negative impacts including higher residential energy costs for
vulnerable populations, economic incentives for customers to
use less electricity when it is most needed for central air
conditioning (i.e., critical peak pricing), and expedited
disconnections and reconnections for nonpayment, as well as
remote disconnections. The HIA provided five
recommendations to help mitigate these negative impacts,
including analysis of likely impacts on health and safety for
clearly defined groups and at-risk residential customers,
linking benefits and costs of proposed cost recovery on
vulnerable customers, incentives for vulnerable households to
optimize their use of electricity in time-based pricing
programs, deployment of remote connection/disconnection
functionality in a way that promotes health and safety of
vulnerable customers, and robust consumer education and
outreach.
Direct effectiveness - after the
HIA team provided testimony at a
regulatory hearing, the Illinois
Commerce Commission
supported funding a robust
consumer education system,
maintained the current system
requiring a site visit for
disconnection for non payment,
and determined that metrics
designed to measure the impact of
the technology on vulnerable
populations be developed
Minimum Elements of HIA
Met? If no, what's missing
Yes
G-15
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Table G-2. Continued
ID
40
HIA; Year,
Location
Unhealthy
Consequences:
Energy Costs and
Child Health-A
Child Health
Impact Assessment
of Energy Costs
and the Low
Income Home
Energy Assistance
Program; 2007;
Boston,
Massachusetts
Scope/Summar
Evaluate impacts of both
home heating and total
home energy (including
electricity, water heating,
and cooking) costs and a
federally-funded energy
assistance program -the
Low Income Home Energy
Assistance Program
(LIHEAP) -on the health of
children.
Source of
Evidence
Literature review,
policy review,
special collection
(interviews,
demographics
analysis)
Impacts/
1 ml points
Health (physical,
mental,
developmental),
behavioral,
economic,
services
Pathway of
Impact
Community/ house-
hold economics,
exposure to
hazards, education,
housing, healthcare
access/insurance,
air quality, infect-
ious disease, life-
style, mental health,
nutrition, safety and
security
Characterization of Impact
Direction of impacts (negative
health impacts); Distribution/
equity of impacts (low-income
families have disproportionate
impacts; LIHEAP vulnerable
households); Magnitude of
impacts (number low-income
households with children in
Massachusetts who are likely
LIHEAP eligible; number
children in low-income families
who live be low the poverty line.
and are five years old and
younger)
Decision-making Outcome
Effectiveness of HIA
Current LIHEAP benefits, targeted to especially vulnerable
populations, are helpful, but not sufficient in buffering
families from the impact of high energy costs (although their
situation would be even more precarious without this
assistance). Six recommendations were developed that offer
funding, programmatic, and data collection strategies to avoid
the public health impact of unaffordable energy: 1. Federal
government should fully fund LIHEAP at the maximum
authorized level to allow an increase in both participation and
benefit level; 2. Massachusetts state government should
allocate supplementary funds for LIHEAP to increase benefit
levels for vulnerable Massachusetts families; 3. Extend
outreach to clinicians and health care settings; 4. Consider an
initiative to provide energy and utility assistance, through
LIHEAP or other energy assistance programs, to eligible low-
income families more quickly; 5. Enforce the existing
requirement that utility commissions collect and report data
on arrearages and utility disconnections to the Department of
Telecommunications and Energy; 6. Energy assistance
programs should explore the utility of a home energy
insecurity scale to assess initial and subsequent energy self-
sufficiency of households before and after receipt of energy
benefits, providing a useful evaluation of the impact of these
benefits.
Direct effectiveness - members
of the Working Group presented
their findings to the state
legislature in testimony before the
joint committee on housing; HIA
ultimately contributed to a
decision to increase the level of
funding to the program. Groups
in Rhode Island used the HIA
report to advocate for increased
levels of funding in that state, as
well
Minimum Elements of HIA
Met? If no, what's missing
No; Element 4 (monitoring plan)
missing; permanence and
likelihood of impacts not
considered (Element 2.4); and
sources of funding anonymous
(Element 5)
G-16
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Table G-2. Continued
ID
48
HIA; Year,
Location
A Rapid Health
Impact Assessment
of the City of Los
Angeles' Proposed
University of
Southern California
Specific Plan;
2012; Los Angeles,
California
Scope/Summar
Examine how the proposed
University of Southern
California (USC) Specific
Plan would impact
measures of housing,
gentrification, and
displacement and lead to
changes in health for the
communities around the
USC campus, particularly
low-income and vulnerable
populations.
Source of
Evidence
Literature review,
community
consultation,
policy review,
special collection
(residents panel,
GIS)
Impacts/
1 ml points
Health,
economic,
infrastructure,
demographic
Pathway of
Impact
Air quality,
community/ house-
hold economics,
education, exposure
to hazards, health-
care access/
insurance, housing,
infectious disease,
mental health,
mobility/access to
services, nutrition,
social capital
Characterization of Impact
Direction of impacts (positive
health impacts, negative health
impacts); Likelihood of impacts
(definite impacts, likely
impacts); Distribution/ equity of
impacts (people living close to
USC impacted disproportion-
ately, vulnerable populations
most impacted by displacement
/lack of affordable housing and
increased housing costs without
increase in wages);
Quantification of impact
(indices of gentrification and
displacement)
Decision-making Outcome
Effectiveness of HIA
If the USC Plan was implemented without mitigations, the
HIA found that the result would be a high risk of
gentrification, low vacancy rates, increased housing costs in
the communities that surround the University, and further
displacement of current low-income residents. Twelve
recommendations were developed to mitigate the identified
impacts, including developing an Affordable Housing Trust
Fund, financing the preservation of currently affordable units
whose covenants will expire in the next five to twenty years,
improving the local hiring policies, paying a living wage and
hiring local, nonstudent residents for these jobs.
Direct effectiveness - HIA report
was submitted to the Planning
Commission and Los Angeles
City Council to consider in the
USC Specific Plan decision-
making process; USC agreed to
invest $20 million in affordable
housing, use local and
disadvantaged hiring, increase the
number of net new student beds
on campus, and provide legal
assistance, job
training/placement, and business
assistance
Minimum Elements of HIA
Met? If no, what's missing
No; Element 4 (monitoring plan)
missing; magnitude and
permanence of impacts not
assessed (Element 2.4)
50
Anticipated Effects
of Residential
Displacement on
Health: Results
from Qualitative
Research; 2005;
San Francisco,
California
Examine the Trinity Plaza
Redevelopment, which
proposed to demolish an
older apartment building
with over 360 rent-
controlled units and replace
it with 1,400 market-rate
condominiums and the
potential effects of eviction
on health and well-being of
tenants.
Literature review,
community
consultation,
policy review,
special collection
(focus groups)
Health,
economic
Community/ house-
hold economics,
exposure to
hazards, healthcare
access/insurance,
housing, infectious
disease, mental
health, nutrition,
social capital
Direction of impacts (negative
health impacts); Distribution/
equity of impacts (vulnerable
populations and populations
more impacted identified)
Officials from the Department of City Planning initially
concluded that redevelopment of the site would not have
adverse housing impacts, because the proposal increased the
total number of dwelling units; however, public testimony
from residents/tenant advocates and the results of this study
show otherwise. The health impacts of eviction due to
displacement are real and provide compelling evidence for
preventing the loss of existing affordable housing due to
redevelopment through rent subsidies, targeted maintenance
subsidies to landlords who supply affordable housing [to
prevent demolition]; and general maintenance subsidy to all
landlords to make housing more affordable.
Direct effectiveness - Department
of City Planning revised their
determination for the Trinity
Plaza proposal and required the
environmental impact report to
analyze residential displacement
and indirect impacts on health;
the developer implemented an
alternative that allowed the
current residents to remain and
provided 360 permanently rent-
controlled units
No; Elements 2.3 (health
baseline) and 4 (monitoring plan)
missing; magnitude, likelihood
and permanence of impacts not
addressed (Element 2.4);
conclusions are not transparent &
recommendation does not address
problem facing the study (rather it
addresses the larger problem of
loss of affordable housing;
Element 2.5); and documentation
of funding sources not transparent
(Element 5)
G-17
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Table G-2. Continued
ID
52
HIA; Year,
Location
29th St. /SanPedro
St. Area Health
Impact Assessment;
2009; Los Angeles,
California
Scope/Summar
Ensure that health impacts
were considered in the
development plan for The
Crossings at 29th Street - an
11.6-acre development that
included affordable housing
and retail and community
space - and in the broader
policies impacting
redevelopment in the area.
Source of
Evidence
Literature review,
community
consultation,
policy review,
special collection
(survey,
pedestrian
environment and
public transit field
assessment, GIS)
Impacts/
1 ml points
Health,
infrastructure,
services,
economics,
behavioral
Pathway of
Impact
Education,
healthcare access/
insurance, housing,
land use, mobility
/access to services,
noise pollution,
nutrition, physical
activity, safety and
security, parks and
recreation, social
capital
Characterization of Impact
Direction of impacts (positive
health impacts, negative health
impacts); Likelihood of impacts
(definite impacts, probable
impacts, speculative impacts);
Distribution/equity of impacts
(socioeconomic status of
population in study area;
population over-represented in
pedestrian deaths);
Quantification of impacts
(pedestrian quality assessment)
Decision-making Outcome
Effectiveness of HIA
Found the development had the potential to bring many
benefits to the health and well being of local residents in the
area; however, the HIA offered a number of recommendations
to maximize the positive health impacts and minimize the
negative impacts of the development in the following areas -
housing; pedestrian safety, neighborhood walkability, and
public transit; health services and food retail; education; and
parks and recreation. Also recommended that air quality,
noise, and chemical contamination of groundwater and soil
from industrial sources (not included in the HIA) and their
health impacts should be studied in depth as part of the EIR
process.
Direct effectiveness -the City
Council representative in the area
agreed to implement some of the
HIA recommendations and the
developer agreed to reduce the
cost of housing in future phases
of the development per the HIA
findings; all 450 housing units in
the first phase of development
were categorized as affordable
Minimum Elements of HIA
Met? If no, what's missing
No; Element 4 (monitoring plan)
missing; and permanence and
magnitude of impacts not
assessed (Element 2.4)
57
Lowry Corridor,
Phase 2 Health
Impact Assessment;
2007; Minneapolis,
Minnesota
Analyze the potential health
effects of Phase 2
development of the Lowry
Avenue Corridor Project, a
five-mile thoroughfare
located north of downtown
Minneapolis.
Literature review,
policy review,
other
(demographics
analysis, GIS)
Health,
environmental/
ecosystem,
economic,
infrastructure,
other (social)
Community/house-
hold economics,
mobility/access to
services, housing,
lifestyle, physical
activity, mental
health, nutrition,
safety and security,
social capital, water
quality
Direction of impacts (positive
health impacts, negative health
impacts); Severity (permanence)
of impacts (low, medium or
high); Likelihood of impacts
(probable impacts, possible
impacts, speculative impacts);
Distribution/equity of impacts
(socioeconomic status of
population in area; yes or no to
whether each of the specific
health determinants would have
differential impacts on groups)
Overall, the impacts of the Lowry Corridor Phase 2
construction and redevelopment project were determined to
be positive, with exception of potentially negative impacts
from construction-related access to businesses and property
acquisition. Recommendations were identified for each
determinant of health, along with the coordinating entity(ies)
responsible for implementing the recommendation, where
applicable. The 29 recommendations centered around four
primary themes - social connections, right-of-way design,
stabilizing the neighborhood, and physical activity.
Direct effectiveness - raised the
project manager's awareness of
project health impacts, which led
to successful application for
funding through the Non
Motorized Transportation Pilot
Program to purchase and place
countdown timers at key
intersections, bike racks at key
public buildings, and markers to
encourage pedestrian traffic;
recommended incorporating
HIAs into policymaking and
planning for infrastructure in
Hennepin County
No; Element 2.2 (stakeholder
involvement) missing; unclear
whether best available evidence is
used to judge potential health
impacts and make conclusions
and recommendations (Elements
2.4 & 2.5)
G-18
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Table G-2. Continued
ID
61
HIA; Year,
Location
Hospitals and
Community Health
HIA: A Study of
Localized Health
Impacts of
Hospitals; 2008;
Atlanta, Georgia
Scope/Summar
Built upon the Atlanta
BeltLine HIA to
retrospectively examine the
localized health impacts of
Piedmont Hospital - one of
the major anchor
institutions along the
Peachtree Corridor in
Atlanta, Georgia - and
prospectively examine how
plans for future growth
could change those impacts.
Source of
Evidence
Literature review,
community
consultation,
policy review,
special collection
I (surveys,
walkability audit,
demographic
analysis, GIS)
Impacts/
1 ml points
Health,
environmental,
behavioral,
economic,
infrastructure,
services,
demographic
Pathway of
Impact
Air quality,
community/ house-
hold economics,
healthcare access,
mobility/access to
services, noise
pollution, nutrition,
parks and
recreation, physical
activity, public
health services,
safety and security,
social capital
Characterization of Impact
Direction of impacts (negative
health impacts, positive health
impacts); Distribution of impact
(vulnerable populations
identified and block groups
given a vulnerability rating; two
most vulnerable block groups
directly adjacent to the hospital
may be disproportionately
affected by the negative health
impacts); Quantification of
impacts (vulnerability score of
block groups calculated using 6
indicators)
Decision-making Outcome
Effectiveness of HIA
Taking into account the BeltLine redevelopment corridor
improvements and streetcar projects, the HIA identified a
number of general recommendations to increase opportunities
for health and mitigate negative health impacts, such as level
sidewalks with ample buffers between pedestrians and traffic,
improved lighting, bike lanes with sufficient room for
bicyclists/cars, consideration of pedestrian and bicycle access
when making future decisions regarding hospital planning,
improved communication between the hospital and
community groups, increased transit usage, improved
signage, use of universal design methods to develop safe
connections, improved intersection safety, and improvements
to the pedestrian environment.
General effectiveness - findings
and recommendations were
presented to neighborhood
organizations, city officials, and
county commissioners; residents
took ownership ... and formed a
working group that reached out to
Piedmont Hospital requesting
better community relations and
implementation of the HIA
recommendations; hospital staff
responded positively.. .and are
meeting regularly with the group.
(Source: RWJF)
Minimum Elements of HIA
Met? If no, what's missing
No; Element 4 (monitoring plan)
missing; and magnitude,
likelihood, and permanence of
impacts not judged (Element 2.4)
70
Pathways to
Community Health:
Evaluating the
Healthfulness of
Affordable Housing
Opportunity Sites
Along the San
Pablo Avenue
Corridor Using
Health Impact
Assessment; 2009;
Oakland, California
Assess the health impacts
associated with the San
Pablo Avenue Specific Plan
for three sites proposed to
be included in a campaign
for affordable housing, and
encourage the healthfulness
of the San Pablo Area
Specific Plan and eventual
site development
Literature review,
community
consultation,
special collection
(focus groups,
modeling, food
retail and
pedestrian
environment
evaluations,
HDMT, GIS)
Health,
environmental,
economic,
infrastructure,
services
Air quality, noise
pollution, exposure
to hazards, housing,
mobility/access to
services, education,
nutrition, parks and
recreation, physical
activity, safety and
security,
community
economics, social
capital
Direction of impacts (positive
health impacts, negative health
impacts); Comparison of
impacts by site; Distribution/
equity of impacts (mapping of
proximity measures; populations
sensitive to environmental
noise/air pollution, and access to
community/senior centers;
populations more at risk for
traffic collisions);
Quantification of impacts
(Retail Food Environment Index
score; PM 2.5 concentrations
attributable to roadway traffic;
Pedestrian Environment Quality
Index scores; noise modeling;
mapping of noise contours);
Permanence and Magnitude of
air quality impact (pre-mature
mortality due to PM 2.5
exposure per million population)
Found that the health impacts at the three assessed affordable
housing sites would be similar overall. Slight differences in
impacts were noted for concentrated poverty, violence and
crime, and access to a full service supermarket/community
center. A more significant difference between the sites was
determined for quality of schools (i.e., the Albertsons site
lacks access to high-quality public schools). Provided a
number of recommendations designed to mitigate the
expected adverse health impacts, such as increasing space for
healthy retail and public services, offering reduced-cost
transit passes to residents, incentives for car-sharing,
performing a needs assessment of local park programming,
filling gaps in park access, improving park maintenance and
security, build a new public elementary school to handle the
population growth associated with the plan, incorporating
bike lanes and traffic calming features, implementing
strategies for reducing air and noise impacts, and
implementing mixed-use development.
