This health impact assessment aimed to promote safety, access, health, and mobility.
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The creation of this HIA Report was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Georgetown Mobility Study

This health impact assessment assesses the prevalence and severity of bullying, identify the health impacts on students involved, and consider the potential impact on health of the proposed legislation, the Safe and Supportive Minnesota Schools Act.

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The creation of this HIA Report was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

The Safe and Supportive Minnesota Schools Act

This HIA for San Miguel County and the San Miguel County Detention Center (SMCDC) suggests the (ARC) Adult Reintegration Center can improve community health through addiction, violence, and recidivism interventions, including in-patient treatment, the Alternatives to Violence Project, and health services like addiction treatment, dental care, and mental health support.

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The creation of this HIA Report was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Northeast New Mexico Adult Reintegration Center

This Health Impact Assessment examines the potential adverse health effects of climate change in Alaska by offering a comprehensive overview, presenting up-to-date climate information, and providing community strategies for addressing these impacts.

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The creation of this HIA Report was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Climate Change in Alaska

This Health Impact Assessment assesses the health equity impacts of the RMG/Southside Recycling proposal.

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The creation of this HIA Report was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

RMG/ Southside Recycling Permit Application

This health impact assessment reviews the influence that changes to KRS Chapter 431, Kentucky&#8217;s existing expungement policy, would have on health.

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The creation of this HIA Report was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Expungement Policy in Kentucky

This health impact assessment estimates the annual premature mortality burden for adult residents associated with projected changes in tree canopy cover in Philadelphia between 2014 and 2025. 

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The creation of this HIA Report was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Philadelphia’s Tree Canopy Cover Goals

This health impact assessment discusses the disconnect between housing and neighborhood development policies and health outcomes in Memphis, Tennessee, focusing on housing code enforcement.

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The creation of this HIA Report was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Strategic Housing Code Enforcement and Public Health

This health impact assessment aims to quantitatively estimate the health impacts of active transportation infrastructure.

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The creation of this HIA Report was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Three North Carolina Communities

This health impact assessment presents information through a sequential series of questions that support and lead to predictions and recommendations for the new Cuba Continental Divide National Scenic Trail segment. 

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The creation of this HIA Report was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Cuba Continental Divide National Scenic Trail Enhancement Plans

This health impact assessment addresses safety concerns on Minnesota State Highway 61, a major corridor in the area.

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The creation of this HIA Report was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Highway 61 Corridor Redesign

This health impact assessment assessed seven proposed projects for their potential impact on jobs, access to goods and services, and active living.

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The creation of this HIA Report was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Livable Communities Demonstration Account Transit-Oriented Development

This health impact assessment aims to explore how Glendale Forest Park might impact the community&#8217;s health, either positively or negatively, and make recommendations for how the park could promote positive health impacts and reduce adverse effects. 

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The creation of this HIA Report was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Making Nature Accessible in Urban Areas: Glendale Forest Park

This health impact assessment examined the potential public health implications of the Great Lakes Area of Concern (AOC) habitat restoration project (i.e., potential impacts on physical, mental, and social well-being), including the Minnesota Department of Natural Resources (MNDNR) restoration work and how people will access and utilize the project sites following restoration.

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The creation of this HIA Report was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Kingsbury Bay-Grassy Point Habitat Restoration

This Health Impact Assessment evaluates the Parks After Dark (PAD), Los Angeles County Gang Violence Reduction Initiative, program&#8217;s health impacts and costs.

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The creation of this HIA Report was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Parks After Dark

This health impact assessment aims to analyze the health impacts of requesting additional studies for any future McKinley County uranium mining on the following health determinants: 1. Environmental exposures/contamination 2. Displacement and relocation 3. Cultural relevance of the land and community efficacy

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The creation of this HIA Report was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Uranium Mining in McKinley County

This health impact assessment highlighted key findings and recommendations related to green space, physical activity opportunities, and the local economy to inform decisions regarding the land bridge project, which is part of a broader effort to revitalize the Rondo neighborhood.

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The creation of this HIA Report was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Rondo Land Bridge

This project assessed the health needs of Santiam Canyon wildfire survivors after the 2020 wildfires, emphasizing environmental, housing, mental and behavioral, food security, and personal health determinants. 

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The creation of this HIA Report was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Santiam Canyon Wildfire Recovery

The goals of this HIA were to help Seattle Department of Transportation (SDOT) and the impacted community: 1. Examine potential implications for public health related to the Rainier RapidRide 2. Mitigate the Rainier RapidRide&#8217;s negative impacts on the community&#8217;s health by providing recommendations, and 3. Highlight positive impacts on the community of the proposed project.

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The creation of this HIA Report was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Rainier RapidRide Bus Rapid Transit Project

This health impact assessment examines how south Commercial Avenue in the City of Anacortes, Washington, can be redesigned to improve walkability, bikeability, and a general quality of life, as well as attract more residents and tourists

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The creation of this HIA Report was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

South Commercial Avenue Corridor Plan

This health impact assessment to understand how the 15-month shutdown of New York City&#8217;s L-Train would affect commuters&#8217; health.

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The creation of this HIA Report was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

NYC L-train Shutdown

This HIA examined the health impacts of proposed changes in three SMTP sections: transportation safety, healthy communities, and critical connections. 

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The creation of this HIA Report was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Minnesota Statewide Multimodal Transportation Plan

This health impact assessment was initiated due to a Minnesota state legislation mandate to address health equity specifically. 

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The creation of this HIA Report was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Green Zones in the City of Minneapolis

This project aimed to identify the potential health impacts of the proposed rehabilitation for the Big Sky Villas Apartments complex using a Health Impact Assessment (HIA).

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The creation of this HIA Report was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Big Sky Villas Rehabilitation

This health impact assessment provides information for decision-makers and stakeholders in Klamath County as they consider whether to develop and adopt a tobacco retail license ordinance that would help reduce tobacco use rates among youth and what the components of this ordinance should be.

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The creation of this HIA Report was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Tobacco Retail License Ordinance in Klamath County

This health impact assessment explored three redevelopment concepts and their connection to health: Industrial Only, Mixed-Use Commercial and Residential, and Mixed-Use Light Industrial, Commercial and Residential.

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The creation of this HIA Report was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

The Interbay Project

The goals of the Auburn Comprehensive Plan Update HIA included strengthening health-related Comprehensive Plan goals and policies and providing guidance to improve community population-based health outcomes through City actions related to physical activity and healthy food.

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The creation of this HIA Report was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

City of Auburn Comprehensive Plan Update

The goals of the HIA are to establish baseline demographic and health data for comparison in long-term monitoring, to determine the degree of need for new healthy food access options, and to make recommendations to Southeast Volusia Corridor Improvement Coalition (SVCIC) for increasing options to purchase healthy food.

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The creation of this HIA Report was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Healthy Retail Food Access in the South Volusia US 1 Corridor

This Health Impact Assessment aims to guide the City of Marshall and the GreenStep Committee in prioritizing their participation in the Minnesota GreenStep Cities Program to enhance community health.

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The creation of this HIA Report was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Marshall GreenStep Cities

This health impact assessment was conducted in order to determine the health impacts associated with payday lending in Oklahoma.

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The creation of this HIA Report was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Payday Lending in Tulsa County

This Health Impact Assessment reviews HB 86 Kentucky�s proposed Affordable Housing Tax Credit, a program intended to increase the number of affordable housing units available to individuals earning up to 60% AMI of the area median income (AMI).

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The creation of this HIA Report was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Kentucky’s Affordable Housing Tax Credit

This health impact assessment aims to inform decision-making around the Second Chance Women�s Re-Entry Court (WRC), a specialized court-based jail diversion program in Los Angeles County (LAC).

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The creation of this HIA Report was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Sustaining a Women’s Jail Diversion Program

In 2020, Healthy Eating Research conducted a rapid HIA to inform proposed changes to the USDA’s nutrition standards for school meal programs. The HIA found that the implementation of strong nutrition standards following passage of the Healthy, Hunger-Free Kids Act in 2010 resulted in healthier, more well-balanced meals and that these improvements have significant short- and long-term positive implications for child health and cognitive performance. Specifically, the HIA found that strong nutrition standards improve the healthfulness of meals available, selected, and consumed by children both at school and at home; increase participation in the school meal programs; increase food security; and improve cognitive functioning without a negative financial effect on schools.
The HIA predicted that the changes to school meal and smart snack nutrition standards as proposed by USDA could reverse these gains and likely have adverse impacts on their overall health, food security, and academic performance. The report concluded that weakened standards would harm children from underresourced families, most notably those from low-income, low-educated households in rural areas and predominantly Black schools, exacerbating existing food insecurity and chronic disease conditions.
The HIA recommended that USDA maintain strong nutrition standards for all foods served and sold in schools, support school food authorities in meeting those standards via enhanced training and technical assistance, and invest in school kitchen equipment and infrastructure. The HIA also recommended that, should USDA move forward with the proposed policy, the agency prioritize monitoring and evaluation of the effects of those changes.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

USDA Proposed Changes to School Nutrition Standards

This rapid HIA examined the potential health effects of a proposed legislative initiative aimed at providing public and private organizations with protection against liability associated with the provision of facilities and services promoting physical activity. The purpose of conducting this HIA was to investigate whether&mdash;and to what extent&mdash;removing this barrier will lead employers, school districts and community centers to offer their grounds as affordable and convenient places where employees and community members can exercise, thereby increasing physical activities levels in the general population.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Injury Liability Protection for Recreational Physical Activity

In response to a request from a city legislator, the San Francisco Department of Public Health conducted an HIA of a proposed city ordinance that would require city contractors and property leaseholders to pay their employees a &#8220;living wage&#8221; of $11.00 per hour. The HIA quantitatively estimated the potential health effects of the ordinance, predicting potential decreases in days of illness and premature death, and improvements in depressive symptoms.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

San Francisco Living Wage Ordinance

Yavapai County Community Health Services conducted an HIA of the Regional Mobility Management Implementation Plan for Yavapai County. The plan is designed to improve mobility and access within and around the county by addressing linkages between existing public transit services and improving infrastructure for cyclists and pedestrians. The HIA concluded that it would reduce the risk of obesity and chronic diseases and improve mental health and air quality. The report found that the plan would also improve the community&rsquo;s economy, opportunities for social activity, access to medical care, and public safety. 
Funded through the Arizona Department of Health Services and the Centers for Disease Control and Prevention&rsquo;s National Center for Environmental Health.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Yavapai County Regional Mobility Management Implementation Plan

The Florida Department of Health in Hillsborough County, in conjunction with the Hillsborough County Department of Parks, Recreation, and Conservation and Partners in Obesity Prevention, conducted a health impact assessment (HIA) of policy and programming changes that would allow businesses to provide free outdoor fitness classes in five parks and recreation centers in the Town &rsquo;N&rsquo; Country neighborhood of Tampa, Florida. The HIA explored potential health impacts associated with increased physical activity and mental health and well-being.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Town ‘N’ Country Parks and Recreation

