The Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, recently announced eight new grant recipients that will receive funding to conduct health impact assessments (HIAs). The projects will bring health considerations into upcoming decisions on topics including education, sanitation infrastructure, and energy.

“Our new grantees will use health impact assessments to uncover opportunities to improve health in a wide range of policy decisions, as well as to identify and avoid potential unintended consequences,” said Aaron Wernham, MD, director of the Health Impact Project. “These eight HIAs are the latest in a fast-growing field, as more cities and states find them a useful way to bring health into decisions in other sectors.”

By the end of 2007, there were 27 completed HIAs in the United States. There are now more than 225 completed or in progress, according to the Health Impact Project map of HIA activity in the United States.

Funding for some of the new proposals was also provided by the Blue Cross and Blue Shield of Minnesota Foundation and The California Endowment.

Some of the new HIAs that have received funding include:

• Partners for a Healthier Community, Inc. will undertake an HIA to inform decisions about a proposed casino in western Massachusetts. Decision-makers—including the state gaming commission, local government officials, and voters—will consider siting options as well as licensing, regulation, design and development of the casino. The HIA will examine health risks that might be linked to gambling—including substance abuse, mental health, and injury—and potential health benefits related to employment opportunity, access to health insurance, and community revenues. 
• The University of Texas at El Paso, will conduct an HIA on the impacts of proposed water and sanitation improvement projects on the town of Vinton, Texas. Vinton primarily relies on failing septic tanks and cesspools for wastewater removal and domestic wells with poor water quality. Poor water and sanitation are associated with gastrointestinal illnesses and other serious health conditions such as hepatitis, dysentery, and dehydration. Improved systems could not only improve public health but also support economic development and long-term sustainability of local businesses and industry. 
• An HIA by the Kentucky Environmental Foundation, in collaboration with the Purchase District Health Department, will examine the potential health benefits and risks of the retrofit or retirement of the Shawnee coal plant in Paducah, KY, operated by the Tennessee Valley Authority. The HIA will analyze environmental health concerns associated with air and water pollution from the plant and the effects of its closure on the community including employment, individual income, and revenue for local services important to health.

NewPublicHealth recently spoke with two of the researchers conducting the Shawnee coal plant HIA, Elizabeth Crowe, executive director of the Kentucky Environmental Foundation, and Deborah Payne, energy and health coordinator for the Foundation.

NewPublicHealth: What is the scope of the HIA you’re conducting? 

The American Public Health Association (APHA) is currently accepting applications through April 8 for the association’s one-year Public Health Fellowship in Government. Fellows work in a congressional office on legislative and policy health issues. The position gives Fellows the opportunity to learn about the legislative process in Washington, DC, which can be a critical skill once they return to their positions in public health, since policies are an important tool that can be used to protect Americans and their communities from preventable, serious health threats.  And it also allows Fellows to provide critical input, drawing on their knowledge and experience, on the decisions that impact public health at the national policy level.

To get some background on the role of a Fellow and the impact that public health practitioners can have when working in the national policy arena, NewPublicHealth recently spoke with Fern Goodhart, current legislative assistant to Senator Tom Udall (D-New Mexico), who spent the tenure of her fellowship working in the office of Senator Robert Menendez (D-New Jersey). Ms. Goodhart was the first person awarded the APHA policy fellowship and served in 2007-2008.

NewPublicHealth: What was your background before you took the fellowship?

Fern Goodhart: I have worked in public health for 30 years including at a state health department; as director of health education at an ambulatory center; as a medical school instructor; as a member of an autonomous board of health; and as a member of my city council. So I’ve had the opportunity to see how policy was made on the local level and the state level. What brought me to the APHA Fellowship was the desire to see firsthand how policy was made at the federal level.

NPH: What kind of work did that involve?

An article in the  New York Times this week looks at the role of health impact assessments (HIAs), a tool that helps policymakers at all levels of government more fully understand the health effects of proposed laws, regulations, programs and projects—from big infrastructure projects to school curriculum development—and craft recommendations that capitalize on opportunities to improve health.

HIAs are a fast growing tool: nearly 225 of the assessments have been completed or are in process across the U.S., according to the Health Impact Project, a national initiative designed to promote the use of health impact assessments as a decision-making tool for policymakers. The Health Impact Project is a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts.