Undetermined, but general
effectiveness assumed - a letter to
City Council and city staff with
health-based recommendations
was considered during revisions
to the Draft San Pablo Avenue
Specific Plan to incorporate all
public comments to date
No; Element 4 (monitoring plan)
missing; likelihood of impacts not
assessed and permanence and
magnitude only assessed for air
quality impacts (Element 2.4)
G-19
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Table G-2. Continued
ID
76
HIA; Year,
Location
A Rapid Health
Impact Assessment
of the Long Beach
Downtown Plan;
2011; Long Beach,
California
Scope/Summary
Ensure decisions in the City
of Long Beach Downtown
Plan and Long Beach
Downtown Plan
Environmental Impact
Report account for impacts
to low-income and
vulnerable populations in
the areas of housing and
employment.
Source of
Evidence
Literature review,
policy review,
special collection
(demographics
analysis, GIS)
Impacts/
1 ml points
Health
Pathway of
Impact
Housing,
community/ house-
hold economics,
exposure to
hazards, noise
pollution, mental
health
Characterization of Impact
Direction of impacts (negative
health impacts); Likelihood of
impacts (definite impacts,
probable impacts); Distribution/
equity of impacts (lower SES
and minority populations
disproportionately impacted)
Decision-making Outcome
Effectiveness of HIA
Found that the Long Beach Downtown Plan the Downtown
Plan did not identify housing or employment mitigation
measures to offset the Plan's significant health impacts, nor
did it accommodate the needs of Long Beach's most
vulnerable residents. Recommended adoption of the
Affordable Housing Community Benefits (addition of 511
very low income apartments and 375 moderate income
condominiums) and Local Hiring Community Benefits and
Project Labor Agreements (hiring preference and
requirements for local lower and moderate income residents
leading to increases in income, improved job autonomy and
reduced unemployment and poverty) proposed by the Long
Beach Downtown Plan Community Benefits Analysis.
None - HIA findings were used
to advocate for changes in the
proposed Downtown Plan, but the
Long Beach City Council
approved the Plan without taking
into account the findings and
recommendations in the HIA
Minimum Elements of HIA
Met? If no, what's missing
No; Element 4 (monitoring plan)
is missing
80
HOPE VI to HOPE
SF San Francisco
Public Housing
Redevelopment: A
Health Impact
Assessment; 2009;
San Francisco,
California
Explore the positive and
negative health impacts of
past Housing Opportunities
for People Everywhere
(HOPE) VI redevelopment
at two sites - Bernal
Dwellings and North Beach
Place - with the aim of
finding opportunities to
address existing problems
and informing future public
housing redevelopment in
the HOPE SF Program.
Literature review,
policy review,
community
consultation,
special collection
(interviews,
surveys,
demographics
analysis,
modeling, GIS)
Health,
behavioral,
infrastructure,
services
Housing, mobility/
access to services,
safety and security,
physical activity,
social capital,
public participation,
exposure to
hazards, nutrition,
air quality
Direction of impacts (positive
health impacts, negative health
impacts); Likelihood of impacts
(definite impacts); Distribution/
equity of impacts (socio-
economic status of public
housing population; population
likely to be impacted
disproportionately from
displacement; population
sensitive to availability of
affordable housing);
Quantification of impacts
(modeled traffic noise levels and
particulate matter 2.5 emissions
and associated health impacts)
Provided a long list of recommendations to improve health at
the HOPE VI sites, as well as additional recommendations for
on-going HOPE SF redevelopment. HOPE VI
recommendations were provided in the following areas:
healthy housing and environmental health, displacement,
social cohesion, crime and safety, youth programs and
services, and healthy eating and active living. Select HOPE
SF recommendations included broad stakeholder participation
in discussions of how to improve health and address existing
health disparities; design elements to improve safety; use
high-quality healthy building materials; redevelop in stages to
minimize the disruption associated with relocation; ensure
adequate space, programming, and access to healthy foods
and opportunities for active living; be mindful of the diversity
of the residents; and listen to the residents.
General effectiveness at a
minimum, but direct effectiveness
assumed - HIA was included in
the City and County of San
Francisco's discussions about
HOPE SF; particularly HIA
results were used in discussions
around social cohesion,
displacement, programs and
services, and crime in the HOPE
SF process
No; magnitude and permanence
of impacts not assessed (Element
2.4)
G-20
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Table G-3. Summary Table of Select Data from HIAs in the Land Use Sector
ID
HIA; Year;
Location
Health Impact
Assessment - Derby
Redevelopment,
Historic Commerce
City, Colorado;
2007; Historic
Commerce City,
Colorado
Scope/Summar
Evaluate potential impact of
Derby's redevelopment on
physical activity and
nutrition behaviors of the
population of historic
Commerce City.
Source of
Evidence
Literature review,
community
consultation,
policy review,
special collection
(consultants,
walkability study,
traffic assessment,
Photo Voice,
community
forums, survey,
demographics
analysis, GIS)
Impacts/
1 ml points
Health,
behavioral,
infrastructure,
demographic
Pathway of
Impact
Safety and security,
physical activity
and fitness,
nutrition, land use,
social capital
Characterization of Impact
Direction of impacts (positive
health impacts); Magnitude of
impacts (variable, high);
Likelihood of impacts (definite
impacts, probable impacts,
speculative impacts);
Distribution/equity of impacts
(impacts evaluated on residents
of Derby and the surrounding
Commerce City; universal
design favorable for all
demographic groups)
Decision-making Outcome
Effectiveness of HIA
Supported redevelopment plans for Derby, Colorado and
concluded that the Derby Sub-Area Master Plan, Planned
Unit Development zoning ordinance, and Design Guidelines
would create physical conditions in Derby that foster active
living, and to a lesser extent, healthy eating. Recommended a
phased implementation, preparing a bicycle and pedestrian
master plan, integrating green space and open space into
existing plans, establishing a Clean and Safe Initiative,
promoting affordable housing with universal design features,
upgrading transit service and transit facilities, and developing
an implementation plan for elements of the redevelopment
that are within city control.
General effectiveness assumed at
a minimum - the Health
Department's full participation
was invited in the redevelopment
team
Minimum Elements of HIA
Met? If no, what's missing
No; Element 4 (monitoring plan)
missing
Health Impact
Assessment Report:
Alcohol
Environment -
Village of Weston,
WI; 2011; Village
of Weston,
Wisconsin
Assess the impact of an
alcohol policy on the
community's health,
specifically underage
drinking and drinking and
driving behaviors. While
there was no specific policy
under review at the onset of
the project, the potential
impacts of a retail outlet
density policy, specifically a
limit on future Class A
alcohol licenses, on
community health and
development were assessed.
Literature review,
policy review,
community
consultation,
special collection
(stakeholder
interviews, focus
groups, modeling,
community
surveys, GIS,
photomapping,
demographics
analysis)
Health,
behavioral,
economic, other
Land use (alcohol
outlet density),
lifestyle, safety and
security, policy
(alcohol access)
Impact of proposed alcohol
outlet density policy
implementation on alcohol
consumption, underage
drinking, drinking and driving:
Direction, Permanence and
Magnitude of impacts (positive,
moderate impact on medium
number of people); Likelihood
of impacts (probable impacts);
Distribution/equity of impacts
(populations impacted more,
uncertain); Quality of evidence
(many strong studies, one or two
good studies); Projected
outcomes and impacts (positive
or no effect) of policy
implementation on indicators
outlined in scoping phase
Data provided evidence that alcohol density not only impacts
alcohol consumption, but also underage drinking and drinking
and driving behaviors. Positive impacts of alcohol (social
connection and revenue source) outweighed by the negative
impacts (health, disease, injury, death, etc). Primary
recommendations included: a moratorium on future Class A
alcohol licenses, development of a Policy Exemption
Committee, and development of an Alcohol License Review
Board. Secondary recommendations included gathering
consistent health related data among youth in the school
district (i.e., CDC Youth Risk Survey), and gaining support of
the Marathon County Board of Health for future HIA projects
within the County.
Undetermined -
recommendations were presented
to the Village Board, residents,
alcohol prevention professionals
in Wisconsin, and the Marathon
County Board of Health, but no
evidence of a policy change being
considered by the Board to date;
regardless of a decision to adopt
the recommendations, the HIA
was successful in building
important relationships to further
the discussion about alcohol
misuse prevention in the
community
Yes; although funding source not
clearly identified
G-21
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Table G-3. Continued
ID
HIA; Year;
Location
Eastern
Neighborhoods
Community Health
Impact Assessment
Final Report; 2007;
San Francisco,
California
Scope/Summar
Assess the health benefits
and burdens of
development, land use
plans, and zoning controls
in several San Francisco
neighborhoods, including
the Mission, South of
Market, and Portero Hill.
Source of
Evidence
Literature review,
community
consultation,
policy review,
special collection
(interviews, focus
groups, surveys,
HDMT, GIS)
Impacts/
1 ml points
Health,
environmental/
ecosystem,
behavioral,
economic,
infrastructure,
services,
demographic
Pathway of
Impact
Environmental
stewardship, safety
and security,
mobility/ access to
goods and services,
social capital,
housing,
community/ house-
hold economics,
infrastructure, land
use, community
participation, noise
Characterization of Impact
N/A; HDMT tool developed out
of the ENCHIA process can be
used to quantify and prioritize
impacts of development on
health
Decision-making Outcome
Effectiveness of HIA
A formal assessment of the development plans was not
completed due to delays in the planning process; however, the
ENCHIA process concluded with the creation of San
Francisco's Healthy Development Measurement Tool
(HDMT) for future plan and project evaluation - a set of
metrics to assess the extent to which urban development
projects, plans, and policies affect health.
General effectiveness at a
minimum, but direct effectiveness
assumed - San Francisco
Planning Dept committed to
using the HDMT indicators and
development criteria, where
possible, in developing the
Eastern Neighborhood rezoning
and area plans; the HIA
broadened participant
understanding of how
development affects health and
created a practical tool (HDMT)
for evaluating the health impacts
associated with development.
Minimum Elements of HIA
Met? If no, what's missing
No; due to delay in development
planning, Elements 2.4-4
(judgement of impacts, synthesis
of evidence, recommendations,
and monitoring plan) unable to be
completed
10
Health Impact
Assessment: An
Analysis of
Potential Sites for a
Regional
Recreation Center
to Serve North
Aurora, Colorado;
2010; North
Aurora, Colorado
Inform a policy decision
about the specific location
of a regional recreation
center in North Aurora,
identify impacts to health,
and provide
recommendations for the
Aurora Residents for
Recreation Task Force
(ARRTF), City Planners,
and City Council.
Literature review,
special collection
(survey,
demographics
analysis, GIS)
Health,
behavioral,
economic,
services
Physical activity,
mobility/access to
services, safety and
security, social
capital, community
economics
Direction of impacts (positive
health impacts); Likelihood of
impacts (definite impacts);
Magnitude of impacts (portion
of population that would benefit
based on proximity);
Distribution/equity of impacts
(area deficient in recreational
space and with a high
percentage of demographic
groups at risk for disease and
getting too little physical
activity)
Concluded that a new regional recreation facility in North
Aurora will have a positive health impact on the community.
In light of the health disparities and potential cost to the City
to provide equitable access to all North Aurora residents, the
Fitzsimons Centerpiece site was recommended for the
recreation facility (after the ideal location was determined to
be unviable because owners were not willing to sell or lease
the property). Also provided a list of recommended criteria to
be incorporated regardless of which site is selected, as well as
site-specific recommendations.
Undetermined - the location
recommended by the HIA was
later determined not to be a viable
option and therefore was not the
chosen site for the recreational
facility; it is not apparent,
however, whether any of the site
specific recommendations from
the HIA were implemented in the
design, many of which related to
access (specifically for north
Aurora residents)
No; Elements 2.2 (stakeholder
input) and 4 (monitoring plan)
missing; evidence of a scoping
phase not apparent (Element 2.1);
permanence of impacts not
assessed (Element 2.4); and
funding and roles not transparent
(Element 5)
G-22
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Table G-3. Continued
ID
13
HIA; Year;
Location
St. Louis Park
Comprehensive
Plan - Health
Impact Assessment;
2011; St. Louis
Park, Minnesota
Scope/Summar
Assess the St. Louis Park
Comprehensive Plan to
ensure that public health is
considered within the plan.
Source of
Evidence
Policy review,
special collection
(GIS)
Impacts/
1 ml points
Health,
environmental/
ecosystem,
behavioral
Pathway of Impact Characterization of Impact
Air quality, water
quality, land use,
parks and recrea-
tion, physical acti-
vity, nutrition,
housing, mobility/
access to services,
safety and security,
exposure to hazard,
social capital, health-
care access/ insur-
ance, noise pollution
Direction of impacts (positive
health impacts); Distribution/
equity of impacts (populations
most vulnerable to lead
toxicity); Quantitative analysis
for established benchmarks
(buffer analysis/proximity
measures; total market value
for housing compared to
average median income level)
Decision-making Outcome
Overall, the Comprehensive Plan embraced public health
throughout its respective chapters. The HIA provided
recommendations (for incorporation into the City's Compre-
hensive Plan or other planning initiatives) to ensure health is
addressed in planning efforts; they fall into three categories:
Physical Activity and Access to Healthy; Personal Health and
Safety; and Neighborhood/Community Health. Recommend-
ations touched on maintaining tree canopy/views of greenery,
park and trail accessibility, pedestrian lighting, buffering
major roads from sensitive uses, access to healthy food,
housing affordability, protection from air/ water pollution,
transit accessibility, and adopting complete streets policy.
Effectiveness of HIA
General effectiveness at a
minimum, although direct
effectiveness possible -the report
was presented to the Planning
Commission and adopted as a
planning tool for consideration
when updating the
Comprehensive Plan
Minimum Elements of HIA
Met? If no, what's missing
No; Elements 2.2 (stakeholder
input) and 2.3 (baseline health
conditions) missing (although
stakeholder involvement not part
of desk-based HIAs); magnitude,
likelihood, and permanence of
impacts not assessed (Element
2.4); and does not adequately
acknowledge sources of data
(Element 2.5)
15
Health Impact
Assessment: Key
Recommendations
of the Northeast
Area Plan;
Unknown (possibly
2007); Columbus,
Ohio
Evaluate the six key
recommendations of the
City of Columbus Northeast
Area Plan with respect to
physical activity for the
residents of the Northeast
Literature review
Health,
behavioral,
environmental
Physical activity;
secondary pathways:
air quality, social
capital, safety and
security, mobility/
access to services,
parks and recreation
Direction of impacts (positive
health impacts; long term
outcomes)
Recommended specific implementation strategies or features
of each of the six key Area Plan recommendations that foster
physical activity, including mixed-use planning and complete
street tactics that capitalize on existing community centers,
job centers, parks, and bike trails; and urban design
components that emphasize pedestrian access and aesthetics.
Undetermined - the HIA was the
beginning of a working
relationship between two City of
Columbus departments (Public
Health and Planning), and per the
HIA, the relationship is just as
important as the results of the
HIA itself
No; Elements 2.2 (stakeholder
involvement) and 4 (monitoring
plan) missing; magnitude, perm-
anence, likelihood, distribution of
impacts not assessed (Element
2.4); baseline health conditions/
affected populations not
addressed very well (Element
2.3); documentation of funding
sources and HIA point-of-contact
not transparent (Element 5)
16
Yellowstone
County/City of
Billings Growth
Policy Health
Impact Assessment;
2010; Yellowstone
County, Montana
Take a retrospective look at
the Growth Policy that was
adopted in 2003 in order to
identify ways to make
health a part of the decision
making process regarding
community growth by
predicting health conse-
quences, informing decision
makers and public about
health impacts, and provi-
ding realistic recommend-
ations to prevent/ mitigate
negative health outcomes.
