Aaron Wernham: First National Health Impact Assessment Meeting Kicks Off Tomorrow
In response to burgeoning national interest in using health impact assessment (HIA) as a tool to factor health into policy decisions, the Health Impact Project and other leading health organizations will convene a first-ever National HIA Meeting this week from April 3 through April 4 in Washington, D.C. Policy-makers, public health professionals, community-based organizations, researchers and elected and appointed officials from across the country will hear the latest on how HIA can be used to inform policy decisions outside health in areas such as planning, transportation, housing, agriculture, energy, education and the environment. Community leaders and policy-makers want to protect the health of their communities, but they need sound, objective data to identify what could help or hurt people’s health in order to guide their decision-making.
The meeting is being organized by The California Endowment, the National Network of Public Health Institutes, the Centers for Disease Control and Prevention Healthy Community Design Initiative and the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts.
NewPublicHealth spoke with Aaron Wernham, MD, director of the Health Impact Project.
NewPublicHealth: The first ever national HIA meeting is coming up. Who is coming to the conference, and what do you think the key sessions will be?
Aaron Wernham: Well, we really aimed for a broad audience. HIA practitioners as well as people who have been interested in starting to use HIA but just haven’t really begun will all be in the audience. A lot of people from related public health fields will be coming. We’ve also created programming that will be relevant and interesting to people outside the health sector because HIA is really a bridge that aims to help practitioners collaborate with people in a great many sectors, such as transportation planning or housing or energy policy.
NPH: What do you think some of the hallway conversations might be?
Aaron Wernham: What I really hope to hear is some good intermingling between the health folks who are used to talking with each other and people from urban planning, transportation planning, housing and other fields who don’t normally sit in the same conference and talk. And I’m also hoping we’ll hear people expressing interest in figuring out exactly and practically how we can collaborate and work together to build health into these decisions that are so important to health but not otherwise taken into account.
NPH: What has the response been like in planning the conference?
Aaron Wernham: We’ve felt for a long time that there was a real demand for this. The field has been growing in the U.S. for more than ten years, but it’s still quite new with a relatively small body of active practitioners. That being said, we thought the time was right to have a national meeting. But we didn’t expect the level of response we received. We planned to have 250 or 300 people, and we’ve probably received requests from well over 500 people. We have nearly 450 people registered now and had to actually close registration quite a bit early just because of the response.
NPH: When last we spoke, the Health Impact Project had just released a new call for proposals. You recently announced a second round of grant recipients. What have you seen change in the applications for the second set of grants? What are some of the projects you are funding in this round?
Aaron Wernham: On our second round of applications, we received about 250 brief proposals from well over 40 states, and we had a few interesting changes this time. We had a lot of proposals from metropolitan planning organizations. These are the regional bodies mandated by the transportation bill to oversee transportation planning at the regional level in the U.S. We’ve not previously seen a lot of interest from transportation planners, but they’re an incredibly important target for HIA, and this was really gratifying to see a lot of them stepping up and actually applying for funds on their own.
We saw other new sectors as well. We saw a lot on housing policy, for example, and we are funding several, including a couple that are looking at the housing inspection process for low-income housing units. It’s very, very important to health, but also quite expensive. The HIAs are looking at how to build efficiency into the system at the same time as protecting health. That’s critical.
Another housing proposal is on looking at how best to rebuild the public housing that was devastated by a hurricane in Galveston, Texas. And one grantee is looking at the health impacts of legislation that would support casinos in Kansas.
NPH: Can you update us on the first set of grantees? Any particularly interesting outcomes, or any places where HIA showed unexpected benefits for the community?
Aaron Wernham: It’s important to emphasize that some of these are still playing out. There’s a multi-layer decision process that takes place over a few years. So a lot of these haven’t had their full effect. But that being said, some of the earliest tests that we've seen are really exciting. For example, a project that we funded in Oregon by a non-profit group, Upstream Public Health, looked at the potential health risks and benefits of proposed legislation to support a farm to school program in Oregon. The HIA pointed out some ways that the legislation, as initially drafted, could be altered to maximize the benefits, not only for nutrition in schools, but also for the overall economy in farm communities in Oregon, which were really struggling. Those changes were made and ultimately the bill passed—largely, I think, in response to the real health benefits that the HIA helped point out.
And, at the same time we’ve seen I think a lot of examples where doing the HIA has really helped put health on the roadmap and policy-makers and health folks are now actively working on the best way to implement practical changes. In Hawaii, an HIA of the county’s agricultural plan led to a great collaboration where now the state health department, local health folks and the agriculture department are all discussing health together, thinking actively about the best ways to move agriculture forward in Hawaii County in a way that also supports good nutrition and better employment. In Minneapolis, there is a transportation-focused health impact assessment, which recognized many potential benefits, but also pointed out that low-income residents along this transit route could potentially be displaced. I think as a result of that the city council agreed to form a study group to look at the issue and think about how zoning changes could really help maintain affordable housing, affordable business property and maintain the strengths of the neighborhood structure as it is.
NPH: What’s been going on with the field, broadly?
Aaron Wernham: It’s been a really interesting four years. One thing that’s beginning to happen is that HIA feels as if it’s starting to become more of a routine tool for public health. There’s been a lot of interest in the field for a number of years, but we’re seeing every semester now more classes in schools of public health that actually are focused on teaching public health students and planning students basic HIA skills. We’re seeing a lot of regions where there’s been enough collaboration now between transportation, housing, land use planners that the health impact assessment was a catalyst but now there’s a broader range of tools being used to ensure that decisions made in those sectors are increasing attention to health.
I think that’s really the direction the field needs to go. HIA is not the solution for every problem, but it is one very good way to catalyze strong relationships, and I think that’s what I’m starting to see around the country. We’re also seeing, I think, a lot of strength in a few sectors. Energy and natural resource development, land use planning and transportation and housing I think are probably where there’s the greatest recognition of HIA as a tool, and we really need to start seeing it broaden out into fields such as social and economic policies. Some future areas for HIAs could be foreclosure policy and criminal justice practices. There’s been a little bit of HIA work in the fields, but we really haven’t seen the depth of HIA practice there yet.
NPH: Where do inroads still have to be made in order to make HIA a more institutionalized process?
Aaron Wernham: There are a few areas where we really have to keep the field moving ahead and to make HIA a more cross-sector approach to improving public health. Right now, I think there are still a lot of policy-makers both within and outside the health sector, who don’t fully understand the importance of social, economic, land use, transportation decisions to health. We need to continue getting that message out.
But also, at the same time as we tell people how important a tool this is, we need to continue to build really good examples of how HIA will help a transportation planner do their job better and how HIA can help a state legislator wrestling with the tough fiscal decisions make a choice that’s evidence-based and will contribute to health and well-being among their constituents. HIA helps build relationships and helps build a systematic approach to thinking through the health issues.
And I’d really like the field to continue building some bridges to the private sector. Internationally, the private sector has been one of the real leaders in HIA field. We’ve seen large oil and gas companies, large mining companies fully embracing it and beginning to do HIA as part of their environmental studies. I think they’re recognizing this is a good business practice, not just a good health practice. I think we really need more of that, more collaboration between public and private sector, between public health folks and industry.