Leading causes of death in Minnesota: 2010



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This HIA training is supported by a grant from the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts.

  • This HIA training is supported by a grant from the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts.



Welcome & Introductions

  • Welcome & Introductions

  • Connections between health and the environment

  • Introduction to HIA

  • Haila Maze, AICP, City of Mpls—Introduction to ATF Plan

  • Step 1: Screening & Exercise

  • Step 2: Scoping  & Exercises

  • Step 3: Assessment

  • Jared Erdmann, MPH, City of Mpls—Reflections on ATF HIA

  • Step 4-6: Recommendations, Reporting &Monitoring and Evaluation

  • Training Evaluation



Think “Health”

  • Think “Health”













The purpose of an HIA: to provide health information to decision-makers before important decisions are made, so they can make a more informed decision

  • The purpose of an HIA: to provide health information to decision-makers before important decisions are made, so they can make a more informed decision

  • Six HIA steps and HIA process









Leading causes of death in Minnesota: 2010

  • Leading causes of death in Minnesota: 2010

  • Cancer 9,599 166.9

  • Heart Disease 7,144 118.7

  • Unintentional Injury 2,087 36.4

  • Stroke 2,154 35.8

  • Chronic Lower Respiratory Disease 2,012 35.1





Definition: A systematic process that uses an array of data sources and analytic methods and considers input from stakeholders 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 the population. HIA provides recommendations on monitoring and managing those effects.

  • Definition: A systematic process that uses an array of data sources and analytic methods and considers input from stakeholders 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 the population. HIA provides recommendations on monitoring and managing those effects.

    • National Research Council, Improving Health in the United States: The Role of Health Impact Assessment, 2011.


HIA aims to advance the values of

  • HIA aims to advance the values of

    • democracy
    • equity
    • sustainable development
    • the ethical use of evidence
    • a comprehensive approach to health
  • North American HIA Practice Standards Working Group (Bhatia R, Branscomb J, Farhang L, Lee M, Orenstein M, Richardson M). Minimum Elements and Practice Standards for Health Impact Assessment, Version 2. North American HIA Practice Standards Working Group. Oakland, CA: November 2010.



Identify harms and benefits before decisions are made

  • Identify harms and benefits before decisions are made

  • Identify evidence-based strategies and recommendations to promote health and prevent disease

  • Increase transparency in the policy decision-making process

  • Support inclusive and democratic decision-making

  • Support community engagement in the decision-making process

  • Advance equity and justice

  • Shift decision-making from an economic to a quality of life framework

  • Inform a discussion of trade-offs involved with a project or policy

  • Facilitate decisions and their implementation







Two major national funders

  • Two major national funders

    • Centers for Disease Control & Prevention (CDC) (directly funds grantees; ASTHO-HIAs, training, TA)
    • Health Impact Project (PEW and RWJF)
  • SOPHIA (Society of Practitioners of HIA): http://www.hiasociety.org/

  • Two conferences:

    • HIA of the Americas Workshop (Oakland, CA)
    • National Health Impact Assessment Meeting (Sept, WDC)


MN HIA Coalition

  • MN HIA Coalition

  • BlueCross BlueShield Foundation of Minnesota

  • MDH website/listserv

  • Training:

    • MDH 1-hour online training


Educate on and promote the appropriate use of HIA.

  • Educate on and promote the appropriate use of HIA.

  • Share information, tools, best practices and lessons learned (especially what works and what doesn’t) from HIAs.

  • Collaborate on and coordinate (when applicable) HIA-related activities.

  • Seek and vet future projects for HIA funding opportunities.

  • Promote/systematize policies, legislation and funding for HIAs and Health in All Policies.

  • Seek funding to support MN HIAs.

  • Develop a strategic plan/workplan to accomplish goals.