The U.S. Environmental Protection Agency Region 9 (EPA) contracted with Human Impact Partners to develop the scope for a health impact assessment (HIA) of proposed expansion projects for the Ports of Los Angeles and Long Beach, California. The process included public meetings to bring stakeholders together for input. The EPA hoped to use the scoping project as a way to inform stakeholders about HIA and its benefits, and to develop a more concrete understanding of what an HIA on port projects and plans would entail. Some of the pathways and health issues included in the scope were: asthma and other respiratory diseases related to air quality during construction and port operations; stress, hypertension, and other noise exposure effects due to environmental noise during construction and post operations; health concerns related to water pollution from port activities and storm water run-off; traffic safety for pedestrians, bicycles, and drivers due to truck and rail traffic related to port activities; and displacement of residents, businesses, and community resources due to port projects and port-related activities.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Ports of Los Angeles and Long Beach

This HIA, carried out by Bernalillo County Place Matters Team, evaluated the health impacts of the county Pedestrian and Bicyclist Safety and Action Plan. The HIA focused on the plan&rsquo;s potential impact to pedestrian and bicycle accessibility and safety along Mountain View&rsquo;s Second Street. Several health determinants that could be affected by the plan were considered, including: increased physical activity; reduced motor vehicle use; increased social cohesion; increased safety; and increased overall health and well-being of residents. These determinants were examined in relation to health outcomes such as diabetes, obesity, mental health, and accidental injury or death. The HIA offered several recommendations for adoption of the plan, such as installing traffic calming devices; improving safety features of the elementary school zone; installing crosswalks, street lights and traffic signals; installing bus shelters at bus stops; installing sidewalks and walking paths; and rerouting truck traffic to improve safety and air quality.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Bernalillo County Pedestrian and Bicyclist Safety Action Plan

This HIA adds to the scope of a previous HIA that examined the relationship between liquor outlets and violence.&nbsp; The project team assessed the relationship between high concentrations of liquor outlets and violence, with the goal of informing the current &lsquo;non-conforming alcohol outlet amortization proposal&rsquo; to ensure that amortized alcohol outlet licenses do not relocate to become nuisances in other Baltimore communities.
Based on a literature review, the HIA found that there is evidence, with support for causality, that there is a relationship between alcohol outlets and violent crime. Local analyses suggest that neighborhoods with non-conforming alcohol outlets have higher violent crime rates.
The HIA made several recommendations for additional strategies including dispersal standards for new off-premise alcohol outlets; reducing the number of districts where off-premise alcohol outlets are permitted by right; and including median count of crime and health status of the surrounding neighborhood in the conditional use consideration process.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Off-Premise Alcohol Outlets

Merced County is fast-growing and has a higher proportion of residents in poverty compared with California or the U.S., broadly. In addition, the residential vacancy rates are low, making affordable housing scarce.&nbsp;
Individuals and families struggling to pay for housing have limited resources for other essentials, such as food, clothing, health care and medication, utilities, and mental health services, which, in turn, can lead to homelessness, poor nutrition, metabolic syndrome, diabetes, cardiovascular disease, chronic anxiety, and depression. The Merced County Department of Public Health conducted an HIA to examine and predict the housing cost burden for residents and students as it relates to the University of California, Merced (UCM) 2018 Draft Long Range Development Plan (LRDP).&nbsp;
The report’s recommendations include forming a partnership among the City of Merced, Merced County, community-based organizations, and UCM to address housing needs in the city and surrounding areas and maintaining or increasing on-campus student housing as the campus grows.

<h3>Outcome</h3>
Although the county did not implement the recommendations, the HIA gave community partners and residents an opportunity to become more informed about the impacts of housing on their health and about UCM’s plan to house students. In addition, community residents articulated their concerns during UCM-sponsored public comment meetings. According to the Subsequent Environmental Impact Report (SEIR), “Comments received on the Draft SEIR assert that the LRDP‐related demand for housing in the City of Merced would result in increases in rents and the cost of housing for the public. This SEIR does not analyze any indirect socioeconomic effects, such as effects on the cost of housing that could result from the campus‐related demand for housing. [The California Environmental Quality Act] does not require a discussion of socioeconomic effects except where they would result in physical changes, and states that social or economic effects shall not be treated as significant effects (see CEQA Guidelines Section 15131).”&nbsp;
Although the report cites no significant effects in the area of housing and offers no commitment to form a collaborative partnership, it does include plans to house 50% of the student population on campus.&nbsp;

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Draft 2018 University of California, Merced Long Range Development Plan

Upstream Public Health conducted this health impact assessment (HIA) of proposed state legislation designed to reduce car use and ultimately meet greenhouse gas emission targets to help curb global warming. The proposed legislation would provide funds to Oregon&rsquo;s six Metropolitan Planning Organizations (MPOs) to design and implement vehicle miles traveled (VMT) plans using a variety of policies, such as VMT tax and investments in public transit. Specifically, the HIA looked at 11 proposed strategies for reducing the number of vehicle miles traveled in the state and assessed them as they relate to physical activity patterns, air pollution, and vehicle collision rates. The HIA found that five of the policies would be the most beneficial to the well-being of the public. These policies include maximizing the density of neighborhoods already within the urban growth boundary,requiring new developments be mixed‐use and high‐density with good connectivity, improving pedestrian infrastructure of neighborhoods, increasing the coverage area for public transportation, and requiring businesses in metropolitan areas to charge a fee for employee parking. The HIA recommended a combination of these strategies be adopted to decrease individual driving and lower VMT in Oregon.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Oregon Vehicle Miles Traveled Legislation

This health impact assessment (HIA) evaluated the potential academic, health, and economic impacts of subsidizing the costs of student bus passes in Los Angeles County. The Los Angeles County School Attendance Task Force (SATF) was interested in developing a program to further subsidize the cost of bus passes for low-income students in order to increase school attendance. During town hall meetings hosted by the SATF, students cited transportation as a major barrier to school attendance, and suggested developing a free or subsidized bus pass program. Providing access to free or affordable transportation options can affect student school attendance, the financial stability of their families, arrests and court referrals for fare evasion, and their ability to access community resources. These factors are likely to have a short-term impact on students&rsquo; educational attainment, on their likelihood to engage in criminal activities, and on their own and their families&rsquo; stress levels. Student educational attainment has the potential to influence a variety of intermediate and long-term health determinants, including incarceration, teen pregnancy, substance misuse, and mental health. In addition, increasing financial resources for families can allow them to spend money on health-promoting goods and services, including healthy food and preventive services.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Providing Free or Reduced-Fare Student Bus Passes to Reduce Truancy

This HIA informed decisions regarding a proposed biomass energy facility in Placer County, California. The proposed facility would generate electricity from woody debris gathered from surrounding forest lands as a result of ongoing forest fire fuel load reduction programs. The Placer County Board of Supervisors will consider adoption of an Environmental Impact Report (EIR), and will determine whether to approve construction and zoning permits for the facility. The HIA supported the EIR and facilitated the identification of potential health impacts such as how changes in air quality and truck traffic on local roads as a result of the facility could affect health concerns such as asthma, injury rates, and access to services important to health. The Sequoia Foundation partnered with the California and Placer County Departments of Health to carry out this HIA.
<h2>HIA Summary Findings</h2>
The HIA found that Placer County’s proposal for the two megawatt Cabin Creek Biomass Facility Project will likely benefit community health in the Lake Tahoe Region through the removal of forest slash and reduction of wildfire fuels, the diversion of open pile burns to more emission efficient combustion, and the diversification of energy sources.
The HIA showed that this plan for a biomass facility will likely benefit community health through improvements in air quality and reductions in risks from wildfires. The proposed facility would be fueled by forest materials (wood chips, bark, and pine needles) that are currently being generated as a result of ongoing programs enacted to reduce forest-fire hazards in the area. A local elected official applauded the HIA for its independent analysis and its usefulness, not only for local stakeholders, but for communities across the country making similar decisions about alternative energy technologies.
“This health impact assessment by the Sequoia Foundation is to be applauded for its independent, third-party analysis,” said Placer County Fifth District Supervisor and Chairwoman of the Board, Jennifer Montgomery, whose district includes the site of the proposed facility. “The issues reviewed in the assessment were submitted by community residents who live in the surrounding fire-prone areas. The report’s findings will not only inform those local communities, but other communities across the country that are considering similar alternative energy technologies.”
Project Health Impacts and Recommendations
<h3>Air Quality</h3>
Regional air quality will improve from the reduction of open pile burning. Low levels of emissions will be concentrated at the proposed project site; there is little evidence to suggest that these emissions will negatively impact health in surrounding communities.
<h2>Recommendations</h2>
Develop a communications plan between residents and facility operators. Clear communication from facility operators and/or County staff could ease community&nbsp;&nbsp;&nbsp;anxieties regarding the facility.
More frequent on-site inspections—for example, once during summer months and once during winter months—could ease community anxieties regarding emissions during winter months when an inversion layers often present
<h3>Wild Fires</h3>
The project will reduce health effects related to wildfires and wildfire&nbsp;&nbsp;risk.
<h2>Recommendations</h2>
Explore the feasibility of using residential wood waste as biomass fuel for the facility, including materials from wildfire defensible space clearance round homes.
<h3>Greenhouse Gas (GHG) Emissions</h3>
The project can benefit GHG reduction strategies when considering its broader impact on energy production and wildfire reduction. Health effects due to GHG emission reductions will not occur from this project alone.
No Recommendations
<h3>Traffic and Transportation</h3>
The relative increase in traffic and its associated risk to health is very small.
<h2>Recommendations</h2>
Improve&nbsp;&nbsp;signage on SR 89 near Cabin Creek Road warning cyclists of project&#8211;‐related vehicles, and warning vehicles of the presence of a cyclist/pedestrian pathway.
<h3>Water Quality</h3>
The proposed biomass facility will pose minimal health risk in terms of water security given mitigation measures in place.
No Recommendations
<h3>Noise</h3>
Noise is not expected to impact health given the small impact the additional traffic will have on existing noise levels, and the remoteness of the project facility&nbsp;&nbsp;from the nearest households.
<h2>Recommendations</h2>
Develop strong communication channels between nearby community residents and the Project Manager of the biomass facility to ensure that any noise complaints are quickly and expediently resolved.
<h3>Economic and Energy Security</h3>
The project may have small and limited positive health effects related to energy and economic security.
<h2>Recommendations</h2>
Prioritize the hiring of local contractors for both facility construction and operations, as feasible.

