ENVIRONMENT
HEALTH
SOCIETY
tS*.'
A quarterly update increasing awareness and understanding of
the interaction between human health and the environment
A Quarterly Update
Issue 4 - Summer 2012
Message from the
Editor
Welcome to the newest issue
of the Environment, Health
and Society Bulletin focused
on Health Impact Assessments
(H1A)
Page 1
Featured Method
- Health Impact
Assessments
H1A is a promising approach
for assisting governmental
agencies in understanding the
health implications of policies,
plans, programs and regulations
Page 2
Featured Science
Article (Abstract)
Health Impact Assessments Are
Needed in Decision-Making
about Environmental and
Land-Use Policy
Conferences &
Opportunities
Opportunities to learn more
about HI A and present research
findings
Page 9
EHS Program
Update: Open/New
Announcements
Updates on the EHS program
new announcements on funding
opportunities from NCER
Page 10
A Conversation with
Rachel Krause
Communities attempt to reduce
greenhouse gas emissions at
the local level in the absence
of national policies to address
climate change
Page 11
Resources at your
Fingertips
Keep current with resource
links, training opportunities,
courses and mentoring tips
Page 13
Message from
the Editor
Devon Payne-Sturges
National Center Jor Environmental Research
Welcome to the Environment, Health and
Society research methods bulletin. Every
quarter, this bulletin features a method
for evaluating the interaction of human
health and the environment, explaining and
providing information and news about the
featured method.
Along with the newly launched EHS
website (epa.gov/ncer/ehs). this bulletin
seeks to bridge the gap across disciplines
in an effort to transform human health
and environmental protection. In this
edition, we feature a discussion on Health
Impact Assessment (HIA), a decision sup-
port tool to help local governments and
agencies consider the health consequences
of policies, plans, programs or regulations.
HIA views health holistically and can help
decision-makers understand the impact of
the decision on health outcomes and their
social and economic determinants. HIA
can help decision-makers and stakeholders
*3
examine the health equity implications of
decisions. HIA also recommends ways to
boost the health benefits of those activities
and mitigate their negative impacts.
EPA Science to Achieve Results
(STAR) fellow, Rachel Krause, shares
her research on municipal governments'
attempts to address climate change at the
local level. Her research may help other
local governments make better policy de-
cisions concerning climate change mitiga-
tion strategies in the future.
This issue of the bulletin includes
information about conferences,: resources
and article^ about research methods.
EHS Bulletin listserv is sponsored by
the EPA and managed through the EPA's
National Center for Environmental Re-
search (NCER) in the Office of Research
and Development (ORD).
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EHS Bulletin

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SOCIETY
Andrew Bos:
eview
Potential
Tina K.Yuen, Fellow, National Center for Environmental Research
Florence Fulk, Branch Chief, National Exposure Research l aboratory
Health Impact Assessment (HIA)
is an emerging decision-support
tool that has shown promise in as-
sisting local, state and federal agen-
cies in evaluating the public health
consequences of a project, plan
or policy and in utilizing scientific
evidence to support decision out-
comes that will potentially produce
the best possible health outcomes
(NRC, 2011). It is defined as "a
systematic process that uses an array
of data sources and analytic methods
and considers input from stake-
holders to determine the potential
effects of a proposed policy, plan,
program or project on the health of
a population and the distribution of
those effects within a population.
HIA provides recommendations on
monitoring and managing those ef-
fects" (NRC, 2011).
HIA is a structured approach
that uses scientific data, professional
expertise and stakeholder participa-
tion to identify and evaluate public
health impacts of a pending decision
or action (Wernham, 2011). As
both a health protection and health
promotion tool, HIA typically
recommends actions to minimize
adverse health impacts and optimize
beneficial ones (NRC, 2011). The
true value of HIA is its ability to
shed light on potentially significant
information that would otherwise
be under-recognized, unanticipated
or marginalized (Cole et al, 2005),
especially concerning decision set-
tings that do not typically include
health as an important consider-
ation. In this article, we provide
an overview of the practice of HIA
and its potential value to decision-
makers and stakeholders.
What makes HIA different from
other health assessments commonly
used such as human health risk as-
sessment (HHRA), or those con-
ducted as part of an environmental
impact statement (EIS), is that HIAs
will often focus on multiple deter-
minants and dimensions of health
in its assessment. An HHRA will
usually only examine the exposure
patterns and attributable health
effects from a single pollutant.
Health assessments in EIS tend to
be very narrow and not to consider
health broadly (Bhatia & Corburn,
2007). With this conceptualization
of health, the practice of HIA also
draws attention to the structures
and policies that shape health de-
terminants and their distribution
that have consequences for dispro-
portionate disease burden (Bhatia &
Corburn, 2007). One step in the
HIA process is to develop a logic
framework, or a causal model, to
provide a schematic for understand-
ing how the decision under con-
sideration operating through the
various pathways can affect human
health (Cole & Fielding, 2007; Bha-
tia, 2011). An example of a logic
framework is depicted in Figure 1
from the Road Pricing HIA in San
Francisco, CA. The road pricing
policy proposes to increase travel
costs to the downtown area in order
to reduce traffic congestion and im-
prove investments in public transit
infrastructure which, in turn, would
EHS Bulletin
2

