1. Health Impact Assessments And the Built Environment What’s the Connection, ANYWAYS?

2. How is a Health Impact Assessment Defined? The World Health organization defines a Health Impact Assessment (HIA) as “a combination of procedures, methods, and tools by which a policy, program, or project may be judged as to its potential effects on the health of a population.”

3. How do Health Impact Assessments Affect Land Development? 3 HIA is used to evaluate objectively the potential health effects of a project or policy before it is built or implemented. Some planners and policy makers would like to make HIA a standard review procedure as part of the Development Review Process. Health Impact Assessments have their policy connection with the land development process based on the theory that land use and the built environment have a direct correlations to health issues such as obesity, diabetes and asthma.

4. Why are Health Impact Assessments Important to Planners? Their proponents believe that land use patterns that promote automobile use over walking, cycling and using public transit contribute to these health issues by encouraging people to be overly reliant on automobiles. Access to fresh produce and organic products also is affected by the built environment, and thus is often included in this analysis.

5. What are the major steps of conducting a HIA? Screening Scoping Assessing Risks and Benefits Developing Recommendations Reporting Evaluating 5

6. Example – Health Impact Assessment Checklist for Louisville, Ky. Below is a sampling of the types of questions included in the checklist. Development proposals receive a certain number of points per answer which weigh into the approval process. What is the distance from the project site to the nearest fast food outlet? What is the distance to the nearest weekly farmers market? In order to walk to school would a child need to cross a collector-level road or higher where unsafe walking conditions are more likely? What is the proposed net residential density? What is the distance from the nearest permitted stationary source of air pollution? 6

7. Example – Zoning for a Healthy Baltimore The TransForm Baltimore HIA impact assessment focused on the following groups of health outcomes and health-related behaviors: Violent Crime Obesity and Obesity-Related Illnesses Physical Activity and Pedestrian Safety Diet and Nutrition The report presented the following findings on the relationship between health and the built environment: Pedestrian-oriented environments are associated with lower crime, increased walking, and decreased obesity. Mixed land use (i.e. residential and commercial) is associated with increased walking and decreased obesity, but more so for higher income than lower income populations. Increased availability of healthy food options, such as supermarkets and farmers markets are associated with increased healthy eating and decreased obesity. 7

8. Example – Zoning for a Healthy Baltimore (cont.) The following are some examples of recommendations that came out of the report: Increase allowances for community gardens, urban agriculture, and farmers markets. Create pedestrian corridors and transit oriented development zones. Emphasize pedestrian oriented design standards including first floor transparency and reduced parking requirements. Create a separate use definition for liquor stores/off- premise alcohol sales outlets. 8

9. People affected: Does the project or plan affect vulnerable groups (e.g. children, older people, and people with low incomes)? Land use: Does it substantially change the predominant land use (e.g. from residential to commercial)? Institutional capacity: Is the capacity of local government, nonprofit, and private organizations to address any potential problems adequate? Example: Health Impact Assessment from Blue Cross/Blue Shield

10. Key Questions That May Be Asked in a HIA during the Development Review Process: Geographical extent: Does the project apply to a geographic area of a full city block or larger? Reversibility: Will the changes to the physical environment be difficult or expensive to reverse once put in place? Population size: Does the development substantially increase the residential population or workforce of any area of 100 acres or more (e.g. an increase greater than 33%)? Cumulative impact: Is the development occurring in a place where specific local health problems have been identified (e.g. traffic safety, air quality, lack of healthy foods, contaminated brownfield)?

11. Air quality: Are there any residential areas or schools within 200 meters of a major auto-related transportation corridor such as a freeway or road with six or more lanes? Air quality: Does the plan or project area include businesses that disproportionately contribute pollutants (e.g., dry cleaners, automotive paint, manufacturing)? Water quality: Is it developed on a site with existing water and sewer infrastructure? Key Questions (continued)

12. Food: Are there supermarkets or fruit and vegetable stores located within a mile of each home? Safety: Does the plan or project adequately account for safe circulation patterns for all modes such as employing traffic calming measures, using separate facilities for non-motorized modes, or ensuring adequate lighting and sight lines. 12

13. The Building Industry’s Response There are conflicting views and no definitive answers on whether or not land use patterns affect health. While some research indicates high density counties such as New York County(Manhattan) and Suffolk County (Boston) have lower incidents of obesity, other high density counties such as Queens County, NY and Bexar County, TX (San Antonio) have very high incidences of obesity. Such evidence indicated there are many factors at play beyond just the built environment. These factors include ethnicity, culture, income, socio-economic status and technological factors. Therefore, the burden should not fall on the home builder and developer alone to have to jump through an additional “regulatory hoop” in the form of a Health Impact Assessment.

14. Many communities already require dedications for open space, play areas (tot lots) bike trails, contribution to parks and recreation programs and facilities, install sidewalks and other pedestrian-friendly techniques. A Health Impact Assessment is another regulatory burden that will further increase the cost of housing in regions already struggling with the economic downside of unaffordable housing. The new development of today is far more pedestrian oriented and recreation oriented than the development of 1960, when obesity rates were much lower, another indication that the presumed connection between health and the built environment may not hold true. The Building Industry’s Response