&#8211;
This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Placer County Biomass Energy Facility

The Centers for Disease Control and Prevention, in collaboration with the Los Angeles County Department of Public Health conducted an HIA to determine facilitators and barriers of a proposed food procurement policy in Los Angeles County. The proposed policy would require food purchasers, distributors, and vendors of food service to meet specified nutrition standards, including limits on sodium content. During stakeholder interviews, the HIA found 3 key facilitators: an organization’s authority to impose nutrition standards, an organization’s desire to provide nutritious food, and to opportunity to build on existing nutrition policies. The HIA also identified several barriers, including costs and availability of low-sodium foods and existing multi-year provider contracts that are difficult to change. The HIA recommended that further research be conducted in jurisdictions that have successfully implemented food procurement policies and to quantify their long-term health and economic effects on the targeted population.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Reducing Sodium in the County of Los Angeles

Human Impact Partners conducted a health impact assessment (HIA) to assess how current U.S. immigration policy, and specifically the threat of detention and deportation, can affect the health and mental health of parents and children living in mixed-status families. If deportations continued at 2012 levels, the HIA estimated that child health, behavioral, and educational outcomes would decline. Households would likely experience higher rates of poverty and diminished access to food due to the absence of the primary household earner. The HIA made several recommendations including that state child welfare plans include policies to promote reunification of children with parents and legal guardians who have been detained or deported; ensuring that the &#8216;Border Security, Economic Opportunity, and Immigration Modernization Act&#8217; includes components to allow for a direct, clear, convenient, and affordable path to citizenship; and reforming Department of Homeland Security programs and policies to protect the health and well-being of children whose parents or primary caregivers are undergoing detention or deportation proceedings.
Human Impact Partners collaborated with a nationwide group of advocacy, community organizations and academic researchers to complete the HIA.

&#8211;
This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Family Unity, Family Health: Federal Immigration Policy Reform

The Governor of California proposed a budget for FY 2007/2008 that included provisions to reallocate $1.3 billion in gasoline sales tax revenue that had been targeted for transit operations, maintenance, and capital projects to other statewide programs. The HIA examined how the proposed cuts to transit funding could impact public health through air, water, and noise pollution; economics, land-use, physical activity, discretionary time, and social capital. The HIA noted that the proposed cuts would have unpredictable impacts on California&#8217;s complex public transit systems and predicting health impacts is difficult. For smaller agencies that lack other resources to make up the funds and for transit-dependent populations, such as children, seniors, and low-income and disabled persons the impacts could be significant.

<h3>Outcome</h3>
On August 21, 2007 the California State Legislature approved a budget for fiscal year 2007 that included the Governor&rsquo;s proposed re-direction of $1.3 billion in transportation &ldquo;spillover&rdquo; funds to the State&rsquo;s General Funds.

&#8211;
This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Mass Transit Funding in California

Human Impact Partners, together with WISDOM and EX-Prisoners Organizing, conducted an HIA on the health impacts of Wisconsin&rsquo;s revocation system on individuals and families. Revocation is re-incarceration for violating parole, probation, or extended supervision. It often does not result in a new criminal conviction.
The HIA team reviewed literature and data from the Wisconsin Department of Corrections, interviewed staff by phone and email, held focus groups, and interviewed people who had been incarcerated and their families. In reviewing data, the team found that 30 percent of those incarcerated for a revocation during 2015 in Wisconsin had not been convicted of another crime. Forty percent identified as black, but blacks comprise only 6.6 percent of Wisconsin&rsquo;s population, suggesting a significant inequity. The HIA also found that almost half of those incarcerated for a revocation without a new criminal conviction that year were parents. Wisconsin has at least 18 and as many as 23 rules with which a person on standard parole, probation, or extended supervision must comply, but the specificity of these rules varies. Many leave room for wide interpretation by agents enforcing them. Moreover, the investigations and additional time spent in prison can harm a person&rsquo;s future employment and housing prospects&mdash;among the biggest factors for how successfully he or she will re-enter society. Time away from work jeopardizes a steady income and can lead to job loss, making it harder to pay for housing, childcare, and other basic needs. Focus group participants said that this creates a stressful situation that, along with the stigma of incarceration, creates a major barrier to re-entry and can hurt their health.
The HIA recommended that the state fully implement a 2014 &ldquo;short-term sanctions&rdquo; law, which will ensure that responses to parole violations and other noncompliance are consistent and racially equitable. It urged that responses be transparently documented through policy development, clear thresholds and rules under supervision, and workforce development. The Wisconsin Department of Corrections, it said, should provide access to rehabilitation programs as an alternative to revocation and ensure that people on parole, probation, or extended supervision successfully complete these programs. It also recommended that the state grant more due process rights during revocation investigations and proceedings.

&#8211;
This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Excessive Revocation in Wisconsin

Located in the Houston metropolitan area, Pasadena is the second-largest city in Harris County, Texas, and is near two of the four largest refineries in the U.S. Pasadena’s Code of Ordinances states that the director of planning should coordinate the development of a city plan that covers multiple years. The HIA provided recommendations to the director and the city as they developed the plan, which will ultimately guide land use, mobility, and other decisions that could affect health.
Researchers determined that developing multifamily housing on vacant lots could produce health benefits associated with greater population density, including more walking and other physical activity among residents and better air quality. However, the authors noted that living in multifamily housing can result in stress and other negative mental health outcomes, depending on the building’s design and neighborhood satisfaction. Furthermore, developing the city’s vacant lots would play a minimal role in alleviating concentrated poverty. The researchers recommended that the planning department partner with stakeholders to convert some vacant lots to green spaces, small parks, mixed-use developments, or commercial developments. Other recommendations included partnering with the Pasadena Police Department to develop a Crime Prevention Through Environmental Design program for multifamily housing developments; prohibiting new multifamily housing developments near Superfund sites and other places with environmental hazards; and encouraging mixed-use development.
Harris County Public Health and Environmental Services collaborated with the Pasadena Planning Department and other key stakeholders, including Air Alliance Houston and community residents, to conduct the HIA. The HIA will also be included in a comparative analysis to examine the capacity for HIA across levels of local government in the region.

<h3>Outcome</h3>
Because of municipal leadership changes that occurred after the HIA’s release, the final comprehensive plan has been delayed. However, Harris County staff noted that the relationship between Pasadena officials and the county health department is stronger after participating in the HIA process, as demonstrated by their collaboration on a Safe Routes to School plan. Pasadena also applied for and received a Houston-Galveston Area Council livable centers planning study grant.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Healthy Planning in Pasadena, Texas

This rapid health impact assessment (HIA), produced by a team of University of Washington graduate students, identifies potential health concerns and action items as the Seattle Department of Transportation (SDOT) launches a multiyear effort designed to improve infrastructure in the area surrounding King Street Station in the Pioneer Square and Chinatown-International District neighborhoods.
The King Street Station Multimodal Hub (KSSMH), just south of downtown Seattle, takes its name from the array of transportation options that serve the site, including intercity trains, local and regional bus service, light rail, and, in the future, a streetcar. The KSSMH area also encounters heavy use by pedestrians, cyclists, general vehicle traffic, and freight. However, the dispersed nature of these various transportation options makes the area challenging to navigate. This HIA&#8217;s quarter-mile study area straddles two distinct but similarly historic neighborhoods: Pioneer Square and Chinatown/International District. Both neighborhoods feature clusters of restaurants, cafes, food markets, shops, galleries, and cultural activities, as well as social services organizations, housing, and major employers. The neighborhood&#8217;s residents are more racially diverse, generally older, and less affluent than Seattle as a whole, according to the 2000 U.S. Census. In addition, the area serves thousands of commuters and visitors not captured by the census data.
Through meetings with relevant stakeholders, SDOT developed nine consensus goals for the KSSMH project. This HIA focused primarily on two of those goals: (1) build a lid over the openings at street level above railroad tracks and (2) Restoring the street grid pattern of the area by closing the 2nd Avenue Extension.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

King Street Station Multimodal Hub

The City of Spokane is redeveloping the Division Street Gateway, a little over a mile of State Highway 2 that runs through the heart of downtown Spokane from its inception at Interstate 90 to its intersection with the Spokane River and north to the Gonzaga University neighborhood. This is essentially the city&rsquo;s front door and living room, leading to the central business district, civic buildings, and Riverpoint Campus in the University District, home to five university branches. In addition to other safety and aesthetic deficits, this area experiences a relatively high level of bicycle and pedestrian accidents compared to other major streets in downtown Spokane. Together with the City of Spokane, other local organizations and city officials, the Spokane Regional Health District conducted an HIA to measure the potential health impact of the construction plan. The topics studied were transportation, safety, physical and mental health, social cohesion, economy, built environment, and natural environment. Data and recommendations were presented at informational meetings with the development consultant and city planners. The HIA is hoping to inform the final development plan and presented HIA findings at a City Council meeting in mid-2012. The findings are that the Division Street Gateway Project design will improve east-west connectivity for pedestrians and cyclists, enhance Spokane&rsquo;s visual image, and provide safe and effective transportation for all modes.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Division Street Gateway

The Vermont Department of Health and key stakeholders conducted an HIA of the potential effects on the health of Vermont residents of regulating and taxing adult marijuana use. To evaluate possible impacts, the study team examined lessons learned from tobacco and alcohol policies that could be replicated to protect and improve health in a regulated marijuana market. Key takeaways include:
<ul>
<li>Smoke-free policies reduce secondhand smoke, increase the number of people who quit smoking, reduce tobacco initiation rates, and reduce tobacco-related morbidity and mortality. Vermont&rsquo;s smoke-free laws do not cover the use of marijuana.</li>
<li>Limiting access to alcohol and tobacco reduces use. This has been achieved by:
<ul>
<li>Controlling the number of stores that can sell a substance within a certain area. </li>
<li>Restricting the type of outlets that can sell tobacco.</li>
<li>Limiting the times of day that alcohol can be sold.</li>
<li>Raising the age at which a person can purchase alcohol or tobacco.</li>
</ul>
</li>
<li>Increasing taxes, establishing minimum price laws, and prohibiting price discounting reduce the amount of alcohol or tobacco people use. </li>
<li>Allowing local control over outlet density and advertising contributes to a culture of health in the community, even though people can easily travel from one town to another.</li>
<li>Restricting the age of legal alcohol purchase to 21 or older decreases motor vehicle accidents, delays initiation of use, and reduces overall use of alcohol. </li>
<li>Child-resistant packaging saves lives.</li>
<li>Limiting advertising can reduce youth initiation and use. Prohibiting self-service displays, internet sales, free samples, mass media advertising, and flavored products can lower youth tobacco use. </li>
<li>Enforcing these policies vigorously is effective in keeping alcohol and tobacco out of the hands of youth. </li>
</ul>
<h3>Recommendations</h3>
<ul>
<li>The HIA offered the following recommendations should Vermont decide to regulate and tax recreational marijuana: </li>
<li>Ensure that critical staff are hired, regulations and rules are in place, and testing infrastructure is built and functioning before allowing production, distribution, or retail of marijuana products. </li>
<li>Expand and enhance tobacco laws and regulations to include the use of tobacco, marijuana, all smoke delivery systems, and tobacco substitutes. </li>
<li>Do not allow use of marijuana in public places. Ensure that children and youth are not exposed to marijuana use or secondhand smoke.</li>
<li>Fully fund enforcement and oversight. </li>
<li>Standardize and test packaging and potency. Ensure that THC concentration regulations, particularly those relating to packaging, labeling, and testing, are in place before implementation. </li>
<li>Prohibit retail sales of marijuana-infused products for nonmedical purposes.</li>
<li>Set an active-THC blood-level limit for operating a motor vehicle based on the best available evidence.</li>
<li>Implement a public education strategy about the dangers of driving under the influence of THC. </li>
<li>Expand screening for substance use disorders and mental health problems and trauma in primary care.</li>
<li>Consider implementing statewide buffer zones for the sale of marijuana around areas such as playgrounds, schools, and colleges. </li>
<li> Fund surveillance and research efforts to monitor frequency of use and types and potencies of marijuana used by Vermont residents of all ages.</li>
</ul>

<h3>Outcome</h3>
Vermont legalized possession but not the sale of marijuana. The Legislature may consider a full taxation and regulation system in the future.

