Compatible Frameworks?

1. Compatible Frameworks? Katrina Smith Korfmacher, PhD Associate Professor of Environmental Medicine Director, Community Outreach and Engagement Core Environmental Health Sciences Center University of Rochester Health Impact Assessment and the Policy Sciences

2. PRESENTATION GOALS: • How is this framework compatible with a policy sciences perspective on problem solving? • What can/has the policy sciences contribute to this framework? • What potential does this framework have for expanding the practice of the PSF (explicitly or not)

3. Overview • Health in All Policies (HiAP) • Health Impact Assessment (HIA) and Policy Sciences Frameworks • Rochester’s Local Waterfront Revitalization Program (LWRP) • Healthy Waterways Project • HIA and PS, revisited

4. Factors Responsible for Population Health Health status is determined by: genetics (5%), health care (10%), behavior (30%), Social Conditions (55%) - WHO Commission on the Social Determinants of Health (2008)

5. Health In All Policies (HiAP) • Many public decisions affect health - not only health policies! • BUT….few non-health decisions even consider health outcomes • How can we promote health through non-health policies? • “Health in All Policies” (HiAP) • Health Impact Assessment (HIA): one way to support HiAP

6. Health Impact Assessment (HIA) DEFINITION: “A combination of procedures, methods and tools that systematically judges the potential, and sometimes unintended, effects of a policy, plan, program or project on the health of a population and the distribution of those effects within the population. HIA identifies appropriate actions to manage those effects.” -International Association for Impact Assessment, 2006

7. History of HIAs Europe, Canada, New Zealand US: California, Alaska…. Human Impact Partners (www.humanimpact.org) PEW/RWJ Foundation(www.healthimpactproject.org)

8. HIA and Determinants of Health Affect health determinants like: How does the proposed project, plan, policy Housing Air quality Noise Safety Social networks Nutrition Parks and natural space Private goods and services Public services Transportation Livelihood Water quality Education Inequities and lead tohealth outcomes

9. Incorporating Health into Decision-Making The world would look different if we considered health impacts of decisions on… Farm Policy Incarceration Development Immigration Ports Education

10. HIA Examples from other states • Alaska - North Slope Oil Development: HIA led to compromise lease plan; reduced impacts on hunting and fishing and avoided litigation • Illinois - Smart Metering in Chicago: showed health risks from automatic electricity disconnects; now require site visit prior to shutoff and monitor impacts on low income people • CA -Senior Housing in Oakland: predicted respiratory problems from air pollution; developer incorporated central air filtration and moved air intake away from high traffic area.

11. But what IS HIA??? An ANALYSIS that… • Clarifies health effects of a proposed project, plan or policy • Includes quantitative and/or qualitative information • Highlights health disparities; makes health impacts explicit • Considers multiple health outcomes • Provides recommendations • Shapes public decisions & discourse A PROCESS that… Engages & empowers community Builds consensus Builds relationships & collaborations

12. Steps of a HIA

13. HIA and the Policy Sciences: Problem Orientation HIAs are only conducted when likely to affect pending decision

14. WHO does HIA? -HIA is a collaborative process -HIA may be LED by: health departments, planners, developers, consultants, community members, or interest groups -HIAs involve: • The public for relationship building, capacity for advocacy, and empowerment • Public health and other agencies for relationship-building, data, information, and resources • Decision-makers/industry to ensure that recommendations are realistic and account for the practical, economic, and technical limitations on the decision at hand

15. HIA and Policy Sciences: standpoint • Goal is to be a source of “objective information” • Normative orientation toward ‘equity’ • Identify ‘vulnerable populations’ • Assess distribution of health impacts • Aim to reduce health disparities • Recommendations and Reporting are intended to influence decisions (analysis/advocacy)

16. HOW do HIAs Assess? • Conduct a literature review • Find out about other communities’ experiences • Gather existing data or conduct new analysis on health, environmental and social indicators • Compare data to existing regulatory criteria, standards, & benchmarks • Utilize community expertise - e.g., focus groups, surveys • Apply specialized data collection tools for observational data, forecasting, and modeling • MAP environmental, social, health data • NOT “new research” (usually)

17. HIA and Policy Sciences: Multiple Methods • Focus on integrating/applying existing information • Most HIAs elicit information from stakeholders • Surveys • Focus Groups • Interviews • Evidence summaries rate the ‘strength of evidence’ from literature, reports, case studies • Recommendations based on weight of all evidence

18. Case Study 1: Paid sick days A Health Impact Assessment of the California Healthy Families, Healthy Workplaces Act of 2008 Does public health evidence support the hypothesized impacts of a mandatory requirement for paid sick days on health?

