Healthy Homes

The scope of environmental health work includes both indoor and outdoor spaces as well as community planning and design. Environmental health practitioners often work with community planners, policy makers, public health nurses, and building supervisors to ensure that public health is protected, both in their home and outside.

Healthy Homes programs focus on the importance of family and children's health within their home. Whether it is radon infiltration of the presence of vectors or other public health pests, creating a living environment that is free from potential irritants and contaminants allows families and children to thrive.

HUD Secretary's Award for Healthy Homes

The HUD Secretary's Award for Healthy Homes highlights some of the nation's most significant work on the relationship between living environments and resident health, and lays the foundation for future healthy homes work.

• HUD’s Healthy Homes program was created to “to protect children and their families from housing-related health and safety hazards.”
• Healthy Homes addresses environmental health issues such as: mold, lead, allergens, asthma, carbon monoxide, home safety, pesticides, and radon.

A Hidden Problem:  Lead-Poisoned Children in the United States

A study conducted by the California Environmental Health Tracking Program has found disturbing information on the identification, reporting and remediation of childhood lead poisoning. Find out how your state ranks here.

Radon Data Standardization Webinar

Topics / Featured Speakers:

• Radon Pilot Project, Michele Monti, MS, MPH, Centers for Disease Control and Prevention (CDC)
• Radon Communications Toolkit, Holly Wilson, MHSE, CHES, Centers for Disease Control and Prevention (CDC)
• Radon Data Collection in Washington State, Tina Echeverria, PhD, Washington State’s Tracking Portal

WEBINAR

Healthy Homes Resources

• HUD’s Healthy Homes Program
• Health Impact Assessments (HIA), brings together scientific data, health expertise, and public input to identify the potential health effects of proposed new laws, regulations, projects, and programs.

Conditions in the places where we live, work and play have a profound impact on our health. It is important to create conditions where we can easily and safely walk, run or bike; when we have clean air, healthy food and access to affordable housing; and when we are safe from things like violent crime, fires and lead poisoning. Policy makers outside of public health have opportunities to make choices that—if they took health into account—could help stem the growth of pressing health problems like obesity, injury, asthma and diabetes that have such a huge impact on our nation’s health care costs and on people’s quality of life.

Health impact assessment (HIA) is a fast-growing field that helps policy makers take advantage of these opportunities by bringing together scientific data, health expertise and public input to identify the potential—and often overlooked—health effects of proposed new laws, regulations, projects and programs.

Access Utilizing CDC Tracking Data for Health Impact Assessments Toolkit.  

What is HIA?

Health impact assessment (HIA) is commonly defined 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, and the distribution of those effects within the population.”¹ HIA is a practical tool that can:

• provide a structured process to determine a policy or project’s impact on health;
• bring both immediate and long-term health benefits;
• and ensure that policy and project dollars are used efficiently to provide the greatest benefit.

The five principles and values of HIA are democracy, equity, sustainable development, scientific and robust practice, and a holistic approach to health.² HIA continues to be one of the most important processes in public health, given its aim to influence decision-making processes in an open, multidisciplinary, and structured way.³

The HIA Process

Screening

The Screening phase is the first phase of an HIA process. It determines whether an HIA is feasible, timely and would add value to the decision-making process. The following elements should be evaluated during the Screening phase:

• The potential for the decision to result in substantial health effects;
• The potential for unequally distributed impacts;
• Stakeholder interest/concerns about a decision’s health effects;
• The potential for a decision to add new information that would be useful to decision-makers;
• The potential for the HIA to result in timely changes to a policy, plan, program or project
• The availability of resources, time and technical expertise

Scoping

Scoping is the second phase of the HIA process. It determines what health impacts are going to be studied, which populations will be included in the study, and the methods that will be used to conduct an HIA. The following tasks should be performed during the Scoping phase:

• Establish goals and anticipated outcomes of the HIA;
• Establish the HIA scope; – Identify potential significant health and health equity impacts that will be studied; – Set geographic and demographic boundaries;
• Create research questions;
• Identify and select research methods to analyze each research question;
• Determine an approach to evaluation and characterization of impacts and their distribution;
• Engage stakeholders

Assessment

Assessment is the third phase of the HIA process. It includes a summary of existing (baseline) conditions and analysis of potential health impacts. The following tasks should be performed during the Assessment phase:

• Develop a profile of relevant health issues or factors that impact health (e.g., access to transportation, quality housing) and health outcomes (e.g., percentage of adults who have diabetes) among the affected communities;
• Conduct assessment (e.g., literature review, data analysis, key-informant interviews, surveys or focus groups);
• Describe the strength of evidence based on best practices for the relevant field; 
• Create findings and characterize health impacts (e.g., direction, magnitude, likelihood)

Recommendations

Recommendations is the fourth phase of the HIA process. Recommendations are a way to suggest action that can enhance positive health effects and mitigate potential negative health effects related to the proposed plan/project/policy. The following tasks should be performed during the Recommendations phase:

• Use criteria in developing recommendations including: – Responsiveness to predicted impacts; – Evidence-based (informed); – Technical and political feasibility; – Cost-effectiveness; and – Unaccompanied by additional negative consequences.
• Create specific recommendations to address the health and equity impacts identified; Engage stakeholders and community members in developing recommendations and spearheading their future implementation.

Monitoring and Evaluation

Monitoring/Evaluation is the sixth phase of an HIA process. This phase helps determine future health impacts resulting from policy changes and assesses the HIA process, results and lessons learned. The following tasks should be performed during the Monitoring/Evaluation phase:

• Conduct process, impact and outcome evaluations;
• Develop a monitoring plan;
• Make monitoring and evaluation results available to the public.

References

 ^1. European Centre for Health Policy, World Health Organization Regional Office for Europe. (1999). Health impact assessment: Main concepts and suggested approach. Retrieved October 22, 2015, from http://webarchive.nationalarchives.gov.uk/20170106084428/http://www.apho.org.uk/resource/item.aspx?RID=44163

^2. UCLA School of Public Health. (2007). What is Health Impact Assessment? Retrieved October 22, 2015, from http://www.ph.ucla.edu/hs/health-impact/training/pdfs/HIAman07_s1_intro_txt.pdf

³. Lock, K. (2000). Health impact assessment. BMJ: British Medical Journal, 320(7246), 1395.

Resources

Social determinants of health are an important part of HIAs. CDC has compiled scientific research into this area that can be used to provide guidance and resources.

Utilizing CDC Tracking Data in Health Impact Assessments

Toolkit: Using CDC Tracking Data to Inform Health Impact Assessment (HIA)  

This toolkit is intended to assist public health practitioners and students in understanding and using data from the Environmental Public Health Tracking Network funded by the Centers for Disease Control and Protection (CDC) to inform HIA.

About the Environmental Public Health Tracking Network

Data is available on the network from the 25 states and one city the Centers for Disease Control funds to build and maintain local tracking networks as part of the National Tracking Network. These local networks may include data that are not on CDC's website, so be sure to check your state’s page as well. Some of these unique data also may be helpful for conducting HIAs. You can access the portals for all 26 state and local networks here. The portals are intuitive and easy to navigate. If you’d like a quick tutorial on downloading the data, the CDC has one on their site: Video: How to Use Tracking Data.

Phase by Phase Guide to Using Tracking Data for HIA

Tracking data may be used to inform any of the six phases of conducting an HIA. This resource will describe how tracking data can be used in each phase to support HIA. An additional resource for using tracking data is the  Minnesota HIA Data User Guide.

Screening

The Screening phase is the first phase of an HIA process. It determines whether an HIA is feasible, timely and would add value to the decision-making process. The following elements should be evaluated during the Screening phase:

• Part of the screening process is to assess the potential for the proposed decision to result in substantial health effects. To determine whether health outcomes will change, you will need baseline data about the conditions which may be impacted by the decision which can be obtained from the tracking network.
• In the screening phase, you assess the potential for unequally distributed impact. For instance, using the tracking data you can determine the rates at which persons in each age group have gone to the emergency department due to asthma. This will show if different age groups or races/ethnicities are disproportionately affected.
• Assessing the availability of sufficient resources to conduct the HIA is also part of the screening process. This includes determining if the data needed to predict health impacts exists, if it is available and if it is available at the proper scale. Many data are only available at the county level, but in some cases, zip code level data is available. The scale varies by indicator, so be sure to check your particular state and the scale available to ensure that you can access the data you need at the appropriate scale or that some other way of getting to that data is designed into your methodology like a resident survey.

Scoping

Scoping determines what health impacts are going to be studied, which populations will be included in the study, and the methods that will be used to conduct an HIA.

• A central task of the scoping phase is to determine how the decision or project can impact health. Pathway diagrams, which illustrate the impacts of the decision to short-, medium- and long-term health, are useful in identifying health effects and benefits. Tracking data can be used to assess these effects by providing baseline information about health status in a community or by predicting effects and benefits from a policy, plan, or project. See examples of how Tracking data can be used in three different domains of health impact assessment. The previous link also contains pathway diagrams for climate and health; transportation and land use.

• Identifying questions and data: A task of the scoping phase entails identifying the research questions, data sources, and analytic methods that will be used. The Tracking Network can be a source of data for this phase. Using the tracking network data to look at community health status before beginning the HIA is useful. Looking at specific underlying causes of death and health indicators that fall outside the “normal” range can help identify health impacts which might not have come up in the literature review. Because the tracking data is organized geospatially, the researcher can look at the “heat maps” created to see which areas have disproportionate impacts and underlying conditions which might make them more vulnerable to certain stressors.

Assessment

Using tracking data is most intuitive in this phase because it is very data-driven. Tracking Network data may be used to evaluate the health effects and benefits of a plan, project, program, or policy by:

• Assessing baseline health conditions
• Identifying and characterizing vulnerable populations, health disparities, and health inequities
• Evaluating the direction and magnitude of potential health effects due to changes in exposure or actions to protect health

For example, HIA practitioners and communities may want to know more about asthma in a particular area.  The Tracking Network can provide data about asthma hospitalizations and emergency department visits at state and county levels to establish a baseline health estimate and provide information on the region of interest.  State and local tracking programs also may have asthma data at enhanced levels of geography, such as ZIP code or census tract. 

Assessment also includes projections of health impacts to evaluate the direction and magnitude of potential health effects due to changes in exposure or actions to protect health.  Tracking data may be used in quantitative or qualitative assessments to make informed projections based on trends over time.

Recommendations

Recommendations is the fourth phase of the HIA process. Recommendations are a way to suggest action that can enhance positive health effects and mitigate potential negative health effects related to the proposed plan/project/policy. Tracking data can be used to demonstrate the establish baseline data which can be used in modeling impacts of recommendations. For instance, if an HIA identifies that a transportation project will impact the instance of respiratory disease, tracking data can be used to establish the baseline number of persons with asthma or cardio-pulmonary disease and that data can be used in models to predict the number of persons who would be affected if different alternatives are implemented like planting trees.

Monitoring and Evaluation

The final two phases determine future health impacts resulting from policy changes and assesses the HIA process, results and lessons learned. Because the network data is updated on an ongoing basis, the data is especially useful for monitoring and evaluating actions and decisions over time.  For example, use Tracking data to evaluate progress pre- and post-implementation of the HIA decision or action. 

Examples of HIAs Conducted using Tracking Data

Environmental Public Health Tracking is being used to conduct successful HIAs. The studies below are examples of using tracking data, mostly in the scoping phase of the studies. If you have an example you’d like to submit, please email programs@neha.org.

Florida HIA on Extreme Flooding in Escambia County

This HIA was conducted by the Florida Department of Health’s Environmental Public Health Tracking Program in partnership with the University of West Florida and the Florida Department of Health in Escambia County. The team used the Health Impact Assessment (HIA) Framework to examine adverse health outcomes that may be related to an extreme flooding event in Pensacola, Florida (Escambia County) during April 30—May 3, 2014. In this 2014 flooding event, Pensacola received more than 15.5 inches of rain in a single day. Infrastructure impacts from this extreme event included destroyed bridges and roads, and the failure of many sewage lift stations. To determine if there were associated increases in injury, illness, and death, data on reportable diseases, hospitalizations, emergency department (ED) visits, and deaths that occurred during the impact period were compared to a control period in 2008. The results of this comparison were mixed, with some Escambia County ZIP Codes showing increased hospitalizations and ED visits, and some ZIP Codes showing a decrease. However, county-wide, there were increases in the proportion of both injury and respiratory related hospitalizations and ED visits during the impact period. The report also looked at infrastructure impacts and their influence on health including flooding of lift stations and surface water contamination.

Recommendations of the HIA include developing guidance for cleanup activities and a suggestion to raise the electric panels on lift stations above the flood elevation, in order to keep them operational during extreme rainfall events.

Assessing the Health Impacts and Benefits of Regional Climate Action Plan Strategies in Western Massachusetts

This HIA represents a collaborative effort by the Massachusetts Department of Public Health (DPH), the Pioneer Valley Planning Commission (PVPC), and the municipalities of Springfield and Williamsburg. The climate action strategies are based on the regional Pioneer Valley Climate Action and Clean Energy Plan (PV Climate Action Plan) completed by the PVPC in 2013. The aim of that plan was to promote greater understanding of the causes and consequences of climate change in PVPC’s service region (which includes Springfield and Williamsburg) and to identify a set of actions that local governments and other partners could consider to mitigate and adapt to climate effects. Data from the Environmental Public Health Tracking network used include baseline data assembled during the scoping phase such as demographics of the target area, prevalence of diseases including pediatric asthma, lung, and bronchial cancer. Tracking data was also used to inform the identification of vulnerable populations. Recommendations of this study include the establishment of an emergency plan to fuel regional cooling centers in case of power failure, community-scale mitigation strategies like green infrastructure and incentives to drive energy efficiency in government buildings.

Health Impact Assessment of the Massachusetts Department of Transportation Grounding McGrath Study

This HIA was conducted jointly by the Massachusetts Department of Transportation and the Massachusetts Department of Public Health Bureau of Environmental Health to examine the possible health impacts of the alternatives for McGrath Highway in Somerset. Key features in analyzing the impacts/benefits of alternative designs included conducting air dispersion modeling to assess changes in potential exposure to vehicle-related air pollution concentrations in the study area, conducting a screening analysis of vehicle-related noise, and evaluating the influence of multimodal connections, a proposed bike path, and green space to promote increased physical activity. This HIA used tracking data were used in the scoping phase to supply baseline data on demographics and health conditions related to transportation like asthma as well as to identify populations of concern.

Gateway Gold Line Bus Rapid Transit: A Closer Look at Health and Land Use

This HIA examined the impacts of Minnesota’s first rapid bus transit line with a dedicated traffic lane the Washington County, Minnesota. The team was made up of staff from the Washington County Department of Public Works, the Washington County Public Health and Environment, and Saint Paul—Ramsey County Public Health.  The study looked at connectivity, housing, jobs, and safety along the corridor. They used tracking data to support their baseline assessment of demographics and health conditions. This is a comprehensive HIA and its recommendations are wide-ranging. Examples include: changing the zoning code to support land use densities that promote transit; strategies that support economic development in the corridor and to make housing more affordable.

Connecting Health to Transportation

In 2015, the Minnesota Department of Health partnered with the Minnesota Department of Transportation to ensure that health was being considered in the 2017 revision of the Statewide Multimodal Transportation Plan (SMTP). The SMTP is the highest-level transportation plan in the state. MDH and DOT performed a Health Impact Assessment to identify how proposed changes in the SMTP could impact health and offer recommendations that better support health. This HIA used tracking data in the scoping phase in the baseline health assessment to identify trends in demographics and to demonstrate inequities.

Other Data Resources for HIA:

• U.S. Department of Transportation and Centers for Disease Prevention and Control - Transportation and Health Tool 
  The Transportation and Health Tool was developed to provide easy access to data that practitioners can use to examine the health impacts of transportation systems.

• U.S. Environmental Protection Agency - Community-Focused Exposure and Risk Screening Tool (C-FERST)
  C-FERST is being developed as a community mapping, information access tool to help inform community assessments and decision-making.

• U.S. Environmental Protection Agency - Environmental Justice Screening and Mapping Tool (EJSCREEN)
  EJSCREEN is based on nationally consistent data and an approach that combines environmental and demographic indicators in maps and reports.
• Census Reporter 
  As a Knight News Challenge-funded project, this site uses information from the U.S. Census Bureau to provide a user-friendly interface for navigating data.
• Design for Health (DFH) - Tools, Research, and Resources 
  DFH bridges the gap between the emerging research base on community design and healthy living and local government planning. One of its four primary avenues to provide evidence-based tools for conducting HIAs.
• The American Communities Survey 
  The American Community Survey (ACS) is an ongoing survey that provides vital information on a yearly basis about our nation and its people. Information from the survey generates data that help determine how more than $675 billion in federal and state funds are distributed each year. Through the ACS, we know more about jobs and occupations, educational attainment, veterans, whether people own or rent their home, and other topics.