An Introduction to Health Impact Assessment Paul J. Anderson, MD, MPH HIA Program Manager Section of Epidemiology Division of Public Health Department of Health and Social Services

Overview Health at the table Health and design HIA background Alaska HIA program HIA process

Please Note HIA is not legally required in AK Not enforced –Seen as best practice HIA is outside the fence –Worker & community interface

What is HIA? Preventive health report Anticipates human health effects New or current Projects Policies Programs Minimize adverse health effects Maximize health benefits

Definition “HIA is 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, and the distribution of those effects within the population” World Health Organization (WHO), 1999

HIA Background—Global World Health Organization (WHO) Gothenburg Consensus (1999) International construction projects Significant human health effects Not covered by economic and social analyses Growing practice and literature base

HIA Background—USA National Environmental Policy Act 1969 (NEPA) Federal agency requirement Assess environmental impacts Proposed development projects Environmental Impact Statements (EIS)

HIA Background—USA Economic Impact Assessment (EIA) Social Impact Assessment (SIA) Aspects of human health unaddressed –Health infrastructure (clinics, water) –Access to healthcare –Injury and disease patterns –Dietary change Urban development focus

HIA Background—Alaska 2004 HIAs (Grant funded) –NPR-A lease sale permit –Red Dog mine expansion Interest and concern Inevitability of future HIA requests State guidance document needed

HIA Background—Alaska 2008—1 st HIA workshop Created interagency working group Produced HIA toolkit Felt need for coordinated leadership HIA program founded in DHSS Began HIA work in July, 2010

Alaska HIA Program

Mission of HIA Program Protect health and safety of all Alaskans affected by –Proposed development projects –Existing development projects –Major public policy changes –New public programs

Vision of HIA Program A robust program that will serve –To meet felt need for HIA in Alaska –To ensure excellent HIA practice –To provide HIA resources

Core Values of HIA Program Service:Coordinate HIA growth Leadership:Technical expertise Program management Collaboration:Involve key partners Excellence:Rigorous science Best practices

Key Activities Maintain HIA toolkit Perform HIAs Collaborate on HIAs Refine scientific approach Identify best practices

ADHSS HIA Program Strengths Transparency Existing partnerships Access to health data Systematic approach Diverse project involvement Longevity

Toolkit Highlights Section TitlesHighlights Section 1: General BackgroundOverview of HIA and HIA process Section 2: Screening—how to decide whether to conduct an HIA? Project features that affect human health Section 3: Types of HIAsDesktop, Rapid Appraisal, Comprehensive Section 4: Health Effects CategoriesHealth effects table—Health areas routinely reviewed in HIA Section 5: ScopingProcess for prioritizing health issues Table 4: Project design features and examples of health effects

Toolkit Highlights SectionHighlights Section 6: Baseline DataRestrictions with human health data Nutritional surveys Process for collection Section 7: Stakeholder EngagementCultural considerations in Alaska Importance of coordination Section 8: Impact AssessmentHow to rate and rank risks Section 9: MitigationRequired, Negotiated, Voluntary Section 10: Monitoring & EvaluationKey Performance Indicators (KPI) Structural, process, outcomes Section 11: ResourcesFinancial and Informational Sources