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ENVIRONMENT
HEALTH
SOCIETY
POLICY DECISION
DIRECT IMPACTS
MEDIATING IMPACTS
ENVIRONMENTAL/
BEHAVIORAL IMPACTS
HEALTH IMPACTS
EQUITY IMPACTS:
•	Low-income, transit-
dependent populations
•	Youth, seniors, and
sensitive populations
COSTS
Road pricing policy
(increases cost of
driving, potentially,
during heavy
traffic times)
Road pricing revenue
investments:
Transit
Bike infrastructure
Pedestrian
infrastructure
More walking/biking
trips
More public transit trips
Fewer auto trips
Change in time spent _
traveling
ECONOMIC IMPACTS
Increased funds for
transit operations
Increased funds for
bike and pedestrian
infrastructure
Change in
cost of living expenses
Local commerce
Active transportation:
^ PhysciaI activity of
^ walking, biking,
^ including to transit
Lower local
traffic volumes
Environmental noise
Fewer regional
vehicle miles
traveled
Air Pollution:
w Local hot spots, regional
Bike and pedestrian
infrastructure
mprovements
Change in
time available for
other activites
Greenhouse gas
emissions
Livability, social cohesion
Physical activity
recommendation
adherence—benefits
for cancer, depression,
diabetes, heart
disease, obesity

r>
Community
annoyance, stress

-~
-~
Heart attack
Sleep disturbance
Local jobs
goods, services
Asthma
Premature death
Cancer
Traffic injuries and
deaths: pedestrians,
cyclists, and vehicle
drivers
Heat-related illnesses
Water- and food-borne
infectious diseases
HEALTH IMPACTS
Broad range of mental
and physical health
conditions
Figure 1: Logic model from Road Pricing Policy HIA. (Ade
affect other travel habits, access to
resources and neighborhood livabil-
ity.
A litany of public health litera-
ture has demonstrated that social
and economic factors are impor-
tant drivers of health outcomes and
health inequities (CSDH, 2008; Ga-
lea et al, 2011). Despite this grow-
ing awareness, governmental policy
decisions that shapes these factors
are often made without these con-
siderations (Gottlieb et al, 2011).
Thus, a more expansive public
health conceptualization is impor-
Ability to meet basic
needs: housing, food,
transportation, etc.
pted with permission from Bhatia, 2011).
tant to understand the full health
implications of policies and practices
forwarded by governmental bodies
(NRC, 2011). Furthermore in 2002
the prestigious Institute of Medicine
found that "governmental public
health agencies alone cannot assure
the nation's health" (IOM, 2002),
which signaled the need for a more
cross-disciplinary approach to how
society must address the most en-
trenched and stubborn public health
dilemmas. It is becoming apparent
that our government agencies and
other decision-making bodies can no
Associated
health costs
estimated
as feasible
LEGEND
Pathways from direct impacts:
	~ Trip Impacts Local
	~ Trip Impacts Regional
	^ Time Impacts
Economic Impacts
Pathways to health impacts:
Quantified in HIA
Qualitative Assessment
longer work in silos of isolation and
ignore the complicated and complex
interplay between social, economic
and environmental factors on our
nation's health. HIA provides a
flexible, yet structured, process for
transdisciplinary research with the
aim of providing a broader under-
standing of health consequences and
the health equity implications of a
decision.
The HIA process is typically
articulated in a formal product or
report; thus, HIA is both a pro-
cess and a product. HIA is identi-
EHS Bulletin
3

