Protecting health using an environmental impact assessment: a case study of San Francisco land use decisionmaking

Evaluating Racial/Ethnic Equity in Planning-Related U.S. Health Impact Assessments Involving Parks and Greenspaces: A Review

Problem research strategy and findings

Health impact assessment (HIA) reports are used by government agencies, other organizations, and stakeholders to evaluate potential health effects of plans/policies/projects. HIAs have the potential to promote anti-racist practices. We developed and used the Tool for the Racial/Ethnic Equity Evaluation of Health Impact Assessments (TREE-HIA) to score 50 U.S. HIA reports on planning-related projects/plans involving parks and greenspaces (2005-2020). More recent and more comprehensive HIA reports addressed racial/ethnic equity to a greater degree (e.g., median TREE-HIA scores: -1.3 in 2009-2012, 4.0 in 2017-2020, where higher scores indicate greater racial/equity considerations). Overall, HIA reports addressed racial/ethnic equity to a lesser degree than expected given the principal tenet of equity guiding HIAs and urban planning alike (42% had negative TREE-HIA scores indicating inadequate racial/ethnic equity consideration). However, the limited number and types of HIAs included in this study may affect generalization to all HIAs.

Takeaway for practice

HIAs incorporating racial/ethnic equity comprehensively throughout the HIA process will better enable urban planners, HIA practitioners, decision makers, and communities of color to work together to combat racist planning practices through the shared goals of addressing health disparities and equity. TREE-HIA provides professionals and researchers with a brief tool that can be used/adapted to guide and evaluate future HIAs for racial/ethnic equity considerations.

Climate Change, Environmental Disasters, and Health Inequities: The Underlying Role of Structural Inequalities

PURPOSE OF REVIEW

We review and analyze recent literature in public health, urban planning, and disaster management to better understand the relationships between climate change, natural disasters, and root causes of health disparities in the USA.

RECENT FINDINGS

Existing scholarship establishes clear linkages between climate change and increasing occurrences and severity of natural disasters across the USA. The frequency and types of disasters vary by region and impact both short and long-term health outcomes. Current research highlights health inequities affecting lower income and minoritized communities disproportionately, but data-driven studies critically examining the role of structural inequalities in climate-induced health disparities are sparse. Adding to the body of knowledge, our conceptual framework maps how long-standing structural inequalities in policy, practice, and funding shape vulnerability of lower-income, racially and ethnically marginalized individuals. Vulnerability follows three common pathways: disparities in "exposure", "sensitivity", and "resiliency" before, during, and after a climate disaster. We recommend that future research, policy, and practice shift towards solutions that unearth and address the structural biases that cause environmental disaster and health inequities.

Effectiveness of Health Impact Assessments: A Synthesis of Data From Five Impact Evaluation Reports

Introduction

Since the 1990s, the use of health impact assessments (HIAs) has grown for considering the potential health impacts of proposed policies, plans, programs, and projects in various sectors. Evaluation of HIA impacts is needed for understanding the value of HIAs, improving the methods involved in HIAs, and potentially expanding their application. Impact evaluations examine whether HIAs affect decisions and lead to other effects.

Methods

I reviewed HIA impact evaluations identified by literature review and professional networking. I abstracted and synthesized data on key findings, success factors, and challenges from 5 large evaluations conducted in the United States, Europe, Australia, and New Zealand and published from 2006 through 2015. These studies analyzed impacts of approximately 200 individual HIAs.

Results

Major impacts of HIAs were directly influencing some decisions, improving collaboration among stakeholders, increasing awareness of health issues among decision makers, and giving community members a stronger voice in local decisions. Factors that contributed to successful HIAs included engaging stakeholders, timeliness, policy and systems support for conducting HIAs, having people with appropriate skills on the HIA team, obtaining the support of decision makers, and providing clearly articulated, feasible recommendations. Challenges that may have reduced HIA success were poor timeliness, underestimation of time and resources needed, difficulty in accessing relevant data, use of jargon in HIA reports, difficulty in involving decision makers in the HIA process, and absence of a requirement to conduct HIAs.

Conclusion

HIAs can be useful to promote health and mitigate adverse impacts of decisions made outside of the health sector. Stakeholder interactions and community engagement may be as important as direct impacts of HIAs. Multiple factors are required for HIA success. Further work could strengthen the role of HIAs in promoting equity, examine HIA impacts in specific sectors, and document the role of HIAs in a “health in all policies” approach.

Challenges and Opportunities of Integrating Human Health into the Environmental Assessment Process: The Canadian Experience Contextualised to International Efforts

A scoping review of the literature was conducted to identify the most pressing issues pertaining to the application of Health Impact Assessment (HIA) and the integration of health concerns into the Environmental Assessment (EA) process in Canada and internationally. The issues identified include the need for government intervention, gaps in methodology and tools, limitations of capacity and expertise, poor intersectoral, disciplinary and public collaboration/participation, challenges of data quantification and analytic complexity, and the need for process efficiency. The issues presented were also contextualised to the status quo practice of EA in Canada and the Canadian Environmental Assessment Act (CEAA 2012). Recommendations were proposed as a starting point for improved integration. First, a commitment by the actors involved to the protection of human health — aligned with the core mandate of the CEAA. Second, the achievement of intersectoral, disciplinary and public collaboration, led by government, ideally the health sector. The case is made for a new era of Canadian leadership and innovation at the interface of health and EA.

Case study: San Francisco's use of neighborhood indicators to encourage healthy urban development

Neighborhood indicators are quantitative measures of neighborhood quality, including measures of attributes such as crime, noise, proximity to parks, transit services, social capital, and student performance. In 2007 the San Francisco Department of Public Health, with broad public input, developed a comprehensive system of neighborhood indicators to inform, influence, and monitor decisions made by the Department of City Planning and other community development institutions. Local public agencies, businesses, and citizens' groups used the indicators to identify disparities in environmental and social conditions, inform and shape neighborhood land use plans, select appropriate sites for development projects, craft new environmental regulations, and justify demands on developers to make financial contributions to community infrastructure. Among other things, the use of indicators contributed to policies to prevent residential displacement, a city ordinance requiring stricter building ventilation standards in areas with high air pollution, and the redeployment of traffic police to high-injury corridors. Data that can be used to create neighborhood indicators are increasingly available, and participation by public health and health care institutions in the indicators' development, dissemination, and application could help improve several conditions that contribute to poor population health.

The geography of recreational open space: influence of neighborhood racial composition and neighborhood poverty

The geography of recreational open space might be inequitable in terms of minority neighborhood racial/ethnic composition and neighborhood poverty, perhaps due in part to residential segregation. This study evaluated the association between minority neighborhood racial/ethnic composition, neighborhood poverty, and recreational open space in Boston, Massachusetts (US). Across Boston census tracts, we computed percent non-Hispanic Black, percent Hispanic, and percent families in poverty as well as recreational open space density. We evaluated spatial autocorrelation in study variables and in the ordinary least squares (OLS) regression residuals via the Global Moran's I. We then computed Spearman correlations between the census tract socio-demographic characteristics and recreational open space density, including correlations adjusted for spatial autocorrelation. After this, we computed OLS regressions or spatial regressions as appropriate. Significant positive spatial autocorrelation was found for neighborhood socio-demographic characteristics (all p value = 0.001). We found marginally significant positive spatial autocorrelation in recreational open space (Global Moran's I = 0.082; p value = 0.053). However, we found no spatial autocorrelation in the OLS regression residuals, which indicated that spatial models were not appropriate. There was a negative correlation between census tract percent non-Hispanic Black and recreational open space density (r S = -0.22; conventional p value = 0.005; spatially adjusted p value = 0.019) as well as a negative correlation between predominantly non-Hispanic Black census tracts (>60 % non-Hispanic Black in a census tract) and recreational open space density (r S = -0.23; conventional p value = 0.003; spatially adjusted p value = 0.007). In bivariate and multivariate OLS models, percent non-Hispanic Black in a census tract and predominantly Black census tracts were associated with decreased density of recreational open space (p value < 0.001). Consistent with several previous studies in other geographic locales, we found that Black neighborhoods in Boston were less likely to have recreational open spaces, indicating the need for policy interventions promoting equitable access. Such interventions may contribute to reductions and disparities in obesity.

Space, race, and poverty: Spatial inequalities in walkable neighborhood amenities?

BACKGROUND

Multiple and varied benefits have been suggested for increased neighborhood walkability. However, spatial inequalities in neighborhood walkability likely exist and may be attributable, in part, to residential segregation.

OBJECTIVE

Utilizing a spatial demographic perspective, we evaluated potential spatial inequalities in walkable neighborhood amenities across census tracts in Boston, MA (US).

METHODS

The independent variables included minority racial/ethnic population percentages and percent of families in poverty. Walkable neighborhood amenities were assessed with a composite measure. Spatial autocorrelation in key study variables were first calculated with the Global Moran’s I statistic. Then, Spearman correlations between neighborhood socio-demographic characteristics and walkable neighborhood amenities were calculated as well as Spearman correlations accounting for spatial autocorrelation. We fit ordinary least squares (OLS) regression and spatial autoregressive models, when appropriate, as a final step.