Literature review,
community
consultation,
policy review,
special collection
(focus groups,
experts)
Health, services
(emergency
responders),
infrastructure,
economic
Physical activity,
safety and security,
social capital,
nutrition, mobility/
access to services,
housing, community/
household econom-
ics, land use
Direction of impacts (each
Growth Policy strategy was
evaluated as a positive,
negative, or no effect health
strategy); Distribution/equity
of impacts (differences in
access to affordable/nutritious
foods and services by
socioeconomic status [e.g.,
food deserts]; populations least
likely to meet physical activity
recommendations)
Identified key strengths and weaknesses of the Growth Policy
as it pertains to health. Recommendations were provided in
several areas that could increase positive health outcomes and
decrease or mitigate negative health outcomes - emergency
preparedness, access to healthy foods, pedestrian and traffic
safety, physical activity, social capital, safety and crime,
affordable housing, and living wage jobs - and a
recommendation made to incorporate a Community Health
section in the revised 2008 Growth Policy.
Direct effectiveness -
recommendations were provided
to the governing bodies of the
Growth Policy for use during the
revision process and ultimately
all recommendations were
implemented with minor changes;
health outcome evaluation to be
conducted in 2011
No; magnitude, likelihood and
permanence of impacts not
assessed (Element 2.4)
G-23
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Table G-3. Continued
ID
18
HIA; Year;
Location
Knox County
Health Department
Community Garden
Health Impact
Assessment:
Recommendations
forLonsdale, Inskip
and Mascot;
Unknown; Knox
County, Tennessee
Scope/Summar
Inform policy decisions
related to the placement and
maintenance of community
gardens in Knox County,
Tennessee and to
objectively present the facts
surrounding community
gardens and why zoning
code should be changed if
needed in order to support
their placement within
residential and
nonresidential communities
Source of
Evidence
Literature review,
policy review,
special collection
(demographics
analysis)
Impacts/
1 ml points
Health,
behavioral,
economic
Pathway of
Impact
Land use, nutrition,
mobility/access to
services, social
capital, commun-
ity/household
economics, safety
and security
Characterization of Impact
Direction of impacts (positive
health impacts); Distribution/
equity of impacts (food
availability, affordability, and
justice for economically
disadvantaged; all three pilot
neighborhoods are of low
socioeconomic status)
Decision-making Outcome
Effectiveness of HIA
Community gardens offer many benefits (enhanced nutrition
and physical activity), but there are challenges involved
(zoning, siting, water access, security, and community
interest). Lonsdale and Inskip were determined to be best
suited for community gardens out of the three pilot
neighborhoods because both are tight-knit communities with
ample water sources and sidewalks that provide easy access
to the garden site. Going forward, the HIA recommended that
areas of below average food access/availability and low SES
be identified on a county-wide basis to prioritize selection of
communities for community gardens. General
recommendations included: siting gardens in food deserts to
increase food access and availability; siting gardens in low
SES communities to increase food affordability and food
justice; siting gardens near water access; and siting gardens
near gardeners
Direct effectiveness - upon
presentation of the HIA report,
the zoning was changed to
support the placement of gardens
in designated areas of Knox
County
Minimum Elements of HIA
Met? If no, what's missing
No; Elements 2.2 (stakeholder
involvement) and 4 (monitoring
plan) missing; the presence of a
scoping phase (Element 2.1) not
evident; and magnitude,
likelihood, and permanence of
impacts not assessed (Element
2.4)
19
Alaska Outer
Continental Shelf -
Beaufort Sea and
Chukchi Sea
Planning Areas, Oil
and Gas Lease
Sales 209, 212,
217, and 221 Draft
Environmental
Impact Statement;
Appendix J - Public
Health; 2008;
Alaska
Examine the health impacts
of the proposals for oil and
gas leasing in the Beaufort
and Chukchi seas, as well as
the 10 alternatives to these
proposed actions addressed
intheEIS.
Literature review,
policy review,
community
consultation,
special collection
(interviews,
modeling)
Health,
environmental/
ecosystem,
behavioral, other
(cultural),
economic
Production active-
ties; air quality;
water quality; oil
spill cleanup;
habitat loss; seismic
survey; community/
household econo-
mics; vessel and
aircraft noise
pollution; climate
change; secondary
impacts: social
capital, safety and
security, nutrition,
exposure to
hazards, infectious
disease, lifestyle,
physical activity,
mobility/access to
services; visuo-
spacial changes
Direction of impacts (negative
health impacts, positive health
impacts); Distribution/equity of
impacts (impacts on native
Alaskans and vulnerabilities of
population); Magnitude of
impacts (negligible, minor,
moderate, major); Likelihood of
impacts (potential impacts,
anticipated impacts, cumulative
impacts); Permanence of
impacts (timeline/extent of some
impacts noted)
The No Action Alternatives would have no direct/indirect
impacts to public health, but relative to the alternatives that
involve oil and gas leasing, would offer the least revenue and
employment. Identified a number of health effects for the
other alternatives, which involved oil and gas leasing to
different extents. Subsistence harvest disruptions were a
major concern and could impact general health and wellbeing,
diet and nutrition, injury rates, and rates of chronic diseases.
Identified standard mitigation measures assumed to be in
place from existing government policies/programs, as well as
potential new mitigation measures recommended to address
newly identified health effects associated with the alternatives
in the EIS. New mitigation measures included public health
baseline assessment and health monitoring; subsistence and
nutrition monitoring/mitigation; air quality baseline
assessment, modeling, monitoring, and mitigation; best
practices to prevent OCS discharges; socioeconomic
monitoring and mitigation; health impact evaluation for siting
of on-shore infrastructure; and noise related monitoring and
mitigation.
General effectiveness assumed -
one of the first examples of a U.S.
federal agency including
information from HIA in an EIS;
MMS agreed to consider
mitigation measures in the HIA
for this and other region-specific
EIS; Arctic lease sales were
cancelled in March 2010 after a
ruling that the 2007-2012 national
offshore oil and gas leasing
program did not properly evaluate
environmental sensitivity or
benefits/risks of development;
Beaufort and Chukchi leases
possible in new leasing program,
with areas important to the
environment and/or subsistence
conditions excluded
No; Element 4 (monitoring plan)
missing; and documentation of
funding sources not transparent
(Element 5)
G-24
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Table G-3. Continued
HIA; Year; Source of Impacts/ Pathway of
ID Scope/Summary Characterization of Impact Decision-making Outcome
Location Evidence 1 ml points Impact
20
21
Divine Mercy
Development
Inform recommendations on Literature review, Health, Air quality, land Direction of impacts ; Recommended actions to reduce or eliminate the health
incorporating health and policy review, environmental/ use, mobility/access Distribution/equity of impacts impacts of the Divine Mercy Development, such as
Health Impact climate change indicators special collection
Assessment; 2011; into the Minnesota (demographics
Fairbault, Environmental Assessment analysis, GIS)
Minnesota
Fort McPherson
Worksheet (EAW) used in
the environmental review
process.
As part of a project to bring Literature review,
Rapid Health a Health in all Policies community
Impact Assessment: (HiAP) perspective into the consultation),
ecosystem
Health
Zoning for Health baseline realignment and special collection
Benefit to
Surrounding
Communities
closure process for Fort (windshield tours,
McPherson and assessed the meetings, GIS)
zoning provisions that
During Interim govern permitted uses of
Use; 2010; Atlanta, land, green space, and
Georgia
transportation to gauge their
effect on health.
to services, water (populations vulnerable to monitoring the adjacent feedlot for air quality issues, higher
quality, safety and certain climate change-related residential/commercial densities, sufficient pedestrian
security, housing, health impacts ; park proximity infrastructure, housing for renters and those below median
nutrition, noise and physical activity; benefits of household income, recreational facilities and bike trails, 40%
pollution, parks and public transit for disadvantaged tree canopy, incorporating transit service, tracking accidents
recreation, trees and populations; vulnerable to identify problem intersections, incorporating grocery store
vegetation, physical populations to noise pollution) and community garden features, and additional storm water
activity, social
capital
Land use, nutrition,
management features. The HIA found health indicators in the
categories of air quality, water, and noise were thoroughly
analyzed in the EAW; those in the categories of housing,
food, and safety were almost entirely absent; and the
transportation, parks, land development, and trees and
vegetation categories were discussed, but not thoroughly
analyzed. General recommendations on incorporating public
health and climate change indicators into the EAW were to be
included in a separate report.
Direction of impacts (positive Redevelopment may result in positive health impacts for the
physical activity, health impacts, negative health surrounding communities and eventually new residents, but
lifestyle, social impacts); Likelihood of impacts interim use of the property could have a crucial impact on
capital (speculative impacts, possible community health. Recommended some enhancements to
impacts, probable impacts, promote positive impacts during this time, including
definite impacts); permitting community gardens, small-scale farming, and
Distribution/equity of impacts farmers markets in green space and designated areas;
(health impacts of green space permitting the use of existing facilities for meetings and
connectivity and accessibility on programming; limiting fast food restaurants and
certain populations); Strength of establishments that serve or sell alcoholic beverages; limiting
evidence outdoor and storefront advertising; enforcing federal policy
prohibiting tobacco advertising in the vicinity of schools,
parks, and playgrounds; and prohibiting bars/restaurants that
do not support the state tobacco policy.
L^^^^^^^^^^^^^^H^^^^^^^^^H
Minimum Elements of HIA
Effectiveness of HIA . .
Met: It no, what's missing
Undetermined - HIA Report No; Elements 2.2 (stakeholder
provided to Divine Mercy input) and 4 (monitoring plan)
Development and separate report missing; and magnitude,
on incorporating health and likelihood, and permanence of
climate change in the EAW impacts not assessed (Element
process presented to MN 2.4)
Environmental Quality Board, but
impact unknown
General effectiveness at a No; Elements 2.3 (baseline health
minimum, although direct conditions) and 4 (monitoring
effectiveness possible -the plan) missing; and magnitude and
design contract has a requirement permanence of impacts not
to consider Health in all Policies assessed (Element 2.4)
(HiAP) and the preliminary
redevelopment design includes
better connectivity and the
addition of athletic fields and a
grocery store; not evident
whether this was a direct impact
of the HIA or the greater HiAP
effort in general
G-25
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Table G-3. Continued
ID
22
HIA; Year;
Location
Re: November 10th
Merced County
General Plan
Update (MCGPU)
Preferred Growth
Alternative
Decision; 2009;
Merced County,
California
Scope/Summar
Examine the two growth
alternatives being
considered for the Merced
County General Plan
Update - one that focused
development in existing
urban areas and another that
would allow for the creation
of new towns in the county
- and associated health
impacts.
Source of
Evidence
Literature review,
policy review
Impacts/
1 ml points
Health,
environmental,
economic
Pathway of
Impact
Mobility/access to
retail and services,
physical activity,
social capital,
safety and security,
nutrition, land use,
community/househ
old economics,
water
quality/availability,
climate change, air
quality, exposure to
hazards
Characterization of Impact
Direction of impacts: Growth in
existing urban areas (positive
health impacts); Developing
new towns (negative health
impacts); Likelihood of impacts
(definite impacts, probable
impacts, speculative impacts)
Decision-making Outcome
Effectiveness of HIA
Identified links between development decisions and health,
existing conditions related to health in Merced County, and
ways that the General Plan Update growth scenario
alternatives would potentially impact health outcomes for
current and future county residents. Recommended focusing
population growth and development in areas where there is
existing urban development, infrastructure, and municipal
services; promoting higher residential densities in urban
areas; and implementing a Tax Revenue Sharing Agreement
between Merced County and the six area cities.
None - though letters were sent
to the Board of Supervisors and
public comment favored the
option of growth in already
developed areas, decision-makers
ultimately selected a development
option that was not found by the
HIA to be the healthiest
Minimum Elements of HIA
Met? If no, what's missing
No; Elements 3
(recommendations /mitigations),
4 (monitoring plan), and 5
(transparent documentation)
missing; input of stakeholders not
solicited in HIA (Element 2.2);
magnitude, distribution, and
permanence of impacts not
assessed (Element 2.4);
assumptions, strengths, limits not
identified (Element 2.5)
24
SE 122nd Avenue
Planning Study
Health Impact
Assessment; 2011;
Portland, Oregon
Evaluate both the health
impacts of the SE 122nd
Avenue Pilot Project
recommendations
themselves, as well as the
health impacts of the 20-
minute neighborhood form.
Literature review,
community
consultation,
special collection
(demographics
analysis, field
visits/site
observations,
surveys,
modeling, GIS)
Health,
environmental
Physical activity,
land use, mobility/
access to services,
parks and open
spaces, air quality,
safety and security,
social capital,
nutrition
Likelihood of impacts (only
intended/likely impacts
addressed); Direct and indirect
impacts; Direction of impacts
(positive health impacts,
negative health impacts);
Magnitude of impacts (portion
of population affected);
Distribution/equity of impacts
(impact on vulnerable
populations; groups most likely
to be adversely impacted by
exposure to outdoor air toxics)
Found that most of the pilot study's recommendations would
directly or indirectly improve physical activity, bicycle/
pedestrian safety, and social cohesion (and vulnerable groups
would generally share in these positive benefits), but also
have the potential for both positive and negative impacts to
exposure to outdoor air pollutants and food access.
Recommendations included prioritizing improvements in
pedestrian and bicycle infrastructure/connectivity; involving
immigrant groups and communities of color in
designing/improving public spaces; addressing concerns of
low-income/minority transit riders; developing a pro gram to
monitor changes in outdoor air toxics; conduct a Community
Food Assessment; identifying and recruiting business that
provide gathering space and healthy food retail; developing a
"healthy food zone" ordinance, etc.
Undetermined, but general
effectiveness assumed at a
minimum - efforts were made to
integrate health information and
stakeholders into the pilot project
prior to the HIA
No; Element 4 (monitoring plan)
is missing; and permanence of
impacts (Element 2.4) not
assessed
G-26
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Table G-3. Continued
ID
26
HIA; Year;
Location
Health Impact
Assessment:
Hawai 'i County
Agriculture
Development Plan;
2012; Hawaii
County, Hawaii
Scope/Summar
Evaluate the potential
positive and negative
impacts of three Agriculture
Plan policies - institutional
buying (farm-to-school
programs), commercial
expansion of food
agriculture, and home
production -on the health of
Hawaii Island residents.
Source of
Evidence
Literature review,
community
consultation,
policy review,
special collection
(surveys, expert
consultation,
accessing
unpublished data,
modeling, focus
groups)
Impacts/
1 ml points
Health,
economic,
environmental
Pathway of
Impact
Nutrition, food-
borne illness,
community/house-
hold economics,
cultural connected-
ness, environmental
stewardship/ecosys-
tem sustainability
Characterization of Impact
Direction of impacts (positive
health impacts, negative health
impacts); Magnitude and
Likelihood of impacts (based on
policy implementation -
negligible, small impact on few,
moderate impact on many or
strong impact on few, strong
impact on few or small impact
on many, strong impact on
many); Distribution/equity of
impacts (populations most
affected and disproportionate
burden of obesity); Quality of
evidence
Decision-making Outcome
Effectiveness of HIA
Found that expansion of Farm-to-School programs would
improve food security and nutritional quality and create jobs
in agriculture/food processing; increased production of fresh
food for the local market would improve community food
security and nutritional quality and create jobs, increase farm
output, and increase farm earnings/state tax revenues; and
promotion of home gardening would have a large impact on
improving food security and nutrition security (particularly
among low-income Hawaii County residents), increase
consumption of fruit and vegetables, increase physical
activity, and improve individual well-being and community
cultural connectedness. Provided a number of
recommendations for each Agricultural Plan policy, but
highlighted two recommendations: expanding Hawaii Island
food production so that 30% of food demand can be supplied
locally by 2020; and promoting and supporting educational
programs for agricultural industry participants.