&#8211;
This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Marijuana Regulation in Vermont

The purpose of this HIA was to inform policy decisions related to the placement and maintenance of community gardens in Knox County Tennessee. The HIA was used to educate policy makers about why certain communities might be better suited for a gardens. Although zoning can have a major effect on the placement of community gardens, not all zoning codes will support the placement of a garden, especially within city limits.

<h3>Outcome</h3>
Upon presentation of the HIA report, the zoning was changed to support the placement of gardens in designated areas of Knox County.

This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Knox County Health Department Community Garden

Between 2011 and 2014, the Oregon Health Authority Public Health Division conducted three health impact assessments (HIAs) on elements of Portland Metro’s Climate Smart Communities planning project. The Portland metro regional government requested the HIAs to ensure that decision-makers had access to public health evidence and best practices as they shaped and approved a greenhouse gas reduction plan for light-duty vehicles.
This HIA found that the plan’s proposed strategies would have significant health benefits for the Portland metropolitan area, including increased physical activity, fewer traffic injuries, and reduced exposure to air pollutants. Because residential density, mixed-use development, and safe streets with sidewalks are associated with active transportation, the investments outlined in the plan would support healthy behaviors. The report also highlighted the importance of developing affordable housing options in areas connected to public transit.

<h3>Outcome</h3>
Development and adoption of the strategy was completed in three phases. As part of phase one, Metro staff worked with partners, including the Oregon Health Authority, to research strategies used to reduce emissions in communities around the world. This work resulted in a toolbox describing the range of potential approaches, their effectiveness in reducing emissions, and their other potential benefits. In phase two, Metro worked with regional technical and policy advisory committees and business and community leaders to craft three approaches and criteria to evaluate them. In phase three, the council adopted the Climate Smart Strategy with broad support from local and state government partners.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Community Climate Choices

Transportation produces 25% of the Portland, Oregon Metro region&rsquo;s greenhouse gas (GHG) emissions, contributing to a warming climate that could severely impact our health and quality of life. Our climate is already changing, and the way we work together to prevent future changes will have both immediate and long-term impacts on our well being. Changes in policies and infrastructure could limit exposure to air and noise pollution, encourage us to be more physically active, and reduce traffic-related injuries and deaths. By understanding impacts, tradeoffs and unintended consequences, we can both reduce our greenhouse gas emissions and improve the health of everyone in our region.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Climate Smart Community Scenarios

This HIA, carried out by the Benton County Health Department, evaluated a series of policy-change scenarios to amend the existing county code for Accessory Dwelling Units (ADUs). ADUs are small, self-contained residential units that are built on the same lot as&mdash;and are secondary to&mdash;an existing single-family home. The HIA was intended to inform a community debate around the issue. Some of the health influences examined in the HIA include access to goods and services, social cohesion, healthy housing, transportation and mobility. The HIA recommended that an amendment be made to the existing ADU county code to allow dependent ADUs. However, it suggested a series of mitigation strategies that: 1) required the ADU resident be the home owner, a relative or caregiver; 2) did not allow the ADU to be used as a rental property; 3) capped the number of ADU permits allowed each year; and 4) required a regular review of the policy to minimize the occurrence of any unintended consequences.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Benton Accessory Dwelling Units

In March 2012, project partners received funding from the Michigan Department of Community Health Division of Environmental Health to conduct a Health Impact Assessment (HIA) of alternative development scenarios in the Michigan Street Corridor. The project is part of a larger effort funded by the Michigan State Housing Development Authority and the U.S. Department of Housing and Urban Development&rsquo;s Sustainable Communities Program. The funding for this HIA comes from a grant awarded to the Michigan Climate &amp; Health Adaptation Program from the Centers for Disease Control &amp; Prevention (CDC) Climate Ready States and Cities Initiative.
The proposed changes to the Michigan Street Corridor aim to advance housing, economic and community development, transportation, and environmental outcomes to ensure a sustainable future for Grand Rapids and the West Michigan region. The HIA looked at health issues including asthma and air quality, personal injury, obesity, and socioeconomic inequity.
The HIA made several recommendations for the project that would likely have the greatest positive impact on health. The HIA recommended that the redesigned street accommodate all modes of transportation, and enhance mobility for individuals with disabilities. The HIA also recommended that mid-block crossings for pedestrians be provided as neighborhoods become less dense and that affordable housing along the corridor be prioritized, especially for those that work in the corridor.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Michigan Street Corridor Plan: A Health Impact Assessment

In partnership with the Southeastern Regional Planning &amp; Economic Development District (SRPEDD) and Fall River Mass in Motion, the Metropolitan Area Planning Council conducted an HIA that examined the proposed Phase 2 of the Quequechan River Rail Trail (QRRT) project in the City of Fall River, Massachusetts. Phase 1 of the project was one mile of trail in Fall River&rsquo;s Flint and Maplewood neighborhoods. Phase 2 is a 1.6 mile extension, connecting the existing section of the QRRT to downtown Fall River. The HIA examined the potential health impacts associated with constructing Phase 2, focusing on physical activity, economic development and air quality. The proposed trail extension runs through densely populated areas, providing increased opportunities for residents to be physically active and likely reducing health disparities in Fall River. The extension will also likely provide a boost to local businesses and increase home values, positively affecting health outcomes associated with socioeconomic conditions. Walking or biking trips on the QRRT are likely to replace a number of car trips in Fall River, resulting in improvements in air quality. The HIA also made several recommendations for the engineering, design, and maintenance of the trail and to improve overall city and regional connectivity by utilizing the trail. Recommendations include: trail lighting to be used during non-daylight hours; include a long-term maintenance plan to encourage a positive image of the trail; and add bicycle infrastructure in and around the Fall River downtown business and commercial areas to help attract QRRT users.

<h3>Outcome</h3>
To improve pedestrian and cyclists&#8217; safety, the HIA suggested that the Quequechan River Rail Trail incorporate visible signage and traffic calming elements at trail crossings. The HIA also recommended the addition of bicycle infrastructure in and around Fall River&#8217;s downtown business area to increase the use of bicycle share programs. The HIA fostered connections between stakeholders in the transportation sector and those who are concerned about health, equity, and social determinants of health. Construction of the trail was completed, and the trail was opened to the public, in August 2016. Funding has been allocated for Department of Community Maintenance staffing to manage maintenance on all trails.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Quequechan River Rail Trail Phase 2

This HIA, conducted by Health Resources in Action, examined the impacts of a proposed multi-use development of land parcels in Boston&rsquo;s Dorchester Codman Square neighborhood. The Codman Square Neighborhood Development Corporation (CSNDC) was considering potential uses of the adjacent land parcels at 100 Ballou Avenue. The HIA examined the potential uses of the parcels as they related to impacts to chronic health conditions like obesity and heart disease, mental health, and rates of injury. The HIA determined that the proposed development of a tot lot, teaching and production gardens, and a learning and teaching kitchen would have positive impacts on health. In particular, the development would likely improve physical activity, social interaction, and social cohesion. The HIA also provided recommendations to the CSNDC to improve development of the lots, including:
<ul>
<li>Use Active Design principles for the Tot Lot to promote physical activity and social interaction</li>
<li>Install safe ground cover for the Tot Lot to prevent injuries</li>
<li>Make raised garden beds to avoid growing food in contaminated soil</li>
<li>Partner with local gardening and cooking organizations to learn best practices and hold events/programs to promote social interactions</li>
</ul>
The HIA also included recommendations for ongoing monitoring of the site.
This HIA was supported through funding from the Massachusetts Department of Public Health through the Centers for Disease Control Health Community Design Initiative.

&#8211;
This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Oasis on Ballou Mixed-Use Development

The Louisville Metro Department of Public Health and Wellness, IDEAS xLab, and the Commonwealth Institute of Kentucky conducted an HIA to examine how implementing Project HEAL could affect health in the Smoketown neighborhood of Louisville, Kentucky. Project HEAL is a community development model that uses arts and culture activities to increase civic engagement and drive equitable policy change. The HIA examined potential changes to social isolation and cohesion, civic engagement in policymaking, educational achievement, economic well-being, and the physical environment as a result of three initiatives: One Poem at a Time, an effort to limit negative advertising in low-income communities; Hero+Shero Journeys, an environmental justice program at a local middle school; and HOPEBOX (also known as Smoketown Laundry), a full-service laundromat, community center, and local business incubator for worker-owned co-ops in the health sector.
Using baseline health data from the federal Centers for Disease Control and Prevention and Center for Health Statistics, a literature review, and community feedback gathered through arts and culture activities, the HIA found that the primary health benefit of Project HEAL would be increased social cohesion and improved mental health outcomes. Other potential benefits include enhanced academic performance, better environmental health, and increased opportunities for economic well-being.&nbsp;

<h3>Outcome</h3>
The Project HEAL and HIA processes increased community cohesion and engagement in Smoketown, which helped ensure that the Louisville Metropolitan Sewer District (MSD)&rsquo;s new 16.7 million-gallon sewer overflow basin was built underground, with a grassy park on top, rather than above-ground as originally planned. Smoketown residents wrote letters and attended public meetings for a full year encouraging MSD board members to revise the plans. The ribbon cutting was Dec. 15, 2017.
Through the One Poem at a Time initiative, inspirational pictures and quotes from Smoketown residents replaced cigarette, alcohol, and payday loan advertisements on billboards throughout the neighborhood. When those rentals ended, the Louisville Metro Department for Public Health and Wellness diabetes prevention program purchased seven billboards highlighting access to healthy foods in Smoketown. Using data from the HIA, neighborhood leaders spoke out when three new liquor stores applied for licenses within the 1.2-square-mile community, and all three licenses were denied at the local level. Two appealed to the state: One was denied, and the second changed its plans and became a grocery store. Smoketown leaders and Project HEAL representatives are continuing their discussions with the city council about ordinances to limit negative advertising and alcohol outlet density in low-income census tracts.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Project HEAL (Health.Equity.Art.Learning)

With funding from St. Luke’s Foundation, Vitruvian Planning and the Eagle (Idaho) Parks and Recreation Department conducted an HIA to understand how the city’s Pathways and Trails Plan might influence the health of area residents.