Schematic Redesign Study on the former MN Trunk Hwy 194 completed in January 2011

  • Schematic Redesign Study on the former MN Trunk Hwy 194 completed in January 2011

  • Straight, four-lane, high speeds, main arterial

  • Barrier for all non-motorized transportation/school access

  • Local HIA Team: ph educator, engineer, city planner, GIS specialist

  • MDH technical assistance



Built off of existing partnerships

  • Built off of existing partnerships

    • Used public meetings for input
  • Duluth’s HIA:

    • Accessibility & Safety
    • Physical Activity
    • Livability
    • Pollution
    • Food Access
  • HIA becomes an addendum to the Sixth Avenue East Schematic Redesign Study



Evaluated the May 2010 Douglas County Comprehensive Plan

  • Evaluated the May 2010 Douglas County Comprehensive Plan

  • Recruited Advisory Committee

    • Aging population
    • Social capital
    • Access to places
    • Safety & transportation
  • Recommended specific language and policy statements

  • Recommendations adopted into plan



Desktop HIA

  • Desktop HIA

  • Mixed use development, 181 acres, near Faribault

  • Church campus, school, low-density residential, senior living, townhomes, commercial

    • 10 Health Categories: Air Quality, Land Development, Parks, Trees & Vegetation, Transportation, Housing, Food, Water, Noise, and Safety
  • 26 health indicators

  • Results shared with developer



1st Comprehensive HIA in MN

  • 1st Comprehensive HIA in MN

  • Community driven: ISAIAH, Take Action MN, PolicyLink

  • 3 Areas of Assessment:

    • Healthy Economy
    • Healthy, Affordable Housing
    • Safe and Sustainable Transportation


Screening - to determine if an HIA is useful for a specific project or policy

  • Screening - to determine if an HIA is useful for a specific project or policy

  • Scoping - identify which health effects to consider

  • Assessment - determine which people may be affected and how they may be affected

  • Recommendations - suggest changes to proposal to promote positive or mitigate adverse health effects

  • Reporting - present the results to decision-makers

  • Monitoring and evaluating - determine the affect of the HIA on the decision process



Presentation on the Above the Falls Master Plan by Haila Maze, AICP, City of Minneapolis

  • Presentation on the Above the Falls Master Plan by Haila Maze, AICP, City of Minneapolis





What is HIA Screening?

  • What is HIA Screening?

  • The Screening process helps determine if:

  • … the HIA is feasible

    • Is there sufficient information about the decision?
    • Is there available resources to conduct the HIA?
  • … the HIA can be done in a timely manner

    • Can the HIA fit within the decision-making time frame?
  • … the HIA would add value to the decision making process

    • Is health already at the table?
    • Will the proposed project benefit from an HIA and promote health and influence positive change to the community?


No added value

  • No added value

    • Chula Vista Plan to Improve Walkability
      • Plan was already considering health
      • Health advocates involved in design
      • Resources better focused elsewhere
  • No influence on decision

    • Milwaukee Zoo Interchange Project
      • Time: insufficient time to complete HIA for drafts
      • Stakeholders: DOT was not open to considering health (recommendations seen as another obstacle or more red tape)




How to start the screening process:

  • How to start the screening process:

  • Define the decision

    • What is being proposed?
    • What is the timeline for the decision?


2. Decide who will be involved in the screening process

  • 2. Decide who will be involved in the screening process

    • Identify the stakeholders (i.e., residents, business owners, regional agencies, local organizations, elected officials)
  • 3. Determine if potential partners are ready to work on the HIA

    • Do they have the resources available to conduct an HIA?


4. Evaluate the program, plan, or policy based on screening criteria (including will the program have a significant impact on health)

  • 4. Evaluate the program, plan, or policy based on screening criteria (including will the program have a significant impact on health)

  • Utilize a Screening Worksheet or a Checklist

  • There are a number of worksheets to choose from

  • Use the worksheet that best meets your needs



Has a project, plan or policy been proposed?

  • Has a project, plan or policy been proposed?

  • Is there time to conduct HIA before decision is made?

  • Will the project, plan or policy affect health?

  • Would health inequities be impacts? How?

  • Are health impacts likely to be significant in terms of number of people impacted (magnitude), severity of impact, or immediacy or permanence of impacts?

  • Is there expertise, evidence and/or research methods available to analyze health impacts?



Is health already being considered?

  • Is health already being considered?

  • Are there clear links between the proposal and health?

  • Are decision-makers open to considering HIA findings?

  • Will the HIA process have potential health impacts?

  • Do stakeholders have the interest and capacity/resources to participate in the HIA?



The Final & Essential Screening Task

  • The Final & Essential Screening Task

  • Define the decision and its alternatives

  • Decide who will be involved in the screening process

  • Determine if potential partners area ready to work on the HIA

  • Evaluate the project plan, or policy based on screening criteria

  • 5. Notify stakeholders of your decision

    • Will you be conducting an HIA?




