Why assess health impacts of development?
In Washington State, the Growth Management Act and other statewide directives have focused attention on promotion of public health through planning and environmental review:
* Under the GMA, wherever possible, land use elements “…should consider utilizing urban planning approaches that promote physical activity.” [RCW 36.70A.070(1)]
* The GMA also requires transportation elements to include plans for pedestrian and bicycle “…facilities and corridors that address and encourage enhanced community access and promote healthy lifestyles.” [RCW36.70A.070(6)(vii)]
* In 2007, Governor Gregoire signed a legislative directive, Senate Bill 6099, that asked Seattle-King County Health and the Puget Sound Clean Air Authority to conduct a health impact assessment of the SR-520 Bridge Replacement and HOV project, focusing on air quality, greenhouse gas emissions, and other public health issues.
As planners increasingly incorporate public health considerations in planning projects, how can the effectiveness of these approaches be evaluated? Health Impact Assessments (HIA) are intended to help provide this evaluation. HIA can be used to evaluate objectively the potential health effects of a project or policy before it is built or implemented. It can provide recommendations to increase positive health outcomes and minimize adverse health outcomes.
How can we measure the effect of development on general health?
A Health Impact Assessment (HIA) is a way in which to evaluate the impacts of planning and development on human health. An HIA uses a combination of procedures, methods and tools by which a policy or project is judged as to its potential effects on the health of a population, and the distribution of those effects within the population.
An HIA encompasses an array of qualitative and quantitative methods and tools. From awareness-raising, rapid-assessment methods to more data-intensive approaches, HIA comes in a variety of forms. Rapid HIAs can be completed in a few days or weeks. Full HIAs may require months to complete. The decision to conduct a rapid or a full HIA is often determined by the available time and resources.
What does the HIA process look like?
Although the approach and standards for HIAs are still evolving, draft standards were formulated in 2008 by the North American HIA Practice Standards Working Group at the North American Conference on Health Impact Assessment.
In general, the full HIA process follows six steps.
1. Screening: determining whether or not an HIA is warranted, and how an HIA would add value to the decision-making process
2. Scoping: determining which health impacts to evaluate and the methods for analysis.
3. Assessment: analyzing impacts using existing research as well as qualitative and quantitative data collection research methods to determine the magnitude and direction of potential health impacts.
4. Synthesis and Communication: reporting the findings of the HIA. This can take many forms, including written reports and public testimony.
5. Evaluation: learning from the HIA process and assessing its impact on decision-making.
6. Monitoring: tracking the effects of the decision and its implementation on health determinants and health status
While the majority of the HIAs in the United States have been conducted in California, an example of a full HIA conducted in Washington is the Seattle-King County Health and the Puget Sound Clean Air Authority HIA of the SR-520 Bridge Replacement and HOV project. This HIA focused on four categories: Construction Period; Transit, Bicycling and Walking; Landscaped Lids and Green Spaces; and Design Features for Healthy Communities. The report also included almost a dozen appendices, including issue reports and white papers covering environmental topics like air quality, water quality, noise and greenhouse gases as well as quality of life issues such as physical activity, safety, social connections, and mental well-being. (http://www.kingcounty.gov/healthservices/health/ehs/hia.aspx)
In addition, a number of smaller, rapid HIAs have been undertaken within Washington State for various issues.
What is a rapid HIA?
A Rapid HIA generally centers on a workshop bringing together stakeholders to identify and assess health impacts. As the name suggests, it’s a relatively speedy slimmed down version of a HIA. It usually includes participatory workshops and desktop research. Because of the reduced cost of a Rapid HIA, it is a common method to determine health impacts. Three examples of this type of HIA within the state of Washington include the City of Spokane Pedestrian Strategies within the Downtown Plan Update, the City of Puyallup South Hill Regional Growth Center, and the City of Vancouver Highway 99 Sub-Area Plan.
The City of Spokane conducted a rapid HIA that looked at policy statements supporting multi-modal transportation, specifically bike and pedestrian connections, which were within the 2008 Spokane Downtown Plan Update. The HIA was a collaborative effort between the City of Spokane Planning Department, the Spokane Regional Health District, and The Lands Council. The recommendations include the development of a pedestrian zone during certain hours on the weekends, and use of the HIA to prioritize pedestrian improvements.
The City of Puyallup initiated a redevelopment plan for the South Hill Regional Growth Center, which had been experiencing tremendous commercial growth. The City and the Tacoma-Pierce County Health Department had developed a collaborative relationship and secured funding for a Health Impact Assessment of this redevelopment plan. The agencies intended to use a Health Impact Assessment to inform decision-makers and further shape the proposed plan. The HIA assessed potential health impacts such as access to healthy foods, crime and safety, injury, physical activity, sense of community, and transportation. The HIA provided land use recommendations including integration of different land uses, including transit-oriented development on major transit routes; provision of a variety of housing options; and multi-modal transportation options.
The City of Vancouver conducted an HIA for the Highway 99 Sub-area Plan. The goal of the HIA was to support the plan’s vision by using an established socio-ecological model of health promotion to validate the plan’s health promoting features. It focused on factors influencing key health determinants, specifically physical activity, nutrition and reliance on motor vehicles. The HIA provided recommendations that were supported by accompanying health impact research.
Within the United States, the awareness of the impact of the built environment on health is growing, and Health Impact Assessments are beginning to be accepted as a valuable tool among the larger planning community. In order to solidify its role in the land use planning process, planners and public health officials need to work cooperatively regarding their respective methodologies, and opportunities for involvement and influence.
How can I learn more?
Several websites provide additional information regarding HIAs and links to completed health impact assessments:
http://www.who.int/hia/en/ (World Health Organization)
http://www.sfphes.org/HIA_Tools/HIA_Practice_Standards.pdf (HIA Practice Standards)
http://www.designforhealth.net/resources/healthimpact.html (Design for Health)
http://www.designforhealth.net/pdfs/HIA/BCBS_Rapidassessments_011608.pdf (Rapid HIA toolkit)
http://www.ph.ucla.edu/hs/hiaclic/archive.htm (UCLA HIA Archive)
Editor's Note: Karen Swenson, AIC,P is a Senior Associate for the Blumen Consulting Group, a Seattle area land use and environmental planning firm and Northwest Hub sponsor. Karen has 15 years of experience in community and environmental planning. You can reach Karen by email at karens@blumencg.com.
