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Design For Health

Visually Interesting HIAs

Those giving presentations mentioning HIAs are often looking for good visuals to go in the presentations. The Design for Health web site now has a list of visually interesting HIAs at  http://www.designforhealth.net/resources/hiaexamples.html#vih (compiled by Inna Kitaychik). Some have photos but many have maps, plans, graphs, and charts. 

Page Ave HIA was led by Christy Hoehner and Jodi Polzin.
It is one of the visually interesting HIAs highlighted on th
DFH web site.

Planning for Healthy Places with Health Impact Assessments

 

A screenshot of the online slide show
A few years back the American Planning Association in association with the National Association of County and City Health Officials created the online course Planning for Healthy Places with Health Impact Assessments at http://advance.captus.com/planning/hia2/home.aspx. Don’t be put off by the initial survey that you have to fill in to get into the site—it’s short and you don’t need to be an APA member to access it! Sponsored by the Centers for Disease control and Prevention the initial course was developed by Rajiv Bhatia, Laura Biazzo, MPH, Division of Nutrition and Physical Activity of the Centers for Disease Control and Prevention, Brian Cole, Andrew Dannenberg, Carrie Fesperman, and Candace Rutt.


With Christine Green
from APA and Nisha Bochwey from the University of Virginia I’ve worked to update the program (without changing the voiceover except for one short additional module!)—Christine is the maven of resources and Nisha did a stellar job on quizzes. There are a lot of new examples. The computer generated voice is a bit weird but the content is a good introduction to HIA—and thanks to the CDC it’s free.

What’s in a Name?

 

Plan available directly from the
City of Bloomington
Recently, I was looking at the Pew Health Impact Project web site and noticed a featured HIA: the Xcel Energy Corridor: http://www.healthimpactproject.org/resources#reports
This is an excerpt from a plan featured on the Design for Health web site (one of the 19 Minnesota communities in Phase 1 of the project). On Design for Health site it is listed under the place name (Bloomington) and plan name (Alternative Transportation Plan) at http://www.designforhealth.net/cases/bloomington.html

Whatever the name it’s great to have these examples featured in multiple places.

Visuals: What Does a Rapid HIA Look Like?

This blog has dealt earlier with the logistics of doing an HIA but what does a workshop look like? One source is the Arden Hills Healthy City Planning Workshop Summary Report Appendices. This document contains images of each stage of the half-day workshop. Go to http://designforhealth.net/wp-content/uploads/2012/12/cases/HIA_ArdenHills_Appendices_3June2010.pdf and look at pages 33-36. More information about the process is available at: http://designforhealth.net/cases/ardenhillsworkshop.html.

Images from Arden Hills workshop. Photos: Design for Health.

 

Tools: What is a Rapid HIA?

On the face of it Rapid HIAs are quick, but that’s not the whole story. A rapid HIA while faster than a full, environmental impact assessment-style HIA, still takes some time. It is also different to some other quick HIA types such as desktop screening or scoping exercises.

Students performing a practice health impact assessment
at the School of Planning and Architecture, Vijayawada
Fundamentally a rapid  HIA is an interactive workshop—taking half a day or a day–that brings together stakeholders to identify and assess health impacts. However, additional time is needed to engage stakeholders in identifying key concerns and interest groups, to prepare background docuemtns for the workshop, have participants read those docuemtns, and write up the results. The good news is that a lot of the background information is similar to typical analyses that are standard in many planning and public health processes. Background information on health is available from several sources. Examples of completed HIAs are online.
Several toolkits are also available.
Design for Health  has two versions. The most recent Rapid HIA toolkit was ublished in 2008 but will be updated over the coming year. It draws on a number of previous examples, including the famous Merseyside model.  In 2010 DFH conducted a rapid HIA, termed a Healthy City Planning Workshop. This took a more flexible approach than the 2008 toolkit and also adapted worksheets from a number of recent HIAs. The reports from the workshop include basically all the information used to run and report on the HIA workshop–the actual information packet provided to participants in advance; the agenda of the meeting, copies of handouts, worksheets, and presentations from the workshops; a series of photos keyed to parts of the agenda; and the workshop’s summary report. This makes the report usable as a toolkit.
The Merseyside Guidelines for Health Impact Assessment (2001) published by the International Health IMPACT Assessment Consortium, is often cited as the most widely used HIA model in England. 