Direct effectiveness - staff
members met with the Office of
Planning during the strategy
development period and made
additional specific suggestions
during the draft review period; all
of the key issues and most of the
HIA recommendations were
included in the final state strategy
documents
Minimum Elements of HIA
Met? If no, what's missing
Yes
29
Case Study:
Bloomington Xcel
Energy Corridor
Trail Health Impact
Assessment; 2008;
Bloomington,
Minnesota
Assess potential health
impacts and obstacles to the
proposed Xcel recreational
trail corridor and support for
including the Xcel trail
corridor in the Alternative
Transportation Plan
Community
consultation
Health,
environmental
Safety and security,
mobility/access to
services, social
capital, physical
activity, water
quality, air quality,
land use
Direction of impacts (positive
health impacts); Distribution/
equity of impacts (sectors of the
community that would utilize or
be affected most by the trail)
Found that the Xcel powerline corridor was suitable for
use as a trail corridor and that impacts on health would be
positive. Recommended enhancements: safety measures (e.g.,
lighting, and police presence); amenities (e.g., benches,
bathrooms, bike facilities, and quiet spaces); landscape design
(e.g., community gardens and vegetation buffers); community
involvement initiatives; traffic enhancements (e.g., traffic-
calming measures; and other actions, such as funding and
drawing on existing community trail examples.
General effectiveness - raised
awareness among policy makers;
fully documented the results of
the HIA workshop outcomes in
the Alternative Transportation
Plan
No; Elements 2.3 (baseline health
conditions), 2.5 (documentation
of data sources, assumptions,
strengths, limitations) and 4
(monitoring plan) missing; and
magnitude, likelihood, and
permanence of impacts not
assessed (Element 2.4)
G-27
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Table G-3. Continued
ID
31
HIA; Year;
Location
Health Impact
Assessment for
Proposed Coal
Mine at Wishbone
Hill, Matanuska-
Susitna Borough
Alaska (DRAFT);
2012; Matanuska-
Susitna Borough,
Alaska
Scope/Summar
Review potential positive
and negative human health
impacts related to the
proposed Wishbone Hill
Mine (WHM) - a surface
coal mine located in the
Matanuska-Susitna valley
near Sutton, Alaska.
Source of
Evidence
Literature review,
community
consultation,
policy review,
special collection
(focus groups, risk
assessments,
demographics
analysis,
modeling, GIS)
Impacts/
1 ml points
Health,
environmental/
ecosystem,
economic, other
(social, cultural,
spiritual)
Pathway of
Impact
Community/house-
hold economics,
social capital,
safety and security,
exposure to
hazards, noise
pollution, air
quality, water
quality/quantity,
soil quality,
nutrition, lifestyle,
healthcare access,
mobility/access to
services, cultural/
spiritual, habitat,
visual effects, solid
waste
Characterization of Impact
Direction of impacts (positive
health impacts, negative health
impacts); Distribution of
impacts (Zone 1, 2, 3, & 4 based
on proximity); Equity of
impacts (identification of
potentially impacted
communities that meet CEQ
definitions of minority or low-
income population; populations
susceptible to air pollution);
Likelihood of impacts (high,
medium, low); Exposure
assessment (particulate matter,
chemicals of potential concern
in air and water, vapors);
Toxicity assessment
Decision-making Outcome
Found the mine would have both positive and negative health
impacts, but significant data gaps existed prohibiting the full
fate-transport and social impacts from being quantified. These
health effect categories required the highest priority attention
- exposure to hazardous materials; water and sanitation;
social determinants of health; food, nutrition, and subsistence
activity; non-communicable disease; infectious disease; and
accidents/injuries. Mitigation recommendations, included: a
review of best practices; a stakeholder engagement/
communications strategy; air permit requirements for fugitive
dust control and monitoring; expanded exposure receptor grid
modeling and modeling/monitoring of deposition mode,
diesel exhaust particulates, groundwater/surface water
monitoring; a transport safety study/risk analysis for major
routes; medical emergency response plans and drills;
traditional/local knowledge surveys; review subsistence
activities in the area; monitor water quality and quantity
effects; and monitor local hospital emergency room visits and
discharge data.
Effectiveness of HIA
Undetermined - public comments
collected on draft HIA and are
being incorporated into the final
HIA; it appears no further steps
have been taken to move forward
on the coal mine (e.g., the
required air permit application),
but the Matanuska Susitna
Borough Assembly ignored the
requests of local health
professionals, coalition partners
and concerned citizens asking
them to pass a resolution that
would require a Comprehensive
Health Impact Assessment
Minimum Elements of HIA
Met? If no, what's missing
No; Element 4 (monitoring plan)
missing; magnitude and
permanence of impacts not
addressed (Element 2.4); and
funding sources not transparent
(Element 5)
34
City of Ramsey
Health Impact
Assessment; 2008;
Ramsey, Minnesota
Assess the potential health
impacts of current city
planning practices, set goals
for improvement, and
develop future policy
directions in conjunction
with the 2008 City of
Ramsey Comprehensive
Plan update.
Literature review,
policy review,
special collection
(threshold scoring,
GIS)
Health,
environmental,
Air quality,
exposure to
hazards, land use,
housing, mental
health, mobility/
access to services,
parks and
recreation,
nutrition, safety and
security, social
capital, water
quality, physical
activity
Impacts not characterized/
judged - only current
achievement of thresholds
scored
Found that the best scoring indicators were for air quality,
housing quality, mental health, safety, and social capital;
access to transit/densities to support transit, close
retail/supermarket opportunities, urban services, and an
extensive sidewalk/trail system were limited. Recommended
future planning efforts focus on areas that are realistic to
improve upon by policy makers for city development (i.e.,
land use planning to improve the city's health threshold
measures). Recommendations included items such as securing
a stop on the Northstar commuter rail, implementing zoning
changes, requiring tree canopy and buffer zones, adopting a
Complete Streets policy, etc.
Direct effectiveness -
recommendations from the HIA
were used to provide many Goals
and Strategies within various
chapters of the Comprehensive
Plan
No; Elements 2.1 (scoping), 2.2
(stakeholder input), 2.3 (baseline
health conditions), 2.4
(judgement of impacts), and 4
(monitoring plan) are missing;
and HIA is not transparent
(Element 5)
G-28
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Table G-3. Continued
ID
37
HIA; Year;
Location
Atlanta Beltline
Health Impact
Assessment; 2007;
Atlanta, Georgia
Scope/Summar
Make health a part of the
Atlanta BeltLine decision-
making process by
predicting health
consequences, informing
decision makers and the
public about health impacts,
and providing realistic
recommendations to prevent
or mitigate negative health
outcomes.
Source of
Evidence
Literature review,
policy review,
I special collection
(surveys,
demographics
analysis, modeling
[forecasting],
GIS)
Impacts/
1 ml points
Health,
environmental,
behavioral,
economic,
infrastructure,
services,
demographic,
other
Pathway of
Impact
Air quality,
community/house-
hold economics,
exposure to
hazards, land use,
housing, lifestyle,
noise pollution,
parks and
recreation, mental
health, mobility/
access to services,
nutrition, public
health services,
safety and security,
social capital, soil
quality, physical
activity, water
quality
Characterization of Impact
Direction of impacts (positive
health impacts, negative health
impacts, neutral health impacts);
Magnitude of impacts (affected
populations identified for each
impact; impact on number of
individuals living, working, and
going to school in proximity to
the TAD; larger city and
regional impacts); Distribution/
equity of impacts (demographic
and geographic analysis to
determine equity of impacts;
census tracts with the highest
concentration of vulnerable
populations identified);
Permanence/severity of impacts
(identified impacts with the
most serious potential health
consequences); Timeline of
impacts
Decision-making Outcome
Effectiveness of HIA
Identified several issues that transcend specific health impacts
and are more due to the challenges of implementing a large,
multi-faceted project: timing of various components of the
BeltLine, integration of the BeltLine, prioritization of people,
design that accommodates all users, and processes that
substantively involve all stakeholders and coordinate efforts.
Identified recommendations to address the overarching issues,
as well as impacts on access and social equity, physical
activity, safety, social capital, and the environment.
Prioritized recommendations included items such as making
health protection/promotion a consideration in public funding
priorities and timing; Safe Routes to Schools programs; a
coordinated fare/schedule system for transit; a 25-year public
involvement plan; a single information hub; adding park acres
to meet the target of 10 acres/1,000 people; improvements to
trail accessibility; policies/programs to prevent displacement;
access to healthy foods in the southeast planning area;
educational intervention to encourage physical activity; and
locating sensitive uses away from high-volume road segments
or mitigating air pollution.
Undetermined
Minimum Elements of HIA
Met? If no, what's missing
Yes
G-29
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Table G-3. Continued
ID
38
HIA; Year;
Location
Zoning for a
Healthy Baltimore:
A Health Impact
Assessment of the
Transform
Baltimore Zoning
Code Rewrite;
2010; Baltimore,
Maryland
Scope/Summar
Evaluate the impacts of
Baltimore's comprehensive
zoning code rewrite,
TransForm Baltimore, to
maximize the potential for
the zoning recede to prevent
obesity and other adverse
health outcomes and reduce
inequities in these outcomes
among children and
adolescents in Baltimore.
Source of
Evidence
Literature review,
community
consultation,
policy review,
special collection
(interviews, expert
consultation, GIS)
Impacts/
1 ml points
Health,
behavioral,
infrastructure
Pathway of
Impact
Land use, lifestyle,
mobility/access to
services, nutrition,
physical activity,
safety and security
Characterization of Impact
Direction of impacts (positive
health impacts, negative health
impacts, unclear health
impacts); Magnitude of impacts
(percent increase in residents
living in neighborhoods and
districts that meet certain
parameters under the new draft
code); Distribution/equity of
impacts (identified likelihood of
impacts for residents based on
poverty level)
Decision-making Outcome
Identified elements of the draft zoning code that should
remain in the final version of the code (i.e., supported
elements), elements that should be revised to promote health
and welfare and mitigate the unintended negative health
consequences, and recommendations for the code rewrite
process and planned administration of the new code (once
ratified). Supported elements were those that improved access
to healthy food, created walkable environments, strengthened
the link between health and zoning, and were easy to use.
Recommended revisions to the draft code included:
preventing concentration of off-premise alcohol sales outlets
and address problematic existing off-premise alcohol sales
outlets; creating a walkable environment by including
CPTED; and developing incentives for Healthy Food Stores
through the zoning code and through other mechanisms.
Changes to the code re-write process and plan for code
administration included recommendations for incorporating
stakeholder feedback and enhancing public engagement,
conducting mapping meetings, and other strategies to make
the new zoning code as easy to use as possible.
Effectiveness of HIA
Undetermined
Minimum Elements of HIA
Met? If no, what's missing
No; Element 4 (monitoring plan)
missing; and likelihood and
permanence of impacts not
assessed (Element 2.4)
39
Hood River County
Health Department
Health Impact
Assessment for the
Barrett Property;
2011; Hood River
County, Oregon
Investigate the potential
health benefits of turning a
former orchard into a
community park with open
play fields, trails, and
community gardens and the
potential health risks for
users of the property from
exposure to residual
pesticide chemicals.
Literature review,
community
consultation,
policy review,
special collection
(interviews,
surveys, focus
group, demo-
graphics analysis,
GIS)
Health,
behavioral,
economic,
environmental
Exposure to
hazards, land use,
lifestyle, nutrition,
parks and
recreation, physical
activity, social
capital, soil quality,
water quality, noise
pollution, safety
and security,
mobility/access to
services, commun-
ity/household
economics
Direction of impacts (positive
health impacts, negative health
impacts); Magnitude of impacts
(identified those affected by the
development); Distribution/
equity of impacts (impact on
vulnerable populations)
Found the Hood River County health-related needs (including
chronic disease management and risk factors, nutrition and
food insecurity, and behavioral and social health) could be
addressed with a park on the Barrett Property. The HIA made
recommendations to maximize the health impact of the
Barrett Property, including: grading and preparing the land
for park development; testing the soil to determine potential
chemical residues present on the land from previous pesticide
use; monitoring for unintended health and cost consequences;
designing the layout of the park to take into consideration the
desired use of the land by the entire community, particularly
vulnerable populations; once developed, promote availability
and accessibility of the park to vulnerable populations; attract
wellness programming/events to the park; and educate
decision-makers about the HIA.
Undetermined - park is still being No; likelihood and permanence of
planned; in June 2012, there was impacts not assessed (Element
an appeal by orchardists to block 2.4); and limitations and
the building of the park uncertainties not identified
(Element 2.5)
G-30
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Table G-3. Continued
ID
41
HIA; Year;
Location
Technical Report 9:
Highway 99 Sub-
Area Plan Health
Impact Assessment;
Unknown; Clark
County,
Washington
Scope/Summar
Source of
Evidence
Impacts/
1 ml points
Support the Sub-Area Plan Literature review, Health,
vision (to apply land use
planning to build a healthy
community) by using an
established socio-ecological
model of health promotion
to validate the plan's health
promoting features.
policy review,
special collection
(GIS)
environmental/
ecosystem,
behavioral,
economic,
infrastructure,
services
Pathway of
Impact
Air quality,
community/house-
hold economics,
mental health,
education, housing,
land use, lifestyle,
mobility/ access to
services, noise
pollution, nutrition,
parks and
recreation, physical
activity, safety and
security, social
capital
Characterization of Impact
Direction of impacts (positive
health impacts, negative health
impacts, status quo);
Distribution/equity of impacts
(general description of
"population affected;" impact on
vulnerable populations)
Decision-making Outcome
Effectiveness of HIA
Identified the health outcomes of the development if the
community vision elements were or were not achieved. A list
of recommendations were provided for achieving affordable
housing, living wage jobs, mixed income residential areas,
mixed use areas, increased air quality, decreased noise
pollution, access to healthy foods, urban trees, access to
transit, bicyclist and pedestrian friendly areas, parks and
green spaces, reduced traffic risks, and community safety.
Direct effectiveness - HIA was
included in the Appendix of the
final Area 99 Sub-Area Plan and
policy makers embraced some of
the recommendations, such as
promoting access to stores and
services by locating these
developments within walking
distances of neighborhoods
Minimum Elements of HIA
Met? If no, what's missing
No; Element 2.2 (stakeholder
input) and 4 (monitoring plan)
missing; magnitude, likelihood,
and permanence of impacts not
assessed (Element 2.4);
limitations or uncertainties behind
data not identified (Element 2.5);
and documentation of funding
sources and HIA point-of-contact
not transparent, no participants
other than "Clark County Health"
named, and no context for why
the county conducted the HIA
(Element 5)
43
Inupiat Health and
Proposed Alaskan
Oil Development:
Results of the First
Integrated Health
Impact Assessment/
Environmental
Impact Statement
for Proposed Oil
Development on
Alaska's North
Slope; 2007;
National Petroleum
Reserve, Alaska
Developed as part of a
supplemental
Environmental Impact
Statement (ElS)to examine
health impacts of oil and
gas development in the
Teshekpuk Lake Special
Area of the Northeast
National Petroleum Reserve
(NPR)-A (North Slope
Bureau, Alaska).
Literature review,
community
consultation,
special collection
(interviews)
Health,
environmental/
ecosystem,
behavioral,
economic
Air quality,
community/house-
hold economics,
land use, exposure
to hazards,
infectious disease,
lifestyle, mental
health, nutrition,
safety and security
, soil quality, water
quality, social
pathology
Direction and Likelihood of
impacts (definite negative health
impacts, probable negative
health impacts, speculative
negative health impacts,
unlikely negative health
impacts, positive health
impacts); Distribution/equity of
impacts (impacts on low-income
and Native Americans assessed;
risks evaluated in the context of
disparate incidence, prevalence,
and mortality from cancer);
noted extent of impact based on
degree of disturbance
Highlighted a number of potential health risks and benefits of
the proposed leasing, including: impacts on the local diet and
rates of obesity and diabetes; exposure to pollution; social
problems; and the use of oil and gas revenues to support local
services important to health. Mitigation measures
recommended by the HIA included establishment of a health
advisory board to monitor impacts, public health monitoring,
studies and management offish and game, contaminant
control, public safety measures, infectious disease controls, an
oil spill control plan, and a sustainable community plan.