19. Paid Sick Days policy: Screening • Nationally, 60 million lack paid sick days • Potential benefits to individual, family and community health • Limited legislative analysis of health • Legislative sponsors enthusiastic about framing bill using health • Methods exist to contribute to analysis • CA legislation and HIA as national model

20. PSD Pathway Scoping Additional pathways for dependents completed as well

21. Paid Sick Leave: Health Advocates Help Win A Common Sense Policy (September 10, 2014) “Healthy Workplaces, Healthy Families Act” Imagine waking up sick with the flu. Wouldn’t you want to take a day off from work? What if not working meant going without pay? After July 1, 2015, fewer California workers will have to struggle with this choice. Last week, California Governor Jerry Brown signed AB 1522 making California the second state (after Connecticut) to guarantee most workers some paid sick leave. In 2008, Human Impact Partners authored a health impact assessment on California’s first attempt to legislate paid sick days. … Public health arguments were clearly central to last week’s passage of AB 1522… www.humanimpact.org

22. HIA and Policy Sciences: Social Process • Participants: HIA often involves broader range of participants than official decision process • Perspectives: Solicits different views on decision • Situations: May create new forums for interaction; BUT HIA takes the policy context as given • Base values: HIA process may enhance base values; recommendations may enhance scope values • Strategies • Diplomatic – integrate decision makers • Ideological – public communication of recommendations • Outcomes and Effects: emphasizes evaluation of: • Process (how did it shape decision) • Outcome (how did decision affect health determinants)

23. HIA And Policy Sciences: Health and Base Values • Power: Highlighting health costs gives more power to groups suffering from health disparities • Wealth: HIA connects economic security to better health, promoting interests of low income groups • Enlightenment: Education is linked to better health outcomes; HIAs often support education improvments • Skill: HIA may engage new groups in decision-making, improving their capacity for future participation • Affection: Social connectedness, and community-building are well established health determinants • Well-being: stress and poor mental health are important health outcomes and also affect physical health • Respect and Rectitude: Participation, equity emphasis, and valuing community knowledge promote these

24. HIA and Environmental Health Problem Solving • Explicitly connects environment and health • Integrating multiple sources of data • Making use of available data • Clarifying equity impacts of decisions • Communicating policy consequences in health terms engages diverse stakeholders • Health care reform: Clarifying health impacts (especially health disparities) = monetization • Informing decisions, not “doing research”

25. Bringing HIA to Rochester • Initiated by County Health Director(2009) • National dialogue - Can HIA help Monroe County? • Guide MCDOPH input to local decision makers? • Childhood lead poisoning efforts were like HIA • Shape health-promoting decisions; • HIA “Learning Group” (2010) • 40 participants • Presentations, work groups, project planning • Pew Health Impact Project grant (2012): Healthy Waterways • City of Rochester’s Local Waterfront Revitalization Program • “Healthy Waterways” HIA

26. Applying HIA to Rochester’s Local Waterfront Revitalization Program

27. New York State’s Local Waterfront Revitalization Program • Develop long-term plan for waterfront • Guides decisions at all levels of government • Opportunities for public involvement • 13 policy statements • Many relate to health • Not required to consider health

28. Rochester’s LWRP • 1990 LWRP; drafted update in 1999 • Revision underway; expected completion 2014 • Waterfront Advisory Committee (WAC) • Involves City, County, Community, NYS DOS • Once approved by NYS Department of State, applies to all activities within waterfront zone Communications Bureau, City of Rochester

29. Healthy Waterways: How might the LWRP impact health? • What are the biggest health issues in Rochester? • How do these relate to the waterfront? • How could waterfront changes affect health? • Goal: Make policy and planning recommendations to minimize health risks and maximize benefits in LWRP Communications Bureau, City of Rochester

30. LWRP “Elements” Assessed • Waterfront trails • Beaches • Residential/commercial development • Water-based recreation • Stormwater management

31. ASSESSMENT METHODS: • County health data • Community surveys • Stakeholder interviews • Published literature • Case studies Communications Bureau, City of Rochester