Human Impact Partners, Oakland provides several relevant tools including a number of guides and worksheets: http://www.humanimpact.org/hips-hia-tools-and-resources. Be sure to scroll down the page because a lot of the more interesting material is at the bottom.

Tools for Conducting an HIA on a Comprehensive Plan

I’ve recently had a number of queries about how to conduct a health impact assessment on an existing comprehensive plan. This is a great thing to do because it can help prioritize changes in an update. How to conduct an HIA is a big topic, but fortunately there are a lot of resources available with more coming online over the next year.

One place to start is the set of Comprehensive Planning Checklists on the Design for Health web site: http://designforhealth.net/resources/legacy/checklists/. They are based on evidence–though there is stronger evidence for the “essential for health” sections than the “good for health” ones. Each question has a column that explicitly states which area of research it is based on and these are described more fully in online research summaries (see next point). These checklist are also broken into standard categories for comprehensive or general plans in the United States. Two other resources, highlighted in an earlier blog, may be useful: the Australian Healthy Urban Development Checklist and British Delivering Healthier Communities in London.

Research Summaries that form the basis of the DFH checklists that are available for free: http://designforhealth.net/resources/researchsummaries/. The current versions reperesent work up to about 2007 or 2008 and in fast developing areas–such as food–we’ll be preparing updates in the next year. For extra information in the interim you might look at the “pathways” section of HIA-CLIC http://www.hiaguide.org/sectors-and-causal-pathways/pathways.
Model of Downtown Tianjin in the
Tianjin planning museum.
Photo: Ann Forsyth.

For advice about what to do after you have used the checklist and done your evaluation, the Design for Health web site has Information Sheets linked to the research summary topics that have examples and cases:
http://designforhealth.net/resources/planningissues/

In addition, a course on Planning for Healthy Places with Health Impact Assessments by the American Planning Association in association with the National Association of County and City Health Officials, is also a good place to start: http://professional.captus.com/Planning/hia/default.aspx. It is currently being updated by a team including Christine Green and Kimberly Hodgson at APA, Nisha Botchwey from the University of Virginia, and myself, with advice from Dee Merriam of the CDC. The update will substantially expand the resources section so there will be lots more information than this brief note can provide.


How Do People Connect Places and Health in Practice?

I am often asked how to connect health and place, practically. There are two main ways of thinking about this–one relates to topics and another to methods.

In terms of topics there are several lists available. Most end out looking like the following list, adapted from Design for Health (http://www.designforhealth.net/resources/generalhealthissues.html). However other, quite similar, lists exist (http://www.hiaguide.org/sectors-and-causal-pathways/pathways). They mix health issues and environmental features mainly because different issues are thought about in those terms. They also play out differently for various groups including children, seniors, people with low incomes, and so on.
Self-build housing in Beihai, China
  • Accessibility to places, people, and services that can promote health
  • Air quality
  • Disasters–including climate change
  • Environment + housing quality related to pollutants
  • Food quality
  • Healthcare access
  • Mental health–often related to stress (e.g. plants can reduct stress)
  • Noise
  • Physical activity options
  • Safety—from accidents and crime
  • Social capital/connections–with complicated relations to place
  • Water quality

A range of methods help practitioners make these connections:

  1. Policy and Program Collaborations: The UN Healthy Cities Program is an example, focusing on building awareness and collaboration among partners including governments and universities.
  2. Health Impact Assessments: These are actually a range of tools, both participatory and technical, aiming to link local knowledge and health research/data maximize health benefits+ minimize health risks for all groups. They can be done on a range of policies, programs, and plans, not only ones affecting places.
  3. Quality of Life Tools: This is a term for a range or preexisting tools and methods that focus on the connection of people and place, and connections between people. Examples include safety audits, food security assessments, and asset maps. Various social development tools such as anti-racism trainings with a place-based approach, also fit in this category.
  4. Healthy Community Plans and Designs: Such proposals translate health research into practice at scales from the building to the region.

