hia in transportation planning

HIA in Transportation Planning: What to expect from transportation & public health stakeholders

Nicole Iroz-Elardo, PhD [email protected] July 16, 2014

Outline

•  Overview of HIA •  Survey of the Field •  Why Engage Stakeholders

•  Who Par=cipates

•  Types of HIA/Cases •  Lessons Learned •  Best Prac=ces

Systematic process

Data & analysis

Input from

stakeholders

Potential effects on

health

Distribution within a

population

Recommendations and mitigations

Inputs Outputs Conclusions

What is Health Impact Assessment?

Screening Scoping

Recommending Reporting

Monitoring

Evaluation

Assessment (Multiple)

The HIA Procedure

HIA as Health in All Policies

How can we ensure considera=on of health in decisions made in non-‐health sectors?

Social and Environmental Determinants of Health

Survey of the HIA Field

Source: hIp://www.healthimpactproject.org/hia/us#status:Complete on 7/4/2014

WHY ENGAGE STAKEHOLDERS IN HIA?

•  “right of people to par>cipate in a transparent process for the formula=on, implementa=on, and evalua=on of policies that affect their life both directly and through elected decision makers”

– Gothenburg Consensus

•  Generally interpreted to include par=cipatory elements, although par=cipatory nature is overstated.

Founda=onal Value: Democracy

•  Norma=ve Reflect democra=c ideals • Empowerment

•  Substan=ve Improve informa=on

•  Instrumental Generate legi=macy • Reduce conflict • Increase odds of smooth implementa=on

Ra=onales for Par=cipa=on

Glucker, (2013). Public Par=cipa=on in Environmental Impact Assessment: Why, Who, and How? EIAR .

WHO PARTICIPATES IN HIA?

Everyone!

•  Public Health •  Target Sector (Transporta=on) •  Government

•  Advocacy Organiza=ons •  Decision Makers (hopefully)

•  Public(?)

HOW?

HIA Advisory Group

Differences in Language

• Mortality vs Fatality • Morbidity vs Injury •  Access

– To highway/road system – To (health promo=ng) services

•  Safety – Real vs Perceived

Planning and Public Health: Diverse Fields

•  Land Use (zoning, codes) •  Transporta=on/Infrastructure •  Environment

•  Design •  Preserva=on •  Community Development (Housing, Social) •  Economic Development (Real Estate)

•  Regulatory (NEPA) •  Toxicology •  Engineering

Planning and Public Health: Diverse Fields

•  Biostats •  Epidemiology •  Environmental •  Occupa=onal •  Toxicology (allied)

•  Health Services/Primary/ Clinical Care

•  Health Management/Policy/Admin

•  Community/Health Promo=on

•  Health Behavior/Educa=on

•  Child & Women’s/Maternal

•  Infec=ous Disease •  Interna=onal

Types of HIA Harris-‐Roxas & Harris (2011). Differing Forms, Differing Purposes. EIAR.

Mandated Decision-‐Support

Advocacy Community-‐Led

Voluntary No Yes Yes Yes

Purpose? Meet Regula=ons Inform the Decision

Change the decision

Increase Community Control

A Spectrum of HIAs…

I-‐710 Corridor HIA

Clark County Bike-‐Ped HIA

Lake MerriI BART HIA






Change the decision


Health Purpose

Minimize nega=ve impacts

HIA Author? Consultant for Government Agency

Informed by Environmental Health

Role of Stakeholders

Technical Info

Case: I-‐710 Corridor

Differences in Expecta=ons

Transporta>on -‐ AQAP

•  Regulatory -‐ Risk Analysis with Toxicology

•  Air Quality, Safety, Noise

•  NEPA process à –  Timing / Data Confiden=ality –  Defined Alterna=ves

•  AQAP Advisory CommiIee

Public Health -‐ HIP

•  Social Determinants of Health Analysis (Epidemiology) & Equity

•  Air Quality, Safety, Noise PLUS bike-‐ped, access, etc

•  Wai=ng on modeled data, but then

no =me for health models

•  No control •  Used to working with public

including advocacy groups






Change the decision


Health Purpose


Maximize Health Min Dispari=es


Government Agency, some health non-‐profits


*Env Health *Social *Health Equity


Technical Info Inform

Founda=onal Value: Health Equity

•  “HIA is not only interested in the aggregate impact of the assessed policy on the health of a popula=on, but also on the distribu>on of the impact within the popula>on in terms of gender, age, ethnic background, and socioeconomic status.”

– Gothenburg Consensus

•  SES à Spa=al Distribu=on •  Vulnerable Popula=ons (young, old, minority, sick) •  Implies Decision Rule = Maximize Health & Minimize Health Dispari=es

Case: Clark County

PREPARED BY:Alta Planning + Design

October 2010

Clark County, WABicycle and Pedestrian Master Plan

Good Collabora=on

•  Planning and Public Health had a decent working rela=onship

•  Integra=on of Advisory CommiIee worked because Planning allowed Public Health significant =me on the advisory commiIee

•  Plan was not terribly conten=ous – Health Promo=ng

– Vision






Change the decision


Health Purpose


Maximize Health Min Dispari=es Max Health



Health non-‐profits in partnership with CBO



*Social *Health Equity *Env Health


Technical Info Inform Guide






Change the decision


Health Purpose


Maximize Health Min Dispari=es Max Health

Min Dispari=es Max Health



Health non-‐profits in partnership with CBO

CBO’s in partnership with health non-‐profits



*Social *Health Equity *Env Health

*Social *Health Equity


Technical Info Inform Guide Control

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Madison Square Park

Source: http://memorymap.oacc.cc/project-info/taichichats.html

Lessons Learned

•  Conflict with HIAs onen aligns with – Type of plan: Health Promo=ng vs Risk Reduc=on

– Scale of the plan – Previous/ongoing rela=onships between planners and public health authors of HIA

•  Good facilita=on can go a long way •  Professionals misjudge other professionals, assuming uniform interests

Lessons Learned (con=nued)

•  Transporta=on planners should try to… – Understand who is performing the HIA to hint at the type of HIA

– Learn about the social determinants of health and health equity

– Be clear about data =melines

– Offer GIS data if available, par=cularly for safety

Lessons Learned (Con=nued)

•  HIA prac==oners should try to… – Understand regulatory constraints – Ask about past health partners – Be flexible about products – Scoping is the ideal =me for stakeholder engagement à budget enough =me

– Beware of giving up control of the HIA advisory commiIee

Best Prac=ces

•  Stakeholder engagement plan •  Meet with planners very early on

•  Ask about the =ming of their process and when they would most appreciate input

•  Ask/aIend each other’s advisory commiIee

•  In advisory commiIees, do not assume one planner or one public health person can represent the en=re field

QUESTIONS?

Contact Info: Nicole Iroz-‐Elardo, PhD [email protected]