RESULTS

Significant positive spatial autocorrelation was found in neighborhood socio-demographic characteristics (e.g. census tract percent Black), but not walkable neighborhood amenities or in the OLS regression residuals. Spearman correlations between neighborhood socio-demographic characteristics and walkable neighborhood amenities were not statistically significant, nor were neighborhood socio-demographic characteristics significantly associated with walkable neighborhood amenities in OLS regression models.

CONCLUSIONS

Our results suggest that there is residential segregation in Boston and that spatial inequalities do not necessarily show up using a composite measure.

COMMENTS

Future research in other geographic areas (including international contexts) and using different definitions of neighborhoods (including small-area definitions) should evaluate if spatial inequalities are found using composite measures but also should use measures of specific neighborhood amenities.

City governments and aging in place: community design, transportation and housing innovation adoption

PURPOSE OF THE STUDY

To examine the characteristics associated with city government adoption of community design, housing, and transportation innovations that could benefit older adults.

DESIGN AND METHODS

A mixed-methods study with quantitative data collected via online surveys from 62 city planners combined with qualitative data collected via telephone interviews with a subsample of 18 survey respondents.

RESULTS

Results indicate that advocacy is an effective strategy to encourage city government adoption of these innovations. Percent of the population with a disability was positively associated, whereas percent of the population aged 65 and older was not associated or negatively associated, with innovation adoption in the regression models. Qualitative interviews suggest that younger individuals with disabilities are more active in local advocacy efforts.

IMPLICATIONS

Results suggest that successful advocacy strategies for local government adoption include facilitating the involvement of older residents, targeting key decision makers within government, emphasizing the financial benefits to the city, and focusing on cities whose aging residents are vulnerable to disease and disability.

Integrating Urban Form and Demographics in Water-Demand Management: An Empirical Case Study of Portland, Oregon

Theories of water-resource management suggest that water demand is mediated by three interacting factors: technological innovations, pricing structures, and individual behaviors and demographics. While these factors provide useful insights for ongoing water conservation strategies, such as outreach and education campaigns, pricing schemes, and incentives aimed at residential developments, few studies examine the relationship between land-use planning and water demand. This paper reports the results of a study on land-use zoning and development-induced water consumption in Portland, Oregon. We used a geographic information system to integrate land-use records, water-consumption data, sociodemographics, and property tax information for over 122 550 parcels of varying land uses, and employed multiregression analyses to measure the effect of urban form—as measured by both the type and the structure of land uses—on regional water demand. While our results corroborate previous studies that link demographic characteristics to water demand, we go further by identifying zoning and structural attributes of the households as explaining over 93% of water use in all parcels. The paper concludes with a discussion of the opportunities and challenges for coordinating water-resource management with land-use planning.

Health, traffic, and environmental justice: collaborative research and community action in San Francisco, California

Health impacts on neighborhood residents from transportation systems can be an environmental justice issue. To assess the effects of transportation planning decisions, including the construction of an intraurban freeway, on residents of the Excelsior neighborhood in southeast San Francisco, PODER (People Organizing to Demand Environmental and Economic Rights), a local grassroots environmental justice organization; the San Francisco Department of Public Health; and the University of California, Berkeley, collaborated on participatory research. We used our findings regarding traffic-related exposures and health hazards in the area to facilitate community education and action to address transportation-related health burdens on neighborhood residents.

Integrating human health into environmental impact assessment: an unrealized opportunity for environmental health and justice

The National Environmental Policy Act and related state laws require many public agencies to analyze and disclose potentially significant environmental effects of agency actions, including effects on human health. In this paper we review the purpose and procedures of environmental impact assessment (EIA), existing regulatory requirements for health effects analysis, and potential barriers to and opportunities for improving integration of human health concerns within the EIA process. We use statutes, regulations, guidelines, court opinions, and empirical research on EIA along with recent case examples of integrated health impact assessment (HIA)/EIA at both the state and federal level. We extract lessons and recommendations for integrated HIA/EIA practice from both existing practices as well as case studies. The case studies demonstrate the adequacy, scope, and power of existing statutory requirements for health analysis within EIA. The following support the success of integrated HIA/EIA: a proponent recognizing EIA as an available regulatory strategy for public health; the openness of the agency conducting the EIA; involvement of public health institutions; and complementary objectives among community stakeholders and health practitioners. We recommend greater collaboration among institutions responsible for EIA, public health institutions, and affected stakeholders along with guidance, resources, and training for integrated HIA/EIA practice.

Water, ecology and health: ecosystems as settings for promoting health and sustainability

Despite the proposed ecological and systems-based perspectives of the settings-based approach to health promotion, most initiatives have tended to overlook the fundamental nature of ecosystems. This paper responds to this oversight by proposing an explicit re-integration of ecosystems within the healthy settings approach. We make this case by focusing on water as an integrating unit of analysis. Water, on which all life depends, is not only an integral consideration for the existing healthy settings (schools, hospitals, workplaces) but also highlights the ecosystem context of health and sustainability. A focus on catchments (also know as watersheds and river basins) exemplifies the scaled and upstream/downstream nature of ecosystems and draws into sharp focus the cross-sectoral and transdisciplinary context of the social and environmental determinants of health. We position this work in relation to the converging agendas of health promotion and ecosystem management at the local, regional and global scales--and draw on evidence from international initiatives as diverse as the WHO Commission on Social Determinants of Health, and the Millennium Ecosystem Assessment. Using water as a vehicle for understanding the systemic context for human wellbeing, health promotion and disease prevention draws inevitable attention to key challenges of scale, intersectoral governance and the complementary themes of promoting resilience and preventing vulnerability. We conclude by highlighting the importance of building individual and institutional capacity for this kind of integration--equipping a new generation of researchers, practitioners and decision-makers to be conversant with the language of ecosystems, capable of systemic thought and focused on settings that can promote both health and sustainability.

Integrating human health into environmental impact assessment: an unrealized opportunity for environmental health and justice

OBJECTIVES

The National Environmental Policy Act and related state laws require many public agencies to analyze and disclose potentially significant environmental effects of agency actions, including effects on human health. In this paper we review the purpose and procedures of environmental impact assessment (EIA), existing regulatory requirements for health effects analysis, and potential barriers to and opportunities for improving integration of human health concerns within the EIA process.

DATA SOURCES

We use statutes, regulations, guidelines, court opinions, and empirical research on EIA along with recent case examples of integrated health impact assessment (HIA)/EIA at both the state and federal level.

DATA SYNTHESIS

We extract lessons and recommendations for integrated HIA/EIA practice from both existing practices as well as case studies.

CONCLUSIONS

The case studies demonstrate the adequacy, scope, and power of existing statutory requirements for health analysis within EIA. The following support the success of integrated HIA/EIA: a proponent recognizing EIA as an available regulatory strategy for public health; the openness of the agency conducting the EIA; involvement of public health institutions; and complementary objectives among community stakeholders and health practitioners. We recommend greater collaboration among institutions responsible for EIA, public health institutions, and affected stakeholders along with guidance, resources, and training for integrated HIA/EIA practice.

Creating tools for healthy development: case study of San Francisco's Eastern Neighborhoods Community Health Impact Assessment

The San Francisco Department of Public Health recently completed a 2-year collaborative process, the Eastern Neighborhoods Community Health Impact Assessment (ENCHIA), to evaluate the potential positive and negative health impacts of land use development. ENCHIA resulted in a number of outcomes, including (1) a vision of a healthy San Francisco; (2) community health objectives to reflect the vision; (3) indicators and data to assess and measure the objectives and vision; (4) a menu of urban development strategies to advance the objectives; and (5) the Healthy Development Measurement Tool, an evidence-based tool to support accountable, comprehensive, evidence-based, and health-oriented planning. This case study describes the 18-month ENCHIA process, key outcomes, and lessons learned. The case study also provides an overview of the Healthy Development Measurement Tool and examples of its first applications to urban planning. Given the growing understanding of built environmental influences on health, ENCHIA illustrates the ability of a local public health agency to effectively engage in land use policy as a health promotion strategy.

Use of health impact assessment in the U.S.: 27 case studies, 1999-2007

OBJECTIVES

To document the growing use in the United States of health impact assessment (HIA) methods to help planners and others consider the health consequences of their decisions.

METHODS

Using multiple search strategies, 27 HIAs were identified that were completed in the U.S. during 1999-2007. Key characteristics of each HIA were abstracted from published and unpublished sources.

RESULTS

Topics examined in these HIAs ranged from policies about living wages and after-school programs to projects about power plants and public transit. Most HIAs were funded by local health departments, foundations, or federal agencies. Concerns about health disparities were especially important in HIAs on housing, urban redevelopment, home energy subsidies, and wage policy. The use of quantitative and nonquantitative methods varied among HIAs. Most HIAs presented recommendations for policy or project changes to improve health. Impacts of the HIAs were infrequently documented.

CONCLUSIONS

These completed HIAs are useful for helping conduct future HIAs and for training public health officials and others about HIAs. More work is needed to document the impact of HIAs and thereby increase their value in decision-making processes.