Caring for the Community: Health Impact Assessments

Posted on Mar 11, 2013 by Ailee Slater (G+)

If you have lung cancer from smoking, that's your fault; not the result of a childhood surrounded by tobacco advertising and nicotine-dependent adults. If you're obese, that's because you don't eat well; not because you live in a city where car dependence is a must. If you have a chronic illness, it must be the result of family genetics or poor lifestyle.

For most people, these statements don't ring true. We know instinctively that our health is influenced not just by the choices we make, but by the places where we live - suburban dwellers tend to suffer more from obesity than urban dwellers,  low income people living in an area with good public transit will have better access to jobs and health care services, and so on. In recent years, public health care organizations in the United States have begun to put more emphasis on how a community can affect the health of an individual, and one significant example of such interest in community health is the rising popularity of Health Impact Assessments. A Health Impact Assessment, or HIA, provides advice to communities on how to stay healthy; much like a physician provides guidance to an individual patient.

The HIA will be commissioned to evaluate a new policy or project, and comment on how that plan could affect the health of the community. Will the project increase or decrease opportunities for outdoor recreational activities? Will it expand or limit access to public parks and other green space? Will the project make it more difficult for children to get to school, or for parents to buy fresh fruit and vegetables? These are important questions when evaluating the long term effects of city development upon the health of residents. Once research has been conducted, the HIA will provide a report and recommendations to project decision-makers and other stakeholders in the plan. The HIA may point out flaws, recommend alterations, or even encourage the project to move along at a faster pace. Although commissioning a Health Impact Assessment is optional for project managers, the popularity of HIAs has greatly increased in the United States during the past two decades.

Clearly, city planners and politicians have realized that - in the same way we already analyze projects for environmental impact - housing, transportation and other city development works should likewise be evaluated for impact on health. HIAs are frequently used abroad, with European nations claiming great benefits of such evaluations. In America, public health organizations such as the Centers for Disease Control and the Department of Health and Human Services strongly recommend the use of HIAs. One of the early Health Impact Assessments occurred in 2003, assessing the Los Angeles City Living Wage Ordinance. This ordinance required employers to take one of two actions - increase employee wages to $7.99 per hour, or contribute $1.25 per hour to that employee's health insurance payments, in an effort to reduce poverty and improve living conditions for low wage workers in the city. The wage ordinance was strongly supported by labor unions and other organizations concerned about the privatization of public works projects leading to lower wages and less insurance for workers.

The Health Impact Assessment of the Living Wage Ordinance came to an interesting conclusion - giving employees insurance instead of higher wages was better for overall health. Although the HIA did find that increasing wages would lead to a lower mortality rate long-term, these pay raises thanks to the ordinance were not enough to substantially reduce employees' levels of poverty. Health insurance, on the other hand, was found to both reduce mortality and improve the health of workers and their families more than a simple wage increase. This policy assessment in Los Angeles is just one example of how HIAs can direct businesses and politicians toward making healthy decisions. Besides issues directly related to insurance and health care, HIAs are also interested in how a policy or project will affect fitness opportunities for the community. In Atlanta, Georgia, a Health Impact Assessment was commissioned to evaluate a proposal to build a beltline connecting 40 parks throughout the city. This beltline would include 33 miles of trails, a 22 mile rail transit loop, and join together all Atlanta council districts.

In order to evaluate this beltline project, the HIA began by collecting data to make a profile of the Atlanta population, considering everything from income levels, to prices of rental houses, to air quality, to access to schools, work, shopping and health facilities. In the end, the assessment found that the beltline stood to provide a great many health benefits to the community - crime could be reduced, the population would likely see increased physical activity through access to trails and parks, and assuming that rental prices were not allowed to increase steeply, low income families especially would stand to benefit from the beltline. The HIA recommended a shorter timeline for the project so that the community could enjoy these health benefits as soon as possible. In identifying the importance of HIAs, a 2011 joint report from the National Research Council and the Centers for Disease Control notes that, for many years, city planning projects have unwittingly contributed to the United States' struggles with obesity. When the Interstate Highway Act was passed in 1956, it set America on a path toward private car ownership rather than reliance on public transport.

Since that time, Americans have enjoyed the pleasures of auto use along with the pains - less daily physical activity, more pollution, and more chances for accident and injury. The report estimates that fifty percent of Americans suffer from chronic health problems such as diabetes and heart disease, worsened by the obesity that has accompanied this American trend toward suburban living and private car ownership. Indeed, policies involving transit and transportation stand to benefit very much from an initial Health Impact Assessment. In 2012, San Francisco announced that it would be engaging an HIA to study how the area's Regional Transportation Plan may affect different demographics within the city. Residents living on a low income, for example, may see changes to lifestyle and health depending on how public bus routes are re-organized. Next month, when final results and recommendations are set to be published, the health of yet another community will stand to benefit from the work of a Health Impact Assessment.