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ENVIRONMENT
HEALTH
SOCIETY
fied as one approach to integrate
public health in all policies, a goal
articulated in the National Preven-
tion Council's Strategy report and
by other public agencies (Collins &
Koplan, 2009; HiAP, 2010; NPC,
2011). The World Health Orga-
nizaiton strongly supports the use
of HIA in decision making and has
identified four core values funda-
mental to HIA: equity, sustainability,
democratic participation and best
use of evidence (WHO, 1999).
HIA's strong emphasis on public
participation, especially of overly
impacted communities, also distin-
guishes it from HHRAs and EISs.
Active public participation provides
highly relevant information of per-
ceived exposure health outcomes,
risks to health and safety and com-
munity health outcomes (Tamburri-
ni et al., 2011). HIAs also highlight
the perspective that reduction in
social disparities in health ought to
be a central concern for policymak-
ing. Examining a decision's effect
on existing or future distribution
of health impacts is fundamental to
its practice and objectives (North
American HIA Practice Standards
Working Group, 2010). HIA is
typically thought to consist of six
steps as depicted in Table 1.
The practice of HIA recognizes
that an assessment of health impacts
should be based on the synthesis of
the best available evidence, which
could be either quantitative or
qualitative in nature depending on
the research questions and the avail-
ability of data (North American HIA
Practice Standards Working Group,
2010). Potentially significant health
impacts may not lend themselves to
quantification but deserve consider-
ation in the decision-making con-
text nonetheless (Cole & Fielding,
2007; North American HIA Practice
Standards Working Group, 2010).
Quantification of data is seen as the
gold standard, but such methods
have high information requirements.
Only a small number of health
impacts are amendable to quantifi-
cation. For example, dose-response
functions used in HHRAs exist for
a limited number of environmental
exposures and attributable health
outcomes due to the high evidence
threshold for establishing causal-
ity (Bhatia & Seto, 2011). Relying
solely on these techniques would
present only a partial accounting of
relevant health effects (Bhatia, 2011;
NRC, 2011).
By including qualitative data,
HIAs are able to provide insights
into people's behaviors, perception
of risk and the social, cultural and
political considerations that influ-
ence exposures to environmental
hazards. HIA is able to assess and
characterize health impacts through
formal methods such as structured
and unstructured interviews, focus
groups, surveys and public testi-
mony or written comments (Bhatia,
2011). Unlike HHRA, HIA is also
able to qualitatively describe rela-
tionships between health determi-
nants and health outcomes lacking
dose-response functions (Cole et al,
2005). Chief limitations of these
approaches are that the information
generated may be given little legiti-
macy within the regulatory context
and a litigious system that puts a
premium on quantitative evidence
(Cole & Fielding, 2007).
HIA Step
Elements of HIA Practice
Screening
Determines if an HIA is needed and likely to provide useful
information, considers availability of information, time constraints
and openness of decision-makers to the HIA process
Scoping
Develops a plan for the HIA with stakeholders, such as identifying
health risks and benefits, research questions, methods and data
sources to be used and populations likely to be affected by the
decision outcome
Assessment
Assessment of health impacts usually begins with a baseline health
status; potential health effects of the decision are conducted using a
range of methods and data sources
Recommendation
Develops recommendations to boost health benefits and mitigate
negative impacts; develos a plan for implementing
recommendations; considers stakeholder input
Reporting
Disseminates findings to decision-makers, affected communities
and other stakeholders via written reports, summaries,
presentations, fact sheets, etc.; information is usually tailored to the
intended audience
Monitoring and
Evaluation
Process evaluation assess the process of carrying out the HIA and
its fidelity to best practices or standars; impact evaluation focuses
on the impact of the HIA on the decision-making process; outcome
evaluation assesses the implementation of the decision affected by
the health outcomes or health determinants
Table 1. Six Steps of HIA. (Adapted from Wernham, 2011).
EHS Bulletin
4