Focus area includes or adjacent to diverse neighborhoods with large health disparities

  • Focus area includes or adjacent to diverse neighborhoods with large health disparities

  • Land use barriers to accessing the river

  • Proposal to transition predominantly industrial -> parks and residential land uses

  • Health concerns: water, noise and air pollution

  • Master Plan update – incorporate findings from:

    • ATF Policy Review & Implementation study
    • Park Board’s RiverFirst visionary design
    • HIA recommendations


Example screening worksheet

  • Example screening worksheet



ATF Screening Criteria

  • ATF Screening Criteria

    • the strength of the connection between the land use alternative and health;
    • the extent of potential impact (i.e. reach) among the resident populations;
    • timing of implementation of the land use alternative such that it could be informed by the HIA;
    • stakeholder support for the alternative;
    • potential health effects on current health status of priority populations; and
    • effect on the local economy.


The worksheet should have helped you determine if:

  • The worksheet should have helped you determine if:

  • … the HIA is feasible

    • Is there sufficient information about the decision?
    • Is there available resources to conduct the HIA?
  • … the HIA can be done in a timely manner

    • Can the HIA fit within the decision-making time frame?
  • … the HIA would add value to the decision making process

    • Will the proposed project benefit from an HIA and promote health and support positive change in the community?


Two Main Goals:

  • Two Main Goals:

  • Create the plan for the HIA

  • Determine health indicators to be assessed



Determine:

  • Determine:

  • Team responsible for conducting the HIA

  • Group who will oversee the HIA process



How should stakeholders and the affected communities be involved?

  • How should stakeholders and the affected communities be involved?

  • Advisory Committee

  • Steering Committee

  • Technical Committee

  • Public meetings

  • Small group discussions





First meeting(s):

  • First meeting(s):

  • Discuss HIA plan, timeline and the decision and alternatives

  • Ground rules

  • Goals of HIA & screening

  • Communications plan—is everyone at the table?

  • Geographic area

  • Population(s) and subpopulations to be studied





Scoping* next meetings:

  • Scoping* next meetings:

  • Examine the range of possible health issues

  • Come to agreement on priority health issues

  • Discuss pathways

  • Determine research questions, data sources & methods+

      • *scoping flows into assessment
      • +data sources & methods-discussed in assessment




Bill 2800 (HB 2800), the Farm to School and School Garden legislation, as introduced in January of 2011:

  • Bill 2800 (HB 2800), the Farm to School and School Garden legislation, as introduced in January of 2011:

    • (1) allocate $19.6 million in state funds, equivalent to 15 cents per lunch and 7 cents per breakfast, to reimburse schools for purchasing Oregon food products, and
    • (2) provide $3 million in competitive education grants to support food, garden and agriculture activities, up to 150 school teaching gardens each fiscal year.
  • Source: Henderson, T., Rader, M., Sorte, B., Ratcliffe, M. M., Lawrence, A., Lucky, J., and Harris, C. (2011) Health Impact Assessment: Farm to School and School Garden Policy, HB 2800, Upstream Public Health and the Health Impact Project. http://www.upstreampublichealth.org/sites/default/files/F2SHIA_FINAL.pdf



Employment

  • Employment

  • Diet & Nutrition

  • Farm to School & School Garden Education

  • Environmental Health

  • Social Capital





Determined land-use decisions to evaluate

  • Determined land-use decisions to evaluate

  • Health issues:

    • Obesity
    • Mental Health
    • Environmental Quality (air, noise and water quality)
    • Safety and Security
    • Neighborhood Cohesion
    • Neighborhood Livability
    • Employment




Pathways can be direct:

  • Pathways can be direct:

  • Or indirect:

  • and can be fairly complicated…







HIA land use decision alternatives to be investigated:

  • HIA land use decision alternatives to be investigated:

  • To add 108 acres of parkland;

  • To extend existing Riverfront biking and walking trails by 4.2 miles.

  • To add over the long term 3000 jobs; and

  • To add over the long term 1000 new housing units.



















