1. INTEGRATING HEALTH IMPACT ASSESSMENT (HIA) INTO PRE-DISASTER AND RESILIENCE PLANNING James K. Mitchell Professor of Geography Rutgers University Edward J. Bloustein School of Planning and Public Policy, New Brunswick, NJ, May 17, 2016

2. HIA Recommendations HEALTH IMPACTS OF DISASTERS * e.g. PTSD, substance abuse, anxiety, depression, suicide, isolation/anomie. RECOVERY HEALTH ISSUES (examples)  Slower recovery of disadvantaged vulnerable groups  Elevated housing increases problems for elderly  Changes in access to nutritious food sources affects obesity/diabetes  Relocation may damage social support networks IMMEDIATECLEAN-UPDELAYED (long term) InjuriesAccidentsMental health problems* AllergiesDehydrationStress-related disorders* Disease outbreaksHeat ExhaustionNutritional diseases Diarrheal diseasesAllergic reactions Respiratory conditionsAsthma exacerbation Hypothermia Poisoning

3. HIA Recommendations POST-DISASTER RECOVERY PROBLEMS Recovery is a weak component of hazard management –Slow, piecemeal, bewildering, contentious, marked by disconnects between decision makers and affected publics –Reproduces existing vulnerabilities –Typically neglects mitigation Without major improvements losses are likely to accelerate –Worsening physical risks –Widening vulnerability gaps –Emerging new kinds of vulnerabilities Health Impact Assessments are a promising innovation with potentially large benefits –Improved health for people in disaster impacted communities –Sustainable disaster recovery measures that add to hazard resilience

4. HIA Recommendations DISASTER DIMENSIONS OF EXISTING HIAs 350+ ongoing/completed HIAs (mid-2015) A few HIAs make recommendations that strengthen short-term responses Emergency Preparedness Plan (Billings, MT) Denial of permit for facility that hindered emergency evacuation (Bernalillo County, NM) Rejection of county plan that hindered emergency evacuation (Merced County, CA) But natural hazards are generally not included Hermosa Beach, CA oil drilling project omitted climate change risks Coachella Valley, CA omitted flood risks to proposed developments C.20 HIAs address natural hazard reduction directly; most focus on mitigation of chronic low intensity problems (e.g. routine flooding)

5. HIA Recommendations GOALHIA LOCATIONLINKAGE TO DISASTER REDUCTION RecoveryGalveston, TXReplacement of housing destroyed by hurricane Ike RecoveryLittle Egg Harbor, NJBuyout scenarios for properties affected by hurricane Sandy RecoveryHoboken, NJPost-Sandy comprehensive storm water management plan MitigationCana Martin, PRDredging and sewer projects in chronically flood prone area MitigationProctor Creek, Atlanta, GA Green infrastructure in chronically flood prone area MitigationCole Creek, Omaha, NEUse of vacant lots created by flood buyouts & erosion control MitigationAnn Arbor, MIUrban forestry as aid to high temperature reduction MitigationDelaware County, OHStorm water runoff control from new shopping mall MitigationMarin County, CAHousing code enforcement in poor drainage area MitigationRochester, NYChanges in lakefront storm water management MitigationChicago, IL“Smart” power cutoffs to elderly during cold/heat extremes MitigationPlacer County, CAHealthy forest management for reduction of wildfire risk MitigationGreenville, WIGround water contamination from hazardous material storage MitigationFitchburg, WIFlood reduction in vicinity of golf course MitigationState of KentuckyClean energy in mined area subject to landslides and floods MitigationState of CaliforniaDrinking water alternatives in drought affected areas Preparedne ss Various CA countiesEarthquake effects in San Francisco Bay area

6. HIA Recommendations “Making Healthier Decisions about Disaster Recovery: Opportunities for the use of Health Impact Assessments”  What is already known about disaster-related HIAs? Literature review (Appendix)  Institutional readiness for employing disaster recovery HIAs HHS, FEMA, HUD, EPA, other federal agencies State and local governments Advocacy Groups  Expert opinions: Thought leader perspectives HHS Workshop (March 2015) HIA Thought Leaders Meeting (June 2015) Natural Hazards Workshop (July 2015)  HIA case studies in New Jersey Hoboken & Little Egg Harbor  Recommendations

7. HIA Recommendations A GOOD TOOL CAN BE EVEN BETTER  The process of Health Impact Assessment needs no fundamental changes to make it useful in support of disaster recovery policies, plans and projects  It would benefit from a combination of modifications to make it more appropriately fitted for that purpose.

8. HIA Recommendations 1. AWARENESS  Publicize HIAs among target user groups in communities of hazard and health professionals that have responsibilities, skills and/or interests in disaster recovery and resilience planning.

9. HIA Recommendations 2. PIVOTS OF APPLICATION  Insert HIAs into the disaster recovery decision-making system at key points.  National and regional, area-wide decisions –Federal and State Task Force rebuilding strategies –NFIP regulations –FEMA Public Assistance Program –Hazard Mitigation Plans –Community Development Block Grants –NOAA Coastal Resilience Grants –Climate Adaptation plans –Energy Plans  Local, site-specific decisions –Construction permits –Protective structures –Open space acquisition –Land use and facility use changes

10. HIA Recommendations 3. APPRAISAL OF RECOVERY ALTERNATIVES  Conduct a systematic analysis of the health impacts of the full range of disaster recovery alternatives, to provide a databank of information about their comparative health outcomes and other consequences.

11. HIA Recommendations A TWO-STAGE HIA STAGE ONE Identify common post-disaster decisions that have the greatest potential to affect health. Prepare programmatic HIA-informed analyses of alternative recovery actions at these points. STAGE ONE Identify common post-disaster decisions that have the greatest potential to affect health. Prepare programmatic HIA-informed analyses of alternative recovery actions at these points. STAGE TWO Conduct HIAs that incorporate Stage One results, with minimum standards for community involvement and technical assistance. Support their use in formal decisions about pre- disaster planning and post-disaster recovery with appropriate incentives and/or mandates. STAGE TWO Conduct HIAs that incorporate Stage One results, with minimum standards for community involvement and technical assistance. Support their use in formal decisions about pre- disaster planning and post-disaster recovery with appropriate incentives and/or mandates.

12. HIA Recommendations 4. GUIDANCE FOR CHOOSING AMONG HIAS  Provide decision-makers and HIA users with better guidance for choosing among different kinds of HIAs in post-disaster contexts.  Desktop, Rapid, Comprehensive, Programmatic

13. HIA Recommendations 5: GRASSROOTS TECHNICAL SUPPORT  Provide appropriate technical support for local advocacy groups that seek to use HIAs for the joint reduction of health inequities and disaster vulnerabilities.

14. HIA Recommendations 6: BROADENING AND INTEGRATION  Encourage research organizations to develop methods for integrating health impact assessments with economic assessments and environmental impact assessments.