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ENVIRONMENT
Quantitative analyses also can
and do play important roles in the
practice of HIA. These analyses add
precision to the evaluation of the
magnitude of health effects, where
enough data is available, and allow
for direct comparison among alter-
natives or with a numerical thresh-
old (Bhatia & Seto, 2011; NRC,
2011). Although HIA methods are
not standardized, analyses can be
descriptive, inferential or predic-
tive through the use of mathemati-
cal models to forecast the potential
effects of policy proposals (Bhatia,
2011; Cole & Fielding, 2007).
HIAs have applied quantitative
techniques to estimate numer-
ous health effects, such as avoid-
able mortality, pedestrian injuries,
asthma hospitalizations and sleep
disturbances. HIAs often employ
methods utilized in HHRAs to pre-
dict health impacts due to changes
in exposures (Bhatia & Seto, 2011).
For example, the HIA on road pric-
ing in San Francisco, CA estimated
changes in health impacts attribut-
able to traffic-related particulate
matter 2.5 micrometers in diam-
eter (PM, 5), traffic-related noise,
changes in walking and bicycling
patterns and injuries related to
pedestrian and bicyling collisions
with vehicles. This HIA used a host
of models which forecasted varia-
tions in transportation patterns and
volume, noise and air quality as well
as dose-response functions based
on published equations (Wier et al,
2011). In another HIA in San Fran-
cisco regarding a living wage ordi-
HEALTH
SOCIETY
The Massachusetts Low-Income Energy Assistance Prograr
children associated with unaffordable energy costs. (Child
above is for demonstration purposes only.
nance, observational models based
on the peer-reviewed published
studies of the relationship between
income and health were applied to
predict improvements in premature
deaths of workers and improve-
ments in school completion and risk
of early childbirth of their offspring
(Bhatia & Katz, 2001). HIA, as
demonstrated, is flexible enough to
incorporate FIHRA as one compo-
nent of its overall scope of analysis
when appropriate and achievable.
Most HIAs use mixed qualitative
and quantitative approaches.
HIAs are conducted by practitio-
ners from a variety of backgrounds
and disciplines both within and ex-
ternal to the field of public health,
such as urban planners, policy
analysts, environmental health sci-
entists, physicians, epidemiologists
and community advocates. Each
brings useful expertise and per-
n (LIEAP) HIA addressed health risks for low-income
Health Impact Working Group, 2007). Note: The picture
spectives to the process; thus, the
practice of HIA does not necessitate
a rigid set of skill requirements.
Engaging in the practice of FIIA may
help build the technical capacity of
those involved to conduct, under-
stand and communicate the findings
of the HIA as well as build the in-
terpersonal capacity of practitioners
to work across disciplines toward a
common goal. FIIA does, however,
require practitioners and decision-
makers, as well as other stakehold-
ers, to possess some understanding
of determinants of health, a com-
mitment to the values and principles
of HIA and an appreciation of both
qualitative and quantitative data.
The practice of FIIA is com-
mitted to the concept of equity;
therefore this tool has the potential
to examine environmental justice
concerns and may help federal
agencies fulfill the objectives under
EHS Bulletin
5

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ENVIRONMENT
HEALTH
SOCIETY
Executive Order 12898, which
states that federal agencies shall
make environmental justice part of
their mission by considering impacts
of their activities on low-income
and minority populations (Clinton,
1994). The U.S. Environmental
Protection Agency (EPA), along
with other federal agencies, has re-
cently prioritized the integration of
environmental justice into its pro-
grams and decisions (Jackson, 2010;
OEJ, 2011).
Equity can be integrated into
every stage of an HIA. It is de-
rived both through the process of
conducting the analysis (process
equity) and by supporting a deci-
sion outcome that will potentially
produce the most equitable results
(decision equity). Process equity is
achieved through the consideration
of data and methods to highlight the
distribution of impacts across sub-
groups, the use of a broad definition
of health that incorporates social
determinants. Cumulative impacts
and distribution of impacts across
demographic subgroups are often
considered to some degree; how-
ever, it is usually not the objective to
reduce the combined health effects
of the decision or action to a single
metric (Bhatia, 2011). Reducing
different kinds of hazards to a com-
mon measure can be problematic,
especially when concerned about
distributional effects (NRC, 1989).
Instead, HIA attempts to synthesize
and present results on dissimilar
health effects that are intelligible
and useful to stakeholders and
The HIA on road pricing in San Francisco considered health impacts due to traffic-related noise and particulate
matter and forecasted variations in traffic patterns, volume, noise and air quality. Note: The picture above is for
demonstration purposes only.
decision-makers (NRC, 2011). Key
findings from the various deter-
minative pathways analyzed can be
discussed descriptively or displayed
in a summary table for ease of com-
parison and communication (Bhatia,
2011). Decision equity involves
making recommendations that may
increase health benefits and ensure
that the distributions of health im-
pacts or health determinants are fair
to all stakeholders (Harris-Roxas
et al, 2004).The recommendation
stage is an important step needed to
communicate research findings and
suggest strategies to boost health
benefits and mitigate against nega-
tive ones. HIA is also outcomes-
driven and solutions-oriented with
an overall aim of using the best
available evidence to support deci-
sion options that have the highest
potential to produce the most favor-
able health outcomes.
A health assessment describing
health outcomes, health determi-
nants, distribution of health impacts
and/or the health status of affected
and vulnerable populations is also
typically conducted within an HIA
(North American HIA Practice
Standards Working Group, 2010).
Such an assessment of baseline dis-
tribution of health and environmen-
tal risks is essential for comparing
equity impacts of policy options and
identifying opportunities to address
existing disproportionate burdens
EHS Bulletin
6