Recommendations
<ul style="list-style-type: disc">
<li>Focus on areas with the highest socio-economic need for bicycle paths, pedestrian trails, and accessible green spaces when selecting sites for the first projects.</li>
<li>Ensure that future developments include appropriate sidewalks, pathways, easements, and connections to the greater trail network.</li>
<li>Tailor programming such as bike clinics, safety campaigns, horseback rides, and promotional events to the characteristics and health priorities of nearby residents. </li>
<li>Explore the trail system’s potential to improve access to health care, food outlets, community gardens, and healthy housing.</li>
<li>Enhance isolated trail segments by incorporating features such as water stations, shade trees, and sunblock stations and ensure cellphone service for emergency communication.&nbsp;</li>
</ul>

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Eagle Pathways and Trails Plan

The Center for Quality Growth and Regional Development conducted an HIA, funded by a grant from the Health Impact Project, to inform the Cargo Atlanta Citywide Freight Study, which developed policies to facilitate efficient freight movement in and around the city. The HIA examined the potential health implications of various policies, including diesel emissions standards, traffic patterns, and employment, which can affect respiratory and cardiovascular disease, injury rates, and general health.
Under the same grant, the center collaborated with the Atlanta Regional Commission to establish a statewide framework for factoring health considerations into freight planning, with an emphasis on disproportionate impacts on low-income communities and people of color. To encourage future use of the framework in public decision-making about freight, the center provided technical assistance to university, government, and nonprofit entities and piloted the framework in this HIA and a second one that it conducted on the&nbsp;Coastal Region Metropolitan Planning Organization Freight Transportation Plan.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Cargo Atlanta Citywide Freight Study

This health impact assessment, or HIA, will inform the 2015 Georgia Qualified Allocation Plan for low-income housing tax credits. The plan is required each year as the Internal Revenue Service allocates housing tax credits to state agencies, which then award the credits to developers of qualified projects. The HIA, conducted by the Georgia Health Policy Center, will focus on the proposed criteria for allocating the tax credits and consider how these criteria will affect health through the effects of decisions on housing for vulnerable populations and community development. The project will focus on engagement by the Georgia Department of Community Affairs, real estate developers, state regional commissions, community representatives, and relevant federal agencies to build support for implementation of HIA recommendations.

&#8211;
This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Georgia Qualified Allocation Plan for Low-Income Housing Tax Credits

The Fulton County, Georgia, Department of Health Services conducted a rapid HIA of the Fulton Industrial Boulevard Framework, a redevelopment plan to revitalize an area of unincorporated south Fulton County in Atlanta. The plan includes transportation and freight improvements and changes the land use in the corridor, which was a center of industrial development in the 1950s and 1960s. 
The HIA used surveys, community meetings, phone, and e-mail outreach to determine health priorities for community members and business leaders. As a result, the HIA focused on the potential health impact of increased air pollution related to widening Fulton Industrial Boulevard and increased vehicular capacity.
The HIA recommended effective roadway design, taking into account pedestrian safety and anticipated increased traffic capacity. It also recommended that area and regional transportation plans be enhanced to improve transit opportunities and promote alternative modes of transportation along the corridor.&nbsp;

&#8211;
This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Fulton Industrial Boulevard Framework

The HIA addressed the health effects of zoning provisions on the nearby residents&#8217; nutrition, physical activity and social cohesion during the interim-use phase of a major redevelopment and new land use plan for Atlanta&#8217;s Fort McPherson&#8217;s Base Realignment and Closure (BRAC) process. The zoning provisions that govern permitted uses of land, green space and transportation were analyzed to gauge their effect on nutrition, physical activity, alcohol consumption, tobacco use and social connections. Potential changes in these factors&mdash;which are known to influence health&mdash;were considered and predictions about the risk of health outcomes, such as cardiovascular disease, diabetes, obesity, mental health and cancer, were put forth. The HIA recommended allowing community gardens in green space and areas within &frac14; mile of schools, senior housing, transit stations and adjacent neighborhoods; allowing use of selected, accessible, existing buildings for community meetings; and limiting fast food restaurants or prohibiting their development near areas where children congregate.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Fort McPherson Interim Zoning

The Georgia Tech Center for Quality Growth and Regional Development conducted a rapid health impact assessment (HIA) on the Decatur, Georgia, Community Transportation Plan, focusing on potential health impacts of transportation and patterns of land use on safety, social connections, and physical activity. The HIA found that the plan could lead to a slight reduction in car use and associated health problems, such as injuries and obesity. Additionally, the increase in biking and walking in the city would raise physical activity levels and offer more opportunities for social interaction.
To best leverage the potential health benefits of new transportation and land use&nbsp;patterns, the HIA recommended developing a community-wide campaign to promote physical activity, partnering with local schools to encourage childhood physical activity, ensuring that intersections comply with the Americans With Disabilities Act and are easily accessible, emphasizing the mobility of Decatur&#8217;s most vulnerable populations, and prioritizing connectivity throughout the city.

<h3>Outcome</h3>
After completion of the Community Transportation Plan, the City of Decatur created an Active Living Division to provide support services that contribute to the quality of life of its citizens.

&#8211;
This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

City of Decatur Community Transportation Plan

An HIA that examined the expected health benefits of proposed highway design changes (e.g., reducing lanes, adding sidewalks, medians, bike lanes and on-street parking) to the Buford Highway Corridor.&nbsp; Special emphasis was placed on the potential impacts on physical activity and pedestrian injuries.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Buford Highway and NE Plaza Redevelopment

The first-ever HIA on a major metropolitan transportation and comprehensive growth plan will be led by the Center for Quality Growth and Regional Development (CQGRD) at the Georgia Institute of Technology&#8217;s College of Architecture. Plan 2040&mdash;which is being conducted by the Atlanta Regional Commission, the local intergovernmental-coordination agency&mdash;integrates multiple aspects of regional planning, including transportation, land use, water and air quality, housing and greenspace through the year 2040. CQGRD will examine the plan&#8217;s potential impact on a range of health issues, such as injury and asthma rates, and the risks of obesity and diabetes.

&#8211;
This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Atlanta Regional Plan 2040

This HIA was a collaborative effort of the Center for Quality Growth and Regional Development (CQGRD), a research center of the Georgia Institute of Technology&#8217;s College of Architecture and staff at the Centers for Disease Control and Prevention. Focused on the planning process for the Atlanta Beltline—a major public transit, trails, parks and urban-redevelopment project—the HIA addressed a wide range of health issues, including opportunities for physical activity and social interconnectedness; safety; access to healthy food; and environmental issues, such as air and water quality. Some of the recommendations included: 1) making health promotion a consideration in the prioritization and timing of public funding by developing a mechanism to consider health impacts throughout the entire project; 2) appointing public health experts to decision-making bodies; 3) establishing policies and programs to prevent displacement in areas surrounding the BeltLine Tax Allocation District (TAD); and 4) accelerating the implementation schedule so that the much-needed health benefits of the Beltline would be realized sooner.

<h3>Outcome</h3>
Due, in part, to the HIA, health has been prioritized in implementation through a Decision-Support Tool, Beltline board appointments and the mayor&#8217;s commitment to construct the BeltLine ten years ahead of schedule. Acknowledging the HIA&#8217;s overarching conclusion that the Beltline would offer important health benefits for Atlanta residents, the U.S. Environmental Protection Agency awarded a $1 million dollar grant to clean up abandoned industrial sites along the corridor and speed the development process.The city of Atlanta formed a police team to patrol the BeltLine&#8217;s greenspaces and has made other efforts to improve perceived safety-all recommendations in the HIA.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Atlanta Beltline

The Florida Department of Health in Lee County conducted an HIA of community-driven alternatives to the county&rsquo;s neighborhood connectivity plan for the Tice historic community. The HIA investigated the potential health implications of community connectivity and access to green space and schools in the plan. 
The report concluded that the plan stood to benefit the health and safety of residents and visitors by improving neighborhood connectivity and infrastructure for pedestrians and cyclists.&nbsp;
The HIA was supported by the National Association of County and City Health Officials.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Tice Community Connectivity and Redevelopment

MetroPlan Orlando, in partnership with the University of Central Florida and the Winter Park Health Foundation, conducted the first transportation HIA in central Florida. The state Route 50 Bus Rapid Transit HIA analyzed the potential effects of implementing bus rapid transit along 22 miles of SR 50 on the physical, social, and emotional health of residents through improved access to goods, services, jobs, and education; mobility through nonvehicular travel; and economic development opportunities. The study area extended through the heart of Orange County and two major destination points: downtown Orlando and the University of Central Florida. The study area included the Pine Hills neighborhood, the historic downtown neighborhoods, Union Park, and Azalea Park. Approximately 48 percent of Orange County residents depend on mass transit.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

State Route 50 Bus Rapid Transit

The City of Orlando, Florida recently acquired an additional two acres to expand Loch Haven Park, a 45-acre park established in the 1930s and home to many of Orlando&rsquo;s art and cultural institutions. The Loch Haven Park Improvement Plan was developed to take advantage of opportunities to improve park cohesion during this expansion, since many areas of the park were acquired and developed in a piecemeal fashion. The East Central Florida Regional Planning Council, with funding from the Winter Park Health Foundation, conducted an HIA of the Loch Haven Park Improvement Plan.
The HIA explored the potential impact on health through increased opportunities for physical activity, increased safety and perceived safety, and social capital. The improvement plan includes repairing and expanding pedestrian walkways; updating and improving lighting throughout the park; and increasing signage for wayfinding. The HIA found that implementing the proposed Loch Haven Park Improvement Plan would probably have positive effects on health.
The HIA also made recommendations to help maximize the potential health benefits. The HIA found that the improvement plan did not include specific widths for pathways to be improved. The HIA recommended that pathways be widened to account for two way pedestrian traffic, as well as multiple users (pedestrians and cyclists) during events in the park. The HIA also recommended that in addition to surveying and engineering new pathways, existing pathways should be surveyed to rectify impediments (such as utility poles) and ensure ADA compliance. The HIA also recommended incentives for employees and patrons to increase utilization of public transportation on SunRail and LYNX to decrease vehicle trips to the park. In addition to the wayfinding improvements already suggested in the improvement plan, the HIA recommended a central kiosk, to create cohesiveness among park amenities and provide a central location for park users.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Loch Haven Park Improvement Plan