Direct effectiveness - HIA was
included as part of the
Supplemental EIS; BLM included
HIA mitigation measures that fell
within its statutory authority (land
management). BLM agreed to
consider a measure that would
require BLM and developers to
work with a Health Advisory
Board to further delineate impacts
and identify and institute
appropriate mitigations
Yes
G-31
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Table G-3. Continued
ID
44
HIA; Year;
Location
Page Avenue
Health Impact
Assessment;
Unknown (possibly
2010); Pagedale,
Missouri
Scope/Summar
Provide an impartial
assessment of the health
impacts of the Page Avenue
Redevelopment on
individuals, youth, and
families living primarily in
Pagedale, Missouri as well
as surrounding communities
in University City and
Wellston.
Source of
Evidence
Literature review,
community
consultation,
special collection
(interviews,
surveys, focus
groups, risk
assessment, GIS)
Impacts/
1 ml points
Health,
behavioral,
economic,
infrastructure,
Pathway of
Impact
Air quality
(indoor),
community/house-
hold economics,
education, exposure
to hazards, health-
care access, mental
health, housing,
lifestyle, mobility/
access to services,
nutrition, physical
activity, public
health services,
safety and security,
social capital, noise
pollution (indoor)
Characterization of Impact
Assessed impacts of
Redevelopment Plan and each
of the top 5 recommendations
for the seven priority impacts;
Direction of impacts (positive
health impacts, negative health
impacts, no known impacts,
significant health impact);
Likelihood of impacts
(speculative impacts, probable
impacts, definite impacts);
Distribution/equity of impacts
(populations at greater risk to
some adverse health endpoints);
Overall population
impact/Magnitude of impact
(high or moderate; based on
expected reach and likelihood of
impact across all priority
impacts)
Decision-making Outcome
Overall, the redevelopment will positively impact the health
of the community; the only potential negative impacts
concerned relocation of people's homes and businesses.
Because of concerns about prolonged phasing or lack of detail
in the current plan, some priority impacts were more certain
(access to goods, services, and recreation; access to healthy
foods; housing) than others (employment, pedestrian safety,
community safety, community identity). The HIA identified
Top Recommendations representing common themes from
the assessment (replacing symbols of disinvestment and
improving pedestrian infrastructure; implementing orchards
and gardens; supplementing physical improvements with
education and programming; prioritizing opportunities for
youth recreation; and foster stakeholder engagement) and
fifty-one (51) specific recommendations in seven priority
areas (Employment, Access to Goods, Services & Recreation,
Access to Healthy Foods, Pedestrian Safety, Community
Safety, Community Identity, Housing).
Effectiveness of HIA
Undetermined (Note: Publication
date not given in document but
online research shows that it was
published in January 2012. There
has probably not been enough
time for this to have had an
impact)
Minimum Elements of HIA
Met? If no, what's missing
No; Element 4 (monitoring plan)
missing; and permanence of
impacts not assessed (Element
2.4)
G-32
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Table G-3. Continued
HIA; Year; Source of Impacts/ Pathway of Minimum Elements of HIA
ID Scope/Summary Characterization of Impact Decision-making Outcome Effectiveness of HIA
Location Evidence 1 ml points Impact Met: It no, what's missing
45
47
Pittsburg Railroad Determine the health Literature review, Health,
Avenue Specific impacts of the Pittsburg community behavioral,
Air quality, Positive and negative impacts Identified opportunities that would improve health through Direct effectiveness -the No; Element 4 (monitoring plan)
community/house- shown for all pathways and the creation of a complete neighborhood around the BART Planning Department used results missing
Plan Health Impact Railroad Avenue Specific consultation, economic, hold economics, | endpoints except for noise, | station, as well as some modifiable health and environmental from the HIA to save affordable
Assessment; 2008; Plan - a transit-oriented special collection
Pittsburg, design plan to build anew (interviews,
California
The East Bay
Greenway Health
train station, new residential demographics
and commercial uses, public analysis, HDMT,
space, and pedestrian and modeling, GIS)
bicycle improvements.
Highlight potential positive
impacts of the Greenway
Literature review,
community
infrastructure, land use, healthcare
services, access/insurance,
demographic, education, exposure
environmental to hazards, housing,
Health,
behavioral,
lifestyle, mental
health, mobility/
which had only negative quality threats associated with the project's location adjacent housing sites originally facing
impacts; Direction and to a freeway corridor. Forty-five (45) recommendations were opposition, require air quality and
Likelihood of impacts (definite made by the HIA to increase benefits of the plan and to noise mitigation measures, and
positive/negative health impacts, mitigate negative impacts, including conducting a retail and improve pedestrian and bicycling
probable positive/negative public services needs assessment; allotting more affordable facilities; HIA process also
health impacts, speculative housing in the project than the current zoning ordinance engaged community residents in
access to services, positive/negative health called for; including high-quality ventilation systems in any data collection and partnered with
noise pollution, impacts); Distribution/equity of housing within one-half mile of the freeway; installing triple- a local health clinic
nutrition, parks and
impacts (populations more paned windows to protect from noise; hiring local residents
recreation, physical vulnerable to vehicle collisions for the construction phase of the project; implementing traffic
activity, safety and and air pollution); calming measures; implementing strategies to encourage use
security
Land use, lifestyle,
mental health,
Quantification of impacts of BART and decreased use of cars; and locating residential
(neighborhood completeness uses and other sensitive land uses in the project area to
[HDMT] ; vehicle trip generation minimize exposure to significant sources of air pollution and
and greenhouse gas emissions noise.
[URBEMIS and EMFAC];
PM2.5 residential use- and
traffic-related pollution
emissions [CALINE3QHCR];
% change in health endpoints
due to PM2.5 concentrations);
Permanence of impacts (PM2.5
pollution effects high, medium,
low; accidents and injuries (by
speed); Magnitude of impacts
(PM2. 5 population impacts)
Direction of impacts (positive
health impacts, negative health
The Greenway, as proposed, presents an opportunity in land
use that could be very beneficial to the health of residents
Direct effectiveness - HIA was
included as an appendix to the
No; Element 4 (monitoring plan)
missing; and magnitude,
Impact Assessment; pedestrian and bike trail consultation, infrastructure mobility/access to impacts); Distribution/equity of who live near the route, many of whom are poor, are people final East Bay Greenway Concept likelihood, and permanence of
2007; Oakland to could have on health and to special collection
Hayward,
California
uncover and suggest (GIS)
mitigations for potential
barriers that would hinder
the project from reaching its
full positive health impact.
services, parks and impacts (demographics of of color, and currently suffer from health inequities. Plan and many of the impacts not assessed (Element
recreation, physical affected communities)
activity, safety and
security, social
capital, air quality,
noise pollution
Recommended building the Greenway with specific design recommendations were built into
features (e.g., connecting to existing trails/paths, universal the plan itself
design principles), offering programming to maximize usage,
and implementing mitigation steps to increase safety (e.g.,
lighting, police involvement, traffic calming, etc.).
2.4)
G-3 3
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Table G-3. Continued
ID
49
HIA; Year;
Location
Taylor Energy
Center Health
Impact Assessment;
2007; Taylor
County, Florida
Scope/Summar
Analyze the impact of a
proposed coal-fired electric
plant, including risks from
air pollution and benefits to
health from employment by
the plant and the
"community contribution"
Source of
Evidence
Literature review,
community
consultation,
policy review,
special collection
(risk assessment,
demographics
analysis,
modeling)
Impacts/
1 ml points
Health,
economic,
environmental/
ecosystem
Pathway of
Impact
Air quality,
community/ house-
hold economics,
exposure to
hazards, infectious
disease, land use,
water quality
Characterization of Impact
Direction and Likelihood of
impacts (definite negative health
impacts, definite positive health
impacts, speculative positive
health impacts, definite no
impact); Magnitude of impacts
(low, medium, high);
Distribution/equity of impacts
(racial disparities in health and
sensitive populations identified;
change in risk of mortality due
income); Permanence and
Quantification of impacts
(impacts on life expectancy
[additional or averted death
estimates])
Decision-making Outcome
Found substantial racial disparities in health and predicted
both positive (economic) and negative (air pollution) health
impacts from the Taylor Energy Center. Provided multiple
recommendations, including establishing baseline levels/
monitoring mercury emissions; installing an air quality
monitor; adopting a policy to remain carbon negative;
targeting job recruitment to include a representative or greater
proportion of black residents; recruiting and training a diverse
population of Taylor County residents for professional jobs at
TEC; and investing in the community. Also provided one
recommendation to mitigate the smoking attributable
mortality discovered in the baseline health status - to
implement additional smoking cessation programs and
provide health prevention/education programs.
Effectiveness of HIA
Undetermined - no mention of
HIA on the official project site;
however, they do appear to be
doing some air quality monitoring
as recommended by the HIA
Minimum Elements of HIA
Met? If no, what's missing
Yes
58
Battlement Mesa
Health Impact
Assessment (2nd
Draft); 2010;
Battlement Mesa,
Colorado
Address citizen concerns
about health impacts of
natural gas development
and production in the
Battlement Mesa Planned
Unit Development (PUD).
Literature review, Health,
policy review,
special collection
(demographics
analysis, risk
assessment, GIS)
environmental,
behavioral,
economic,
infrastructure,
services,
demographic
Air quality,
community/ house-
hold economics,
education, exposure
to hazards, land
use, healthcare
access/insurance,
housing, infectious
disease, lifestyle,
mental health, noise
pollution, safety
and security, social
capital, soil quality,
water quality
Direction of impacts (negative
health impacts, positive health
impacts); Permanence of
impacts (duration of exposure
long, short to long); Magnitude
of impacts (moderate to high,
low to high, low to medium,
low); Likelihood of impacts
(likely, possible, unlikely);
Distribution/geographic extent
of impacts (local, community-
wide); Equity of impacts
(vulnerable populations
identified); Frequency of
impacts (infrequent, frequent, or
constant)
Found that the health of the Battlement Mesa residents would
most likely be affected by chemical exposures, accidents, or
emergencies resulting from industry operations, and stress-
related community changes. General recommendations in the
HIA included pollution prevention, protection of public
safety, and increased communication through the
development of a Community Advisory Board. Over 70
specific recommendations were also provided in the eight
areas of concern identified by the community. These
recommendations focused on reducing air emissions,
continued monitoring of air and water sheds, and strict
enforcement of existing regulations; use of best available
current technology and rapid adoption of new technologies to
decrease emissions; reduction of risk of traffic and industrial
accidents; and development of a community advisory board to
facilitate communication with the goal of improving
community well-being.
Direct effectiveness -the Board
of County Commissioners
recognized the many gaps and
monitoring needs that were
identified in the HIA and
contracted with the Colorado
School of Public Health to design
an Environmental and Health
Monitoring Study (EHMS) that
could begin to gather this
information; the HIA will be used
as a reference document if further
land use application is made
Yes
G-34
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Table G-3. Continued
HIA; Year; Source of Impacts/ Pathway of
ID Scope/Summary .
Location Evidence 1 ml points Impact
59
60
Douglas County Evaluate updates to the Policy review,
Comprehensive Douglas County community
Health, Healthcare access,
behavioral,
mental health,
Plan Update Health Comprehensive Plan, which consultation, economic, mobility/access to
Impact Assessment; provides a framework and special collection infrastructure, services, parks and
2011; Douglas policy direction for future (demographics
County, Minnesota land use, transportation, analysis, GIS)
natural resource and
The Executive Park
park/open space decisions.
Summarize the results from
Literature review,
services recreation, physical
Health,
activity, safety and
security, social
capital, land use
Air quality,
Subarea Plan the first application of San policy review, environmental/ education, exposure
Health Impact Francisco's Healthy special collection ecosystem, to hazards, land
Assessment: An Development Measurement (demographics behavioral,
use, healthcare
Application of the Tool to the Executive Park analysis, economic, access/insurance,
Healthy Subarea Plan, which modeling, GIS, infrastructure, housing, lifestyle,
Development proposes to build 2,800 HDMT)
Measurement Tool units of new residential
(HDMT); 2007; San housing on a 71-acre area in
Francisco, the southeastern corner of
California
San Francisco.
services
mental health,
mobility/access to
services, noise
pollution, nutrition,
physical activity,
public health
services, parks and
recreation, safety
and security, social
capital
Minimum Elements of HIA
Characterization of Impact Decision-making Outcome Effectiveness of HIA t . .
Health indicators used to The Comprehensive Plan was assessed against 12 health Direct effectiveness - several No; Elements 2.3 (baseline health
measure health issues - provided indicators - identifying aging population and senior services, language and policy conditions, except for baseline
a description of the indicator, connectivity, recreational amenities (community facilities, recommendations were included aging conditions) and 4
supporting language and policy gardens, parks, and trails), economic opportunities, mixed-use in the final plan (monitoring plan) missing;
statements already in the Plan development, traffic accidents, and complete streets/traffic
that address the indicator, and calming. Specific language and policy statements were
recommendations for language recommended for incorporation into the Final Comprehensive
and/or policy statements to be Plan in order to ensure that priority health areas of concern
added to the Plan; Distribution/ were addressed.
equity of impacts (assessed
impacts on the aging
population)
Direction of impacts (positive
The Executive Park Subarea Plan met between one-third and
health impacts, negative health two-thirds of the development targets for each of the six
impacts); Likelihood of impacts elements evaluated and overall, approximately 50% of the
(increased likelihood, decreased targets evaluated. In addition to specific recommendations for
likelihood); Distribution of all of the HDMT objectives, the HIA also provided a number
impacts (income inequality; of general/crosscutting recommendations, including
potential reduction in existing additional implementation actions/strategies for incorporation
disparities in health status) into the plan and improvements to transportation and access
to goods and services. Overall, the application of the Healthy
Development Measurement Tool (HDMT) to the Executive
Park Subarea Plan demonstrated that the HMDT is a feasible
methodology that can be used to conduct a comprehensive
health and sustainability assessment of land use development
projects.
Undetermined
direction, likelihood, magnitude,
and permanence of impacts not
assessed (Element 2.4); and little
supporting evidence
used/documented (Element 2.5)
No; Element 5 (transparent
documentation) missing;
permanence and magnitude
impacts not assessed (Element
2.4); supporting evidence for the
HDMT indicators/methodology
and references not provided in
most cases (Element 2.5); follow-
up measures included in
recommendations, but monitoring
plan not identified (Element 4)
G-3 5
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Table G-3. Continued
ID
63
HIA; Year;
Location
Oak to Ninth
Avenue Health
Impact Assessment;
2006; Oakland,
California
Scope/Summary
Assess the influence of the
Oak to Ninth Avenue
development project - a
waterfront mixed-use
neighborhood - on
determinants of human
health.
Source of
Evidence
policy review,
special collection
(survey,
modeling, GIS)
Impacts/
1 ml points
Literature review, Health,
environmental/
ecosystem,
behavioral,
economic,
infrastructure,
services,
demographic
Pathway of
Impact
Air quality,
community/ house-
hold economics,
education, exposure
to hazards, housing,
land use, lifestyle,
mental health,
mobility/access to
services, noise
pollution, parks and
recreation, physical
activity, safety and
security, social
capital
Characterization of Impact
Direction of impacts (positive
health impacts, negative health
effects); Magnitude of health
impacts (additional traffic
related injuries per year; %
residents that will experience
sleep disturbance; health effects
of freeway air pollutants over 10
years); Distribution/equity of
impacts (populations affected by
lack of affordable housing,
disparities in park accessibility,
air quality, noise, and
pedestrian safety);
Quantification of impacts
(forecasted changes to
pedestrian injury rates; traffic-
related emissions)
Decision-making Outcome
Estimated a number of negative health impacts from the
development and provided recommendations related to each
factor evaluated. Major recommendations/mitigations
included: improving public/stakeholder participation,
improved access to the waterfront, traffic calming and other
pedestrian safety measures, distribution of housing costs and
mixed-income housing, public transit and other options for
reducing VMT, in-home systems for air quality and noise
mitigation (HVAC, insulating windows, etc).