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ENVIRONMENT
HEALTH
SOCIETY
(OPEI, 2010). A baseline condi-
tions assessment is recommended
in HHRA (NRC, 2009), but is not
routinely conducted.
The EPA has also recognized
the potential of IIIA.The recently
created Sustainable and Healthy
Communities Research Program
within the Office of Research and
Development has highlighted HIA
as a promising approach to "inform
and empower decision-makers to
equitably weigh and integrate hu-
man health, socio-economic, envi-
ronmental and ecological factors
to foster community sustainability"
(US EPA ORD, 2011).The Office of
Federal Activities within the Office
of Compliance and Enforcement
also elevates the practice of HIA as
a meaningful method to support
environmental justice consider-
ations in assessments related to the
National Environmental Policy Act
(OECA, 2011). HIA is a tool that
can help EISs improve the consid-
eration of health as required under
NEPA (Wernham, 2011; Cole et al,
2004) as well as incorporate public
participatory and transdisciplinary
approaches into research conduct-
ed at the EPA as outlined in Plan
EJ 2014 (US EPA, 2011). Other
federal agencies and interagency
workgroups such as the Centers for
Disease Control and Prevention and
the National Prevention Council
have also promoted the potential of
HIAs to introduce a broader con-
sideration of public health determi-
nants in decision-making processes
in order to maximize health (CDC,
HIA assessed potential impacts to traditional
The Northeast National Petroleum Reserve Supplemental EIS HIA assessed potential impacts to traditional culture
and food supply of the surrounding Alaska Native communities. (Wernham, 2007). Note: The picture above is for
demonstration purposes only.
2012. Health Impact Assessment. Retrieved May 29, 2012.
Available at http:,/ / www. cdc. gov /heal thyplaces /hia. htm.
Child Health Impact Working Group. 2007. Unhealthy
Consequences: Energy Costs and Child Health: A Child Health
Impact Assessment of Energy Costs and the Low Income Home
Energy Assistance Program. Boston, MA: Child Health Impact
Working Group.
Clinton, W 1994. Executive Order 12898 - Federal
Actions To Address Environmental Justice in Minority Popula-
tions and Low-Income Populations. Washington, DC: Federal
Register.
Cole, B.L., & J.E. Fielding. 2007. Health Impact Assess-
ment: A Tool to Help Policy Makers Understand Health Beyond
Health Care. 28:393-412.
Cole, B.L., R. Shimkhada, J.E. Fielding, G. Kominski,
& H. Morgenstern. 2005. Methodologies for Realizing the
Potential of Health Imp act Assessment. American Journal of
Prevention Medicine 28(4): 382-389.
Cole, B.L., M.Wilhelm, P.V Long, J.E. Fielding, & G.
Kominski. 2004. Prospects for Health Impact Assessment in
the United States: New and Improved Environmental Impact
Assessment or Something Different? Journal of Health Politics,
Policy and Law. 29(6): 1153-1186.
Collins, J., & J.P. Koplan. 2009. Health Impact Assess-
ment: A Step Toward Health in All Policies. JAMA. 302(3): 315-
317.
Commission on Social Determinants of Health (CSDH).
2008. Closing the Gap in a Generation: Health equity through
action on the social determinants of health. Geneva: World
Health Organization.
Galea,S.,T. Melissa, K.J. Hoggatt, C. DiMaggio, &A.
Karpati. 2011. Estimating Deaths Attributable to Social Fac-
tors in the United States. American Journal of Public Health.
101(8): 1456-1465.
Gottlieb, L., S. Egerter, & P. Braveman. 2011. Issue Brief
Series: Exploring the Social Determinants of Health: Health
Impact Assessment — May 2011. Princeton, NJ: Robert Wood
Johnson Foundation.
2012; NPC, 2011).
The practice of HIA is a pro-
pitious approach providing gov-
ernmental agencies, from local
to national levels, a more holistic
assessment of the both the benefits
and detriments of the proposed ac-
tions or projects. It has the potential
to improve public participation in
decision-making activities, expand
the consideration of health, and help
incorporate environmental justice
into decisions regarding actions and
policies at all levels.
References
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ment in San Francisco: Incorporating the Social Determinants
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Bhatia, R., & M. Katz. 2001. Estimation of Health Ben-
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Public Health. 91(9): 1398-1402.
Bhatia, R., & E. Seto. 2011. Quantitative estimation in
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ronmental Impact Assessment Review. 31:301- 309.
Centers for Disease Control and Prevention (CDC).
EHS Bulletin
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ENVIRONMENT
HEALTH
SOCIETY
Harris-Roxas, B., S. Simpson, & L. Harris. 2004. Equity
Focused Health Impact Assessment: a literature review. Sydney,
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Institute of Medicine (IOM). 2002. The Future of the
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Office of Environmental Justice (OEJ). 2011. Plan EJ
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US Environmental Protection Agency (US EPA). 2011.
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ties/ docs/ SHCFramework.pdf
Wernham, A. 2007. Inupiat Health and Proposed Alaskan
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Wernham, A. 2011. Health Impact Assessments Are
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Comerford, M. Harris, J. Bedoya, S. Cowles, R. Rivard. 2011.
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World Health Organization (WHO). 1999. Health
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Recommended Additional Reading
Bhatia, R., & J. Corburn. 2011. Lessons from San
Francisco: Health Impact Assessments Have Advanced Political
Conditions for Improving Population Health. Health Affairs.
30(12)=2410-2418.
Corburn J. 2002. Environmental justice, local knowl-
edge, and risk: the discourse of a community-based cumulative
exposure assessment. Environmental management. 29(4):451-
66.
Corburn J, & Bhatia R. 2007. Health impact assessment
in San Francisco: Incorporating the social determinants of
health into environmental planning. Journal of Environmental
Planning and Management 50(3): 323-341.
Dannenberg, A.L., R. Bhatia, B.L. Cole, S.K. Heaton,
J.D. Feldman, & C.D. Rutt. 2008. Use of Health Impact As-
sessment in the U.S: 27 Case Studies, 1999—2007. American
Journal of Preventive Medicine. 34(3):241-56.
Harris, P., B. Harris-Roxas, M.Wise, & L. Harris. 2010.
Health Impact Assessment for Urban and Land-use Planning
and Policy Development: Lessons from Practice. Planning
Practice and Research. 25:531-41.
Hodge, J.G., E.C.F. Brown, M. Scanlon, & A. Corbett.
2012. Legal Review Concerning the Use of Health Impact
Assessments in Non-Health Sectors. Washington, DC: Health
Impact Project.
Horowitz, P., & C.M. Finlayson. 2011. Wetlands as Set-
tings for Human Health: Incorporating Ecosystem Services and
Health Impact Assessment into Water Resource Management.
Bioscience. 61(9):678-688.
Human Impact Partners. 2011. A Health Impact Assess-
ment Toolkit: A Handbook to Conducting HIA, 3rd Edition.
Oakland, CA: Human Impact Partners.
Lock, K. 2000. Health impact assessment. British Medi-
cal Journal. 320(7246): 1395-8.
Mindell, J., A. Hans ell, D. Morrison, M. Douglas, & M.
Joffe. 2001. What do we need for robust, quantitative health
impact assessment? Journal of Public Health. 23:173-8.
Quigley R., den Broeder L., Furu P., Bond A., Cave B.,
& Bos R. 2006. Health Impact Assessment. International Best
Practice Principles. International Association of Impact Assess-
ment. Special Publication Series No. 5. Fargo, North Dakota:
IAIA.
Stakeholder Participation Working Group of the 2010
HIA of the Americas Workgroup. 2012. Guidance and Best
Practices for Stakeholder Participation in Health Impact Assess-
ments: Version 1.0. Oakland, CA.
Veerman, J.L. ,J.J. Barendregt, &J.P. Mackenbach. 2005.
Quantitative health impact assessment: current practice and
future directions. Journal of Epidemiology and Community
Health. 59:361-370.
Veerman, J.L., J.P. Mackenbach, & J.J. Barendregt. 2007.
Validity of predictions in Health impact assessment. Journal of
Epidemiology and Community Health. 61:363-366.
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Needed in De
Abstract
The importance to public health
of environmental decisions — includ-
ing those about land use, transporta-
tion, power generation, agriculture
and environmental regulation — is
increasingly well documented. Yet
many decision makers in fields not
traditionally focused on health con-
tinue to pay little if any attention to
the important health effects of their
work. This article examines the
emerging practice of health impact
assessment and offers real-world ex-
amples of its effective implementa-
tion, including studying the impact
of nearby highways — a major source
of air pollution — on proposed new
housing for seniors. The article
argues that officials at the federal,
state and local levels should consult
health experts and consider using
health impact assessments when
their decisions on such issues as ur-
ban planning, land use and environ-
mental regulation have the potential
to directly affect the conditions in
which people live and work.
Wernham, A. (2011). Health impact assessments are
needed in decision making about environmental and
land-use policy. Health Affairs. 5(3):247-267.
Conferences &
Opportunities
1.	The 12th Annual HIA Conference
August 29 — 31, 2012
Quebec, Canada
http: / /www.hia2012.ca/en /home,
aspx
2.	The Joint Center for Political and Eco-
nomic Studies Health Policy Institute
2012 Place Matters National Health
Equity Conference, "Models ojAction,
Innovation, and Collaboration"
September 5, 2012
Renaissance Hotel
Washignton, DC
http: / /www.jointcenter.org/events/
place-matters-2012-national-he.alth-
equitv-conference	
3. 2012 Summit on the Science of Elimi-
nating Health Disparities: Building a
Healthier Society, Integrating Science,
Policy and Practice
October 31 — November 3, 2012
Gaylord National Resort Convention
Center
National Harbor, MD (outsideWash, DC)
: / / www.nimhd.nih.
5. The Health Impact Project: 2012 Ad-
vancing Smarter Policies for Healthier
Communities Callfor Proposals
September 14,2012 (deadline)
http: / / www.healthimpactpro-
ject.org /project /opportunities /
document/2012-Health-Impact-Proj-
ect-CFP.pdf
http:
.gov/sum-
mit site / index.html
4. The National Environmental Justice
Advisory Committee (NEJAC) Public
Meeting
July 24-25, 2012
Crystal City,VA
http: / /www.epa.gov/environmental-
justice /nejac/register, html
EHS Bulletin