32. TRAIL USER SURVEYS/COUNTS SURVEYS: 265 Trail users surveyed Demographics, trail use frequency Preferences for trail improvement COUNTS: 12 sites, 54 hours of observation Counted 2019 trail users User numbers vary by location National model estimates total use at sites from 25,000 to 300,000/year

33. WHO USES THE TRAIL? • Demographically similar to County population • EXCEPT: 69% male • 44% walkers live less than half a mile from trail (locals) • Incomes of local users close to City average • 76% of local users use trail at least weekly • Trail is an important exercise resource, especially for low income neighbors

34. 40% of Rochester’s population lives in a ‘waterfront neighborhood’ • Includes 45% of DEC “environmental justice” areas • The mean income in PLEX, a southwest neighborhood , is a third lower than city average • The PLEX low birth weight rate is nearly double that of the County • Mean Years Potential Life Lost (YPLL) in PLEX is twice as high as County average

35. Physical Activity in Southwest Rochester • 63% residents reported meeting CDC’s weekly recommended activity level (150 minutes exercise); similar to county mean • 71% of whites • 58% of blacks • County health data show racial differences in obesity, heart disease, diabetes, etc. • Obesity cost calculator • “If the trail weren’t here, I wouldn’t exercise.” TRAIL is more than a “recreation destination” – opportunity for physical activity and transportation by low income waterfront residents

36. Example: TrailRecommendations • Policies: “Prioritize connecting trail through downtown and to adjacent neighborhoods” • Projects: “Add amenities like better lights, water fountains, benches, fishing areas, or exercise equipment to encourage use” • Programs: “Expand programs to encourage trail use by diverse populations, especially waterfront residents;” • Communication: “Improve signage TO trail from neighborhoods and vice versa.” • Monitoring: “Conduct annual trail user surveys”; “Establish trail management group to coordinate improvements, maintenance, use by neighbors and visitors”

37. SUMMARY: Healthy Waterways and the LWRP • Health considered as a ‘goal’ in LWRP • Community health data included in inventory and analysis • Shifted focus from “destination” to include “waterfront neighbors” • Recommendations integrated into LWRP subpolicies • New partners identified for implementation (future grants, projects, planning, monitoring) • Full report:bit.ly/QorjRS or http://www2.envmed.rochester.edu/envmed/EHSC/outreach/coec/projects/HIA/HealthyWaterways.html

38. Providence, RI Riverwalk • In 1994, replaced the world’s widest bridge at 1,147 feet with new streets, cobblestone pathways, Venetian-style bridges, sculptures, fountains, boat landings, and parks including the four acre Waterplace Park with an open air auditorium. • The Riverwalk hosts year round public art and cultural events • Waterfire events regularly attract over 350,000 people. • Hotel room rentals doubled between 1999 and 2000, and in August 2003 they rose over 50%. Payne, Thomas. Waterfire Providence Organization. 13 June 2012. Web. http://waterfire.org/about/history/

39. HIA and PSF: Decision Process • Intelligence: HIA assessment • Promotion: HIA reporting • Prescription: HIA recommendations + assessed decision process • Invocation: ?? • Application: ?? • Appraisal: HIA evaluation • Termination: ??

40. What can PSF Bring to HIA • Standpoint: • Can one be ‘objective,’ ‘collaborative’, decision-relevant recommendations’ and ‘equity promoting’? • Social process: • HIA takes the “decision context” as fixed; other ‘situations’ may matter • Decision process: • HIA engages primarily in intelligence and promotion • Helps explain frequent “recommendations beyond the recommendations.” • Plan better for monitoring/evaluation of impact on decision, implementation, and health outcomes?

41. What can HIA contribute to PSF • HIA is both an analysis and a process – limited, but broader than what would happen without it (partial application?) • Language of health is easy to understand and has broad support; includes equity, participation, and well-being

42. Summary: HIA and PSF • How is this framework compatible with a policy sciences perspective on problem solving? • Goal = multimethod, problem-oriented, equity-promoting ways to improve of policy decisions • What can/has the policy sciences contribute to this framework? • Provide conceptual grounding for practice • Heighten awareness of limits to HIA role in policy process • What potential does this framework have for expanding the practice of the PSF (explicitly or not) • Translation of ‘base values’ into ‘health language’ / data • Cross walk into public health issues • Growing field of ‘practicioners’ with problem orientation