Use of Health Impact Assessment in the U.S. 27 Case Studies, 1999–2007 Andrew L. Dannenberg, MD, MPH, Rajiv Bhatia, MD, MPH, Brian L. Cole, DrPH, Sarah K. Heaton, MPH, Jason D. Feldman, MPH, Candace D. Rutt, PhD
Objectives: To document the growing use in the United States of health impact assessment (HIA) methods to help planners and others consider the health consequences of their decisions. Methods: Using multiple search strategies, 27 HIAs were identified that were completed in the U.S. during 1999 –2007. Key characteristics of each HIA were abstracted from published and unpublished sources. Results: Topics examined in these HIAs ranged from policies about living wages and after-school programs to projects about power plants and public transit. Most HIAs were funded by local health departments, foundations, or federal agencies. Concerns about health disparities were especially important in HIAs on housing, urban redevelopment, home energy subsidies, and wage policy. The use of quantitative and nonquantitative methods varied among HIAs. Most HIAs presented recommendations for policy or project changes to improve health. Impacts of the HIAs were infrequently documented. Conclusions: These completed HIAs are useful for helping conduct future HIAs and for training public health officials and others about HIAs. More work is needed to document the impact of HIAs and thereby increase their value in decision-making processes. (Am J Prev Med 2008;34(3):241–256) © 2008 American Journal of Preventive Medicine
Introduction needed: (1) to increase awareness of their use across the country, (2) to document that HIAs are applicable he use of health impact assessment (HIA) has in U.S. settings, (3) to increase their political accept- been increasing in the United States in recent ability, (4) to serve as models for further HIAs, and years, fueled by a growing recognition among T (5) to be used as examples in U.S.-based HIA training public health, planning, and transportation profes sionals that land-use and transportation-planning courses. Fewer resources may be needed to conduct decisions can have a substantial impact on the pubnew HIAs if investigators can draw on the literature lic’s health. HIA is a tool to help planners and reviewsother and methods from similar HIAs previously decision-makers better recognize the health conse completed in the U.S., noting the differences in local quences of the decisions they make. HIA is definedenvironment as and project/policy specifications. For ex “a combination of procedures, methods, and tools ample,by the U.S.-based analysis of the health impacts of 3,4 which a policy, program, or project may be judgedadditional as income from a living wage ordinancemay to its potential effects on the health of a population,be useful as part of an analysis of health effects attrib and the distribution of those effects within the utable to employment generated by a new commercial population.”1 development in the U.S.; data on links between health Health impact assessments have been widely used andin income from Europe would be less applicable for Europe and elsewhere,2 and methods are similar in such an analysis because of differing social, economic, Europe and the U.S. However, domestic examples areand political conditions. In 2004, an expert panel examined the potential for From the National Center for Environmental Health (Dannenberg,increased use of HIAs in the U.S. and suggested next Heaton, Feldman) and National Center for Chronic Disease Preven steps that could advance the use of5 TheseHIAs. steps tion and Health Promotion (Rutt), Centers for Disease Control and Prevention, Atlanta, Georgia; San Francisco Department of Public included conducting pilot HIA projects, developing a Health (Bhatia), San Francisco, California; and School of Public database of completed HIAs, increasing the capacity to Health, University of California, Los Angeles (Cole), Los Angeles, California train people to conduct HIAs, developing practical Address correspondence and reprint requests to: Andrew L. Dan forecasting methods, developing incentives to increase nenberg, MD, MPH, Division of Emergency and Environmental the demand for HIAs by decision-makers, and evaluat Health Services, National Center for Environmental Health, CDC, 4770 Buford Highway, Mailstop F-60, Atlanta GA 30341. E-mail: ing the impacts of completed HIAs on decision [email protected]. processes.5
Am J Prev Med 2008;34(3) 0749-3797/08/$–see front matter 241 © 2008 American Journal of Preventive Medicine • Published by Elsevier Inc. doi:10.1016/j.amepre.2007.11.015 This paper summarizes characteristics of 27 HIAs California Endowment,13 the CDC,30,31 anonymous do completed in the U.S. between 1999 and 2007. This nors,24,25 university fellowships,26 –29 and local govern assemblage of completed HIAs may be useful for public ments.22,23 Six HIAs in California and Alaska8,10,26–29 health professionals and others who are considering were conducted in conjunction with environmental conducting an HIA. impact assessment processes.32 Most investigators followed the commonly accepted steps for conducting HIAs, including screening (deter Methods mining if health impacts are involved); scoping (deter The initial list was derived from HIAs in which the co-authors mining which health impacts will be examined, how, were involved as primary investigators or consultants. Addi and for whom); assessment of the direction and mag tional HIAs were identified through networking at profes nitude of the health impacts; communication of results sional meetings and through inquiries received by the co and recommendations to decision-makers; and evalua authors related to their previous publications and tion of the HIA’s impact on the decision-making pro presentations about HIA. In September 2007, a literature cess.33 The San Francisco ENCHIA (Eastern Neighbor search was conducted on Medline, SocIndex, TRIS (Trans hoods Community Health Impact Assessment) project9
portation Research Information Services), Environmental used a collaborative planning process that included Science and Pollution Management, and Google Scholar; a visioning, assessing baseline conditions, identifying pri message was disseminated on the HIA–USA listserv6 request
ing additional studies. ority needs and opportunities, and forwarding propos Details about the completed HIAs were obtained from the als for action. Most investigators used literature reviews, published literature, websites, and communication with the expert opinion, and/or stakeholder input in the scop primary investigators. Key characteristics of each HIA report ing and assessment steps. were abstracted, including year, location, type of project or Community involvement was a component of most policy, and information about who conducted and funded HIAs, such as those for the San Francisco redevelop the HIA, and about the methods, scoping, assessment, rec ment projects and area plans,8,9 residential develop ommendations, dissemination, and impacts of the HIA. A ment in Oakland, the Massachusetts housing rental draft of the summary table was sent to the primary investiga voucher and home energy assistance policies, and the tors for each HIA listed, with a request that they edit the Florida power plant plan. Community stakeholders appropriate section so the tabular information would accu assisted in identifying and assessing health impacts for rately reflect their work. All investigators provided the edits as the Alaska oil and gas leasing programs, Jack London
requested. senior housing plan, and those on San Francisco’s land-use plans and public housing carpet policy as Results these HIAs involved a facilitated structured dialogue among stakeholders and experts. In other HIAs,