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SOCIETY
Environment, Health and Society Program Updates
Children's Environmental Health Webinar Series (ongoing)
The webinar series kicked off in February 2012 and is held the second Wednesday of each month,
1:00 p.m. — 2:30 p.m. EST. The purpose of the webinars is to highlight and discuss the research findings from the various
EPA/NIEHS Children's Centers and to give the Centers an opportunity to share their work with a wider audience. The
August webinars will focus on autism-related research. For more information and to register for future webinars, please
visit http://wwwepa.gov/ncer/events/index.html#cehc-webinar
Upcoming Tribal Environmental Health Research Program Grantee Progress Webinars
These webinars will take place on October 17 and November 7, 2012. The purpose of the webinars is to highlight and
discuss the research findings from the various STAR Tribal grantees and to allow the researchers an opportunity to share
their work with a wider audience. For more information and to register for future webinars, please visit http: //wwwepa.
gov/ncer/
Cumulative Risk Assessment Webinar Series
EPA's Risk Assessment Forum (RAF) Cumulative Risk Assessment (CRA) Technical Panel, in collaboration with EPA's
NCER STAR Grants Program, announces a monthly CRA Webinar Series. Addressing multiple exposures to chemical and
nonchemical stressors and cumulative risks and impacts in environmental decisions has long been a challenge for EPA and a
concern of communities and environmental justice organizations. The CRA Webinar Series will be presented monthly, and
be announced in two sessions, the first running through Dec. 2012, and the second to be announced in December 2012
and to run through December 2013. For more information and to register for future webinars, please visit http://www-
epa .gov/ncer/
EHS Bulletin
10

