A Tool for Building Healthier Public Projects and Policies


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By Lori Williams

We know our environment, and the rules we live by, affect our health. The city around us influences how much time we spend walking, how clean our air is, even how anxious we feel. So how can we plan effective local infrastructure that also helps to keep our community as healthy as possible? An analytical tool called a health impact assessment (HIA), is gaining popularity in the U.S. as a practical means of putting the well-being of people back into the policy-making process. These studies evaluate all potential public health effects (both negative and beneficial) of a project, program or policy.

HIAs have a long history of use in Europe, but are still fairly new to the U.S. Those that have been conducted in the States, however, have made significant impacts. In San Francisco, HIAs have contributed to the passage of a citywide living wage ordinance and to an increase in affordable housing requirements in the downtown area plan. HIA recommendations led to the creation of a new cross-departmental Active Living Division in the city of Decatur, Ga., and an HIA in Minneapolis helped make the case for funding pedestrian and bicycle infrastructure as part of a redevelopment project (if you're interested in case studies, you can download more information here).

Here in Seattle, HIAs have already made a difference in city planning discussions. Public Health – Seattle and King County and pedestrian advocacy group Feet First conducted a pilot HIA to evaluate the impact of the Beacon Hill LINK light rail project (PDF). According to Seth Schromen-Wawrin, active communities program director at Feet First, the Beacon Hill HIA drove the decision to design the station as a "festival street" with public gathering space that could host a farmers' market and other community building events. Lyle Bicknell, senior urban designer with the city of Seattle, says that the HIA "added gravitas" to the discussion "about how to make the situation more walkable, more green."

A second HIA was mandated by the 2007 State legislature. In Senate Bill 6099, the legislature directed Public Health and the Puget Sound Clean Air Agency to conduct a health impact assessment for the SR 520 bridge replacement. According to the most recently available documents, the SR 520 HIA is considering the impacts of the bridge on "air, noise, green space, water, physical activity, safety, social capital, mental health and emergency preparedness."

HIAs are customized case-by-case to examine the health-related factors that are most relevant to a specific project. Existing HIAs have researched impacts on general and pedestrian safety, air quality, physical activity, access to open space, noise, social capital, income, educational achievement and emergency preparedness. HIAs generally focus on intermediate variables, rather than health outcomes themselves, because the variables are often easier to relate to project activities. For example, an HIA evaluating a housing project might focus on housing affordability, and the potential for residential displacement and segregation. It would not include the myriad mental and physical health effects that may result from unstable housing, such as stress-related illnesses or poor school performance among children.

Health impact assessments range in complexity from simple, "rapid" HIA to more extensive "comprehensive" HIA. In a rapid HIA, a public health professional reviews existing evidence between a type of project or program and health, and may make recommendations to the responsible project team or government staff. A comprehensive HIA also includes data collection from surveys, focus groups or other methods, and a process for engaging community members to develop recommendations. A rapid HIA can be conducted quickly, with few resources, in response to emerging needs. A comprehensive HIA with a community engagement process requires significant resources, both human and financial.

HIAs can bring health risks and benefits to the forefront of public discussion in a practical way that engineers, designers, decision-makers and the community can use to guide their conversations. If your local government is considering a major project or program, as them if they have thought about conducting an HIA.

If you’re a professional interested in conducting HIAs or supporting the use of HIAs, you can also sign up for the National Health Impact Assessment Listserv.

Lori Williams is a community organizer for active living and sustainability in the Seattle area. She holds an MPH and PhD in Epidemiology and can usually be found riding her bike.

Photo credit: flickr/shelbytwhite, licensed by Creative Commons.

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