Effectiveness of HIA
Direct effectiveness -the
project's environmental impact
report (EIR) was found deficient
by a California Superior Court,
resulting in invalidation of the
Oakland City Council's adoption
of that EIR and related
documents; however, the EIR was
revised and in January 2009, the
Oakland City Council adopted a
resolution to approve the EIR
revisions and re-adopt the related
EIR certification
Minimum Elements of HIA
Met? If no, what's missing
No; Element 4 (monitoring plan)
missing; baseline conditions not
well-established (Element 2.3);
and likelihood and permanence of
impacts not assessed (Element
2.4)
64
A Health
Assessment of
Mixed Use
Redevelopment
Nodes and
Corridors in
Lincoln, Nebraska;
2011; Lincoln,
Nebraska
Analyze the nodes and
corridors proposal in the
Comprehensive Plan to
determine whether the
proposed changes would
truly generate health
benefits in Lincoln.
Literature review,
policy review,
special collection
(modeling,
stakeholder
meeting, GIS)
Health,
environmental/
ecosystem,
behavioral
Land use, physical
activity, air quality,
mobility/access to
services
Direction of impacts (positive
health impacts); Distribution/
equity of impacts (benefits
attributable to the Lincoln
population; populations most
affected by improved air
conditions); Quantification of
impacts (change in walkability)
The walkability analysis showed mixed use redevelopment in
the identified nodes will generate an increase in walkability
over current conditions and a subsequent improvement in air
quality due to reduced vehicle travel. No recommendations
provided.
None
No; Elements 3 (recommend-
ations and mitigations), and 4
(monitoring plan) missing;
identification of baseline
conditions limited (Element 2.3);
and not all potential impacts
assessed (Element 2.4)
G-3 6
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Table G-3. Continued
ID
67
HIA; Year;
Location
Healthy Tumalo
Community Plan: A
Health Impact
Assessment on the
Tumalo Community
Plan; A Chapter Of
The 20-Year
Deschutes County
Comprehensive
Plan Update; 2010;
Tumalo, Oregon
Scope/Summar
Evaluate the draft Tumalo
Community Plan in the
context of community
health and support county
planners by providing
recommendations that could
be incorporated into the
final plan
Source of
Evidence
Impacts/
1 ml points
Literature review, Health,
community infrastructure,
consultation, behavioral
special collection
(community
meetings, surveys,
GIS)
Pathway of
Impact
Physical activity,
safety and security,
rural livability,
social capital,
mobility/access to
services, parks and
open space
Characterization of Impact
Direction of impacts (negative
health impacts, positive health
impacts); Distribution/equity of
impacts (vulnerable populations
at risk of obesity)
Decision-making Outcome
Recommended changes to existing policies in the Tumalo
Community Plan and/or the addition of new policies to
promote positive health outcomes, including improving the
safety and accessibility of the major highway that runs
through town, creating new parks and infrastructure to
maximize the safe and healthy use of riverfront property as a
recreational facility, and building trails or other connections
between existing recreational facilities and downtown, local
schools and businesses.
Effectiveness of HIA
Direct effectiveness - some
community input from HIA
process incorporated into updated
Tumalo Community Plan
language, and a needs assessment
is also currently underway as a
result of the HIA project to
develop a Safe Routes to School
program
Minimum Elements of HIA
Met? If no, what's missing
No; baseline health conditions not
well established (Element 2.3);
magnitude, likelihood, and
permanence of impacts not
assessed (Element 2.4); sources
of data and synthesis of evidence
not transparent (Element 2.5); and
no plans for monitoring provided
(Element 4)
Strategic Health
Impact Assessment
on Wind Energy
Development in
Oregon (Public
Review Draft);
2012; Oregon
Assess ways that wind
energy developments in
Oregon might affect the
health of individuals and
communities where they are
built and maintained,
develop evidence-based
recommendations for future
facility siting decisions,
engage community and
stakeholders, and assess the
utility of HIA for specific
wind farm siting decisions.
Literature review,
policy review,
community
consultation,
special collection
(survey, GIS)
Health,
economic,
environmental
Air quality, climate
change, commun-
ity/household
economics,
education, exposure
to hazards,
infectious disease,
land use, noise
pollution, safety
and security, social
capital
Direction of impacts (positive
health impacts, negative health
impacts); Likelihood of impacts
(definite impacts, possible
impacts, unlikely impacts);
Permanence and Magnitude of
impacts (low); Distribution/
equity of impacts (populations
vulnerable to air pollution
effects, night-time noise, wind
turbine sound, and community-
level conflicts; extent of
exposure from construction-
related emissions by population;
disparities in SES between rural
and urban areas); Quantification
of impacts (impacts of
background sound and long-
term outdoor community sound
at certain levels)
HIA was not focused on a specific facility or community, but Undetermined
rather what is currently known about the health impacts from
wind farms (noise, visual impacts, air pollution, economic
effects, and community conflict) and the policies and
standards used to site wind facilities in Oregon. The HIA was
designed to provide a framework and reference materials for
future assessments and decisions on proposed wind energy
installations. Provided several general recommendations, such
as implementing strategies to minimize sound generation;
addressing community concerns as part of the siting process;
using up-to-date, current state of science noise modeling to
plan facilities boundaries and turbine locations; considering
the distance, orientation, and placement of turbines relative to
homes and buildings to reduce shadow flicker; and increasing
community-wide economic benefits from wind energy
developments. Also provided recommendations and
mitigation strategies for site-specific wind facility
assessments, including tools and models for assessing
baseline air pollutant levels and local air pollution impacts;
systems and protocols for documenting, responding to, and
evaluating complaints; implementing sound mitigation
strategies; and using visual obstructions to block flicker
No; baseline health conditions not
established (Element 2.3)
G-3 7
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Table G-3. Continued
ID
69
HIA; Year;
Location
Impacts on
Community Health
of Area Plans for
the Mission, East
SoMa, andPotrero
Hill/Showplace
Square: An
Application of the
Healthy
Development
Measurement Tool;
2008; San
Francisco,
California
Scope/Summar
Source of
Evidence
Use the Healthy Literature review,
Development Measurement policy review,
Tool (HDMT) to examine special collection
potential health implications (HDMT,
of the Eastern modeling)
Neighborhoods Area Plans,
using 26 of 27 community
health objectives within six
healthy city vision elements
- environmental steward-
ship, sustainable and safe
transportation, social
cohesion, public
infrastructure/access to
goods and services,
adequate and healthy
housing, and healthy
economy.
Impacts/
1 ml points
Health,
environmental/
ecosystem,
behavioral,
economic,
infrastructure,
services
Pathway of
Impact
Environmental
stewardship, air
quality, community
/household eco-
nomics, education,
exposure to
hazards, land use,
healthcare
access/insurance,
housing, lifestyle,
mental health,
mobility/access to
services, noise
pollution, nutrition,
parks and
recreation, physical
activity, public
health services,
safety and security,
social capital
Characterization of Impact
Quantification (HDMT used to
evaluate whether Area Plans
met Development Targets
(proxies for meeting
Community Health Objectives):
Direction of impacts/plan
strengths and weaknesses
(positive health impacts/plan
strengths, negative health
impacts/plan weaknesses);
Distribution/equity of impacts
(populations vulnerable to air
pollution; disparities in
proximity of households to
roadway air pollution sources;
populations with limited ability
to walk)
Decision-making Outcome
Effectiveness of HIA
Eastern Neighborhood Area Plans met approximately 55% of
the analyzable development targets (i.e., targets that were
applicable and for which adequate data was available).
Identified several concerns revolving around Plan
implementation and collaboration and deferral of Area Plan
implementing actions to future studies. Based on HDMT
evaluation, a number of recommendations were developed
that related to environmental sustainability, preservation of
open space, community-supported agriculture (CSA) and
community gardens, identification of pollution sources,
reviews of zoning to minimize locating sensitive uses in close
proximity to those sources, traffic calming measures, etc.
Overarching recommendations for comprehensive community
planning were also developed, such as increased specificity/
level of detail in the Area Plans and transparency of how
decisions regarding Plan and rezoning elements are made, and
timely coordination of studies informing the Area Plans.
Direct effectiveness - SFDPH
provided input on planning
strategies to meet identified
health needs and policy and
implementation recommendations
at several stages of the Area Plan
development (including during
evaluation of the draft and final
Area Plans using the HDMT);
some of these recommendations
were incorporated
Minimum Elements of HIA
Met? If no, what's missing
No; Element 4 (monitoring plan)
missing; baseline conditions for
health not documented (Element
2.3); magnitude, likelihood,
distribution, and permanence of
impacts not assessed (Element
2.4); sources of data not
acknowledged and synthesis of
information not transparent
(Element 2.5); and documentation
not transparent (Element 5)
G-3 8
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Table G-3. Continued
ID
71
HIA; Year;
Location
MacArthur BART
Transit Village
Health Impact
Assessment; 2007;
Oakland, California
Scope/Summar
Examine the health impacts
of the MacArthur BART
Transit Village - a proposed
redevelopment of the
MacArthur Bay Area Rapid
Transit Station parking lot
and adjacent property into a
mixed use village.
Source of
Evidence
Literature review,
community
consultation,
policy review,
special collection
(survey, field
visits, modeling,
demographics
analysis, GIS)
Impacts/
1 ml points
Health,
environmental,
economic,
services
Pathway of
Impact
Housing, mobility/
access to services,
parks and
recreation, safety
and security, air
quality, noise
pollution, social
capital; secondary
pathways: house-
hold/community
economics,
physical activity,
exposure to
hazards, nutrition
Characterization of Impact
Direction of impacts (positive
health impacts, negative health
impacts); Likelihood of impacts
(definite impacts, probable
impact); Magnitude of impacts
(number of housing units;
regional air quality impacts);
Distribution/equity of impacts
(park access inequities;
affordable housing locations to
ensure against environmental
injustice; populations vulnerable
to pedestrian-vehicle injuries,
air pollutants, noise levels;
populations disproportionately
affected by violent crime;
populations that could benefit
greatly from open space);
Quantification of impacts
(student generation estimates;
forecast of child care demand
and changes to pedestrian injury
rate; modeled PM2.5 levels and
forecasted health effects; cancer
risk estimation due to diesel
particulate matter; projected
carbon monoxide exposure;
measured/modeled noise levels)
Decision-making Outcome
Effectiveness of HIA
Found that the MacArthur Bart Transit Village could impact a
large number of individuals, many of low socioeconomic
status, both positively and negatively. Provided over 80
recommendations, including consideration of basic safety and
affordability needs; strategies to meet sustainable
transportation goals; essential retail services for the mixed-
use retail corridor (e.g., full service grocery); ample quality
parks and natural space; a comprehensive pedestrian safety
countermeasure plan; mitigations to reduce air and noise
pollution exposure; incorporating CPTED elements into the
design; strategies to include more west side residents in
design and planning; unbundling parking from unit sales;
bicycle parking and connection to the local bike network;
pedestrian safety improvements especially for school routes;
and using building materials and ventilation systems to reduce
allergens and toxic exposures.
Undetermined
Minimum Elements of HIA
Met? If no, what's missing
No; Element 4 missing
(monitoring plan); and
permanence of impacts not
assessed (Element 2.4)
G-3 9
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Table G-3. Continued
ID
72
HIA; Year;
Location
Healthy Corridor
for All: A
Community Health
Impact Assessment
of Transit-oriented
Development Policy
in St. Paul
Minnesota; 2011;
St. Paul, Minnesota
Scope/Summar
Examine the rezoning
ordinance that would lay the
foundation for the
implementation of transit-
oriented development
(TOD) along the Central
Corridor to understand the
impacts of the light rail line
and subsequent land use
changes on community
health, health inequities,
and underlying conditions
that determine health.
Source of
Evidence
Literature review,
special collection
(demographics
analysis,
modeling, risk
assessment,
survey, GIS)
Impacts/
1 ml points
Health,
economic,
infrastructure,
demographic,
services
Pathway of
Impact
Community/househ
old economics,
housing, exposure
to hazards, land
use, mobility/
access to services,
physical activity,
safety and security,
social capital
Characterization of Impact
Direction of impacts (positive
health impacts, negative health
impacts); Distribution/equity of
impacts (racial disparities in
household income, educational
attainment, unemployment;
geographic health disparities;
populations that would
experience increased access,
housing burden, and
displacement; populations more
vulnerable to negative impacts;
populations that must be
considered and heard);
Permanence of some impacts
(low or medium/near term,
high/long-term/ irreversible);
Magnitude of impacts
(population affected);
Likelihood of impacts (definite
impacts, probable impacts,
speculative impacts);
Quantification of impacts (loss
of on-street parking; localized
job analysis; statistical analyses;
geographical analysis)
Decision-making Outcome
Effectiveness of HIA
Analyzed how the anticipated changes in land use would
affect existing conditions in the corridor according to two
different scenarios; one was market-based using estimates
from a market analysis conducted by a real estate firm and the
other used the maximum allowable development outlined in
the rezoning proposal. The most important finding was the
vulnerability of communities of color and low-income
individuals in the Central Corridor to the potential negative
impacts of the rezoning and new light rail line. Best practices
in equitable development were identified and
recommendations developed to mitigate the negative impacts
and maximize the positive outcomes of the zoning.
Considering local context and community needs, five policy
recommendations were prioritized around development and
preservation of affordable housing, and developed into more
detailed policy briefs. Priority recommendations were:
developing a community equity program to retain affordable
housing; codifying the City's commitment to affordable
housing; implementing a density bonus program for
developers who provide affordable housing in new residential
and mixed-use development projects in the Central Corridor;
relieving the lack of commercial parking; and implementing
first source hiring.
General effectiveness at a
minimum, but direct effectiveness
assumed - rezoning did not
specifically include the priority
recommendations of the HIA, but
mechanisms were put in place to
address the affordable housing
issues raised (i.e., city council
requested feasibility analyses,
created a forum for consensus
building, and developed a
resolution to create an affordable
housing work-group); policy
debate around the rezoning
shifted as a result of the HIA and
introduced health into the
discussion. HIA led to increased
capacity building in the
community, and HIA steering
committee became a coalition
engaged in the city zoning
decision-making processes
Minimum Elements of HIA
Met? If no, what's missing
Yes
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Table G-3. Continued
ID
73
HIA; Year;
Location
Health Impact
Assessment Point
Thomson Project;
2011; Alaska
Scope/Summar
Identify human health
impacts associated with
each of the five proposed
design alternatives of the
proposed oil and gas
development in Alaska's
remote Point Thomson area.
Source of
Evidence
Literature review,
policy review,
community
consultation,
special collection
(interviews, field
visits, risk
assessment, focus
groups,
demographics
analysis)
Impacts/
1 ml points
Health,
behavioral,
infrastructure,
services,
environmental/
ecosystem
Pathway of
Impact
Air quality,
exposure to
hazards, lifestyle,
healthcare access,
mental health,
nutrition, infectious
disease, land use,
public health
services, safety and
security, social
capital
Characterization of Impact
Direction of impacts (negative
health impacts, positive health
impact, no health impact);
Magnitude (intensity) of impacts
(low, medium, high, very high);
Duration/frequency
(Permanence) of impacts (Less
than 1 month/happens rarely;
short-term - less than a year/low
frequency; medium-term - one
to six years/ intermittent
frequency; long-term - more
than six year, life of project/
constant frequency);
Distribution of impacts
(geographical extent);
Likelihood of impacts
(exceptionally unlikely, very
unlikely, unlikely, about as
likely as not, likely, very likely,
virtually certain); Nature of
impacts (direct, indirect,
cumulative); Equity of impacts
(potentially affected
communities divided into three
zones based on likelihood of
significant health impacts);
Ranked significance of
impact/risk assessment score
(low, medium, high, very high)
Decision-making Outcome
The most significant positive and negative impacts of the
project were centered in the Zone 1 communities and the
coastal hunting areas utilized by both communities and were
associated with transportation corridors; exposures to
hazardous materials; emergency medical services; continued
evolution of subsistence and nutrition behaviors; and
psychosocial effects. Mitigation strategies and
recommendations developed in response to the medium- to
high-impact negative effects and organized around health
promotion and disease prevention: 1. Follow proposed EPA
regulations on stack emissions and implement baseline stack
monitoring; 2. Increase community education about safety
measures in place for arctic projects and ongoing community
engagement; 3. Restrict access and increase security and
safety patrols; 4. Conduct baseline nutritional surveys and
ongoing monitoring; 5. Develop response plan for
augmentation of existing health care infrastructure in local
clinics.