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ENVIRONMENT
HEALTH
SOCIETY
Shutterstock 87258298

A Conversation with Rachel Krause
NCER
Greenhouse gasses like carbon
dioxide are major contributors to
climate change. Overarching policy
efforts at the national and interna-
tional levels to implement and en-
force greenhouse gas reductions are
necessary to address climate change,
but have been difficult to achieve.
Even in the absence of a larger
policy agenda, over a thousand
local governments in the United
States are voluntarily reducing their
greenhouse gas emissions. This
phenomenon is initially surprising
considering that it runs counter to
established economic principles,
such as free-riding, where some
communities would take advantage
of stricter regulations elsewhere to
boost their own economies as well
as the common belief that smaller
governments do not focus on larger,
global issues. "There's no climate
legislation nationally, which is why
policymaking at the state and par-
ticularly the local level matters so
much," said Rachel Krause, a former
EPA STAR fellow.
The ability of these small local
governments to address large-scale
environmental problems drew
Krause's interest while she earned
her Ph.D at the University of In-
diana examining environmental
policy, particularly as it relates to
urban governance and management.
She was interested in understand-
ing not only what these communi-
ties were doing, but also why they
made these policy decisions, and
how effective they were in tackling
this complex problem. Her research
examined the type and extent of
greenhouse gas mitigating activities
that have been implemented. Her
work contributes to the broader
understanding of policy decision-
making around climate change at
the local level.
"It's the opposite of what you
might expect," Krause said. She ex-
plained that the active commitment
by these cities to regulate emissions
in their area against all expectations
to do so was clear, but at the time
she began her research there was
little data to support their efforts.
Research would be necessary to
analyze the activities undertaken
by the cities to limit the effects of
EHS Bulletin
11