Come to agreement on priority health issues

  • Come to agreement on priority health issues

  • Prioritization Criteria

    • Health impacts with the greatest potential significance, magnitude, severity, certainty, permanence
    • Stakeholder/community priorities
    • Equity
    • Available resources: time, existing data/research, ability to collect new data for gaps in data/research
  • Determine research questions, data sources & methods





Healthy Corridor For All (MN)

  • Healthy Corridor For All (MN)



HB 2800: Farm to School and School Garden Policy (OR)

  • HB 2800: Farm to School and School Garden Policy (OR)



Screening - determine if HIA is useful for specific project or policy

  • Screening - determine if HIA is useful for specific project or policy

  • Scoping - identify health effects to consider

  • Assessment – perform research, determine populations affected & how

  • Recommendations - suggest changes to proposal to promote positive or mitigate adverse health effects

  • Reporting - present results to decision-makers

  • Monitoring and evaluating - determine effect of HIA on decision process



Main goals:

  • Main goals:

  • Profile baseline conditions, characteristics of target populations

  • Analyze potential health effects of decisions





U.S. Census

  • U.S. Census

  • Hospital-discharge records

  • Disease registries

  • Behavioral Risk Factor Surveillance Survey



Scale discrepancies

  • Scale discrepancies





















Qualitative

  • Qualitative



Mixed methods

  • Mixed methods

  • Qualitative: literature review, public meetings

  • Quantitative: extensive use of existing data for summary statistics and predicting impacts





Mixed methods

  • Mixed methods

  • Qualitative: literature review, interviews, community forums

  • Quantitative: secondary data analysis, economic procurement analysis (IMPLAN)







In THEORY:

  • In THEORY:

  • Identify determinants

  • Complete baseline profile

  • Assess potential impacts

  • Estimate change in population health



You don’t have to predict everything with absolute certainty

  • You don’t have to predict everything with absolute certainty

  • Look at all the evidence available and make an informed judgment based on

    • analysis of data
    • expertise
    • experience
  • Validity = Transparency





Use results from assessment to develop recommendations and mitigations to address any negative health impacts and maximize health benefits

  • Use results from assessment to develop recommendations and mitigations to address any negative health impacts and maximize health benefits

  • Recommendations -- alternative ways to design a project, plan, or policy including its location or timing to benefit health

  • Mitigations -- management strategies to lessen anticipated adverse health effects of a decision



Recommendations can focus on Process and/or Outcomes

  • Recommendations can focus on Process and/or Outcomes



Recommendations and mitigations should be:

  • Recommendations and mitigations should be:

    • Responsive to predicted impacts
    • Specific and actionable
    • Best practices or evidence-based
    • Experience-based and effective
    • Technically feasible
    • Politically feasible
    • Economically efficient


Work with existing businesses; they will likely continue to be located in the ATF area. Explore ways of effectively engaging businesses to assist in achieving the ATF plan objectives, for example by promoting environmentally safe or greener practices and increasing job density.

  • Work with existing businesses; they will likely continue to be located in the ATF area. Explore ways of effectively engaging businesses to assist in achieving the ATF plan objectives, for example by promoting environmentally safe or greener practices and increasing job density.



Focus on improving already existing residential areas and housing along Riverway streets that may have been hit hard by the recession and the housing and foreclosure crisis to help mitigate crime and safety concerns and promote health through well-maintained neighborhoods.

  • Focus on improving already existing residential areas and housing along Riverway streets that may have been hit hard by the recession and the housing and foreclosure crisis to help mitigate crime and safety concerns and promote health through well-maintained neighborhoods.



Explore alternatives for youth, elderly, people with disabilities and other vulnerable populations to access the Riverfront such as planning for off-road trails to accommodate biking and walking traffic and public transit.

  • Explore alternatives for youth, elderly, people with disabilities and other vulnerable populations to access the Riverfront such as planning for off-road trails to accommodate biking and walking traffic and public transit.



Farm to School HIA:

  • Farm to School HIA:

  • Recommendations to legislation (HB 2800)

  • Reimburse schools only for purchased foods “produced” or “processed” in Oregon so as to increase economic activity in our state.