The key characteristics of the 27 HIAs completed in the no substantial community involvement occurred due 3,4,7–31 U.S. between 1999 and 2007 are summarized in to time, resources, or human subjects research Table 1. The HIAs were conducted in California constraints. � � � (n 15), Alaska (n 3), Georgia (n 3), Massachusetts Health disparities among various racial and socioeco � � � (n 2), Colorado (n 1), Florida (n 1), Minnesota nomic groups are a prominent component of many of � � (n 1), and New Jersey (n 1). The types of policies and the HIAs, especially ones related to housing, urban projects examined included wage policies, walk-to redevelopment, home energy subsidies, and wage pol school programs, residential and commercial redevel icy. For example, investigators noted increased burdens opment, after-school programs, land-use planning, of asthma and lead poisoning among children living in farm policy, transportation, parks and trails, power substandard housing,24 delayed cognitive development plants, land-leasing policy for oil exploration, and in households experiencing food insecurity,25 and that public subsidies for housing and home heating. increased employment from the Florida power plant Investigators for the HIAs included local and federal could lead to health benefits for African Americans public health officials; faculty from schools of public living nearby.23 health, medicine, and architecture; and private consult The methods used to make predictive judgments on ants. Decision-making organizations for the projects health outcomes varied. In some cases quantitative and policies examined in the HIAs included county and measures of health status and environmental condi city councils and planning agencies, state agencies and tions were used to describe existing conditions, provid legislatures, federal agencies and the U.S. Congress. ing general evidence of priorities and needs. Most HIA Some of the HIAs were conducted with limited or no reports included an assessor’s judgment of the direc external funding by investigators within the scope of tion, but not necessarily the magnitude, of an effect on their health department positions,3,7–11,30,31 while oth a health indicator, such as asthma morbidity, academic ers were conducted by volunteers12,14,15 or with funding performance, personal safety, mental health, and social from the Robert Wood Johnson Foundation,4, 16–21 The capital. Some HIAs used validated dose–response func
242 American Journal of Preventive Medicine, Volume 34, Number 3 www.ajpm-online.net tions to quantitatively predict changes in physical activ experience. The issues examined in these HIAs are ity, obesity, life expectancy, respiratory morbidity, sleep diverse, suggesting that HIA methods may be useful for disturbance, teen pregnancy, school outcomes, and a wide range of projects and policies. These studies pedestrian injuries. Other HIAs used direct measure highlight the multidisciplinary nature of HIAs and the ment or modeling to quantify environmental measures need for effective collaboration between public health of noise, air and water quality, and access to parks. practitioners and nontraditional partners such as land- Some HIAs also used qualitative research methods, use and transportation planners. including focus groups, interviews, and structured dia Health impact assessments are valuable as a public logues, to support predictive judgments. health tool in decision-making processes to highlight Most of the HIAs included recommendations to the importance of health disparities among racial and mitigate predicted adverse health impacts of the pro socioeconomic groups.2,9,35 For example, the HIAs of posed policy or project, and/or to increase predicted redevelopment projects and plans in San Francisco8 led health-promoting components of the proposal. Some to substantial proposal improvements by identifying the HIA findings encouraged or discouraged a project or potential for adverse health impacts. policy from moving forward. For example, the Atlanta The 27 HIAs that were reviewed were conducted by a BeltLine HIA encouraged the project to proceed be small number of investigators, most of whom had no cause of its substantial health promotion value, and the formal training in conducting HIAs. The many HIAs California after-school program HIA indicated the pro done in California suggest successful leadership from posed policy was unlikely to reach the adolescents most HIA advocates working in these communities. Broader likely to engage in risky behaviors. geographic distribution of HIA use may be expected as Communication of the results of various HIAs in a result of HIA courses and training materials now cluded reports released to the media and posted on being developed and disseminated by organizations websites, formal public testimony presented to deci including the San Francisco Department of Public sion-makers,3,8,9,14,22,24 comments integrated into envi Health,34 University of California Los Angeles,36 Uni ronmental assessments,8,10,26–29 and publication in versity of California Berkeley,37 University of Minne peer-reviewed journals.3,4,8,28 Information on the out sota,38 National Association of County and City Health come and impact of these HIAs is incomplete. In some Officials,39 Human Impact Partners,40 and CDC.41 This cases, policy or plan decisions have been challenged review of completed HIAs may assist these efforts. and changed, in part due to issues raised in an HIA. For The investigators who conducted the 27 HIAs did so example, in San Francisco, the Trinity Plaza and Rin on a voluntary basis with or without specific funding, con Hill HIAs led to displacement protections, addi out of concern that public health issues were receiving tional affordable housing, and funds for parks and inadequate attention in the decision-making process. community facilities; the living-wage ordinance HIA3 Funding for HIAs is difficult, and more funding sources contributed to its passage by the city board of supervi are needed if the use of HIAs is to grow in the U.S. sors; and the public housing flooring policy HIA7 California and Maryland have considered legislation to resulted in the adoption of new standards for public support HIAs of built environment projects, and Wash housing. In addition, the local development authority ington recently linked the conduct of an HIA to accepted the Florida power plant HIA recommenda funding for a major highway bridge replacement.42 tions to recruit minorities for the jobs created by the While environmental impact assessments (EIAs) oc project. casionally include health risk assessments and the En In one case, the HIA created an evaluation method vironmental Protection Agency (EPA) conducts formal ology through a participatory process. The Healthy health-effects forecasting as part of legally mandated Development Measurement Tool,34 developed through cost–benefit analyses,32 HIAs are not routinely re the ENCHIA process in San Francisco, includes a quired in any settings in the U.S. Although HIAs are structured approach that evaluates land-use develop not formally part of the EIA scope and analysis, proce ment plans and projects on over 100 community-level dural rules require EIAs to take into account evidence indicators of health, using objective development crite relating a decision’s environmental effects to potential ria as surrogates for improvements in health. adverse health effects. Collaboration through HIA and ENCHIA’s primary recommendation was the institu EIA processes may result in better outcomes. An EIA tionalization of this tool into local land-use planning. may acknowledge the findings of an HIA and consider This tool has been subsequently applied for five land- mitigations, may critique HIA findings, or may provide use plans locally. an alternative analysis. In each case, the EIA response to HIA findings furthers the public consideration of the
Discussion underlying health issues. Some HIAs in California and Alaska contributed analyses that were integrated within After many years of HIA use in Europe and elsewhere, concurrent EIAs. For example, in the Trinity Plaza HIAs are emerging in the U.S.; this report reviews that project,8 officials changed the scope of the EIA to
March 2008 Am J Prev Med 2008;34(3) 243
page )
to
next
on
contributed ( continued and requested developer proposed Supervisors endorsed to analyze impacts in replacement housing subsequent citywide minimum wage increase for existing residents under rent control wage ordinance and recommendations annual progress report from city housing authority City Board of and/or affected Impact of HIA on subsequent decisions population
authority to increase would be associated with new units built without department that displacementanalysis be done required and prevention developer strategy developed EIR or mitigate; resulting from a living wage passage of living substantial health benefits to passage of carpeting and for the housing awareness of policy for requesting removal of existing carpeting A modest gain in income HIA Recommended proportion of Recommended to planning Decisionmakers Recommendations to stakeholders
is
ncreased self-
but increased estimates of decisionmakers and
a
health
disparities related to area of health disparities related to leaseholders working for city; rated measures of low SES. days, medical care utilization, and mortality risk; increased residence and substandard housing with deferred maintenance. ambient noise asthma attacks area of high housing costs; groups suggested displacement would lead to increased psychological stress, fear, crowding, substandard living conditions due to limited affordable replacement housing, food insecurity due to increased rent burden, and reduced social capital educational attainment of workers’ children; increase in alcohol consumption associated with reduced onquantitative: I Assessment: Population 10,000 contractors and Quantitative: Reduced sick Quantitative: None Nonquantitative: Carpeting 360 low-income households in Nonquantitative: Tenant focus N health impacts
