Health Impact Assessment for Active Transportation

State: WA Type: Model Practice Year: 2011

This practice focuses on the impact of built environment on obesity and physical activity. Nearly 2/3 of the Clark County adult population is overweight or obese; approximately 25% of 10th graders are overweight or obese; only 41% of 10th graders meet physical activity recommendations (60 minutes on at least 5 of the past 7 days). Unincorporated Clark County is relatively low density and automobile dependent. Consequently, the practice addresses the lack of opportunities for physical activity, particularly for low income and minority populations.
The target population includes the residents (211,000) of the unincorporated area of Clark County, Washington. Our practice, a Health Impact Assessment (HIA) of the Bicycle and Pedestrian Plan, depending on the extent implemented, will reach 95,000 to 211,000 residents. The goals of the HIA are to: (1)Increase the visibility of health concerns in the policy decision-making process regarding transportation planning; (2)Target infrastructure improvements to maximize the benefits of physical activity, specifically biking and walking; (3)Evaluate the HIA effectiveness in reaching goals (1) and (2). The HIA was implemented between 1/1/2010 and 1/1/2011. The practice was implemented through a RWJ Active Living Research grant ($100,000). Clark County Public Health (CCPH)implemented the HIA in partnership with the Clark County Department of Community Planning (DCP)and support from the County Board of Commissioners (they also serve as the Board of Health). The grant provided support for a1.0 FTE Urban Planner in our health department and additional .05 FTE Planner support to the DCP. In addition, CCPH provided in-kind support, specifically support for leadership oversight of the process and ESRI (GIS software vendor) provided updated census estimates at the block group level. We have met the first two goals: the DCP has incorporated our HIA into the final bicycle and pedestrian plan and has adopted several of our recommendations; the Board of Health has discussed the health impacts of the plan in their decision making process. CCPH's early involvement in the planning process and a collaborative relationship with DCP contributed to the success of the HIA.
Agency Community RolesCCPH is the lead in conducting this HIA. We have completed all steps of the HIA process: screening, scoping, assessment, reporting, and evaluation. As part of the baseline assessment, CCPH developed, procured, and updated data sets that were used in analysis of existing conditions. Staff used GIS to map and describe both existing conditions and anticipated impacts from plan proposals. Additionally, CCPH participated in the planning process by dedicating staff time to the planning committee and by convening community partners to raise the profile of health issues related to the plan. ImplementationOur model practice used the health impact assessment (HIA) process to influence the development and adoption of Clark County’s bicycle and pedestrian plan. CCPH conducted rapid and comprehensive HIAs by summarizing research literature, compiling local data from new and existing sources, and analyzing it using GIS. C CPH involved the community by participating as a stakeholder in the planning process and by presenting HIA information at public events such as open houses and planning committee meetings. This included answering questions and commenting on plan development and final adoption. To evaluate the effectiveness of the practice, CCPH analyzed the text of the adopted plan and compared it to our HIA recommendations, noting whether they were fully adopted, partially adopted, not adopted, or contradicted. Key informant interviews served as the process evaluation component. The timeline for conducting the rapid and comprehensive HIAs was approximately one year. Evaluation took place over the following three months, with a total duration of fifteen months.
(1)Increase the visibility of health concerns in the policy decision-making process regarding transportation planning: Process measures will include the number of meetings attended, presentations, and circulation of the HIA report documents. Outcome measures, derived from a survey at public open houses will evaluate the priorities of citizen attendees. An additional survey will solicit responses from committee members, community members, planners, and decision makers regarding the HIA. (2)Target infrastructure improvements to maximize the benefits of physical activity, specifically biking and walking; We will analyze of the number of recommendations implemented from the Rapid HIA and the extent of adoption by examining the degree to which our recommendations were integrated into the final plan approved by the Board of Health (Board of County Commissioners). (3)Evaluate the HIA effectiveness in reaching goals (1) and (2). We will know that we have fulfilled goals (1) and (2) if the ultimate decision makers acknowledge and incorporate health recommendations into the final bicycle and pedestrian plan. A final evaluation element will consist of key informant interviews with policy makers, specifically the Board of County Commissioners, to examine how and why they used information from our HIA in making decisions on the plan. We believe the results form our evaluation will be uesful for other health departments involved in health and active transportation planning to promote health and prevent chronic disease in their communities.
The HIA is part of a larger effort to align planning and public health in Clark County, with the long-term goal of including health issues in all decisions related to the built environment. As a result of this experience, Clark County Community Planning has engaged CCPH on several current planning issues, including sub-area (neighborhood) planning, aging readiness planning, and comprehensive planning. Also as a result of partnerships formed during this HIA, additional HIAs have been requested by the City of Vancouver and by the Vancouver-Clark Parks and Recreation district. An important long-term benefit of this HIA comes from the associated comprehensive baseline health assessment, which allows CCPH to be more strategic in the screening phase of future HIAs. In forming partnerships with planning organizations, CCPH has been able to monitor emerging built environment issues and to strategically prioritize our involvement in the planning process. In some cases, this has resulted in additional HIAs, and in others a different approach is warranted. For example, the Clark County Board of Commissioners has directed Clark County Public Health to draft a Health Element for the next update of the county’s Comprehensive Growth Management Plan. Through this planning process, CCPH and Community Planning will identify strategies to further raise the visibility of health issues and to continue addressing them in built environment decisions.