 “People in the public health world and in the business and development world are waking up to the need to get at health care problems and bring down health care costs,” says Aaron Wernham, MD, MPH, director of the Health Impact Project, in the New York Times article. “So we see a fair amount of uptake in certain sectors — the health impact assessment is out there and growing.”

Growth of the tool is also well indicated by last year’s sold out Inaugural National Health Impact Assessment Meeting. Registration has just opened for the second National Health Impact Assessment Meeting, to be held in Washington, D.C., September 24 and 25, 2013.

The meeting will bring together policymakers, public health professionals,  HIA practitioners; community-based organizations; researchers and decision makers from non-health agencies all who may use  or rely on the results of  HIAs in the fields of planning, transportation, housing, agriculture, energy, environment, and education.

The health upside to a new casino can be the increased quality of life and life expectancy associated with new jobs. But, it can bring health downsides too, including the fallout associated with gambling addiction. Those are some of the key findings in a new health impact assessment (HIA) from the Kansas Health Institute (KHI), released this week. The HIA was funded by a grant from the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and the Pew Charitable Trusts, and conducted by KHI together with the University of Kansas School of Medicine-Wichita.

“Our first HIA intended to inform the discussion of potential casino development…” says Robert F. St. Peter, MD, who is KHI’s chief executive officer. “In many cases,” says St. Peter, issues like these may not seem to have direct connections to health, making them a good fit for [a] health impact assessment.”

The results of the new HIA suggest that there may be positive impacts of casino development related to new jobs; the negative impacts would be related to increases in pathological gambling, which is also associated with nicotine dependence, substance abuse, depression, insomnia, and domestic violence. The HIA offered recommendations including:

• Train physicians to screen for problem gambling behaviors
• Eliminate smoking within and around casino buildings
• Strengthen local services to treat and prevent gambling addictions and related conditions
• Operate a “safe ride” program for patrons and residents
• Use a “loss limit” strategy to prevent substantial financial losses among casino visitors

Read a recent NewPublicHealth interview with Tatiana Lin, KIH senior analyst and strategy team leader, who was the director of the Casino HIA. 

The Network for Public Health Law will sponsor the 2012 Public Health Law Conference, with the theme “Practical Approaches to Critical Challenges,” from October 10 through 12, 2012, in Atlanta. Follow NewPublicHealth during the conference for interviews and session updates. Goals of the conference include:

• Examining practical legal approaches to address priority public health issues
• Learning about helpful public health law resources and evidence-based research
• Discussing public health legal questions and answers
• Building partnerships to accomplish public health objectives and foster innovation

 According to the Network, target audiences for the conference include attorneys, local, state, tribal and federal public health officials and practitioners, policy-makers, advocates and academics and researchers.

NewPublicHealth spoke with Dan Stier, director of the Network for Public Health Law about the Network’s accomplishments since its founding two years ago, and upcoming goals.

>>BONUS: Read our earlier Q&A with Dan Stier, offering a sneak preview of what's to come at the 2012 Public Health Law Conference.

NewPublicHealth:  How much has awareness of the Network grown since you launched in 2010?

Dan Stier: The volume of the requests has grown greatly, as have the complexity and timeliness of the requests. The fact that people are becoming increasingly aware of us means that we really are addressing issues in real time. Dramatic current examples include legal questions on public health services related to West Nile virus and Hurricane Isaac in real time.

>>Read an interview with James Hodge of the Network on legal questions on these and other recent public health crises.

Other requests include longer-term issues like shared services among local health departments. State and local health departments face budget cuts and so they are figuring out ways to do things more efficiently and economically, and oftentimes, that involves shared service agreements between local health departments. We’ve seen much more activity along those lines. More recently we’ve gotten an increasing number of questions on maternal and child health, particularly with respect to the provisions relating to children in the Affordable Care Act, so we now advertise that as another area of specialty.

NPH: How have people become aware of what the Network offers? 

Quebec will be the host city of the 12th HIA International Conference this week, the first time the meeting will be held in North America.

Quebec is a strong choice as host city. In 2001, the province of Quebec institutionalized health impact assessments (HIAs) by requiring that all laws and by-laws that could have an effect on health be evaluated for their impact. To help develop effective strategy, internal procedures were created at the Ministry of Health and Social Services to respond to requests, as well as HIA guidelines, a research program, and communication tools to help disseminate the HIA outcomes. Over 500 requests for advice have been generated since the requirement was put in place.