Effectiveness of HIA
General effectiveness - HIA
included as Appendix R to the
Final EIS and HIA-identified
human health impacts noted in
the project's Record of Decision
(ROD), but the Army Corps of
Engineers determined that project
would have a minimal
detrimental effect on human
health; the ROD approved
Alternative B (the proposed
action) with modifications and
mitigation measures
Minimum Elements of HIA
Met? If no, what's missing
No; Element 4 (monitoring plan)
missing; and documentation of
funding sources not transparent
(Element 5)
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Table G-3. Continued
ID
77
HIA; Year;
Location
Humboldt County
General Plan
Update Health
Impact Assessment;
2008; Humboldt
County, California
Scope/Summar
Source of
Evidence
Evaluate six key areas of Literature review,
the Humboldt County special collection
General Plan Update (GPU) (focus groups,
to identify how indicators of surveys,
healthy development would demographics
change as a result of the analysis, GIS)
three alternatives being
considered - denser
development in urban areas,
limited growth to exurban
areas, and unrestricted
growth across the county.
Impacts/
1 ml points
Health,
environmental,
infrastructure,
economic
Pathway of
Impact
Housing, commun-
ity household
economics, land
use, mobility/access
to services, mental
health, nutrition,
physical activity,
social capital,
safety and security,
water quality, air
quality,
environmental
stewardship
Characterization of Impact
Direction and Likelihood of
impacts for each alternative;
Distribution/equity of impacts
(vulnerable populations; policies
that reduce this disparity most);
Direction and Likelihood of
impacts from the recommended
Plan Alternative: Housing
(positive health impacts, definite
no change); Transportation
(positive health impacts); Public
Infrastructure (positive health
impacts); Economy (no clear
direction or likelihood
identified); Safety/Social
Cohesion (positive health
impact, mixed health benefits);
Environmental Stewardship
(positive health impacts, definite
no change, negative health
impacts)
Decision-making Outcome
Effectiveness of HIA
The recommended plan alternative was denser development
in urban areas, as it is likely to have the most positive overall
health impacts and require the fewest health related
mitigations. For the six areas considered, recommendations
were provided for mitigating negative health impacts and
promoting positive health impacts. Example
recommendations by area: Housing (develop policies to
encourage affordable housing, establish programs to assist the
homeless population); Transportation (develop policies to
increase public transit use and encourage walking and
biking); Public Infrastructure (increase access to parks, senior
centers medical facilities and childcare, provide incentives to
grocery stores selling produce); Economy (develop policies to
attract and retain industries that provide a living wage, health
insurance and workforce education); Safety/Social Cohesion
(activities to promote community building, increased
emergency preparedness); Environmental stewardship
(restrict housing placement to the periphery of agriculturally
zoned land, decrease energy consumption, promote
consumption of locally-grown food). HIA also led to the
development of a rural HDMT.
Direct effectiveness - HIA was
included as an Appendix to the
GPU; the Housing Element of the
GPU increased the amount of
affordable housing due to the
HIAs results and the
Transportation element included
some of the HIA research and
findings in that section
Minimum Elements of HIA
Met? If no, what's missing
No; Element 4 (monitoring plan)
missing; and magnitude and
permanence of impacts not
assessed (Element 2.4); and
documentation of HIA point-of-
contact not transparent (Element
5)
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Table G-3. Continued
ID
78
HIA; Year;
Location
Rapid Health
Impact Assessment:
Vancouver
Comprehensive
Growth
Management Plan
2011; 2011;
Vancouver,
Washington
Scope/Summar
Examine the 2011
Vancouver Comprehensive
Plan and its impact on two
key determinants of health -
physical activity and access
to healthy food.
Source of
Evidence
Literature review,
special collection
(surveys,
demographics,
modeling, GIS)
Impacts/
1 ml points
Health, services
Pathway of
Impact
Land use, physical
activity, mobility/
access to services,
safety and security
Characterization of Impact
Direction and Likelihood of
impacts (Planning changes - all
definite positive health impacts;
Zoning changes - minimal, but
positive impacts probable);
Distribution/equity of impacts
(Planning changes - equal
impacts or positive differential
impacts on geographically-
focused populations; Zoning
changes - unclear, equal
impacts, positive/negative
differential impacts on
populations); Quantification of
impacts (walkability index;
Walk Score index; Connected
Node Ratio; total Floor Area
Ratio; bikeway network density:
GIS mapping); Strength of
evidence (Planning direction
changes - some to strong;
Zoning changes - moderate)
Decision-making Outcome
Effectiveness of HIA
Concluded that the proposed planning direction changes,
policy changes, and zoning changes would likely be
beneficial to community health, but need to be implemented
through development standards to be effective. Several
recommendations were given to further improve opportunities
for physical activity and access to healthy food: 1. Physical
Activity - developing land uses and transportation networks
that support physical activity; enhancing connectivity;
managing parking to encourage active transportation;
improving safety and comfort for pedestrians and bicyclists;
increasing use of transportation modes; and reducing
disparities in access to physical activity and protecting
vulnerable populations; 2. Healthy Food Access -recruiting
and retaining healthy food retail; promoting opportunities to
grow food in home and community gardens; reducing the
availability of unhealthy food options relative to healthy food
options; promoting food security; and reducing disparities in
food access and protecting vulnerable populations.
Undetermined
Minimum Elements of HIA
Met? If no, what's missing
No; magnitude and permanence
of impacts not assessed (Element
2.4)
G-43
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Table G-4. Summary Table of Select Data from HIAs in the Waste Management/Site Revitalization Sector
ID
HIA; Year;
Location
Health Impact
Assessment of
NRMT's Request
for a Special Use
Permit; 2011;
Bernalillo County,
New Mexico
Scope/Summar
Source of
Evidence
Address the health impacts Community
of the proposed dirty
materials recovery facility.
consultation,
literature review,
policy review,
special collection
(applicant
Impacts/
1 ml points
Health,
environmental,
behavioral,
economic,
demographic,
infrastructure,
information, GIS) other
Pathway of
Impact
Neighborhood
livability, traffic
congestion, air
quality, noise
pollution, odor,
community/house-
hold economics,
mental health,
exposure to hazards
Characterization of Impact
Distribution/equity of impacts
(siting facility in vulnerable
community); Direction of
impacts (negative health
impacts); Likelihood of impacts
(probable impacts, speculative
impacts)
Decision-making Outcome
Recommended denying the requested special use permit; for a
relatively modest recycling achievement, the communities
would experience significant health burdens, which would
likely contribute to the already statistically significant high
death rates and shorter life spans of residents and the potential
for further environmental degradation.
Effectiveness of HIA
Direct effectiveness - influential
in land-use hearings; permit
denied by Planning Commission
Minimum Elements of HIA
Met? If no, what's missing
No; Element 4 (monitoring plan)
missing
25
Concord Naval
Weapons Station
Reuse Project
Health Impact
Assessment; 2009;
Concord, California
Analyze how the
alternatives being
considered for the CNWS
Reuse Project would help
realize health and well
being benefits or potentially
lead to negative health
outcomes.
Literature review,
community
consultation,
policy review,
special collection
(focus groups,
demographics
analysis,
modeling, GIS)
Health,
economic,
environmental,
infrastructure,
services,
demographic
Housing, commun-
ity/household
economics, parks
and open space;
secondary impacts:
mobility/access to
goods and services,
physical activity,
nutrition, air
quality, water
quality, noise
pollution, social
capital, safety and
security
Direction of impacts (negative
health impacts, positive health
impacts); Distribution/equity of
impacts (opportunities for
ethnically/economically
segregated neighborhood;
ensure parks contain facilities
useable by individuals with
limited mobility)
Concluded that the Concentration and Conservation was the
healthier of the two alternatives being considered from
several perspectives; however, both alternatives were
predicted to lead to negative health impacts if mitigations
were not implemented. Recommendations included
maximizing residential density near the commuter rail station;
increasing the amount of affordable housing; adopting a
living wage ordinance; adopting local hiring policies;
maximizing the land available for parks and open space;
promoting public transit and ensuring neighborhood is
walkable and bikeable; encouraging healthy goods and
services to be provided on-site via zoning and other
mechanisms. Also noted that some mitigations, especially
those regarding affordable housing, must be in place before
the footprint of development is finalized and the Navy puts
the land to auction.
Direct effectiveness - advocates
used the HIA to win a plan that
has significant amounts of land
reserved for parks and open space
and relatively high density
housing; the Final EIR approved
by the City Council responded to
some of the recommendations,
but changed little. Concord City
Council voted to move forward
with the second most dense land
use option proposed and has
taken steps to ensure that a
significant amount of affordable
housing is built at the site
No; Element 4 (monitoring plan)
missing; and no quantification of
the magnitude, likelihood, or
permanence of impacts (Element
2.4) due to limited availability of
final options
33
Neenah-Menasha
Sewerage
Commission
Biosolids Storage
Facility, Greenville,
07; 2011;
Greenville,
Wisconsin
Review potential health
concerns and propose
methods to reduce those
risks with the building of a
biosolids storage facility.
Literature review,
community
consultation,
policy review,
special collection
(interviews,
survey, aerial
photo, GIS)
Health,
environmental
Air quality,
exposure to
hazards, infectious
disease, land use,
mental health,
safety and security,
soil quality, water
quality
Direction of impacts (negative
health impacts); Permanence of
impacts (life of the proposed
facility); Magnitude of impacts
(unknown); Likelihood of
impacts (probable impacts,
unlikely impacts, uncertain
impacts); Distribution/equity of
impacts (unknown)
Concluded that if biosolids were handled in an appropriate
manner and according to regulations, they should not result in
a human health hazard. Recommended that the Neenah-
Menasha Sewerage Commission track and respond to
complaints and that biosolids-related health complaints be
monitored so that trends or other indicators of adverse health
effects can be recognized and investigated in a timely manner.
Public Health staff will monitor health effects using a
standardized tool developed by a North Carolina research
group for investigating health incidents associated with
biosolids applied to land.
Undetermined - unclear if plans
to build biosolids storage facility
was dropped due to the HIA or
public pressure
No; Element 2.3 (baseline health
conditions) missing; scoping
phase solely focused on health
(no social or economic
parameters considered; Element
2.1); and lack of transparency in
funding and participants (Element
5)
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Table G-4. Continued
ID
74
HIA; Year,
Location
Assessment of Open
Burning
Enforcement in La
Crosse County;
2011;LaCrosse,
Wisconsin
Scope/Summar
Determine the potential
health impacts of creating a
uniform open air burning
policy within La Crosse
County.
Source of
Evidence
Literature review,
policy review,
special collection
(survey)
Impacts/
1 ml points
Health,
economics,
environmental
Pathway of
Impact
Household
economics,
exposure to
hazards, safety and
security, air quality
Characterization of Impact
Direction of impacts (negative
health impacts); Magnitude of
impacts (number of La Crosse
County residents; Coulee
Region river system);
Distribution/equity of impacts
(populations at the greatest
disadvantage for disposing of
waste); Economic impacts
(offsetting depending on the
area of the county)
Decision-making Outcome
For municipalities with limited resources for education and
enforcement, a detailed bum policy is an opportunity to
provide education and guidance for people on solid waste
disposal services and the policies surrounding what can be
burned. HIA helped to confirm/update burn information that
was compiled by the Solid Waste Department in 2010, and
data collected through the HIA will help direct education
efforts toward the municipalities. Recommendations provided
included inquiring with municipal stakeholders how solid
waste service decisions are made and what barriers exist,
educating the community about solid waste disposal services
and burning rules, making municipality solid waste services
and schedules readily available on-line, and collecting survey
information from fire chiefs that did not respond to the
original HIA survey.
Effectiveness of HIA
Undetermined - no county-wide
ordinance found, but the HIA did
begin a relationship between
Health Department and fire and
municipal staff for cooperative
consideration of quality of life
improvements for residents
Minimum Elements of HIA
Met? If no, what's missing
No; Element 4 (monitoring plan)
missing; likelihood and
permanence of impacts not
assessed (Element 2.4), and
documentation of funding sources
not transparent (Element 5)
G-45
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G-46
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Appendix H -Rules of Engagement Memo
The following is an excerpt from the Healthy Corridor for All: A Community Health Impact Assessment
of Transit-oriented Development Policy in St. Paul Minnesota:
Guidelines for Engagement in Healthy Corridor for All HIA
Healthy Corridor for All
Guidelines for Engagement: Goals, Values, Collaboration, and Roles and Responsibilities
Project Description
Work has begun on a new transit [ins, the Central Corridor light Rail Transit line {CC LRTf, connecting
downtown Minneapolis with downtown St. Paul. The CCLRT is a Si billion transit investment with
potentially up to $2 bil lion investment in local development- The Central Corridor Development Strategy
(CCIJS} has been developed to gyide this investment The City of St. Paul is currently undergoing a
rescuing process along the corridor in order to enable the CCDS. The anticipated timeline for the
rezoningto be complete in Spring 2010.
ISAIAH, Take Action Mirmesota/Hmong Organizing Project, and Policyiink are conducting a Healtti
Impact Assessment (HIA) on the proposed Central Corridor rezoning to identify health benefits and
burdens associated with the rezoning, and to make recommendations to alleviate negative health
impacts stemming from the rezoning.
HIA Definition; Health impact assessment may be defined as 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, (tatsmotianal Association of
Impact Assessment, 2O06J
Purpose: To analyze the potential positive and negative health implications of land use changes resulting
from the new Central Corridor Transit Line.
Timeline and Final Product: Healthy Corridor for Ail will begin in Summer 2010, Preliminary findings are
anticipated in late Winter of 2011 with a final report availabl e in Spring of 2011, with monitoring
continuing into Fall 2011. The final product will be a report detailing the findings of the HIA and
recommendations. The conveners and the Community Steering Committee will hold a community
meeting to share preliminary findings and recommendations with stakeholders in late Writer or early
Spring of 2011.
HIA Goals:
Assess the impacts of the CCLRT zoning on overall community health, health inequities by race,
income, and place, and underlying conditions that determine hea Ith in the Central Corridor and
the East side.
insure positive health benefits are maximized and negative health impacts are addressed by the
decision-making process.
Empower Central Corridor and East side local communities to effectively and meaningfully
engage in the CCiRT zoning process.
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HIA Core Values:
The core values that will guide this HIA include:
Equity
Racial ju slice
Community empowerment
' Collaboration
i Accountability
Scientific integrity
HI A Collaborators:
These goals and values are central to how the Healthy Corridor for AH project team will carry out the
HIA, from the scopmg to the monitoring phase. To support tti is process, the project team will establish a
voluntary Community Steering Committee made u p of community stakeholders and a Technical
Advisory Panel composed of partners with technical expertise relevant to the project.
The Community Steering Committee, made up of constituency-based organizations representing or
serving community members, particularly low-income people and people of color, living and working in
the East and Central Corridor communities,, will be at the center of the HIA. Specifically, the Community
Steering Committee will make key H IA decisions and help drive HIA activities, including developing a
scope, identifying indicators, developing recommendations, and communicating findings. There may
also be opportunities to collect information. Community Steering Committee members have a
commitment to improving community health and well-being, promoting equity and have a commitment
to grass-roots community building in East and Central Corridor communities
The Technical Advisory Panel, made up of agencies, organizations and individuals with an interest in the
rezoning process, will provide technical expertise to the HIA. The Committee will review the scoping
plan, review assessment methods and findings, share qualitative and quantitative data, and participate
in the monrtorrng process. Technical Advisory Panel members have a commitment to improving health
and well-being in the City of St. Paul and the region. Members will commit to providing technical
knowledge, data and resources to the Community Steering Committee to conduct the HIA.
The Community Steering Committee will convene for up to five in-person meetings of J-5 hours each
over a one year {ending in July 2011). Technical Advisory Panel members will be consulted as needed.
Specific roles and responsibilities of both groups are described in detail below.
Principles of Collaboration:
Membership in both groups is strictly voluntary. However, a number of agreements and commitments
must be made in order to participate on either the Steering Committee or the Technical Advisory Panel.
