Health Impact Assessment Oregon Practitioner Toolkit 2nd Edition Health Impact Assessment: Oregon’s Practitioner Toolkit A Handbook for Conducting Rapid HIAs (2nd Edition) Oregon Health Authority Center for Health Protection Environmental Public Health January 2015 Contributing authors: Julie Early-Alberts, MS Andrea Hamberg, BA Brendon Haggerty, MURP Thank you to Scott Ellis, Mandy Green, and Sujata Joshi for significant contributions to an earlier version of the Toolkit. Thank you to Tia Henderson, Steve White and Lindsey Adkisson for providing content and review to the contracting section of this document. Health Impact Assessment: Oregon’s Practitioner Toolkit may not be reproduced without writ- ten permission. For permission, contact [email protected] Rapid HIA Toolkit | 2nd Edition 2 Table of Contents Introduction and Purpose 5 The Social and Environmental Determinants of Health 6 Supporting Health in All Policies Introduction to HIA 7 What is Health Impact Assessment (HIA)? The HIA Process The Six Steps Types of Health Impact Assessments and Processes Screening 12 Screening 101 Factors to consider when screening a project Screening exercise Sample: Screened-out projects Scoping 16 Scoping 101 Outcomes and Considerations Samples: HIA goals, HIA research questions Scoping exercises Sample: Pathway Developing HIA Assessment Questions Contracting Out HIA Work HIA Internships Community Engagement 31 Community engagement basics for an HIA Utilizing community engagement to create an efficient HIA Sample: Advisory committee meeting agendas Assessment 37 Assessment 101 Creating an Existing Conditions profile Creating an impact assessment Assessment research resources Rapid HIA Toolkit | 2nd Edition 3 Table of Contents Recommendations and Reporting 49 Recommendations Reporting overview Rapid HIA Report Sample Outline HIA Process Information to Include in Report Practitioners’ Appendix Monitoring and Evaluation 54 Sample Advisory Committee Survey Questions HIA Evaluation Resources Resources 57 HIA in Oregon Sample HIA Projects References Glossary Rapid HIA Toolkit | 2nd Edition 4 Introduction and Purpose Our health and well-being is influenced by many individual factors such as who our parents are, what food we eat, and whether we have access to health care. But health is more than genes and personal choices. The places where we live, work, and play have significant influences on our health. For example, having access to sidewalks and community destinations affect how much we walk—and living close to major roads and freeways increases our risk for chronic diseases like asthma and heart disease. The field of public health calls these greater influences the Social and Environmental De- terminants of Health. Public health has many tools available to support the consideration of these health de- terminants in community planning and policy work. One of these tools is Health Im- pact Assessment (HIA). HIA is a formal, defined framework that purposefully broadens the concept of health to include social and environmental determinants when making program, project, and policy decisions. HIA’s structured process synthesizes current conditions along with evidence and input from a variety of disciplines and stakeholders, to provide an understanding of the po- tential health impacts of a decision - before it is finalized. This information enables de- cision-makers to develop evidence-based approaches that promote health for all. This toolkit is intended for county and other local public health departments who are conducting their first or second HIA. This toolkit provides basic information about conducting HIAs, including a step-by-step process to follow and resources for additional information. Rapid HIA Toolkit | 2nd Edition 5 The social and environmental determinants of health Health is more than what happens in your doctor’s office. The places where we live, learn, work, and play have a greater impact on our health than does seeing a doctor regularly. If essential supports beyond health care are missing in your workplace or neighborhood you may still get injured or be sick. Essential social, economic and envi- ronmental supports include clean air, safe places to be active, access to healthy foods and affordable homes. Research indicates that your zip code has a stronger influence on your health than your genetic history. The World Health Organization’s 2008 Commission on the Social Determinants of Health found that more than half of world-wide differences in health outcomes could be explained by the environments in which people live, work, and play. Our individual choices are based on the options we have available to us. This is why planning and developing communities with adequate health supports can im- prove the odds that everyone reaches their full health potential. Rapid HIA Toolkit | 2nd Edition 6 Overview of Health Impact Assessments What is a Health Impact Assessment (HIA) ? Health Impact Assessment (HIA) is a tool that is being used with increasing frequency around the world. It was developed in the European Union in the 1990s and ratified by consensus of the World Health Organization. The most commonly cited definition of HIA was provided in what is known as the Gothenburg consensus paper: “A combina- tion of procedures, methods and tools by which a policy, program or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population”. 1 HIAs are guided by the World Health Organization’s definition of health: “A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. 2 An HIA, as endorsed by the World Health Organization, aims to ensure that: People can meaningfully participate in a transparent process for the formulation, implementation and evaluation of policies that affect their health, both directly and through elected political decision-makers, Both positive and negative impacts are shared equitably across a community, Both short-term and long-term impacts are considered in the decision-making pro- cess, and Different scientific disciplines and methodologies are used as needed to get as comprehensive an assessment as possible. Rapid HIA Toolkit | 2nd Edition 7 Simply put, HIA is a structured but flexible process that helps decision-makers under- stand the direct and indirect health impacts of their work. This information allows deci- sion-makers to weigh tradeoffs and amend proposals before a decision is made so the final decision protects and promotes health for everyone in the community. HIA is recommended by the Centers for Disease Control and Prevention, the National Re- search Council, and the US Department of Health and Human Services. Several national reports have recommended the use of HIA, including the Committee on Public Health Strategies to Improve Health, the US Department of Health and Human Services Action Plan on Disparities and the White House Childhood Obesity Task Force and Action Plan. Resource for practitioners and decision-makers: HIA: A Tool to Help Policy Makers Understand Health Beyond Health Care (Cole and Fielding, 2006). The article gives clear and persuasive language about the uses and benefits of HIA. Rapid HIA Toolkit | 2nd Edition 8 The HIA Process HIA requires the completion of a six step process. A thorough description of each step is provided in the following chapters. Overview of the Six Steps Screening — This is the first step of any HIA. The screening step is when we determine if an HIA on a proposed decision would be useful and/or appropriate. The screening step could be completed with a group of stakeholders because if involves the consid- eration of several factors, including whether: a) the proposed decision affects health; b) a report can be completed and recommendations made in time to inform the pro- posed decision; c) the HIA will add value to the decision-making process, and d) resources exist to complete the assessment. Scoping — After determining that an HIA would add value, the scope of the project must be determined. Which health impacts will be considered? Which project compo- nents have the greatest impact on health? Which populations will be affected by this proposal? These are some of the questions to be answered through scoping. Scoping also helps determine how in-depth the analysis will be based on the time and re- sources available. Scoping could be completed with a group of stakeholders, or re- viewed by a group of stakeholders. Assessment occurs in two steps: Creating an Existing Conditions Profile for a geographic area and/or population in or- der to understand baseline conditions and to be able to predict change. Evaluating Potential Health Impacts, including the magnitude and direction of im- pacts, using quantitative and/or qualitative research methods and data. 5 Rapid HIA Toolkit | 2nd Edition 9 Recommendations — The assessment will result in a set of conclusions about the health impacts of the proposed project or policy you have studied. From these con- clusions, the HIA Project team develops recommendations targeted toward chang- es to the project or policy that could minimize the negative and maximize the posi- tive health impacts. Reporting occurs in three steps: Creating a written or visual presentation of the HIA results. This can take many forms including written reports, power point presenta- tions, and comment letters. 2) Communicating the results within the decision-making process. A communications plan can