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ENVIRONMENT
HEALTH
SOCIETY
climate change. In addition, other
communities may be able to learn
from their experiences. Krause
undertook an extensive survey of
these municipalities, sending online
questionnaires to gather data on
their greenhouse gas mitigation ac-
tivities. Krause eventually collected
information on 329 cities, almost
half of all American cities with more
than 50,000 people.
She found that the reasons for
addressing climate change and
methods to meet their aims varied
from city to city, but there were
some notable trends. All of the cities
surveyed implemented some type of
greenhouse gas reducing measure.
Of the 26 identified activities to
address climate change, the aver-
age city engaged in nearly half. The
main finding of the study was that
it was the size and assets of a local
government that were the primary
drivers of climate change mitigation
strategies at the municipal level.
"Human and financial resources
mattered much more than anything
else," Krause said. Cities with more
staff and funding had the resources
to devote significant attention to
greenhouse gas reduction initiatives
and often did so. There was a range
of measurable effects of the plans
undertaken by the cities, Krause
stated. Cumulative efforts resulting
from a single action to use renew-
able electricity to power city gov-
ernment operations was estimated
to produce an annual abatement of
between 5.8 and 29.2 million met-
ric tons of carbon dioxide equiva-
lent.
These results point to the idea
that climate protection even on a
local scale can have an impact on
energy-saving and reducing green-
house gas emissions. Gathering
this information into one place and
analyzing it will, therefore, provide
a resource for future municipal
climate protection plans which will
influence policymakers as they work
on strategies to limit climate change
caused by humans and industry.
Editor's note: Cynthia McOlirer andTina K.Yuen
contributed to this article.
EHS Bulletin
12

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SHUTTEI
HIA Funding Opportunities
The Health Impact Project, a collabo-
ration of the Robert Wood Johnson
Founda tion and The Pew Charitable
Trusts, http: / /www, heal t liim pa ctproj ect.
org/
Robert Wood Johnson Foundation
(RWJF). http: //www.rwjf.org
Active Living Research (RWJF).
http: / / www.activelivingresearch. org
Centers for Disease Control and Pre-
vention, Healthy Places, http: / /www,
cdc. gov /healthvplaces / hia h tin
HIA Resources
Health Impact Project resources.This
website is a clearinghouse of pub-
lished HIAs. Ill 11): /'/www. Ileal 11) in) pari-
project.org/resoiirces
Centers for Disease Control and
Prevention, Healthy Places website.
http: //www.cdc.gov/healthyplaces/hia.
him
San Francisco Department of Public
Health: Program on Health, Equity,
and Sustainability.This website has a
number of tools and models, http: / /
www.sfphes.org/resoiirces
Human Impact Partners tools and
resources. This website has a range of
tools and guidances for the practice
of HIA. http : / / www.humaiiimpact. org /
hips-hia-tools-and-resources
UCLA HIA-CLIC Methods and Re-
sources. This website is also a clear-
inghouse on published HIAs. http: //
www.hiaguide.org/methods resources
National Association of County &
City Health Officials, http: / /www.
naccho.org/topics/environm ental/laiiduse-
plamiiiig / HI Aresoiir ces. cfin
HIATrainings
Planning for Healthy Places with
Health Impact Assessments Online
Training, httpt //professional.captiis.
com / Planning/hia2/Lists/PreCour seSnr-
vey/NewForm.aspx?Sonrce=http" o3A" o2F
0 o2Fprofessioiial.captus.com0 o2FPlamiing0o
2 Fhia2° o 2 FLists0 o 2 FPre Conr seSnr vev° o 2 Fo
verview.aspx
San Francisco Department of Public
Health: Program on Health, Equity,
and Sustainability. HIA Training.
http:/ / www.sfphes.org/ services/hia-
training
Human Impact Partners. HIA Train-
ing. http: / /www hum animpact, org /hia-
training
UCLA HIA-CLIC. HIA Training.
http: / / www.hiaguide. org / training
HIATools & Guides
Transportation Health Impact Assess-
ment Toolkit.
This toolkit is designed for use by planning
and health professionals, and provides a
framework for public health departments,
city planners, project managers, and other
stakeholders to conduct I IIAs on proposed
transportation projects, plans, and policies.
A key question at the core is how public of-
ficials, community members, and planners
can ensure that future transportation poli-
cies consider health, http://www.cdc.gov/
healthvplaces/traiisportation/FIIA toolkit,
htm
Design for Health.
This is a collaborative project between the
University of Minnesota, Cornell Uni-
versity, and the University of Colorado
that serves to bridge the gap between the
emerging research base on community
design and healthy living and the everyday
realities of local government planning.
http: / / www.designforhealth.net/
HIA Blog
Health Impact Assessment Blog. http: / /
healthimpactassessm ent. blogspot. com /
Resources at your Fingertips

— The EHS Bulletin staffincludes Devon Payne-Sturges, KelljWidener, Myles Morse, Cynthia McOlivei, Kenny McFmlane, Eric Hal Schwartz
bHEl and Tina K. Yuen. Special thanks to Rachel Krause and Ashley Bubna. Editorial views and opinions expressed are not necessarily those of
United States NCER, ORD and l l'A. To contact the EHS Bulletin staff: Devon Payne-Sturges at (703) 347-8055 or payne-sturges,devoa(o)£pa.gor.
Environmental Protection
	Agency	
EHS Bulletin	13

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