triggers in asthma sufferers; health carpeted and asthma housing units, specifically and affordability; social cohesion;residential health disparities related to area of residence, ethnicity, apartments displacement and and measures of SES. segregation Quantitative: None Airborne allergens Occupants of 6114 public Housing adequacy Scoping: Health determinants affected; health disparities affected by the decision identified; quantitative and nonquantitative Income
experts, residents, model relating asthma-prevention dialogue among HIA; scope based on intersection of health priorities, public forecasting worker income to human health status outcomes using data from advocates, and responsible agency determinants, plan outcomes; hearings, and pathways and empiric evidence published national observational studies representatives; review of evidence on asthma triggers focus groups; report used logic Structured multi-day Rapid desktop Developed
authority on minimum flooring housing by private developer to replace housing units increase wage for city contractors and leaseholders options in public housing developments existing rent- condominiums with controlled community Policy of local Project proposed Policy to
3 8
Key features of 27 health impact assessments conducted in the United States, 1999–2007
7
Housing, SFDPH, Francisco, 2003 SFDPH, San San Francisco, for Public 2002 housing redevelopment, SFDPH, San Ordinance, Francisco, 1999 2. Flooring Policy 3. Trinity Plaza HIA name, group conducting HIA, Policy, plan, location, and year program, or project Methods Table 1. 1. Living Wage
244 American Journal of Preventive Medicine, Volume 34, Number 3 www.ajpm-online.net
and page ) plans safety and tool of
and next impact measures housing its on use area planning created community policies HDMT
and plan’s adopted
quality review
impacts; for ordinances
recommended air pedestrian EIR plans;
3
( continued affordable requirement improved location; community fund services infrastructure local adopted; commission endorsed measurement on incorporated multiple implementing actions recommended through evaluation mitigation for noise recommendations for under of Increased 1 Draft
be
to revised report area
policies jobs– quality local a tool
policies and
a
of 20
to of for and income calming; analysis of development; mitigation reduction from that impact adoption; by 3 tool use–air part countermeasures; ventilation city changes city-level as
for
traffic multiple noise land balance 20 modeling
demand
resulting department healthy immediate recommended housing disaggregated conducted environmental for advocated for recommended institutionalization measurement planning; recommendations plans application mechanical mitigate conflicts; measures; intersection circulation traffic
Health Identified Exposure
of to of
and new future in and traffic
and land groups
of area housing
for
and
health local area of and 20 44,000 44,000 health roadways; ethnicity, to health community disturbance related supply baseline
to
with with SES. 12,000 pollution economic jobs– lack Increased schools Focus
local uses; and and residents
of Mortality
effects busy violence 100 year among sleep air increased and SES; area area SES. neighborhood industrial, of None None Predict
and morbidity ethnicity, pedestrian related with with ethnicity, related of per
and and in in of
housing near mismatch; and residence,
indicators. disparities neighborhood neighborhood existing existing
of with existing measures conflicts neighborhood neighborhood area demand disparities residence, measures mortality associated segregation; hazards associated imbalance neighborhood future residents inadequate infrastructure; disparities residence, measures assessment health on priorities development future residents use residential, transportation health area and additional collisions respiratory residents noise-related
14,000 Quantitative: Nonquantitative: 134,000 Quantitative: Nonquantitative: 134,000 Quantitative: Nonquantitative:
use and and safety
noise- meas vision parks, tool air commute in land indicators air objectives; adequacy to
evaluated community
space,
affordability; development 27 urement and residential segregation; access open schools; quality; time of health existing conditions development plans against and criteria pollutant emissions; conflicts; pedestrian related
Housing Stakeholder Roadway
and in in logic of based and public
policy and vehicle- and health
evidence
associated of used
of
included scope predictive
outcomes; change design desktop
intersection EIR; health pedestrian HIA; on of determinants, community priorities, hearings, plan report pathways empiric community visioning; indicators selection; and strategy prioritization; development application Healthy Development Measurement Tool effects with environment outcomes documented an developed used model collisions
Rapid Process Analysis
for for and and for
downtown plan plans plans new residential neighborhood rezoning proposal three contiguous neighborhoods rezoning proposals four contiguous neighborhoods Area Area Area
8 9 10
San
Area 2004 2006 2007
and
San San Hill Report,
Impact ( continued ) SFDPH, Plans 1. Rincon Eastern Eastern Plan, Francisco, Neighborhoods Community Health Assessment, SFDPH, Francisco, Neighborhoods Rezoning Area Environmental Impact SFDPH, Francisco, 4. 5. 6. Table
March 2008 Am J Prev Med 2008;34(3) 245
in
page ) and project next engaged review group on on team pending
has final
recommenda
under HIA and ( continued tions with stakeholder discussion design; decisions Plan Developer Pending Impact of HIA on subsequent decisions and/or affected population
risk to add injury
reduce and local area and services;
features; plan’s quality; transport process reduce
for
improving specific public
reduce features of
other air security; to and bicyclist by
nonsmoking; measures; systems to actions; 135 with and provide amenities
design planning goods indoor private
design specificity to
isolation measures building pets; incorporate and noise-insulating services crime implementing area’s transportation access coordinate development; recommendations plan improve use make increase walkability traffic-calming allow to pedestrian risks; safety of Recommendations to decisionmakers and stakeholders Increase Incorporate Optimize
of of low
high illness,
criteria land-use area fear 87 and health housing chronic and
life injury,
to mostly with minority heart
continued )
and benefits with residential and ( and disparities Stakeholder Adverse Reduced minority local estimates of and improved against a SES. neighborhood respiratory new
services
area None Increase None evaluated ethnicity, related and elderly of –2007 minority
of in activity, on pedestrian obesity diabetes, health development to health injuries, potential population
disturbance,
retail of content and 1999
units housing inadequate infrastructure; disparities residence, measures interviews; plan HDMT elderly; related populations. affordability impacts sleep physical crime; from SES rates diseases. obesity, disease, bicycle osteoporosis; mental expectancy Assessment: Population affected; health disparities identified; quantitative and nonquantitative 2800 Quantitative: Nonquantitative: Low-income Quantitative: Nonquantitative: Affected Quantitative: Nonquantitative: health impacts States,
to
and and motor of United using the
access use air and the pedestrian
activity; cohesion; concerns services; in pollutants; evaluation existing conditions development outcomes HDMT indoor quality; retail environmental noise; safety; community violence social greening landscape; vehicle air safety Scoping: Health determinants affected by the decision Structured Outdoor Physical
of conducted
acre
data for area of review; review;
among
71 84 to among review experts; experts;
secondary
for residents, residents, analysis assessments
HDMT plan mixed-use residential development; assessed community-level indicators area structured participant dialogue area neighborhood organizations, and environmental health literature secondary analysis area neighborhood organizations, and environmental health literature expert scope; data
Application Facilitated Dialogue
impact
to
of and 54 low- and build senior paths elevated
2800
of proposed to to mixed-use
retail health transit waterfront miles private 27 income by developer build neighborhood on commercial site develop units housing new services 12 walking biking under rail tracks unit of Policy, plan, program, or project Methods Project Project Project
11
features Park 2007
Plan,
Oakland Alameda 12 senior
project, San Impact Impact CA, Key
London Bay 13 Area 2006 Executive Jack East Sub SFDPH, Francisco, Gateway housing Human Partners, CA, Greenway, Human Partners, County 2007 HIA name, group conducting HIA, location, and year 8. 9. Table 1. 7.
246 American Journal of Preventive Medicine, Volume 34, Number 3 www.ajpm-online.net
as page )
or health used next of review
on project stakeholder referendum have arguments on approved of under ( continued without consideration mitigation impacts; groups health basis effort Project Plans Unknown
wage quality health routes safety speed in
network; as
health
one-tenth add
air building add
grocery the allergens
pedestrian from of notify connect
bike
lower insurance use cost public
ventilation
uninsured
park; sales; needed produce
other workers; reduction benefit reduce pedestrian local for new exposures and to buyers unit parking
health
would to to
parking; full-service and
measures; add
toxic amount and
waterfront covered
to traffic-calming, limits, safety potential risks housing bicycle project recruit store; improvements; materials systems and provisions of insurance workers the increases equivalent mortality Incorporate Unbundle Wage
of
of per low-
to
for or by year for SES. for
housing income space low- acres death
poverty matter many would costs; Oakland residents per
7500
increase rent
deaths facilitates to
15 health and have related or freeway activity increased of contractors
of
area
extra increased Open supply Increased Increased 1.4 not unmet and accessibility; who disturbed will health
health-related 10,000 units;
uninsured insurance
pedestrian deaths from
17% Increased injury needs; services and
workers
one related Loss
housing 19% sleep; and on including particulate
line
years; city;
population noise; sleep 6.4
families and would physical residence risk disparities
neighborhood prevent of and cohesion interaction, existing space;
health rail high of the school housing SES 3.25 study households income income future residents, rate; health area open injuries; ambient and effects adequacy social buy residents low near disturbed cancer emissions; pedestrian per rental-housing social routine residents employees with disparities populations. would year; uninsured prevent in income spending goods
411,000 Quantitative: Nonquantitative: 600 Quantitative: Nonquantitative: Approximately Quantitative: Nonquantitative:
to
open safety,
status quality,
social housing, safety, access physical
school health housing air cohesion
and
quality, air space, environmental noise, affordability, public capacity, cohesion employment opportunities, transportation access, activity, parks greenspace, pedestrian noise, social insurance Pedestrian Affordable Income;
on
field tools data public with with to and and process of group public
stake people; content quantita area national develop literature income screening impact and
proposal, interviews of of used key planning health scoping data, mapping;
health-effects stakeholders; and holders, ment EIA literature; input interviews key GIS quantitative forecasting; planning provided minimal involvement and documents; visits; with experts, residents, business secondary analysis; forecasting data model mortality various and insurance scenarios; consulted advocacy during and tive
Review Review Local
to site city
build parking
mixed- for proposed to to
transit private by developer build neighborhood on underutilized waterfront industrial mixed-use development on station lot increase minimum wage contractors use
Project Project Policy
4
Ninth CA, CA, 2003 Wage project, UCBHIG,
Los ( continued ) Transit to 14 15 1. Oak MacArthur Living Avenue UCBHIG, Oakland 2006 BART Village, Oakland 2007 Ordinance, UCLA, Angeles, 10. 11. 12. Table
March 2008 Am J Prev Med 2008;34(3) 247
)
page
as on bill possible next
rule give
low- on on decisions but to HIA schools to
farm discussions subsequent
affected reviewed of of ( continued income influence subsequent changes priority part about federal Pending Unknown, Results Impact subsequent and/or population
but
also to only after- likely and bill on
education
active; most high-risk programs active farm opportunity and to social realized
be benefit; impact in are
precursors and that one to the be other an physical recruited as
walk-to-school will health programs and recommendations extent are have changes behavior address development children yield the clear programs for encourage classes school activities that psychological risky to benefits to youth some could health Recommendations decisionmakers stakeholders Encourage Youth No
of
air of air be food
/year with 2
youth;
health 21%;
to farm and and
health would small and being be to social students, guardians; increase high-risk and between after-school continued ) prices;
recipients.
would
( likely subsequent Reduced crime Programs Unclear may school estimates in
other 13% or including disparities food
funds
may
their minutes/day a to
between
diversity. school
pedestrian population food
students attract None None Students WIC of low-income
diet Population
30 gains exposure; and –2007 in elementary
and from from
enhanced quantitative by to activity potential production production reduced health high risk
and 600,000 ethnic impacts 1999
to pollution elementary eligible population
million
pollution decrease injuries; capital; neighborhood junior up programs. unlikely or academic insignificant earning status; diverted programs stamp relationship subsidies consumption, ethanol pollution; affected ethanol inefficiencies air students low-income high achieving physical increase overweight reduce BMI 0.09 kg/m Assessment: affected; identified; nonquantitative Nonquantitative: 6.3 Quantitative: Nonquantitative: U.S. Quantitative: Nonquantitative: 1186 Quantitative: health States,
as
safety, crime United
abuse, such the air drugs, air high-risk Health physical by the activity, and
sex in achievement, substance crime, activity, behaviors alcohol, and consumption patterns, pollution obesity, pollution, pedestrian neighborhood safety Scoping: determinants affected decision Educational Dietary Physical
conducted used and of HIA; farm
logic con
used of project related focused forecast existing by logic
data by health Kids air policy, California and to
the from on
dietary ethanol assessments
impacts extrapolating from outcomes published evaluations after-school programs developed frameworks pathways on sumption affected subsidy and pollution to production; existing model outcomes; data National Household Transportation Survey, Healthy Survey, literature; reviewed programs; consulted coordinator Methods Estimated Retrospective Developed
of impact rural
to of
school and or
policy plan, to health land project for of farm 27 increased funding before- after-school programs for subsidies, development, and conservation encouraging children walk and street improvements of program, project Policy, Policy Federal Policy
CA, year features
UCLA, Ballot UCLA HIA, group California, Key and Federal
Bill,
16 17 18 CDC, 1. name, After-School 2002 Walk-to-School Programs Proposition, UCLA, 2003 Farm 2004 Program, and Sacramento 2004 conducting location, HIA 14. 15. Table 13.
248 American Journal of Preventive Medicine, Volume 34, Number 3 www.ajpm-online.net
page ) and state of
of
next
study
on with and CDC’s in minimal board
federal ( continued dialogue and departments transportation, county commissioners county health showed interest findings recommendations
Facilitated Decisionmakers Pending
in and to for than to
area; housing benefits; more housing racks, seating
improve area, density,
products affordable schedule add
improve
market progress approach
health the to pedestrian bicycle plan; public farm professional built faster affordable housing of underserved board; is and 25-year
earlier area, mixed-income adequate
to install machines; master health incremental redeveloping increase assure includes diversity sold; eating cash signage connections current obtain add advisory parks assure housing
Use Create Encourage
low low on of 73.8 social plan access fewer project health health 6.1 with with and under life, per
injuries in crime in activity; injuries
quality within transit; 50,000
1.6 of miles
impact
week, disparities pollution.
capital 2 air and
and
highway increased Current Increase immigrant
and project fruit physical county; and and
air
per
health workers; vehicle on minutes in reduced reduce
others
residents pedestrians, physical
in quality Estimated None Increase
preventive associated associated social health and
and to within 73 injury area; to activity area not redevelopment or
and significant
area and
and current injuries motor city more impact
people improve
other are year; no
change customers low-income greenspace corridor designed and in population. fewer fatalities fewer per week no safety residents market same disparities SES current proposal. has vegetable consumption, activity, services future 230,000 may disparities SES. physical to little equity decrease
14,000 Quantitative: Nonquantitative: 5000 Quantitative: Nonquantitative: 200,000 Quantitative: Nonquantitative:
air
social
safety; safety; quality;
life; transit activity
physical public
of physical services
capital;
land-use water environment; environment pedestrian physical activity; economics; capital; health and patterns; access; activity; pedestrian social quality and noise
Built Nutrition; Built
was
in
review experts city- logic market with
HIA literature opinion, include
reviewed
and modeling farmers expert literature and framework; assessed redevelopment plans; literature; consulted technical and market stakeholders stakeholder opinions; community survey; review; conducted parallel multiple planning processes initiated
Methods Developed Expert
of of new
uses
and
parks, of of corridor policy greyfields
area for brownfields highway redevelopment and changed priority road revitalization for farmers market trails, transit, redevelopment of and
Project Plan Project
19 CDC, Public parks Atlanta, Market,
transit,
20 2004 CQGRD Trenton Highway, for
( continued ) and and and 21 CDC, 1. 2006 Greyfield Farmers Beltline Redevelopment, Buford UCLA Atlanta, UCLA Project Spaces, NJ, trails, project, and 2007 16. 17. 18. Table
March 2008 Am J Prev Med 2008;34(3) 249
page )
to to
on next authority Active due project
on decisions
HIA an
Division
affected
across of emissions making evaluation
2 is ( continued infrastructure improvements; created Living work departments accepted recommendations and indicators; subsequently suspended CO City Development Pending Impact subsequent and/or population
to of for
all
reduce of
impact
Active coal;
person and to
reduce health tracking users to commuting particulate monitored improve staff diverse City’s and promote
county;
employees and issues
for program to for
in requirements
the
all provide hire support so better
assign
to technology safety low-polluting data ambient initiatives funding travel be recreation; connectivity active and intersections abilities; coordinate Living collect matter explore emissions; workforce; benefits procedural program; enrollees could Recommendations decisionmakers stakeholders Prioritize Purchase Increase
low
of for 50% in
visit near and
to health
impact risks families.
and age, or emissions building and with mercury children
lung health numerous instability
black asthma, cause lead 2005; in associated continued ) access; include insecurity for households and (
with
19,256; of their in health Improved Program include estimates fish and Adverse disparities warnings insecurity
a pedestrian dioxide
disabilities.
work education. families. anxiety,
cardiopulmonary could could overall, food risks
None Risks Program and Population associated increased opportunities and employment housing –2007 increased in in quantitative activity and
and increased and affected who
health and
disparities improved
benefits capital carbon
as associated
population residents housing impacts associated health 1999 expectancy households people Decatur; risks income bicyclist safety; increased physical social disparities income increase cancer mortality; emissions consumption plant; increased life employees from health with low-income restrictions increase among and restrictions increased and such depression, hunger Assessment: affected; identified; nonquantitative 20,000 Quantitative: Nonquantitative: County Quantitative: Nonquantitative: 4715 Quantitative: Nonquantitative: health States,
and of and goods United the health- nitrogen air stability, sulfur (PM), Health social by
the to activity; as services; in promoting access and safety; capital opportunity; income; water contaminants such dioxide, oxides, particulate matter mercury emissions conditions, housing affordability housing, mobility, neighborhood environment Scoping: determinants affected decision Physical Employment Housing
conducted
key local life of
air from and and with and review review; review;
input and experts; local groups
data housing of on and and
opinion and during of appraisal community input HIA; informant assessments
from leaders health planning literature key interviews survey scoping; literature quantitative assessment impacts pollutants employee income expectancy; expert analysis; literature interviews experts stakeholders; survey housing authorities; policy with experts, authority advocacy Methods Rapid Stakeholder Secondary
impact
for for
city new or plant a of plan, health of for 27 wide multimodal transportation system coal-fired power eligibility housing vouchers low-income families of program, project Policy, Plan Project Policy
24 year features Child Boston HIA, group
Decatur GA, Energy Healthy FL, 2005 Voucher Key and
of CGQRD, Taylor
Working 22 23 1. name, Massachusetts City Taylor Rental Program, University HIA Group, Community Transportation Plan, Decatur 2007 Center, Development, Inc., County 2007 21. conducting location, HIA 20. Table 19.
250 American Journal of Preventive Medicine, Volume 34, Number 3 www.ajpm-online.net
page ) gas
work Service has next and sale to stage new measures measures on health oil lease project oversees develop Minerals the the ( continued Management that offshore development committed to health-related mitigation at stage mitigation at permitting
Pending U.S. Anticipated
to
EIA
in lease in the ability gas regional
at strategy to energy state assistance gaps continue program
identified, and health; track
and plans of included impacts oil energy and measures funds
address action extend undermine and health-focused of how monitoring
emergency indicators; federal a of
that stage
alternative identify funding program; outreach; data release assistance proposed assessed, report to health study development determinants institute mitigation sale
Increase Nine Develop
to risks to and areas drug food North stable syphilis high 250 who in children Native sources, growth cancer, which
to increased and from increased health assistance; related and and experience injury,
predicted increased of
subsistence sociocultural
social with for chronic
small Decreased Metabolic Increased each
multiple with admissions, if disparities. is well-being HIV access who rates; in villages major overall
risk None None None
heating and Alaskan disruption, alcohol including injuries
many abuse, harmed; diabetes, to heating abuse; alcohol in cancer, and child disparities effects potential health energy. Borough families
hospital residents of
insecurity, large asthma Inupiat Alaska, injury, receiving health poverty home child nutritional problems, alternative and overall of have populations major health resources food tensions, substance domestic increase employment Slope 4000 experience disparities rates pathology, illness. of endocrine insecurity, abuse; exposure
140,000 Quantitative: Nonquantitative: Communities Quantitative: Nonquantitative: Eight Quantitative: Nonquantitative:
is
and and food of of and and access access
air air
which injury
child assistance on on quality; quality;
alcohol alcohol determinant affects security a for developmental growth; prevention water sociocultural disturbances; disturbance subsistence resources; to drugs water sociocultural disturbances; disturbance subsistence resources; to drugs Heating Impacts Impacts
such such with to to and and review review
impacts impacts expert expert review; review; review; of
burden assistance experts,
testimony testimony EIA EIA structure structure EIA EIA
community
low-income other the other the impacts impacts analysis energy on families; stakeholder inter-views energy pro-grams, affordable energy and organizations public from process; opinion; of in as economy, subsistence hunting, social public from process; opinion; of in as economy, subsistence hunting, social
Literature Literature Literature
for lease and oil the acres to home 34 oil of for
Outer natural of
Planning leasing for Chukchi energy assistance low-income families areas U.S. Continental Shelf and gas exploration and development gas within million of Sea Area
Policy Program Plan
Oil
Shelf 25 26 Sea Child Alaska Boston Seismic Alaska, Lease Gas Program, Outer 2006
2007
( continued )
Inter- Energy Council, Working Income and 27 Gas 1. and Massachusetts Arctic Chukchi Low Home Assistance Program, University HIA Group, Continental Oil Leasing Alaska Alaska, and Sale Surveying Activities, Inter-Tribal Council, 2007 Tribal 22. 23. 24. Table
March 2008 Am J Prev Med 2008;34(3) 251
at of and or page )
include key on
BLM next to with
stages timers
traffic measures
to at
project on
decisions
in obtain working Board to for HIA buildings, Health legally
affected of acceptance racks a agreed process;
intersections, agreed helped ( continued mitigation where permissible later rejection subsequent EIA also consider with Advisory manager funding countdown key bike public markers encourage pedestrian BLM HIA Impact subsequent and/or population
in to to
and
routes and driver- areas; support signs
board to creation additional developers signs; mitigation signage required to
transit
limit school employees be lighting; and
that measures health
of intake, advisory and Road’ public included measures speed public development and the safety region
for
health health-based the a feedback in use measures of monitor activities, subsistence public staffing, monitoring pedestrian ‘Share increased maps Recommendations decisionmakers stakeholders Recommended Pedestrian-level
to for
and fears of by of
and
social include and Alaska’s access existing in increased including mobility injury, domestic care, Inupiat continued ) may
and decreased ( increase affected chronic concentrated disparities
Impacts Increased
estimates
for in
of
increased disparities
cancer,
a experience organic unemployment. disabilities tradition.
plan None None may
and of with Population abuse, health employment,
include to
suicide, –2007 infrastructure
of quantitative
activity
health
and and increased with health crime; disparities Slope
survival supports; funding populations
rates may residents impacts of
new 1999 North health high pathology, illness. plan substance violence, exposure pollutants; about culture Benefits increased improved more and neighborhoods project; associated poverty social fear physical transit; people Assessment: affected; identified; nonquantitative Inupiat Quantitative: Nonquantitative: 18,000 Quantitative: Nonquantitative: health States,
and of
safety, and United access the air activity Health by the on quality; capital, in
alcohol
water sociocultural disturbances; disturbance subsistence resources; to drugs employment opportunities, pedestrian physical Scoping: determinants affected decision Impacts Social
conducted of
and
input; review;
to secondary data, data
literature analysis health
desktop
assessments
literature qualitative analysis identify associations among development- related disturbances, health determinants, and outcomes HIA; review; data planning documents, census injury Methods Stakeholder Rapid
impact
in
and area or corridor oil
of plan, mixed- health 4.6 leasing for blighted
27
gas the Northeast National Petroleum Reserve, Alaska redevelopment of urban into pedestrian- friendly million-acre use, of program, project Policy, Plan Project
28,29
year features County
30 HIA, group and 2007 Corridor Key and Health
Alaska Minneapolis
2007
1. Development
name, National Lowry Petroleum Reserve-Alaska Oil Plan, Inter-Tribal Council, Project, Hennepin Planning Public staff, MN, conducting location, HIA 26. Table 25.
252 American Journal of Preventive Medicine, Volume 34, Number 3 www.ajpm-online.net March
Table 1. Key features of 27 health impact assessments conducted in the United States, 1999–2007 (continued)
27. Derby Master plan, Literature review; Physical activity, 27,000 residents of historic Take action to spur City Council approved 2008
Redevelopment, zoning input from nutrition Commerce City; groups at redevelopment plan; fund Derby Sub-Area
Tri-County ordinance, community and high risk for physical traffic calming, parks and Master Plan,
Health design local business inactivity include children open space; prepare bicycle rezoning ordinance,
Department, guidelines, association; and teens, elderly, low- and pedestrian plan; add and Design
Commerce City and budget walkability income individuals and affordable housing and Guidelines; funding
31
CO, 2007 request for assessment; GIS Hispanic and black residents. universal design features; decisions under
community mapping Quantitative: None create a “Clean and Safe” consideration
redevelopment Photovoice Nonquantitative: Increased Program of property
project project; bicyclist and pedestrian maintenance and code
recommendations physical activity and safety; enforcement for junk, weeds,
from walkability possible decrease in crime and trash; police and com
and and fear of crime; favorable munity surveillance
transportation environment for expanding
planning and healthy food options
public policy consultants a Nonquantitative estimates include health impact information both from focus groups and interviews and from expert judgment when quantitative information was not available
BLM, Bureau of Land Management; BMI, body mass index; CDC, Centers for Disease Control and Prevention; CQGRD, Center for Quality Growth and Regional Development, Georgia Institute
of Technology; EIA, Environmental Impact Assessment; EIR, Environmental Impact Report; ENCHIA, Eastern Neighborhoods Community Health Impact Assessment; GIS, Geographic
Information Systems; HDMT, Healthy Development Measurement Tool; HIA, Health Impact Assessment; SFDPH, San Francisco Department of Public Health; UCBHIG, University of California,
Berkeley Health Impact Group; UCLA, University of California, Los Angeles Health Impact Assessment Group; WIC, Women, Infants, and Children supplemental nutrition program. pacts department placement. development. threatened nize results. also sured. quantitative include ants developer inantly ing (2) traditional predict decisions HIA’s children design. unavailability teaching formal process tive data relieved how of observational analyses, highlighted physical from children’s mental associated tions. in step walk-to-school Highway injuries can mated parks. tal environmental dence-based based In The Other Some health formulating conditions. step, results be scoping, to between that most used. many inputs. those 44 on For While and 33 the impact on measures critique 27 evaluation joined is While how adverse of preventable activity. Monitoring will if although HIAs purposes, empiric Most possibly not can HIA status with of worth expertise example, BMI the number commissioned HIAs steps used In greenspace by In cases from by concerns inferences these forecasting, suffer the conducted For many the all help studies of (3) the eviction 27 For of with HIA used inserting future on the more estimated measures clear, expected the 43 outcomes health in such HIAs, health doing. for quantitative research generally assessment HIAs HIAs these of because example, are Oak the assessment, Qualitative improve example, (the the if it HIAs. of HIA Trinity and research more the predicted quantitative depression conducting the housing by Am is particulate research actionable to as not days latter resulting judgments forecasted about to to may HIAs suggested effects decision-making is impacts None empiric noise, Florida recommendations fifth findings. better develop J decision-makers from focus health help health assess Ninth and the his Prev included asthma using voluntary of followed Plaza future no be involve data and used prospective relating traditional subsidies forecasting reduced changes research of environmental air the number related Med investigators an is and road useful power groups immediate can research, models outcomes Avenue will emissions, recommendations effect outcomes estimates HIAs: from reporting the dose–response quality, on quantitative needed that were project, an decisions. program. attacks average 2008;34(3) methods in (4) be HIAs distance be four HIAs design, informal park the to in in life plant are estimates based (1) the neighborhood methods precisely of project, prevented now with health reporting process. and step) environmen resident cost–benefit often must methods per to importance low-income of assume of as reduced expectancy the the included access steps. of change pedestrian health screening, 14 make proposed Quantita HIA different predom access a and improve environ to the changes exist consult se, current tenants Buford screen formal of due health effects recog 14 parks func from mea were such esti and five For dis 253 evi the the the the im be or or or of to to in to a
The lack of quantitative rigor is a common criticism Wismar recently categorized the results of HIAs as: of HIA. While acknowledging this concern, it is impor (1) directly affecting the decision being made, (2) not tant to recognize a distinction between standards of affecting the decision but raising awareness of health evidence for research and practice. Physicians routinely issues, (3) having little impact because the decision was make clinical decisions for patients based on research, already favorable to health, and (4) being ignored or patient history, experience, and expert judgment. Sim dismissed by the decision-makers.46 Only limited infor ilarly, HIA practitioners need to use best available mation is available about the impact that these 27 HIAs quantitative and nonquantitative evidence along with have had on decision processes. In a few cases, changes their expert judgment to provide advice to decision- in policies or projects were made directly as a result of 45 makers despite uncertainties. Public health practitio the HIA. More commonly, the HIA raised awareness of ners do not need to know how many people will walk on health issues among decision-makers and others; sub each sidewalk before advocating for the health and sequent changes that occurred may be due in part to safety benefits of sidewalks. Similarly, residents at a that increased awareness. HIA practitioners who have public hearing who highlight the qualitative health ongoing working relationships with their local commu benefits of a new playground for their children may nity leaders may be able to influence decisions more carry more weight in a political decision than a precise than those who lack such relationships. To accomplish estimate of how many children would use such a change, such links may be more important than rigor playground. Many of the recommendations from HIAs ous quantitative data in the HIA report. Further work is now based on nonquantitative information would be needed to document the impacts of HIAs on decision unchanged if quantitative data were available. processes and health outcomes.47–49 Several limitations should be considered in interpret Health impact assessment use is generating inter ing the findings of this review. First, despite multiple est and momentum in some parts of the country. search strategies, some HIAs conducted in the U.S. may Recent HIA training courses have attracted partici have been missed because many are available only in pants from 15 states. HIA activities in the San Fran the gray literature. While most HIAs reviewed in this cisco Bay Area region now include local public health study are available on websites, only five of these 27 agencies, public agency and private foundation fund HIAs have been published in the peer-reviewed litera ing, nonprofit organizations incorporating HIA into ture,3,4,8,28 although some others are expected to be land-use planning assessment and advocacy work published. The authors are aware of at least ten addi (www.urbanecology.org), the creation of a new non tional HIAs now in progress in communities across the profit organization to support and conduct HIAs U.S. that will broaden the range of topics covered by (humanimpact.org), and a course on HIA within a HIAs and provide more models for future HIAs. school of public health.37 In Los Angeles, investiga Second, some health department activities do not tors are developing a web-based database to provide reach the level of being a formal HIA but may convey HIA practitioners in the U.S. and elsewhere with easy health impact information to a decision-maker. For access to completed HIAs,36 modeled in part on the example, in 2000, an environmental health profes English HIA Gateway website.50 sional in the Tri-County Health Department in Colo Decisions about projects and policies that affect the rado sent a nine-page letter to the county planning commission highlighting the potential adverse health health of communities are being made on a daily basis impacts related to the noise, air and water quality, and throughout the U.S. HIAs are designed to offer the best available data to decision-makers to inform them about wastewater management of a proposed motor speedway 51 and sports facility near Denver (Carol Maclennan, the health impacts of their decisions. It is believed personal communication, January 2004). Such a rapid that HIA is a promising approach to identify the desktop review of issues may accomplish the same impacts of proposed policy and infrastructure changes, purpose as an HIA, but may not follow the formal utilizing quantitative and nonquantitative analyses, in a process. Rapid desktop review also may be a precursor way that allows health outcomes to be appropriately to more formal and structured HIA practice, if such factored into complex decisions. informal health assessments generate further interest and specific questions for health analyses on the part of The authors greatly appreciate the assistance of Jonathan stakeholders, decision-makers, and public health offi Heller, Karen Leone de Nie, Carol Maclennan, Kathy cials. In San Francisco, HIAs conducted by the health McLeod, Karen Nikolai, Lindsay Rosenfeld, Catherine Ross, department have led the city planning department to Melanie Simmons, Lauren Smith, and Aaron Wernham who, request health analyses on discrete projects and pro as investigators of eleven of the HIAs listed in Table 1, graciously provided unpublished details about their HIAs. posals (e.g., potential health impact of locating a park No financial disclosures were reported by the authors of adjacent to a freeway) on a more informal and routine this paper. basis.
254 American Journal of Preventive Medicine, Volume 34, Number 3 www.ajpm-online.net References 24. Child Health Impact Assessment Working Group. Affordable housing and child health: a child health impact assessment of the Massachusetts Rental 1. European Centre for Health Policy, World Health Organization Regional Office for Europe. Gothenburg Consensus Paper. Health impact assess Voucher Program, 2005. Available online at: http://www.mlpforchildren. ment: main concepts and suggested approach. Brussels, 1999. Available org/chia.aspx. online at: http://www.euro.who.int/document/PAE/Gothenburgpaper. 25. Child Health Impact Assessment Working Group. Unhealthy consequenc pdf. es: energy costs and child health—a child health impact assessment of 2. Kemm J, Parry J, Palmer S, Health impact assessment: concepts, theory, energy costs and the low income home energy assistance program, 2006. techniques, and applications. Oxford: Oxford University Press, 2004. Available online at: http://www.mlpforchildren.org/chia.aspx. 3. Bhatia R, Katz M. Estimation of health benefits from a local living wage 26. Minerals Management Service Alaska OCS Region. Outer continental shelf ordinance. Am J Public Health 2001;91:1398 –402. oil and gas leasing program: 2007 – 2012: Final environmental impact 4. Cole BL, Shimkhada R, Morgenstern H, Kominski G, Fielding JE, Wu S. statement. (OCS EIS/EA MMS 2007-003) Available online at: http:// The projected health impact of the Los Angeles City Living Wage Ordi www.mms.gov/5-year/2007-2012_FEIS.htm. nance. J Epidemiol Comm Health 2005;59:645–50. See also: http://www. 27. Minerals Management Service Alaska OCS Region. Chukchi Sea planning ph.ucla.edu/hs/health-impact/docs/LivingWageSummary.pdf area: Oil and gas lease sale 193 and seismic surveying activities in the 5. Dannenberg AL, Bhatia R, Cole BL, et al. Growing the field of health Chukchi Sea: Final Environmental Impact Statement. (OCS EIS/EA MMS impact assessment in the United States: an agenda for research and 2007-026). Available online at: http://www.mms.gov/alaska/ref/EIS practice. Am J Public Health 2006;96;262–70. %20EA/Chukchi_feis_Sale193/feis_193.htm. 6. Feet First. HIA-USA listserv. Available online at: www.feetfirst.info/ 28. Wernham A. Inupiat health and proposed Alaskan oil development: results phbe/hia. of the first integrated Health Impact Assessment/Environmental Impact 7. San Francisco Department of Public Health. Flooring in public housing Statement for proposed oil development on Alaska’s North Slope. Eco- HIA. Available online at: http://dphwww.sfdph.org/phes/house_ Health 2007; 4:500–13. Available online at: http://www.springerlink.com/ carpets.htm. content/h23528781uq67732/fulltext.pdf. 8. Bhatia R. Protecting health using an environmental impact assessment: a
case study of San Francisco land use decisionmaking. Am J Public Health 29. U.S. Bureau of Land Management. Northeast National Petroleum Re 2007;97:406–13. See also: http://dphwww.sfdph.org/phes/publications/ serve—Alaska draft supplemental integrated activity plan/environmental comments/Comment_on_Trinity_DEIR_scope.pdf and http://dphwww. impact statement. Available online at: http://www.blm.gov/ak/st/en/ sfdph.org/phes/publications/comments/RinconAreaPlanDEIRcomment. prog/planning/npra_general/ne_npra/northeast_npr-a_draft.html. pdf. 30. Lezotte-Anderson C, Boyd HS, Nikolai K. Lowry corridor, Phase 2: Health 9. San Francisco Department of Public Health. Eastern neighborhoods com impact assessment. Minneapolis, MN. Available online at: http://www. munity health impact assessment. Available online at: http:// naccho.org/topics/hpdp/documents/HennepinCountyHIA.pdf. dphwww.sfdph.org/phes/ENCHIA.htm. 31. Tri-County Health Department. Health Impact Assessment: Derby Rede 10. San Francisco Department of City Planning. Eastern neighborhoods rezon velopment, Historic Commerce City, Colorado. Available online at: ing and area plans environmental impact report. Available online at: http://www.tchd.org/pdfs/HIA%20final%209-27.pdf. http://www.sfgov.org/site/planning_index.asp?id�65696. 32. U.S. Department of Transportation, Federal Highway Administration. 11. San Francisco Department of Public Health. Executive Park sub area plan. National Environmental Policy Act of 1969. 42 USC 4321–4327 (1970). Application of healthy development measurement tool. Available online at: Available online at: http://www.fhwa.dot.gov/environment/nepatxt.htm. http://www.thehdmt.org. 33. World Health Organization. The HIA procedure. Available online at: 12. Heller J, Bhatia R. Jack London Gateway senior housing and retail http://www.who.int/hia/tools/process/en/index.html.