NewPublicHealth recently spoke with Alain Poirier, MD, chairman of the HIA meeting’s local organizing committee and the former National Public Health Director and Assistant Deputy Minister in Quebec’s Ministry of Health and Social Services.

NewPublicHealth: How did the 2001 law come about?

Dr. Poirier: The Health Minister at the time had been an official with the World Health Organization and so was well acquainted with the work being done in some European countries on evaluation the impact of laws on health. Our Public Health Act said the health minister “shall” be consulted, not “should” be consulted on any measures resulting from a new law or by-law that could have an impact on health.

And just saying that is not enough. I was made the person in charge in the Ministry of Health and Social Services of taking responsibility for the evaluations with the help of different groups, including academia. We also have a public health institute, the Institute National de Santé Publique du Quebec, which also has a mandate to help evaluate public policies and counsel the health minister about the impact of public policy.

We’ve had a lot of demand to evaluate new proposals, in part because every five years all the ministers in Quebec are required to issue a report on strategic planning. So when we screen the strategic planning we could foresee in advance what is going to be worked on in other ministries.

NPH: What is an example in Quebec of an HIA that was done that has resulted in a change in policy?

The twelfth HIA International Conference held this week in Quebec will be the first to take place in North America. Health impact assessments (HIAs) bring together scientific data, health expertise and public input to identify potential health effects of proposed laws, regulations, projects and programs, providing decision-makers with the information they need to advance smarter policies for safe, healthy, thriving communities.

Alain Poirier, MD, chair of the conference local organizing committee and former minister of health and social services in Quebec says the location provides an excellent opportunity for Americans and Canadians, who have not attended this HIA conference in large numbers previously, to learn what is going on in the field across the world, particularly now that HIA is a burgeoning field in the United States. An updated map from the Health Impact Project, a joint program of the Pew Charitable Trusts and the Robert Wood Johnson Foundation, offers an updated look at HIAs completed or underway in the United States. According to the Health Impact Project, in 2007, there were only 27 completed HIAs in the U.S. but the map now counts 100 completed and more than 200 total HIAs. The built environment is the most popular field for HIAs in the country right now, with over 70 completed or in process, followed by transportation, agriculture and food, natural resources, and food and housing.

The map details some recent critical examples of HIAs in the United States:

Economic Policy: New Hampshire State Budget. An HIA will inform lawmakers on how funding changes in parts of the state budget might affect the health of residents.

Built Environment: San Pablo (CA) Corridor. This HIA addressed the health implications of placing affordable housing units along the San Pablo Corridor, a high traffic transit and retail corridor in Richmond and El Cerrito, Calif.

Housing: Trinity Plaza Housing Redevelopment. This HIA examined a proposed redevelopment project in San Francisco that would demolish an older apartment building with over 360 rent-controlled units, and replace them with 1,400 market-rate condominiums.

>>Recommended Reading: NewPublicHealth frequently covers emerging HIA projects across the country. Read about HIAs that examined the potential health impacts of:

• USDA nutrition standards; regarding impact on both student health and school budgets
• High energy costs and smart metering policies
• Low-income rental housing inspections
• Increased public transportation use
• Casino development

Model practices were the focus of a session, “Building Partnerships for Healthy Places,” on the first day of the Weight of the Nation conference. Bringing diverse groups together to improve community health was a common element of each of the presentations.

Chris Danly of Vitruvian Planning in Boise, Idaho, talked about his firm’s recently completed health impact assessment (HIA) on the Haywood County (North Carolina) Community Bicycle Plan—which aimed to determine what projects, policies and programs were needed to foster a bicycle-friendly community, through a collaborative process with diverse partners such as County officials, the Recreation and Parks Department, the Department of Transportation, bicycle clubs and the local general store. The HIA found the plan would have positive health impacts on community health, including making virtually all members of the community aware of bicycling as an option for recreation and transportation, and also for drivers to be more aware of bikers on the road.

Danly also suggested to conference-goers that they work on both short- and long-term goals with partners when it comes to the built environment: “It’s a great long-term vision to have everyone walk or ride, but in the meantime existing conditions needs to be fixed.”

Danly’s other suggestions:

• Identify places where people are active and build on those small areas to get your long-range vision.
• Get excited about small victories such as kids walking two blocks to the pool, instead of driving.
• Near-term improvements can include sidewalks, pedestrian lighting, landscaping, crosswalks, bike racks, public art and lighting for tracks to make them usable in the evenings.
• Partnership opportunities include citizen’s patrols, site sharing, joint use agreements and organized runs.

