1. Exploring how HIA has impacted, policies, programs and the decision-making process in the U.S. Keshia M. Pollack, PhD, MPH Johns Hopkins Bloomberg School of Public Health Department of Health Policy and Management Baltimore, Maryland, USA 2011 XI HIA International Conference

2. Partners Pew Charitable Trust Health Impact Project –Aaron Wernham, Bethany Rogerson, Saqi Maleque Cho Johns Hopkins Bloomberg School of Public Health –Greg Tung U.S. Centers for Disease Control and Prevention –Andy Dannenberg, Arthur Wendel, Candace Rutt, Sarah Kennedy, James Dills San Francisco Department of Public Health –Rajiv Bhatia Funded by Pew Charitable Trust Health Impact Project and JHSPH Faculty Innovation Award

3. Background HIA use is the U.S. is quickly expanding Lots of people are doing HIAs….. What is the process? What are the impacts?

4. Objective To identify the range of HIAs completed in the U.S., the sector and geographical representation of the HIAs, and the resulting role the HIA played in changing a policy, program, or decision-making process.

5. Methods 91 HIAs identified through review of websites and survey of key stakeholders who self-identified as having completed a HIA in the U.S. We did not screen to confirm the HIA (main limitation) Lead practitioners of 58 of the HIAs were contacted and 50 were interviewed Semi-structured interviews –Various topics: define HIA, success, impact, failures, challenges, community involvement, stakeholders, participation by decisionmakers

6. H ow do authors define “success” in their HIAs? Health concerns into the discussion “Brought health concerns into the discussion” “Culture change: planning department is now routinely considering health” “New partnerships between health and other agencies” Education of Policymakers “Educated decision-maker about how a policy that seemed to have nothing to do with health, actually has health consequences” “Decision-makers now routinely thinking about health”

7. H ow do authors define “success” in their HIAs? Impacts “HIA recommendations were 100% adopted into the growth plan” “Influenced the final design of the project” Community –“Addressed community concerns” –“Increasing community awareness about HIA and about how to use the results in their advocacy efforts”

8. Public participation and stakeholder engagement All reports were public A substantial number reported some stakeholder engagement (>50%) At least 18 reported responding to comments on a draft HIA

9. Varied approaches to stakeholder engagement Interviews with community leaders Community council, stakeholder advisory board Formal stakeholder survey Structured surveys Community coalition on HIA team Tribal org. writing HIA Key informant interviews Indirect: part of a planning or EIS process – reading testimony from another process

10. Challenges and reasons that recommendations WERE NOT adopted Skepticism: health connections aren’t obvious, and to non-health agencies, seem unlikely, distal, incredible. Regulatory limits: agency lacks authority to implement recommendations; recommendations not written in statutory/regulatory language Timing: HIA delivered after decision Political resistance: it’s new; it might change the power dynamic. Political controversy around the target of the HIA – “drowning out” the HIA results

11. Potential reasons why recommendations WERE adopted Strong stakeholder and community engagement Timeliness of the HIA Recommendations were clearly written and supported by scientific evidence High dissemination of findings

12. Conclusions HIAs have had several positive impacts and were successful Valuable information from the practitioner –Resources needed to conduct HIA, how to engage stakeholders, and limitations and likely facilitators of success and barriers to HIA use Likely some reporting bias –Need to triangulate with public documents and HIA intended end-users In-depth exploration of policy HIAs

13. Contact Information Keshia Pollack kpollack@jhsph.edu 410.502.6272