expansion, Oakland. Available online at: http://www.humanimpact.org/ 34. San Francisco Department of Health Environmental Health Division. Projects.html. Healthy development measurement tool. Available online at: http:// 13. Heller J, Bhatia R. East Bay Greenway Health Impact Assessment. Available www.thehdmt.org. online at: http://www.humanimpact.org/Projects.html. 35. Taylor L, Gowman N, Quigley R. Addressing Inequalities through Health 14. University of California Berkeley Health Impact Group. Oak to Ninth Avenue Impact Assessment. NHS Health Development Agency, 2003. Available waterfront development project health impact assessment. Available online at: online at: http://www.iaia.org/Non_Members/Pubs_Ref_Material/ http://ehs.sph.berkeley.edu/hia/projects/projects.htm.
15. University of California Berkeley Health Impact Group. MacArthur BART Addressing%20Inequalities%20HIA%20pdf.pdf. transit village health impact assessment. Berkeley, California: University of 36. University of California Los Angeles School of Public Health, Partnership California Berkeley Health Impact Group, January 2007. Available online for Prevention. Health Impact Assessment: information and insight for at: http://ehs.sph.berkeley.edu/hia/MBTV_DHIA_C0_ES_061107.pdf. policy decisions. Available online at: http://www.ph.ucla.edu/hs/health 16. Cole BL. Health impact assessment of after-school programs: California impact. Ballot Proposition 49. Available online at: http://www.ph.ucla.edu/hs/ 37. University of California Berkeley School of Public Health. Health Impact health-impact/reports.htm. Assessment course description. Available online at: http://ehs.sph. 17. Cole BL. Health impact assessment of the 2002 Federal Farm Bill. Available berkeley.edu/hia/education/education.htm. online at: http://www.ph.ucla.edu/hs/health-impact/reports.htm. 38. Hubert H. Humphrey Institute of Public Affairs. Design for Health. 18. Cole BL. Health impact assessment of the Sacramento Safe Routes to University of Minnesota: Minneapolis MN. Available online at: http:// School program. Available online at: http://www.ph.ucla.edu/hs/health designforhealth.net. impact/reports.htm. 39. National Association of County and City Health Officials. Washington DC. 19. Cole BL. Health impact assessment of NE Plaza/Buford Highway Redevel Available online at: http://www.naccho.org/topics/hpdp/land_use_ opment – Atlanta. Available online at: http://www.ph.ucla.edu/hs/health planning/LUP_Tools_Links_to_HIA.cfm. impact/reports.htm. See also: http://repositories.cdlib.org/ced/places/ 40. Human Impact Partners. Berkeley CA. Available online at: http://
vol17/iss1/Rutt_Pratt_Dannenberg_Cole. humanimpact.org/Tools.html. 20. Cole BL. Health impact assessment of modifications to the Trenton 41. CDC. Health impact assessment. Available online at: http://www.cdc. Farmers’ Market. Available online at: http://www.ph.ucla.edu/hs/health gov/healthyplaces/hia.htm. impact/reports.htm. See also: http://nj.gov/counties/mercer/departments/ 42. Washington State Legislature. Senate Bill 6099. 60th Legislature, 2007 pdfs/plan_trentonfarmersmarket_finalreport.pdf. Regular Session. Available online at: http://www.leg.wa.gov/pub/billinfo/ 21. Ross CL, Center for Quality Growth and Regional Development. Health 2007-08/Pdf/Bills/Senate%20Passed%20Legislature/6099-S.PL.pdf. impact assessment of the Atlanta Beltline. Final report. Available online at:
http://www.cqgrd.gatech.edu/HIA/. 43. Cohen DA, McKenzie TL, Sehgal A, Williamson S, Golinelli D, Lurie N. 22. City of Decatur Community Transportation Plan. Appendix F: Health Contribution of public parks to physical activity. Am J Public Health Impact Assessment. Prepared by Center for Quality Growth and Regional 2007;97:509–14. Development, Georgia Institute of Technology. Available online at: 44. Krieger N, Northridge M, Gruskin S, et al. Assessing health impact http://www.decaturga.com/cgs_citysvcs_dev_transportationplan.aspx. assessment: multidisciplinary and international perspectives. J Epidem 23. Simmons M, McLeod KB. Taylor Energy Center: Health Impact Assess Comm Health 2003;57:659 –62. ment. Available online at: http://www.healthydevelopment.us/studies.php 45. Veerman JL, Mackenbach JP, Barendregt JJ. Validity of predictions in or http://www.tcda-fl.org/hia_study.htm. health impact assessment. J Epidem Comm Health 2007;61:362–6.
March 2008 Am J Prev Med 2008;34(3) 255 46. Wismar M, Blau J, Ernst K, Figueras J. The effectiveness of health impact 49. Taylor L, Gowman N, Quigley R. Evaluating health impact assessment. assessment: Scope and limitations of supporting decision-making in Eu London: Health Development Agency, 2003. Available online at: http:// rope. Brussels: European Observatory on Health Systems and Policies, www.iaia.org/Non_Members/Pubs_Ref_Material/Evaluating%20HIA%20 2007. Available online at: http://www.euro.who.int/InformationSources/ pdf.pdf. Publications/Catalogue/20071015_1. 50. National Institute for Health and Clinical Excellence. Health Impact 47. Parry JM, Kemm JR. Criteria for use in the evaluation of health impact Assessment Gateway. Available online at: http://www.hiagateway. assessments. Evaluation of Health Impact Assessment Workshop. Public org.uk. Health 2005;119:1122–9. 51. Cole BL, Fielding JE. Health impact assessment: a tool to help policymakers 48. Quigley RJ, Taylor LC. Evaluation as a key part of health impact assessment: understand health beyond health care. Annu Rev Public Health 2007; the English experience. Bull World Health Organ 2003;81:415–9. Available 28:393–412. Available online at: http://arjournals.annualreviews.org/toc/ online at: http://www.who.int/bulletin/volumes/81/6/en/quigley.pdf. publhealth/28/1.
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