Participants must agree to the delineated H IA goals (see above), and also to the core values of equity,
racial Justice, community empowerment, collaboration, accountability, and scientific integrity. This
means that members will work together to conduct the HIA in accordance with these goals and values,
and will not challenge these goals and values throughout the process.
In addition, ground rules for participation include:
Providing constructive and proactive input {rather than obstructive and reactive input]
Practicing solution-seeking "both/and" thinking (rather than "either/or" thinking]
Page
114
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Being inclusive by respecting different priorities and concerns
Trying on new ideas and perspectives
> Attending t all Community Steering Committee meetings, or finding a proxy in the case of
unavoidable absence
Providing feedback and reviewing HIA materials as requested
Being responsive to outreach regarding the needs of the HIA
Decision-making Process:
During the health impact assessment, the Community Steering Committee and the conveners ml be
making decisions on the direction of the project. The Technical Advisory Panel will be providing technical
guidance and support. The Community Steering Committee will be making many decisions, including:
what issues to include in the HIA and how to define the groups of special concern; what information is
used in the findings; what the recommendations are; and how to use the HIA to take action,
During the HIA process, decisions should be made by consensus whenever possible. Participants will
attempt to bring issues to each other's attention to avoid making unilateral decisions. The partners will
recognize and consider different perspectives. The conveners and the Technical Advisory Panel will work
with the Community Steering Committee to ensure empirical integrity.
Leadership Team
ISAIAH, Take Action Minnesota and PolicyLink will manage and conduct the HIA and convene the
Community Steering Committee and Technical Advisory Panel. ISAIAH is the primary grantee and fiscal
agent for the project. TakeAction Minnesota's Hmong Organizing Program is ISAIAH's primary local
partner and Policyiink is the project's Technical Partner. These organizations work closely together, each
with different, but complementary roles:
- ISAIAH and Take Action Minnesota
o Role: ISAIAH is fiscal agent and lead organization for the project. ISAIAH leads the
process to identify and invite key constituencies into the Healthy Corridor far Aff
Community Steering Committee and Technical Advisory Panel. ISAIAH also leads the
coordination between the local partners and Technical Partner. TakeAction Minnesota's
Hmong Organizing Program is particularly focused on inviting the participation of
Hmong leaders in the project, and assists with general community engagement. Both
organizations collaborate to understand the political dynamics relevant to the success of
the HIA and the timelines, processes, and materials relevant to the HIA analysis.
o HIA Project Manager ISAIAH has hired, on contract, a project manager for the HIA. The
project manager will manage the stakeholder engagement, and serve as the point-
person for the project, acting as the primary contact, coordinator and communicator
between the various groups and agencies cooperating on the project.
- Pdkylink
o Role Technical partner directing the research and empirical HIA process and supporting
the overall HIA. Polio/Link will lead the technical aspects of the HIA with support from
partners
Stakeholder Engagement:
Stakeholder:
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115
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Definition: Stakeholders are persons or groups who are directly or ind irectly affected by a project, as
well as those who may have interests in a project or the ability to influence its outcome, either positively
or negatively.
Engagement: A set of high-level stakeholders will engage in the HIA through participating on a
Community Steering Committee. The Steering Committee will engage a broader group of stakeholders
through individual conversations, community meetings, interviews, surveys and focus groups. The
conveners of the HIA will also hold meetings with stakeholders, hold community meetings to share HIA
findings with interested stakeholders, and strive to engage with as many stakeholders as possible.
Community Steering Committee:
Definition: A group of high level stakeholders who are responsible for providing guidance on overall
direction of the HIA. They will help to obtain strategic input and buy-in from a larger set of stakeholders.
Purpose
o Provide strategic direction for the scope and implementation of the HIA representing
the views of the group or organization the Committee member represents
j Review and provide input on data, materials, and analyses developed throughout the
HIA
o Develop recommendations based on HIA analysis
:> Support HIA to ensure partnership and linkage to other stakeholders and key relevant
processes
o Mobilize and sustain high level of engagement, political commitment and momentum to
achieve the HIA objectives
o Identify available resources and activities relevant to the HIA
o Provide a communication channel to other stakeholders not formally represented on
the Committee
o Monitor ongoing HIA progress
Internal Process
o Potential Community Steering Committee members will be identified through ISAIAH,
TakeAction Minnesota and the Community Steering Committee based on
representation of key constituent groups located in the areas affected by Light Rail.
o Membership is organizational and not individual.
o Any members joining the Steering Committee will sign onto an understanding of the
goals and purposes of the HIA, and will ensure their participation ts constructive to that
end.
o New members or alternates will accept all decisions, analyses and input provided in the
past in order to engage in present and future activities.
o Committee decisions will be made on a consensus basis. Dissenting views may be
recorded if required.
o Committee members may appoint alternates to replace the representatives in the event
of an absence.
o Committee members' input and decisions must be received by the deadlines requested.
The HIA efforts and activities will move forward based on input and decisions received
by indicated deadlines.
o The Community Steering Committee will convene in-perso«i a minimum of five times for
the following purposes:
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H-4
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1. Launch of Community Steering Committee and Development of HIA Scope (July
12* and 13th from 6pm to 9pm).
2. Input on baseline data analysis and next steps (date to be determined].
3. Input on predictions on health impact of proposal (date to be determined).
4. Development and pnoritization of recommendations based on analysis (date to
be determined}.
5. Sharing full analysis with larger stakeholder group (date to be determined].
o In addition to scheduled meetings, the Committee may hold periodic conference calls
with a set agenda on an as-needed basis.
o Individual members may be called upon for expertise on issues within their area of
knowledge.
Meeting notes will be prepared by the chairs of the Committee with a record of what decisions were
made and what actions need to be taken and by whom. The minutes will be prepared within two weeks
of the meeting and sent to all members via email. Committee members will have the opportunity to
add to the notes if anything is left out.
Technical Advisory Panel:
Definition: A group of researchers, experts, and government staff with expertise on key issues related to
the Central Light Rail Corridor HIA project.
Purpose
:> Using best possible technical expertise, review and improve HIA methodologies and
analyses
o Identify and, when possible, provide information, data, activities and resources
o Support HIA to ensure linkages to other technical advisors and key relevant processes
o Share perspective of organization or agency Advisor is representing
o Help identify appropriate monitoring mechanisms to examine the progress of several
health indicators
Internal Process
o Potential Technical Advisory Panel members will be identified through ISAIAH,
TakeAction Minnesota and PolicyLink and Community Steering Committee based on a
review of the Committee's technical needs, data needs, and an overall understanding of
the scientific context of the Central Corridor Light Rail HIA.
o Membership is organizational and not individual.
o Technical Advisory Panel members may appoint alternates to replace them as
representatives in the event of an absence.
o Group members' input and decisions must be received by the deadlines requested. The
HIA efforts and activities will move forward based on input and decisions received by
indicated deadlines.
o Mew members or alternatives will accept al decisions, analyses and input provided in
the past in order to engage in present and future activities.
o The Advisory Group will not be formal voting members of the Community Steering
Committee but will provide guidance, advice and materials to the Committee advice as
needed, in order to help the Committee in their decision-making
o The Advisory Panel members will join as many of the Community Steering Committee
meetings as possible to provide technical advice. Their expertise during the meetings
will be valuable. The foreseeable Committee meetings include approximately five in-
person meetings between July 2010 and May 2011. These meetings include the
following:
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1. Launch of Steering Committee and Development of HI A Scope (July 12* and 13*
from 6fjm to 9pm).
2. Input ort baseline data analysis and next steps (date to be determined}.
3. Input on predictions on health impact of proposal (date to be determined).
4. Development and pnoritiiation of recommendations based on analysis (date to
be determined).
5. Snaring full analysis with larger stakeholder group (date to be determined)
Individual members may be called upon for expertise on issues within their area of
knowledge.
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Appendix I -Opportunities for Stakeholder Involvement in Each Step of HIA
The following is an excerpt from the Guidance and Best Practices for Stakeholder Participation in Health Impact Assessments (Stakeholder
Participation Working Group 2010) and summarizes the opportunities for stakeholder engagement in HIA, as outlined by the North American
HIA Practice Standards Working Group (2010).
HIA Standards for Practitioners Section
Process Oversight: Intended to be used throughout all the stages of the HIA
Essential
Recommended
Screening Stage:
Ess em/a/
Recommended
Scoping Stage:
Essential
Recommended
Accept and utilize diverse stakeholder input.
Have a specific engagement and participation approach that utilizes available participatory or deliberative methods suitable to the needs of
stakeholders and context
1.5
1.6
Deciding whether an HIA is needed, feasible, and relevant
Understand stakeholder concerns in order to determine potential health effects.
Identity and notify stakeholders of decision to conduct a HIA.
Identify stakeholders to potentially partner with a HIA.
Seek diverse stakeholder participation in screening the target policy or HIA plan.
Deciding which health impacts to evaluate and evaluation methodology
Use input from multiple perspectives to inform pathways (between the policy, plan or project and key health outcomes). Use multiple avenues
to solicit input (from stakeholders, affected communities, decision makers).
Ensure a mechanism to incorporate new feedback from stakeholders on the scope of the HIA.
Work with diverse stakeholders to prioritize key elements of analysis.
Seek feedback from stakeholders on HIA scope.
2.2.3
2.3
3.1
3.7
Assessment Stage: Using data, research, and analysis to determine the magnitude and direction of potential health impacts
Essential
Recommended
Use local knowledge as part of the evidence base.
Work to engage al stakeholders in data collection.
Seek feedback from stakeholders on draft findings.
4.2.1
4.2.4
Recommendations: Providing recommendations to manage the identified health impacts and improve health conditions
Essential
Recommended
Reporting & Com
Essential
Recommended
Use expert guidance to ensure recommendations reflect effective practices.
Work with community and other stakeholders to identify and prioritize recommendations.
Seek input on recommendations.
munication: Sharing the results, recommendations
Summarize primary findings and recommendations to allow for stakeholder understanding, evaluation, and response.
Document stakeholder participation in the full report.
Make an inclusive accounting of stakeholder values when deteimining recommendations.
Allow for. and formally respond to, critical review from stakeholders, and make the report publidy accessible.
Seek diverse input on draft final report.
Work with stakeholders to build their capacity to understand and articulate the findings of the HIA.
5.2
6.2
6.3
6.5
6.6-7
Monitoring : Tracking now fie HIA affects the decision and its outcomes
Essential
Recommended
Plan should address reporting outcomes to decision makers.
Monitoring methods and results should be made available to the public.
Involve interested stakeholders in monitoring outcomes.
7.2
7.4
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Appendix J -Risk Assessment Technique for Impact Prioritization
The following is an excerpt from the Point Thomson Project HIA:
2.2.1.1 Risk Assessment Matrix
While there are numerical risk-based environmental standards that regulate biota, air, water and s
oil, there are no similar quantitative regulatory endpoints for public-health outcomes. Winkler
2010 proposes a risk assessment technique that ranks the significance of identified health
impacts allowing health planners prioritize management actions. The entire rating is based on a
modified Delphi approach (Rowe and Wright, 1999), a technique used in judgment and forecasting
situations where pure model-based statistical methods are not practicable.
The HIA team performed this evaluation, as fully described in Winkler 2010 by drawing on
Available health baseline data from the literature review;
Review of the project context, alternatives and developments;
Review of pertinent sections of the Point Thomson Project Environmental Impact
Statement, particularly the Socioeconomic, Environmental Justice, Subsistence, and
Transportation section; and
(iv) Information and recommendations generated by a panel of Alaskan medical and
public health professionals.
The HIA team created a worksheet for each of the eight HECs and each of the five
alternatives. Each of the 40 worksheets was divided into the project phases:
construction, drilling, and operation. The health impact parameters consider:
Duration - determines how long each phase will last; ranked from under a month
to beyond the life of the project
Magnitude - evaluates the intensity of the impact, particularly in light of existing
baseline conditions
Extent - identifies the localities where the projected impact will be experienced, e.g.,
local or regional
Likelihood - evaluates the probability that the impact will occur
Nature - determines whether the impact is direct, indirect or cumulative
Impact - evaluates whether the impact is positive or negative, i.e., whether the impact
will promote or progress, degrade or detract from the well-being of defined
communities or populations
Scoring - as described in Figure 27 and Figure 28 below.
For the risk analysis, a4-step procedure was developed that is illustrated on the risk assessment
matrix (Figure 27 and 28), as modified from Winkler 2010, and as presented below.
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Figure 27 Step 1 of 4-Step Risk Assessment Matrix
Stepl
Impact Level
(score)
Low (0)
Medium (1)
High (2)
Very high (3)
Consequences
A -Health Effect
Effect is not
perceptible
Effect results in
annoyance, minor
injuries or illnesses
that do not require
intervention
Effect resulting in
moderate injury or
illness that may
require intervention
Effect resulting in
loss of life, severe
injuries or chronic
illness that requires
intervention
B- Duration
Less than 1 month
Short-term: 1-12
months
Medium-term: 1 to
6 years
Long-term: more
than 6 years/life of
project and beyond
C-Magnitude
Minor intensity
Those impacted
will be able to
adapt to the impact
with ease and
maintain pre-
impact level of
health
Those impacted
will be able to
adapt to the health
impact with some
difficulty and will
maintain pre-
impact level of
health with support
Those impacted
will not be able to
adapt to the health
impact or to
maintain pre-
impact level of
health
D- Extent
Local/Project
Area
Local/Zone 1:
Kaktovik and
Nuiqsut
Zone 2:
Prudhoe
Bay/Deadhorse
AP
Barrow
Rest of Alaska
US
Global
In Step 1, the extent of the four different consequences (A) effect; (B) duration; (C)
magnitude; and (D) extentis rated according to the criteria set forth in Figure 28. The output of
this rating is a score between 0 and 3 for each consequence, depending on the estimated impact
level:
Low (score = 0)
Medium (score=1)
High (score=2)
Very high (score=3).
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Figure 28 Steps 2, 3, and 4 of 4-Step Risk Assessment Matrix
Step 2
Severity
Rating
(Magnitude +
Duration +
Geographic
Extent + Health
Effect)
Low (0-3)
Medium (4-6)
High (7-9)
Very high (10-
12)
Step 4
Step3
Likelihood Rating
Extremely
Unlikely
< 1%
»
»»
»» »
Very
Unlikely
1-10%
»
»»
»»»
Unlikely
10-33%
»»
»»»
About as
Likely as
Not
33-66%
»»»»
Likely
66-90%
»»
»»
»»»
»»»»
Very
Likely
90-99%
»»
» »
»»»
»»»»
Virtually
Certain
> 99%
»»
»» »
»»»»
»»»»
Impact Rating
Key: Low » Medium »» High »»» Very High »»»»
In Step 2, as shown in Figure 28, the scores of the consequences are summed up and based on
the value the impact severity is assigned as follows:
- Low (0-3)
Medium (4-6)
. High (7-9)
Very high (10-12).
In Step 3 the likelihood of the impact to occur is assessed according to the following
definitions, as presented in IPCC 2007:
Exceptionally unlikely
Very unlikely
Unlikely
About as likely as not:
Likely:
Very likely:
Virtually certain:
< 1 percent
1-10 percent
10-33 percent
33-66 percent
66-90 percent
90-99 percent
> 99 percent
probability
probability
probability
probability
probability
probability
probability.
Step 4 entails the final significance rating, which is identified through the intersection of the impact
severity and the likelihood of the impact to occur, as shown in Figure 28.
A low significance indicates that the potential health impact is one where a negative effect may
occur from the proposed activity; however, the impact magnitude is sufficiently small (with or
without mitigation) and well within accepted levels, and/or the receptor has low sensitivity to the
effect.
Impacts classified with a medium significance and above require action so that predicted negative
health effects can be mitigated to as low as reasonably practicable (Winkler2010). An impact with
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high or very high significance will affect the proposed activity, and without mitigation, may present
an unacceptable risk. The significance is simply stated as positive (e.g. improvement of health
services). If there is a negative accentuation of the health impact compared to the baseline
condition, this is indicated in the risk assessment matrix by the use of a+ sign to indicate a
positive impact or a - sign to indicate a negative impact.
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