Transcript Health Impact Assessment Training

Preliminary Findings
Hawaii Agricultural Plan
Health Impact Assessment
Betsy Cole, EdD
Kohala Center
Ameena Ahmed, MD, MPH
Center for Health Research, Kaiser Permanente
Matthew Loke, PhD
Hawaii Dept. of Agriculture
April 7, 2011
Kim Gilhuly, MPH
Human Impact Partners
1
Health is a state of complete physical, mental
and social well-being and not merely the
absence of disease or infirmity.
- World Health Organization
2
Factors Responsible for Population Health
Health status is determined by:
genetics 20 – 30%;
health care 10%;
social, environmental conditions, and behavior 60 – 70%
J Health Affairs, 2002
3
HIA Definition
Health Impact Assessment
A combination of procedures, methods and tools
that systematically judges the potential, and
sometimes unintended, effects of a policy, plan,
program or project on the health of a population
and the distribution of those effects within the
population. HIA identifies appropriate actions to
manage those effects.
International Association for Impact Assessment, 2006
4
HIA Addresses Determinants of Health
How does the proposed
project, plan, policy
affect
and lead to
health outcomes
5
HIA Purpose
Through HIA report and communications
Judge health effects of a proposed project, plan or policy
Highlight health disparities
Provide recommendations
Shape public decisions & discourse
Make health impacts more explicit
Through the HIA process
Engage & empower community
Recognize lived experience
Build relationships & collaborations
Build consensus
6
Steps of a HIA
Screening
Determines the need and value of a HIA
Scoping
Determines which health impacts to evaluate, methods for
analysis, and a workplan
Assessment
Provides:
1) a profile of existing health conditions
2) evaluation of potential health impacts
Recommendations
Provide strategies to manage identified adverse health
impacts
Reporting
Includes:
1) development of the HIA report
2) communication of findings & recommendations
Monitoring
Tracks:
1) impacts on decision-making processes and the decision
2) impacts of the decision on health determinants
7
Completed & In Progress HIAs1999–2011: 105
WA 3
MT 1
ME 1
MN 5
OR
12
NH 1
MI 1
MA 4
PA 1
OH 1
IL 1
CO 2
CA
45
MO
1
KY 1
NJ 1
MD 2
TN 1
NM
1
GA 7
TX 2
AK 8
Map Courtesy of A. Dannenberg, A. Wendel,
CDC NCEH
Federal HIAs: 2
HI 1
HIA in Hawaii
Hawai’i County Agricultural Development Plan HIA
9
Agriculture in Hawaii County
Hawai‘i County is the site of 63% of farmland and 40% of
existing farm employment in the state
effect of agricultural expansion on the island’s economy could
be significant
State of Hawai’i island imports 85-90% of its food (Hawai’i island
imports less)
legacy of former plantation agriculture and result of globalization
of food supply
Economic impact of increase in local food
production is more often discussed, but
health impacts of this plan have not been
evaluated
10
Hawai’i County Ag. Development Plan
Plan currently being developed by County of Hawai‘i
Department of Research and Development
Plan currently focuses on enhancing opportunities for expansion
of County’s agricultural industry
Residents interested in expanding locally produced food supply
to address issues of
food security
economic development
environmental conservation
Plan will guide County legislative and regulatory action, as well
as decisions about private investment by agricultural business,
for five or more years.
11
Agricultural Plan HIA
Potential impacts of Ag. Plan
Food security
Economic stability
Worker safety
Environmental impact
HIA used to
Assess risks and benefits of Plan
Highlight issues of social and economic equity
Develop recommendations to promote benefits and
mitigate danger to health
Report results to decision-makers and general public
Positively impact community well-being
12
HIA Goals
Include health considerations in the Ag. Plan
decision-making processes
Succeed in developing a Plan that reflects
community priorities
Engage and involve community stakeholders
throughout the HIA
Promote alternatives that will maximize health benefits and
mitigate negative health impacts
Build capacity of stakeholders to use HIA findings and
recommendations to assist in education and awareness building
around the health impacts of policy and land use decisions
13
Agricultural Plan HIA
What have we done thus far?