Historically, U.S. Department of Housing and Urban Development policies have exposed people with a criminal history and their families to eviction and denial of housing. Human Impact Partners, in collaboration with the Ella Baker Center for Human Rights, conducted an HIA that assessed the health and equity impacts of public housing screening policies that exclude people with a criminal history, using the Oakland Housing Authority (OHA) in California as a case study. 
The HIA’s findings include:
<ul style="list-style-type: disc">
<li>Lack of affordable housing leads to poor health outcomes.</li>
<li>There is no evidence that presence of a criminal record is associated with inability to be a responsible tenant.</li>
<li>Myriad policies and practices have led to overrepresentation of people of color in the criminal justice system. Because of this, denial of public housing admissions based on a criminal record is a violation of the Fair Housing Act.</li>
<li>The OHA decreased denials of admission because of a criminal history in the first round of screening from a high of 12 percent in 2010 to as low as 0.8 percent in 2012. OHA did not explain the decline, but the HIA authors later found that the authority had been sued and forced to change its practices.</li>
<li>Among applicants who were rejected for housing because of a criminal history, 75 percent requested an informal hearing; of those, 64 percent had the decision reversed, allowing them to continue the application process. </li>
</ul>
The HIA’s recommendations include:
<ol>
<li>Allow mitigating circumstances to be presented as part of the initial application for public housing. This would decrease the time and human resources needed for informal hearings.</li>
<li>OHA should revise its policies and practices to allow people with a criminal history to join their families in public housing. OHA said it already was doing this, but anecdotal evidence suggested that people were still being denied.</li>
<li>HUD should require that public housing authorities track and publicly report data on the use of criminal histories in housing application decisions, including race and ethnicity of applicants, and do so in a consistent manner.</li>
</ol>

<h3>Outcome</h3>
The federal Equal Employment Opportunities Commission released guidance in 2016, stating that public housing authorities should no longer consider the existence of a criminal record as an eligibility criterion.
OHA pushed back on the report’s recommendations. The agency stated that it does not evict tenants who have a family member with a criminal record staying with them. OHA further said that tracking and reporting admission denial information by race would be too difficult and that it would only do so if ordered to by the federal government. Agency personnel saw no need to incorporate mitigating information in the initial application process and expressed concern that doing so might introduce bias against the applicant.
Human Impact Project’s partners, the Ella Baker Center and the Sargent Shriver National Center on Poverty Law, plan to use the HIA in other jurisdictions.

&#8211;
This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

The Long Road Home: Decreasing Barriers to Public Housing for People With Criminal Records

The San Francisco Department of Public Health Program on Health, Equity, and Sustainability, conducted a health impact assessment (HIA) to address increased heat vulnerability of coastal communities and overheating problems in a high-rise condominium building in San Francisco, California. The HIA focuses on how modern building trends, such as open-floor concepts and floor-to-ceiling windows, may increase heat vulnerability if compensatory cooling design elements are not also included in the building design. Due to the lack of official heat-related illness data, the project team conducted interviews, used San Francisco 311 complaint log data, analyzed publicly available data and user experiences on social media sites, and conducted a literature review.
The HIA found that residential buildings or housing codes in California do not yet provide an enforceable standard for maximum indoor temperatures but professional standards issued by the American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) dictate that the maximum indoor temperature should not be greater than 78-82 degrees Fahrenheit in the summer, depending on humidity. The HIA found that while high temperatures in the city of San Francisco ranged between 67 and 81 degrees Fahrenheit in September 2010, some units in a high-rise condominium building experienced indoor temperatures exceeding 90 degrees Fahrenheit for more than seven consecutive hours over a 3-day period.
The HIA recommended building design elements, such as purge ventilation and ceiling fans, and regulatory and/or code-based solutions and enforcement as part of a comprehensive strategy to mitigate the adverse effects of overheating in buildings.
This HIA was funded by the Centers for Disease Control and Prevention.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Overheating Buildings in Coastal Communities: Homes, Health Impacts, and Opportunities for Collaboration in San Francisco

Two options for the county&#8217;s General Plan Update were being considered: one that focused development in existing urban areas and another that would allow for the creation of new towns in the county. Some of the pathways and health issues explored included access to retail and services, preservation of agricultural land, community safety, water quality and availability, climate change and air quality. The HIA recommended: 1) focusing population growth and development in areas where there is existing urban development, infrastructure and municipal services; and 2) promoting higher residential densities in urban areas to align with the San Joaquin Valley Blueprint Project Preferred Scenario. The organizations that collaborated on this HIA provided the information as a letter to the Merced County Board of Supervisors.

<h3>Outcome</h3>
Though letters were sent to the Board of Supervisors and public comment favored the option of growth in already developed areas, decision-makers ultimately selected a development option that was not found by the HIA to be healthiest.

&#8211;
This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Merced County General Plan Update

The LA County Department of Public Health conducted an HIA to evaluate the potential health impacts of Measure H, a ballot initiative that would raise LA County&rsquo;s sales tax by one-quarter of 1 percent for a decade to fund programs designed by the LA County Homeless Initiative.
The HIA evaluated homelessness as a public health issue, examining three tiers of strategies proposed by Measure H: primary prevention, secondary prevention, and tertiary prevention.&nbsp; The assessment found that primary prevention, or targeting resources to people at greatest risk of becoming homeless, could yield important health benefits. However, the authors caution that this should not be a principal strategy due to the inherent challenge of identifying the target population. Because the population at risk of homelessness in LA County can have income and mental health service needs, the report found that this strategy would benefit from collaboration across LA County departments and links to appropriate services. Measure H&rsquo;s secondary prevention, or early intervention to prevent chronic homelessness, features two approaches: providing rapid re-housing and addressing transitions out of institutions. Although rapid re-housing is an effective short-term solution, the report found that participants may have trouble remaining stably housed in the long term. Meanwhile, evidence showing the benefits of greater collaboration between the criminal justice system and mental health/substance use disorder professionals supports services inside jails that are proposed in Measure H. The report found that these services, along with the measure&rsquo;s plan to fund short-term transitional or &ldquo;bridge&rdquo; housing programs, would help to reduce recidivism and likely increase rates of permanent housing among homeless people exiting institutions. Finally, Measure H&rsquo;s key tertiary prevention strategy&mdash;an intervention to address chronic homelessness&mdash;is permanent supportive housing. This strategy uses stable housing as a foundation for aiding recovery and has been shown to reduce hospitalization and emergency room visits.
The report advocates cross-cutting interventions, or policies and programs that have a measurable impact on two or more of the prevention tiers described above.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Measure H: Preventing and Reducing Homelessness in Los Angeles County

The Sequoia Foundation, in collaboration with the California Department of Public Health and the Public Health Institute, conducted an HIA to provide recommendations to the California Water Board on criteria used to determine funding for drinking water projects, and work to standardize the use of HIAs among California agencies. The state annually revises its drinking water project priorities for the year. Data-driven decisions about funding allocations can improve access to safe and reliable drinking water, especially in rural communities that lack advanced infrastructure.
The HIA team issued two recommendations to the California State Water Resources Control Board: to put a water pricing structure in place that is affordable for low-income consumers but encourages water conservation, and to develop communications plans to inform the community about how consolidating water systems will affect water costs and quality. Recommendations from the HIA will inform future California water resource policies as the state continues to combat a severe drought. Additionally, with funding from a Health Impact Project program grant, the organizations provided training opportunities, HIA resources and tools, and technical assistance for state and local agencies, with a particular emphasis on collaboration among members of the California Health in All Policies Task Force.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

California Drinking Water Project Funding

The School of City and Regional Planning at the Georgia Institute of Technology conducted a rapid HIA to support healthy development in North Birmingham, Alabama, through implementation of the North Birmingham Community Framework Plan. The goal of the plan, created in conjunction with the first comprehensive plan update in 50 years, is to enhance the quality of life for residents through changes to land use, new development, transportation, housing, parks, trails and open spaces, utilities, and economic development. The HIA examined potential health impacts related to employment, healthy food, health care, connectivity, and freight, which were selected as areas of focus by the HIA steering committee and North Birmingham Community Coalition with input from the HIA practitioners.
The HIA found that overall, implementing the framework plan has the potential to improve health in North Birmingham. The final HIA report made recommendations to maximize health benefits, including incorporating economic development and labor force policies into the Regional Comprehensive Economic Development Strategy, offering day care options for North Birmingham Community Residents, expanding the current fresh produce food truck program to all of North Birmingham, and establishing a local health care facility to serve the medical needs of the community. To increase connectivity, the HIA recommended reviewing transit routes throughout North Birmingham and redirecting routes to create an integrated transit system that will provide greater access to important locations inside and outside of the neighborhood. The HIA also suggested traffic calming at key intersections and along roadways with high incidences of car, pedestrian, or bicycle injuries and completing the Finley Boulevard Extension Plan and Shuttlesworth Bridge Pedestrian Flyover.
This project was funded by the Regional Planning Commission of Greater Birmingham.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

North Birmingham Community Framework Plan

Human Impact Partners conducted a rapid HIA of a proposed ordinance in Milwaukee that would allow workers to earn one hour of paid sick leave for every 30 hours of paid work, up to 72 hours of leave in companies with more than 10 employees and 40 hours in firms with fewer than 10 employees. 
The HIA found that only 15 percent of U.S. workers in food preparation and services industries have paid sick leave and that 93 percent of outbreak-related foodborne illness in Wisconsin between 2003 and 2007 occurred in places where food was prepared or served by workers, including restaurants, catered events, schools, recreational facilities, prisons, and nursing homes. In Milwaukee County, 302 cases of outbreak-related foodborne illnesses occurred during this period and 47 percent of Milwaukee&rsquo;s private sector workforce lacks paid sick leave. Focus group participants identified income loss and the threat of job loss as the primary reasons for continuing to work through a personal or family member illness.
The HIA concluded that the health of all Milwaukeeans would benefit if the ordinance passed and workers earned paid leave to use for a personal illness or to care for a family member.

<h3>Outcome</h3>
The ordinance passed with almost 70 percent of the vote.

&#8211;
This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Milwaukee Paid Sick Days

The Seattle and King County Public Health Department, in collaboration with the Puget Sound Clean Air Agency, conducted an HIA to evaluate the health impacts of the State Route 520 bridge replacement and HOV project. The HIA focused on several pathways and health issues including air quality, carbon emissions, traffic injury and opportunities for physical activity. The HIA made several recommendations to reduce the negative effects on air quality including that new or retrofitted diesel powered construction vehicles and equipment be used during the construction phase. The HIA also recommended that connected walking and bicycling facilities be installed throughout the corridor to promote physical activity.