  • Agriculture and Garden education grants will be preferentially given to schools serving:

    • a low-income student population
    • schools with a racially diverse student population
    • schools in rural or urban areas with limited food access
  • Ensure grants support schools developing multiple-component programs that increase child health benefits



Healthy Corridor for All HIA:

  • Healthy Corridor for All HIA:

  • Five Policy Recommendations for Moving Forward

    • Community Equity Program
    • Codifying the Commitment to Affordable Housing
    • Density Bonus Program
    • Relieving the Lack of Commercial Parking
    • First Source Hiring




Two main products:

  • Two main products:



Essential Tasks:

  • Essential Tasks:

    • Determine format and structure
    • Write the report
    • Offer opportunity for meaningful feedback on report
    • Update report or address substantive criticism through a formal written response
    • Implement communications plan


Intro/Project Background

  • Intro/Project Background

  • Screening

  • Scoping

  • Stakeholder Engagement

  • Assessment

  • Recommendations

  • Reporting

  • Monitoring & Evaluation



Bottineau HIA

  • Bottineau HIA

    • Released draft HIA report
    • Published summary in 5 languages: English, Hmong, Laotian, Somali, and Spanish
    • Advertised 2 month public comment period (July 15 – Sept 15)
    • Will incorporate feedback from stakeholders and the public into final HIA report


Letters to proponents and decision-makers

  • Letters to proponents and decision-makers

  • Comment letters on or reports included in draft Environmental Impact Assessment

  • Formal report

  • Presentations

  • Peer-reviewed publications



Monitoring—What happened?

  • Monitoring—What happened?

  • Monitor recommendations & implementation

    • Were the HIA recommendations adopted?
    • Has the policy, program or plan been implemented?
  • Monitor health determinants and outcomes

    • Were there changes in exposures, health outcomes/determinants & any unexpected consequences


Develop a monitoring plan

  • Develop a monitoring plan

  • The monitoring plan should include:

    • goals for short- and long-term monitoring;
    • outcomes and indicators for monitoring;
    • lead individuals or organizations to conduct monitoring;
    • a mechanism to report monitoring outcomes to decision-makers and HIA stakeholders;
    • triggers or thresholds that may lead to review and adaptation in decision implementation; and
    • identified resources to conduct, complete, and report the monitoring.


Process evaluation—Considers whether the HIA was carried out according to the plan and HIA standards

    • Process evaluation—Considers whether the HIA was carried out according to the plan and HIA standards
    • Impact evaluation—Seeks to understand the impact of the HIA itself on the decision-making process or on other factors outside the specific decision being considered
    • Outcome evaluation—Focuses on the changes in health status/health indicators resulting from implementation of the recommendations


Process evaluation of the HIA:

  • Process evaluation of the HIA:

    • What were the successes?
    • What were the challenges?
    • What worked?
    • Who should we include next time?
    • What data sources will you need in the future?
    • Did the HIA meet the HIA minimum standards?
  • Report on evaluation so that new HIA practitioners can learn from your successes and challenges



Performed a self-evaluation.

  • Performed a self-evaluation.

  • Answered key questions:

    • What was accomplished during the various steps of the HIA process and how was it accomplished?
    • What were some of the major successes and challenges during each step of the process?
    • What changes happened to the Above the Falls Plan because of the HIA?
    • What partnerships have formed from the HIA process? How do you see these partnerships working in the future?
    • How has health data been useful in the process?




Some see evaluation as a separate process—objectivity, funding, timeframe

  • Some see evaluation as a separate process—objectivity, funding, timeframe

  • Lack of attention to evaluation is a barrier that will need to be overcome if HIA practice is to be advanced in the US



Screening - to determine if an HIA is useful for a specific project or policy

  • Screening - to determine if an HIA is useful for a specific project or policy

  • Scoping - identify which health effects to consider

  • Assessment - determine which people may be affected and how they may be affected

  • Recommendations - suggest changes to proposal to promote positive or mitigate adverse health effects

  • Reporting - present the results to decision-makers

  • Monitoring & Evaluating - determine the affect of the HIA on the decision process



Improving Health in the United States: The Role of Health Impact Assessment

  • Improving Health in the United States: The Role of Health Impact Assessment

  • Minimum Elements and Practice Standards for Health Impact Assessment

  • Guidance and Best Practices for Stakeholder Participation in Health Impact Assessments

  • Promoting Equity through the Practice of Health

    • Impact Assessment


MDH HIA website

  • MDH HIA website

  • Centers for Disease Control HIA website

  • World Health Organization HIA website

  • Public Health England HIA website

  • UCLA HIA Clearinghouse

  • Health Impact Project website

  • Design for Health: HIA Resources

  • Sustainable Communities Index (formerly HDMT)



Kristin Raab

  • Kristin Raab

  • kristin.raab@state.mn.us

  • 651-201-4893

  • Brenda Hoppe

  • brenda.hoppe@state.mn.us

  • 651-201-4908



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