Mapping Health Issues with GIS: Participatory Approaches

Participatory GIS is a growing field. For those interested in integrating participatory GIS into healthy planning, several web sites provide helpful illustrations of the potential.

Public Participatory GIS based in a company called Vertices in New Brunswick, New Jersey, (http://www.ppgis.info/) provides illustrative maps on topics from bike crashes to a calculator for calories burned walking different routes. Not all maps are local, for example the public health maps rangr from alcohol sales places in New Orleans to food sales in Philadelphia.

Transparent Chennai (http://www.transparentchennai.com/), at the Institute for Financial Management and Research, uses GIS but with a focus on topics such as squatter settlements, environmental hazards, and other aspects of quality of life. What is particularly handy about this site is one can build a map from different kinds of information including environmental, political, infrastructural, and social issues: http://www.transparentchennai.com/buildamap/. This site really shows the potential for a fairly integrated yet still user driven experience that could be particularly helpful for those interested in working with communities on issues of health and place.

Part of a map from Transparent Chennai

Map Kibera (http://mapkibera.org/) started in 2009 by several NGOs in a large squatter settlement in Nairobi Kenya, reportedly was an inspiration for Transparent Chennai. The site has a lot of information apart from maps, showing how different kinds of information—spreadsheets, a blog, twitter, a wiki, and so on—can be linked.

For a more technical, expert-led approach to using GIS see the DFH Threhold Analysis HIA  and research oriented NEAT-GIS and LEAN-GIS protocols. These can however be used in a participatory setting. The Arden Hills Rapid HIA used similar maps as background information, for example (see report appendices).

My thanks to Azhar Tyabji, at the Institute for Financial Management and Research, for leading me to his colleague Nithya V. Raman (and her team’s) work on Transparent Chennai.

When in the Planning or Policy Process Does a Health Impact Assessment Fit?

Many people are interested in when to do an HIA. The simple answer is, it depends. There are a lot of different formats that may be used alone or in combination.

  1. Screening tools to see if an HIA is worth it
  2. Scoping tools to investigate the topics and dimensions worth exploring more
  3. Desktop or mini HIAs that can be done quickly in an office
  4. Rapid assessments or appraisals that re more participatory, drawing on expert and local knowledge (see an earlier post for some examples)
  5. Intermediate HIAs that are more comprehensive or multi-dimensional but not yet on a par with a full environmental impact assessment
  6. Full HIAs—a lot of work
  7. Integrated HIA that are plugged in to other processes
They may also be done prospectively—to figure out what may happen—or retrospectively to assess what did happen. This latter version is often looked down upon as not sufficiently proactive. However, it can be a great way to start a new planning process—looking at the current state of affairs to figure out what to do next. This can be a lot less threatening than assessing a draft plan or policy that people already invested in.
The attached diagram from a Design for Health training captures some of this variety.

y

Integrating health into planning often uses the approach called evidence-based practice. An article on this topic by some of the folks from Design for Health, including me, is currently available for free: http://www.informaworld.com/smpp/content~db=all~content=a918403162~frm=titlelink. It was a finalist in the Association of European Schools of Planning Best Paper Prize: [link no longer active]

Details about the paper are below.
Is There a Role for Evidence-Based Practice in Urban Planning and Policy?
Authors: Kevin Krizek; Ann Forsyth; Carissa Schively Slotterback
Planning Theory and Practice, 2009, 10: 4, 459 — 478.

Abstract
Can the craft of planning take advantage of a growing body of planning-relevant research? Evidence-based practice proposes a better connection between research and professional work, but raises several concerns about the character of valid evidence, the strength and clarity of planning research, and inequalities in the available resources for integrating research into planning practice. Much of planning practice is a reflective craft where skills of mediation, negotiation, listening, and framing are prominent. As part of the planner’s work employing these skills, however, there is a valuable role for research-generated evidence to inform decision making. Evidence-based practice needs careful implementation but it can enrich the field of planning by linking research to practice.
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