•
Screening
•
Scoping
•
Assessment
Preliminary Findings
14
Step 1: Screening
Objective
To decide whether a HIA is feasible, timely, and
would add value to the decision-making process.
HIA is used to assess a defined project, plan, or policy
Have sufficient info about decision
Understand timing
Why did we decide to
conduct an HIA on the
Ag Plan?
Evaluate decision openness
Assess feasibility
Be inclusive
Avoid redundance
15
Screening: Why move forward with an HIA?
• The Hawai’i County Agriculture Development
Plan draft did not explicitly include an
examination of agriculture’s effects on
community health
• Yet issues surrounding the availability of
food and fuel are central to family and
community well-being
• There is growing concern in Hawai’i at
community, county, and state levels about
food security, food quality, and land use as
they relate to individual physical health as
well as environmental and economic health
16
Step 2: Scoping
Objective
To create a plan and timeline for conducting a HIA
that defines priority issues, research questions
and methods, and participant roles.
Goals ☐
Identify health determinants policy will impact ☐
Identify vulnerable populations ☐
Pathway diagrams ☐
Research questions ☐
Preliminary methods ☐
Stakeholders and roles ☐
Workplan ☐
Timeline ☐
17
Scoping: Who did we involve?
•
•
•
•
•
•
•
•
•
Agricon Hawaii LLC
The Brantley Center
Friends of the Future
Hamakua Health Center
Hawaii Alliance for
Community-Based Economic
Development
Hawaii County Department of
Research and Development
Hawaii County Nutrition &
Physical Activity Coalition
Hawaii Island School Garden
Network
Hawaii State Child Nutrition
Programs
• Hawaii State Department of
Agriculture
• Hawaii State Department of
Health
• The Nature Conservancy
• Kamehameha Schools, Land
Assets Division, Hawaii
Island
• Kawanui Farm
• Kona County Farm Bureau
• North Hawaii Outcomes
Project
• Salvation Army
• Taro growers
18
Ag. Plan Policy Recommendations
What specific recommendations included in the
Plan should be a priority focus for the HIA?
What would be the health effects of:
•a general commercial expansion of FFV production
•an expansion of grass fed beef, dairy, and/or
egg production
•an increase in the production of organic FFVP
• an increase in home food production
• extensive biofuel production
• increase in farm workers/being a farm worker
• an increase in new on-farm housing
• an increase in institutional buying, particularly by pre-schools and K-12
schools?
• What are the most effective ways to increase demand for/consumption
of FFVP?
19
Results of June scoping
• Decision to examine health effects of:
– General commercial expansion of fresh
food production
– Increase institutional buying, particularly by
K-12 schools
• If possible with time constraints, examine
– Home food production
• Table other topics, including:
– Increase in new on-farm housing
– Extensive production of biofuels
20
Biofuels scoping
• Reconsideration of this issue as the
political/economic environment changed in Fall 2010
– Military & utility demand for biofuels
– USDA Biomass Crop Assistance Program (BCAP)
• Preliminary Questions:
– What are production potentials and
costs of various biofuels? What are
competing resource uses?
– How do production of food a& biofuel
interact? What are tradeoffs between
them?
– What types of employment are required
for biofuel energy production?
– Are there any populations of concern
affected by biofuel generation?
21
Agricultural Plan HIA
Political landscape for agricultural policy
in Hawaii state and county
22
What indicators did we look at?
Institutional
Buying
Commercial
Expansion
Home
Production
Impact
Assessed
?
Impact
Assessed
?
Impact
Assessed
?
+/impact
+/impact
+/impact
Family food security
++
+
+++
Nutritional quality of
diet
++
++
+++
Child & adult obesity
+
+
++
Food borne illness
-
0
+/-
Community food selfreliance/ emergency
availability
++
++
+++
Farm gate income
+
+
-
Job creation
++
++
0
Domestic product
Tax revenue
23
Current conditions: Food and nutrition
security
• Food security: ability of a family to feed
itself
– Food insecurity  academic delays, poorer
academic achievement, behavioral
problems
– 17% of HI state households are food
insecure (51% of those qualified for NSLP,
29% Native Hawaiians, 52% other Pacific
Islanders)
• Nutrition security: not only enough food,
but access to a balanced diet
• Community food security
24
Current conditions: obesity
• Children who are obese: increased risk of
diabetes, elevated cholesterol, elevated
blood pressure, earlier maturation, social
stigma
• Adults who are obese: diabetes, HTN,
stroke, heart attack, sleep apnea,
depression, premature mortality
• Adults: 74% overweight or obese
• In HI: 67% Native Hawaiians, 49% whites
and Filipinos, 44% Japanese
25
Current conditions: food borne illness
• Disease transmitted by consumption of
toxin- or microbially-contaminated food or
water
• 30% of US population annually has food
borne illness
• Most episodes short lived
• Nationwide: 2.2% of food borne illness
assoc with growing, packing, shipping of
produce; 10% food prep or storage of
produce; 88% other foods
26
27
Step 3: Assessment
Objective
To provide a profile of existing conditions data, an
evaluation of potential health impacts, and
evidence-based recommendations to mitigate
negative and maximize positive health impacts.
28
HIA Assessment & Recommendations Steps
Profile existing conditions
Can you use existing data or do you need to collect data?
What methods will you use to collect data?
Judge the impacts of the decision on selected indicators
What methods will you use to predict impacts?
Use results to develop recommendations and
mitigations to address any negative health impacts
and maximize health benefits
29
Institutional Buying: Findings
• Small improvement in child food security
• Small to moderate improvement in child nutrition security
• Through economic stimulus: small to moderate
improvement in family food and nutrition security
• Small improvement in child obesity in long term; no short
term change
• Moderate increase in jobs in farm and food processing
sector
• Small stimulus to local economy
30
Recommended policies: Institutional buying
• Establish at least one pilot Farm-to-School program by
2013. Fully utilize USDA’s FFVP (fresh fruit and vegetable
program)
• Convene Hawaii County working group to facilitate sale of
locally grown food for Pre-K – 12 schools as a model for
other institutional buyers such as senior programs,
hospitals, nursing homes, youth programs, etc.
• Hawaii County support funding for state-wide Farm to
School coordinator at HDOA and a School Lunch
Coordinator at HDOE.
31
Recommendations: institutional buying
• 1. procurement to allow for more than one
supplier
• 2. breaking up the SFA into 4, countyspecific. Creating 3 new SFA, with
appropriate staffing
– According to Sue Uyehara, it only takes a
few days to establish a SFA; staffing takes
longer
– ?RWJ grant for funding to do this
• 3. Establish a food enterprise zone;
establishing exemption to HR175 as a pilot
program.
32
Recommendations: Institutional buying
(2)
• 4. could start with complex (N. Kohala)
which has 3 schools served by a single
cafeteria
• 5. could do pilot tests of food delivery
systems (ex: cooking for HPA, charter,
and Kana’ako aina) ; recipe to product
model; Sudexo manager for their cafeteria.
• 6. Monitor compliance with HR 175: Track
the purchase $ of locally grown and
produced foods by each SFA
• 7. Require food service staff to attend food
prep training; could pay them to attend
33
Recommendations: institutional buying
• 8. note: authority over school food service
staff is shifting from principals to Glenna’s
office
• 9. Educate farmers on procurement
regulations and provide technical asst.
• 10. Create farmer co-ops to help with #9
and other logistical problems
• 11. ___ shall compile a 1-pager to explain
sources of funding for school food,
including options for geographic
preference
34
Rec’s: institutional buying
• 12. compile regulations that guide current
procurement (ex: req. for large quantities);
and 12.b. work with Glenna’s office (or
other promulgators of regulations) to
amend these
• 13. target particular foods (ex: Okinawan
sweet potato) for institutional buying,
including 1-pager with price, nutritional
content, etc.
• 14. examine work description for cafeteria
workers and managers
35
Commercial Expansion: Why do it?
•
•
•
•
•
Food security
Money stays local
Nutritional content
Decrease food miles
Less risk of invasive
species
Commercial Expansion: How is gov’t helping?
• Promoting Farmer’s Markets
• Promoting “Buy Local, It Matters” campaign
• Supporting Island Fresh & Hawaii Seal of
Quality
• Input subsidies
• Tax credits
• Low-interest agricultural loans
• Crop insurance
• Preferential purchasing
Commercial Expansion: Making the case
- 85% - 90% of the state’s food in imported; i.e.
we grow 10% - 15% of our own food
-$3.1 billion leaves our state to support
agribusiness elsewhere
- We have the climate to grow all the food we
need
- Comparison: New England grows 28% of their
own food
Commercial Expansion: Making the case
• We spend a LOT of money on food
– State of Hawaii consumers spend $3.7
billion per year on food
– Money spent on food is growing by 3.4%
every year in Hawaii
– Each person spends on average $2,899 a
year in Hawaii
– People eat out 47.7% of the time
Commercial Expansion: Making the case
• From 1995 – 2005 food consumption increased
more than food production for the state of
Hawaii:
– For most foods we are becoming less selfsufficient
– The only exception is fresh vegetables.
Economic Multiplier
Indirect
Food that is purchased is
locally grown
Induced
Local farmer
makes $10 more
Local farmer purchases
local inputs
(fertilizer, water, seeds)
Local distribution,
other inputs
$6 more into local
economy
Local farmer hires
more workers
$20 more
into local
economy
EM = 2.0
Workers purchase
local goods &
services
$4 more into local
economy
Findings: Commercial Expansion
• $1 in local vegetable farm sales in Hawaii
generates:
– $2.06 in sales
– $0.54 in earnings
– $0.078 in state tax revenues
• $1 million in local vegetable farm sales in
Hawaii generates:
– 26.3 jobs
• Doubling share of of consumption from local
produce generates:
– If eggs: $17 mill in sales; $4.6 mill in earnings;
half a mill in taxes; 217 jobs
42
Recommended policies: Commercial Expansion
• The HDOE and UH should allocate funding to revive
secondary and community college level agricultural
training, 4-H, and Future Farmers of America programs.
• Agricultural extension services should be refunded to
address local staple food production.
• Expand funding & participation in HDOA’s Buy Local It
Matters campaign
• Business/NGO/USDA collaboration to increase capacity of
farmer’s markets to accept cash vouchers, EBT & credit
cards
• Provide incentives to support development of more food
distribution, packing, and processing infrastructure &
businesses
43
Rec: expanded commercial production
• Create incentives for students to enter ag
education programs (? Loan repayment/
forgiveness programs)
• Ag as a career pathway in high schools,
that would lead to 2 or 4 year pathway in
UH system
• Institute private sector internships in ag
• Address the perception that “there is no
future in ag”/ “ag is such a small sector of
the economy” with potential funders
• Messaging: target audiences include
student contemplating career choice;
funders
44
Recs: expanded commercial production
• Messaging
– HI is value-driven, community-oriented
place
– Ag = saving the world
– Ag = work in natural resources
– Get data on how people are spending their
food dollars in HI
45
Recs: expanded commercial production
• Spend $3,000/ to add question to BRFSS
• Legislative/ BOE mandate to include one
hour of HS instruction on land grant
system/ UH history as ag college
• DOA to market HI products in a more
dedicated way. Unify the disparate countylevel marketing programs. Both $ and
technical assistance are needed
46
Home production: Findings
• Significant improvement in child and family food and
nutrition security
• Small to moderate decrease in child and adult obesity, in
the long term; no change acutely
• Small effect on food borne illness, could be increased or
decreased
• Improvement in child and adult well-being
• No net change in economy, as money previously spent on
food is used to purchase other items
47
Recommended policies: Home production and
consumption
• Expand & support school and community gardening
programs that educate students & families about growing
& preparing fresh food
• Review County regulations & remove unnecessary
impediments to home production/ zoning regulations (ex.
Chicken ban)
• Investigate potential incentives to home food
production/community gardening
• Encourage landlords to allow renters to grow food
• Encourage HI Island School Garden Network to include
information about how school/home gardening can
improve health of children & families in teacher trainings,
publications, & web postings
48
Recs: expanded home/ community prod
• Set aside XX% of each public park for
community gardening plots, and provide
mechanism for accountability if this does
not happen
• Include food preparation instruction with
school gardening instruction
• Legislation: good samaritan law limiting
lawsuits for free food giveaways
• Require food gardens with low income
housing developments. Repeal laws/
regulations prohibiting senior/ section 8
housing from digging
•
49
Recs: expanded home/ comm production
• Educate community about benefits of
gardening
• Tie community garden work to increased
EBT funds
50
Recommendations & Mitigations
A key function of HIA is to identify opportunities for
public decisions to promote health
HIA may suggest
Recommendations: alternative ways to design
a project, plan, or policy its location, or
timing to benefit health
Mitigations: strategies to lessen anticipated
adverse health effects of a decision
51
Recommendations & Mitigations
Consider the following criteria in developing recommendations:
Responsive to predicted impacts
Specific and actionable
Experience-based and effective
Enforceable
Can be monitored
Technically feasible
Politically feasible
Economically efficient
Do not introduce additional negative consequences
52
Example recommendations
Pittsburg:
High quality HVAC system
Triple paned windows
Increase in amount of affordable housing
Humboldt:
Gather data on ped and bike facilities
Focus growth in urban areas
Improve/increase public transit options and publicize it
Inclusionary zoning
Oregon:
Specify that schools can only be reimbursed for foods “produced”
or “processed” in Oregon so as to increase economic activity in
our state
Food, Agriculture and Garden education grants will be
preferentially given to schools serving: 1) a low-income student
population defined where 40% are eligible for free or reduced
meals
53
Your recommendations
• Institutional Buying
• Commercial Expansion
• Home Production
54
Step 4: Reporting
Objective
To develop the HIA report and communicate
findings and recommendations.
Letters to proponents &
decision-makers
Comment letters on draft EIAs
Formal report
Presentations
Peer-reviewed publications
Communication Plan
55
Your recommendations
• Institutional Buying
• Commercial Expansion
• Home Production
56
Step 4: Reporting
Objective
To develop the HIA report and communicate
findings and recommendations.
Letters to proponents &
decision-makers
Comment letters on draft EIAs
Formal report
Presentations
Peer-reviewed publications
Communication Plan
57
Agricultural Plan HIA
Who are the decision-makers?
58
Agricultural Plan HIA
Who influences the decision-makers?
How do we best reach the deciders?
Who can help us shape the recommendations?
Is there other data or findings that we can give that
would be useful?
What are the best messages for each type of
decision-maker?
59
HIA Workplan/Timeline
July 2010
Priority issues identified
Aug 2010–May 2011 Research, analysis, draft
recommendations
June 2011
Draft report completed
July – Aug 2011
Stakeholder comment & suggestions
Sept. 2011
Final report completed & published
Oct. 2011 - on
Use of findings & recommendations to
inform public policy & community action
Monitoring HIA effectiveness in
supporting positive health outcomes
60
Agricultural Plan HIA
Next steps
61
Step 5: Monitoring
Objective
To track the impacts of the HIA on the decisionmaking process and the decision, the
implementation of the decision, and the impacts of
the decision on health determinants.
Did the HIA lead to changes in the design of the
proposed project, plan, or policy?
Did the HIA lead to any changes in health
determinants?
62