&#8211;
This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

State Route 520 Bridge

This HIA will inform the Environmental Protection Agency’s (EPA) selection of a cleanup plan for the Lower Duwamish Waterway Superfund site in Seattle. EPA will announce its Proposed Cleanup Plan in 2012, and a Final Plan in 2013. The HIA will be conducted by the University of Washington with two nonprofit organizations, Duwamish River Cleanup Coalition/Technical Advisory Group (DRCC/TAG) and Just Health Action. DRCC/TAG is EPA’s designated Community Advisory Group for the site.Key health issues that the HIA will address include consuming contaminated seafood, air and soil pollution, as well as concerns such as construction noise, traffic safety, and access to goods and services in the neighborhoods surrounding the site during and after the multiyear cleanup period. The affected populations include two predominantly low income and minority neighborhoods and two federally recognized tribes that fish on the river.Responsibility for implementing the cleanup plan will lie largely with the Port of Seattle, City of Seattle, King County, and The Boeing Company. The three public parties have expressed strong support for the HIA and intend to participate in its conduct. HIA findings and recommendations could influence EPA’s selection of a cleanup alternative, as well as the implementation of additional measures by Seattle, King County, the Port of Seattle, and The Boeing Company.The Mayor and Seattle City Council wrote a letter making recommendations for the cleanup based on issues raised by the HIA.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Lower Duwamish Waterway Superfund Site

The Clark County Community Planning Department in Vancouver, Washington, developed a Sub-Area Plan to revitalize Highway 99 and surrounding neighborhoods. Clark County Public Health conducted an HIA, which was included in the plan. The HIA explored the plan&#8217;s potential effects on several health issues, including access to healthy foods, opportunities for physical activity, reliance on motor vehicles, and the five leading causes of death in Washington: cancer, heart disease, stroke, respiratory disease, and accidental injury. 
The HIA recommended prioritizing affordable housing; enacting a living wage ordinance; developing centralized mixed-use districts (areas offering housing, commercial services, and recreational opportunities); implementing strategies to address pedestrian and bicycle safety, air pollution, and noise; and increasing healthy food outlets, access to parks and green space, traffic calming measures, and strategies to decrease crime and improve community safety.

<h3>Outcome</h3>
The revitalization plan was adopted in December 2008. Policymakers embraced some of the recommendations, such as promoting areas of development that would include services and stores close to neighborhoods. As a result of the HIA, the Clark County Board of Commissioners and Board of Health have begun to embrace a planning model that incorporates broader health considerations, inviting the health department to participate early in the planning of new projects.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Clark County Highway 99 Sub-Area Plan

Public health graduate students at Brigham Young University conducted an HIA to analyze the potential health effects of a bill proposed in the Utah Legislature to require prescribers to get prior authorization from an insurer for any opioid prescription that exceeds 90-morphine equivalents; for benzodiazepines prescribed to patients already taking opioids; and for new chronic opioid prescriptions (i.e., longer than 10 days in duration). This requirement would apply only to private insurance plans over which the state has jurisdiction, plans covering state employees, Medicaid, and workers’ compensation. The HIA predicted that if passed, the bill would reduce opioid prescribing and addiction rates and overdose-related deaths in the state.
<h3>Findings</h3>
Highly likely impacts: 
<ul>
<li>Increased time and cost for prescribers.</li>
<li>Higher patient stress and anxiety because of difficulty getting needed prescriptions.</li>
</ul>
Likely impacts:
<ul>
<li>Modest decrease in prescription of opioids.</li>
<li>Modest decrease in consumption of prescription opioids.</li>
<li>Modest decrease in number of persons addicted.</li>
<li>Increase in other substance misuse (heroin particularly).</li>
<li>Increase in crime and incarceration. </li>
</ul>
Plausible but not well-supported impacts: 
<ul>
<li>Higher patient pain tolerance.</li>
<li>Increased patient suicide.</li>
<li>Decreased addition to prescription opioids.</li>
<li>Increase in health care costs.</li>
<li>Increased productivity costs for pain specialists.</li>
</ul>
<h3>Recommendations</h3>
 To mitigate negative health outcomes, the study recommended that the policy be modified to exempt pain specialists, because although many of the prescriptions they write fall above the 90-morphine equivalent, they have special training in dealing with chronic pain and are more likely than other practitioners to prescribe opioids appropriately. This change also would help mitigate the significant increase in time and cost for pain specialists that would probably result from this policy. In addition, maintaining the pre-authorization requirement for general practitioners would probably increase patient referrals to pain specialists, helping to ensure that patients with chronic pain receive appropriate care. The HIA recommended that the Utah Legislature adopt the policy with this modification.

<h3>Outcome</h3>
The Legislature passed and the governor signed a version of the bill that reflected several of the findings and recommendations. However, the degree to which the HIA influenced the decision-making process is unknown.&nbsp;

&#8211;
This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Proposed Opioid Pre-Authorization Policy in Utah

Public health graduate students at Brigham Young University conducted an HIA to analyze potential health effects of the Utah Medical Cannabis Act (UMCA), a ballot initiative to legalize the use and production of medical marijuana in the state. The authors investigated how the UMCA might affect potential medical marijuana users, adolescents, economically disadvantaged individuals, and recreational drug users. 
The researchers collected information from stakeholders, quantitative data sources, and literature reviews, and used it to divide the impacts of the initiative into six categories of effects: chronic disease and pain management, recreational marijuana use and abuse, the opioid crisis, economic stability, road safety, and use of other substances.
To mitigate adverse effects and maximize benefits, the HIA made recommendations in the following areas:
<ul>
<li>Qualifying conditions for medical marijuana use.</li>
<li>Regulations affecting state-level research.</li>
<li>Education of patients and physicians.</li>
</ul>

<h3>Outcome</h3>
Utah voters approved the ballot initiative in November 2018, and state lawmakers then passed H.B. 3001, the Utah Medical Cannabis Act, on Dec. 3, effectively replacing the ballot proposition. The HIA&rsquo;s impact is unknown.

&#8211;
This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Legalizing Medical Marijuana Through the Utah Medical Cannabis Act

The Clean Air Council, in partnership with the community, industry professionals, and academics, conducted a health impact assessment of a proposed Royal Dutch Shell natural gas and chemical processing complex in Monaca, Pennsylvania. The proposed facility is known as a &ldquo;cracker,&rdquo; which separates natural gas and chemical feedstocks into different compounds that are used primarily in manufacturing plastics.
Although the complex would have economic benefits for the region, the HIA said that plans need to address potential health impacts for air quality, noise and light pollution, increased construction-related traffic, economic impacts, quality of life impacts, and emergency management practices. The report recommended mitigating potential harms through fence-line monitoring, dust control plans, and educational investments in the community.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Ethane Cracker in Monaca, Pennsylvania

The U.S. Forest Service drafted an Environmental Impact Statement (EIS) on a proposal by Roca Honda Resources to develop and conduct underground uranium mining operations at Roca Honda Resources&#8217; mining claims in the Mt. Taylor Ranger District of the Cibola National Forest. Stakeholders expressed the greatest concern over water and cultural issues during the scoping process. The EIS explored the impacts of the proposed mining operation on many resources, including surface water, groundwater, air quality, cultural and historic resources, recreation, and transportation. The EIS identified potential short- and long-term impacts on each of the resources, and recommended appropriate mitigation actions. The EIS found that even after implementation of recommended mitigation actions, adverse impacts to several resources, including groundwater, cultural and historic resources, will likely remain.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Roca Honda Mine

The Douglas County Health Department conducted an HIA to inform connections between new real estate development and existing neighborhoods in the city of Omaha. Neighborhood connectivity is directly related to health outcomes such as increased physical activity, decreased injury, and reduced stress. The HIA identified health and safety issues that should be considered in decisions on street connections and assessed whether the resident engagement aspect of the development review process could be improved.
The HIA estimated probable health impacts from four neighborhood connection scenarios: no connection, pedestrian-bike path only, street connection without traffic calming, and street connection with traffic calming. It found that each scenario would have mixed effects on health. The HIA made recommendations to maximize the positive health impacts of connection decisions and identified two priorities: keep trips on the appropriate street for the specific trip (i.e., local trips on local streets and regional trips on arterials) and minimize speeding. The assessment also recommended establishing a threshold of traffic volume increase that would trigger traffic calming measures. The HIA encouraged developers and officials to engage residents while decision-making flexibility still exists and before developers submit formal applications to city staff.
With grant funding from the Health Impact Project, the county Health Department will also strengthen Build With Health, a collaboration of the department, the city of Omaha, and other partners that was created under a previous HIA grant from the Centers for Disease Control and Prevention. Build With Health will systematically integrate health and community engagement into the city’s overall neighborhood revitalization process, including its required National Environmental Policy Act review for housing projects. Part of this work will create and implement screening checklists that streamline the consideration of health early in the neighborhood redevelopment process.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Omaha Neighborhood Connections

The City of Billings, Montana, in conjunction with consultant firm AECOM, has created a 20-year master plan for the South Billings Boulevard Urban Renewal District (SBBURD). The South Billings Master Plan provides a set of goals that will guide land use, transportation development, community design, and capital improvements through 2032. The goal of the proposed South Billings Master Plan is to set a long-term course for creating a vibrant community in which residents can live, work, and go to school in neighborhoods that are strong, safe, prosperous, and connected. The HIA analyzed the plan’s potential to influence access to healthy foods, encourage mixed-use development through zoning changes, and improve transportation through road maintenance and construction of new sidewalks, bicycle paths, and hiking trails. 

<h3>Outcome</h3>
The South Billings Master Plan was passed by the city council on Feb. 27, 2012. The plan incorporated recommendations from this HIA as well as the Yellowstone County/City of Billings Growth Policy HIA.