The connection between health and energy consumption is an area just beginning to be understood, but when some people are forced to choose between paying their energy bill and paying for food or medicine, it becomes critical. The Health Impact Project has just released a new health impact assessment (HIA) of a pilot program run by Illinois' largest electric utility, Commonwealth Edison. The HIA looked at the health effects of implementing "smart metering," which replaces existing mechanical meters with digital meters that record customer usage in 15-minute increments. The new meters are coupled with a new two-way communication system that allow a utility company to remotely connect and disconnect service, as well as get real-time, detailed customer usage. The purpose of this HIA was to evaluate the potential health impacts of smart metering for residential customers in the ComEd service territory in Illinois.

The HIA looked at three key issues:

• Whether smart metering will raise customer rates for electricity service because of the additional infrastructure investment costs;
• Whether new energy pricing programs enabled by smart metering will provide benefits to customers or increase costs to vulnerable customers at a time when they can least afford it; and
• Whether the use of a remote service switch to connect or disconnect service, particularly in the case of disconnection for non-payment, will have adverse impacts on vulnerable populations

NewPublicHealth spoke about the new HIA with lead researcher, Megan Sandel, MD, MPH, who is the interim executive director of the National Center for Medical-Legal Partnership.

NewPublicHealth: Why is energy a health issue?

Megan Sandel: Understanding how energy and health are connected is a burgeoning field. We understand that the cost of energy can sometimes be particularly important because families may have to make tradeoffs, such as trading off between paying for their heat and necessarily eating enough. Or they’re trading off between paying for their heat or their electricity bill and being able to pay for medicine. And while some people may see the potential concern for some users over heating costs, they may not connect those similar problems can occur with cooling costs. People have actually died in heat waves because they were not able to access their energy needs in a timely way. And so, we were interested looking at this energy proposal and being able to add in possible health implications.

NPH: What populations are most vulnerable or affected due to a lack of affordable energy and why is that?

At the recent first-ever National Health Impact Assessment (HIA) meeting, convened by the Health Impact Project and partners, the break-time chatter was just as fascinating as the official sessions. Attendees ranged from a public health graduate student who applied for a scholarship to attend the meeting as part an independent study on HIA, to a veteran of the San Francisco Department of Health who has been conducting health impact assessments for over a decade.

The meeting addressed the burgeoning number of HIAs completed or in progress, but it also addressed issues related to determining the need for an HIA, preparing and engaging stakeholders, and helping HIA practitioners both assess the findings and determine how best to convey them and make recommendations. The wide range of HIAs presented spanned a wide range of disciplines including housing, transportation, built environment, incarceration, community development and more.

We found a session on policy HIAs to be especially interesting as a tool to look at the potential for use of HIA to impact health outcomes. Examples included:

School Discipline Policies

Human Impact Partners is nearing completion of an HIA on school discipline policies, including zero tolerance (suspending or expelling students for any infraction) and restorative justice. In Los Angeles, Oakland and Salinas school districts, the HIA analyzed how these policies impact those being disciplined, other students and the broader communities through pathways to health outcomes from drop-out rates and educational attainment, prison, violence, drug abuse, mental health and community cohesion.

Wisconsin Treatment Instead of Prisons

WISDOM, a statewide congregation-based community organization in Wisconsin, has been advocating for state funding for treatment alternatives to prison for almost a decade. In 2006, WISDOM and their allies succeeded in convincing the state to fund treatment alternatives such as drug courts, mental health courts and bail diversion projects in seven counties. WISDOM has been funded by a Robert Wood Johnson Foundation Roadmaps to Health Community Grant to work on a policy that would increase the funding to a statewide level. Human Impact Partners is conducting an HIA to answer the question: How would increasing treatment alternatives to prison impact the health of individuals targeted for incarceration, their families, their communities and the state?

Another theme that emerged throughout the conference was the critical nature of engaging communities and diverse partners throughout every step of the HIA. During a plenary session, Health Impact Project director Aaron Wernham said of the recommendations from one HIA he conducted in Alaska, "A lot of these recommendations fall outside anyone’s regulatory authority. If you’re going to get anything done there needs to be a strong relationship with the community." Wernham said he expects to convene a national meeting again in about a year and a half. And he knows they’ll need a bigger facility next time!

Catch up on the rest of our coverage of the National HIA Meeting: