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.

Resources: Health, Place, and Children

Children, because they are still growing and developing, often suffer from different or additional health risks compared with adults. There are many useful resources on this topic–I list a few below specifically tailored to health and places.

Feeding chickens. Photo: Heather Forsyth
Some additional resources are available at http://www.designforhealth.net/resources/children.html

Resources: Planning and Active Living

Active living, the idea that it’s good to build exercise into daily life, has been big news in planning for a while but I still get questions about how to incorporate active living into plans. A decade ago, when it was a fairly new idea, there was the hope that if we built places where people were more prone to do activities like travel walking, that they’d keep exercising as well, increase their total activity, and reduce weight. It turns out to be a bit more complicated than this as I noted in my blog on high density and overweight adolescents in China. Research is quite mixed in its findings—there’s a lot of variation in how people respond to environments. Programs, policies, prices, education, and attitudes all shape how people use environments. But as a bottom line it is useful to provide options for people to be active in different ways so that when they want to do so they can. 

So how can you help provide options? Several web sites provide case studies of communities have done this work.
Mexico City Cycle Day, 2011. Photo: Ann Forsyth
  • Active Living by Design has been around since 2001 and has a useful web site. The group has worked with a number of cities and countied and provides case studies linked to an onsite map: http://www.activelivingbydesign.org/communities.
  • The APA has a webinar with some practice examples: http://www.planning.org/nationalcenters/health/education/webinars/activecommunity.htm
  • Design for Health also highlights some alternative transportation plans including ones by Bloomongton and St. Louis Park. Some of the questions in the DFH Comprehensive Plan Review checklists also target active living—noted in a column: http://www.designforhealth.net/resources/checklists.html

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.

Tools: The National Collaborative for Childhood Obesity Research Measure Registry

Recently I highlighted work of the National Collaborative for Childhood Obesity Research (NCCOR). a group spearheaded by the National Institute of Health, Centers for Disease Control, and Robert Wood Johnson Foundation. They have now released a new tool, or rather a registry of measures related to diet and physical activity: http://tools.nccor.org/measures/. I was part of the team on this project. My role was cataloging some of the physical activity measures, a mix of “questionnaires, instruments, diaries, logs, electronic devices, direct observations of people or environments, protocols, and analytic techniques.” Overall there are over 700 measures.


Example of Straight Line and Network
Buffers Created Using GI


The main search page at http://tools.nccor.org/measures/ allows users to search by domain (e.g. Individual dietary behavior, food environment…), measure type, age of people measured (though as this information seems to have been unevenly cataloged I found it not so useful for environmental measures), and context or type of place. Measures with reliability and validity information, as well as those used in studies of children and adolescents, were given priority. However, for the domain of physical activity environments this would have limited the measures too much so these are drawn from a wider range of sources.

Tools: The Pedestrian and Bicycling Survey (PABS)

I’ve recently been involved creating a new survey for measuring transportation behavior, particularly walking and cycling.  The Pedestrian and Bicycling Survey (PABS) is a mail out/mail back survey designed to be an inexpensive means for local governments to learn about nonmotorized transportation use in their communities.

An important component of the design of the PABS was creating a probabilistic sampling approach that would be relatively straightforward to administer and, if desired, could be carried out in house (within municipal agencies). While other sampling approaches—such as snowball sampling across the internet—can achieve a large number of responses, the probability of any person being asked to take the survey is not known making it a challenge to generalize from the sample to the wider population.

Pedestrians in suburban Hong Kong
Documentation includes a report outlining how the survey was developed and the results of reliability (repeatability) sampling. A manual provides step by step guidance about how to use the survey too. The survey is provided at the end of both documents and is available in English and Spanish. Materials are available for download at http://transweb.sjsu.edu/project/ 2907.html (scroll down to find the manual).
Future plans include creating a more modular version so users can mix and match sections to suit the questions they need answered. Updates will be available at http://www.designforhealth.net/health/PABS.html.

Tools: The National Collaborative for Childhood Obesity Research Catalog of Surveillance Systems

The National Collaborative for Childhood Obesity Research is a group spearheaded by the National Institute of Health, Centers for Disease Control, and Robert Wood Johnson Foundation. The Catalog of Surveillance Systems is a new product, also sponsored by the USDA. The catalog provides a searchable database of ongoing monitoring systems related to health. It includes both public systems such as the Census of Agriculture and National Vital Statistics System and private ones such as the Nielsen Homescan and InfoUSA.com. In all, 77 systems are represented.

The database can be filtered by keywords related to the level (person to community to policy), scope (local, state, national), key health variables, age groups, ethnicity, research design, and cost to use.

Each system has an individual entry including information on distinctive characteristics, sampling, key variables, costs, whether information is linked to geographical databases or to other surveys, example publications using the data, and other resources.

This is an extremely useful database and can provide a quick point of entry for those interested in assessing what data are available.

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.