&#8211;
This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

South Billings Master Plan

Human Impact Partners, working closely with ISAIAH&mdash;a faith-based coalition of more than 100 congregations&mdash;conducted an HIA to assess the potential health effects of a legislative proposal to cap annual percentage rates (APR) on payday loans and increase reporting requirements. The bill is expected to be introduced in the Minnesota Legislature in 2016. The HIA considered the regulatory provisions&rsquo; impact on individual financial and mental health status and family capacity to secure health-related resources and cope with stress. The average payday loan amount in Minnesota is $390, and borrowers earn an average of $30,000 a year. Given the cost of living and average APRs in the state, more than 8 in 10 borrowers are unable to repay on time.
The HIA found that payday lending storefronts are most likely to be located in communities with higher proportions of people of color, people with lower incomes, immigrants, and renters. Census tract analysis found that African-Americans are twice as likely to live within 2.5 miles of a payday lending storefront compared with all Minnesotans. The HIA also found that the majority of Minnesota counties with payday lending storefront operations rank in the bottom half of the state for health outcomes such as premature death and self-rated health.
The HIA recommended that the Minnesota Legislature cap interest rates and limit the number of times a loan can be rolled over. It also suggested that financial institutions such as banks, credit unions, and community-based providers invest in innovative ways to meet the need for affordable small-dollar loans, financial planning, savings, and credit-building services.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Payday Lending in Minnesota

This HIA seeks to inform decisions around the construction of a new jail and juvenile transition center in Muskegon County Michigan. The HIA will focus on environmental and social determinants of health including environmental hazards based on site selection, access to services and quality of those services, and unemployment. The HIA will determine likely effects on health outcomes including substance abuse, chronic disease and injuries from crime and violence.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Muskegon County Jail

The City of Worcester is beginning a comprehensive neighborhood revitalization strategy in the Union Hill area, a neighborhood that has experienced decline in recent decades. The Worcester Division of Public Health, along with the Massachusetts Department of Public Health and staff from the Worcester Office of Economic Development, will conduct a rapid health impact assessment (HIA) of the proposed strategy. Multiple city departments will be engaged in a collaborative format to address the range of needs in the community. The City anticipates that the final strategy can be refined and applied in other neighborhoods around Worcester over time.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

City of Worcester Union Hill Revitalization

This health impact assessment (HIA) addressed a Massachusetts-specific version of the federal Healthy Families Act. The pathways and health issues explored included: 1) the spread of communicable diseases, such as influenza and stomach flu through workers at restaurants, schools and nursing homes; 2) the income and stress-related impacts of loss of salary and employer retaliation for missing work; and 3) the potential effects on emergency room use and delayed medical care.
In 2006, Massachusetts became the first state to provide nearly universal health care. The overall uninsured rate for Massachusetts decreased to 2.6% in 2008. There are still a large number of preventable hospitalizations and emergency room visits in Massachusetts each year. There is no evidence that the number of these events is decreasing due to nearly universal health care in the state.
Through focus groups, the HIA found that workers are concerned regarding access to paid sick days and access to healthcare, delayed healthcare, and hospitalization; ability to care for dependents; infecting co-workers and customers; and overall feeling of not having basic rights as workers and feeling lack of trust from employers.

<h3>Outcome</h3>
The HIA received significant press coverage in Massachusetts and helped shift the policy debate to include health outcomes. One of the HIA authors testified before a joint committee of the Massachusetts House and Senate.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Massachusetts Paid Sick Days

In 2008, the City of Baltimore, Maryland launched a multiyear effort to comprehensively revise the city&#8217;s zoning code, which had not been updated for forty years. In order to help ensure that the revision considered the role zoning can play in creating healthier communities, a group of researchers at Johns Hopkins collaborated with the city health department to conduct a health impact assessment of the draft new code between October 2009 and September 2010. The project focused on some of the most pressing health issues facing the city: obesity, physical activity, nutrition and violent crime. The HIA recommended measures such as: 1) maintaining increased allowances for mixed use development (i.e., residential mixed with commercial), in order to allow residents to walk to needed services; 2) defining and offering zoning incentives for stores that carry healthy food, in order to increase access to healthy food options; 3) limiting the concentration of off-premises alcohol sales establishments, in order to prevent violent crime; 4) including Crime Prevention Through Environmental Design (CPTED) guidelines that help to create pedestrian-friendly environments and &#8220;eyes on the street,&#8221; in order to reduce crime; and 5) improving measures for communicating about zoning changes and setting criteria for evaluating suggested revisions to the code, in order to maximize transparency.

<h3>Outcome</h3>
The HIA made 36 recommendations. Fourteen of these recommendations were included in the first draft of Transform Baltimore.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Baltimore City’s Comprehensive Zoning Code Rewrite

The Kentucky River Area Development District (KRADD) and partners from Jenkins, Kentucky, conducted an HIA to describe the health, social, and economic development impacts of the Elkhorn Lake Improvement Project, which involves repairing and strengthening the dam built in 1912, removing invasive water lilies, and improving green space and recreational facilities. Elkhorn Lake serves as Jenkins&rsquo; water supply as well as a recreation area and focal point for the city.
The HIA sought to increase resident participation in planning for the project, develop new funding resources, inform the KRADD board and local and state decision-makers about the potential health impacts of the project, and support longer-term community development strategies to boost health. It produced the following findings and recommendations:
Dam safety: Because of possible structural deficiency, frequent low-level earthquakes in the area, and increased geologic instability, the HIA recommended creating Emergency Action Plans to prepare the community for a dam breach and flood.
Water quality: The HIA documented repeated historical increases in a variety of contaminants, although water quality remains within normal ranges. It also found that public confidence in the lake&rsquo;s water quality is mixed, probably influenced by Jenkins&rsquo; history as a coal town and awareness of water quality issues throughout eastern Kentucky. The HIA recommended developing mechanisms for improved customer notifications about water quality and safety. 
Park amenities: The existing park amenities around Elkhorn Lake include a few benches along the water&rsquo;s edge, a boat ramp, a small pier, playground equipment, a picnic area, a swimming pool, a softball field, and a restaurant. The pool is new, but other features, such as the playground equipment and connecting path, need repairs or upgrades. To improve opportunities for physical activity and social interaction, the HIA recommended that the city consider park enhancements a separate project and pursue independent funding, rather than tying it to the dam improvement activities and associated funding.
Community development: To jump-start community and economic development, the HIA recommends that Jenkins officials conduct a community-based strategic planning process to clarify short- and long-term goals and visions for the city.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Elkhorn Lake Improvement Project

The National Center for Medical-Legal Partnership (NCMLP) at Boston Medical Center conducted an HIA of a pilot program run by Illinois&#8217; largest electric utility, Commonwealth Edison. The project assessed the potential health effects of implementing &#8220;smart metering&#8221; technology in western metropolitan Chicago. Health effects included how these innovations could alter the risk of potentially life-threatening exposure to heat or cold if the new system allows customers&#8217; power to be automatically disconnected. The HIA also looked at the impact of energy prices on vulnerable populations, such as the elderly and low-income or disabled persons. The findings may serve as a model for understanding the potential impacts of more widespread implementation of the technology. NCMLP and the Chicago nonprofit, Citizens Utility Board, collaborated on the HIA, disseminated the findings and made recommendations to the Illinois Commerce Commission (ICC), the regulatory body monitoring the pilot program.

<h3>Outcome</h3>
After the HIA team provided testimony at a regulatory hearing, the Illinois Commerce Commission supported funding of a robust consumer education system, maintained the current system requiring a site visit for disconnection for non payment and that metrics&nbsp;designed to measure the impact of the technology on vulnerable populations be developed. These decisions were in line with recommendations in the HIA.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Advanced Metering Infrastructure

Vitruvian Planning LLC conducted a rapid HIA on behalf of Boise, Idaho, that analyzed the potential health effects of building a new library in the Bown Crossing neighborhood. The study examined the impacts of programming or services offered at the library, with a focus on youth and older adults, and of the location selection. 
<h3>Findings </h3>
The report determined that the library&rsquo;s site and planned layout would be likely to benefit the health of nearby residents and patrons. The proposed location is convenient to thousands of residents, situated near three elementary schools, two high schools, two main avenues, and three residential communities. The library plans include outdoor green spaces to promote social cohesion and emotional health, and bicycle racks and pathways to encourage access through active transportation. Furthermore, the facility is projected to attract visitors to the Bown Crossing area, potentially bolstering the community&rsquo;s economic health. 
<h3>Recommendations</h3>
<ul>
<li>Use indoor and outdoor spaces for library-organized activities.</li>
<li>Conduct direct outreach efforts to engage senior community members.</li>
<li>Continually seek feedback from library patrons and nearby residents to better design programming and services that meet their needs and interests.</li>
<li>Work with local health care providers to host outreach events, clinics, or other public health interventions.</li>
</ul>

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Bown Crossing Branch Library

Proctor Creek in the Atlanta metropolitan area has been placed on the impaired waters list because it does not meet state water quality standards for fecal coliform. The topography, prevalence of impervious surfaces in the watershed, and strains on the combined sewer system have contributed to pervasive flooding in the communities along Proctor Creek and created environmental, public health, economic, and redevelopment issues. 
 An HIA conducted by the U.S. Environmental Protection Agency examined impacts on the low-income, minority community within a half-mile of the proposed Boone Boulevard Green Street Project to address some of the community&rsquo;s needs. The HIA considered the project&rsquo;s potential effect on a number of health determinants, including water quality, flood management, climate, air quality, traffic safety, nature contact, noise exposure, accessibility, crime, social capital, and household and community economics. Key recommendations included ongoing community engagement in all phases of the Boone Boulevard Green Street Project and support for advocacy groups representing the needs of the community members.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Proctor Creek’s Boone Boulevard Green Street

The Center for Quality Growth and Regional Development, the Georgia Health Policy Center, and the Coastal Region Metropolitan Planning Organization conducted an HIA to understand how policies and guidance detailed in the regional metropolitan planning organization&#8217;s freight study and expected increases in freight train traffic will affect residents&#8217; health in Chatham County. The HIA focused on economic impacts, air quality, noise levels, and traffic safety, which can affect respiratory and cardiovascular disease, injury rates, and general health. It recommended that the county adopt anti-idling policies and create buffers to mitigate noise and air pollution. The HIA also urged it to try to further develop the local workforce and create more job opportunities so the economic benefits associated with increased freight movement are widely shared.
The HIA established a framework for considering the health effects of freight movement that focuses on infrastructure, commodity, and freight needs, and considers the disproportionate impacts on low-income communities and people of color. To encourage use of the framework, the Center for Quality Growth and Regional Development will provide technical assistance to university, government, and nonprofit entities and is piloting the use of the framework on a second HIA on the Cargo Atlanta Citywide Freight Study. Both HIAs are supported by a Health Impact Project program grant.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Coastal Region Metropolitan Planning Organization Freight Transportation Plan

The University of Florida Department of Urban and Regional Planning, in partnership with the Florida Department of Health, conducted a rapid health impact assessment of proposed changes to built environment and transportation access in the Tower Triangle area of the city of Gainesville, in Alachua County, Florida. The HIA focused on how these proposed changes could impact transportation access to healthy food sources.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

Alachua County Transportation Access to Healthy Food Sources

A health impact assessment was completed for a master plan for the South Lincoln housing redevelopment owned by the Denver Housing Authority (DHA). EnviroHealth Consulting completed the HIA and subcontracted to MITHUN firm who was hired by DHA to complete the master plan. In the neighborhood, approximately 38% live in poverty, more than half of the children are poor, over half are Latino. EnviroHealth utilized indicators from multiple sources such as the Healthy Development Measurement Tool. EnviroHealth collected data from community residents, community organizers and City staff i.e., focus groups, interviews, walkability and food audits and analyzed surveys and a health study and other completed documents. The consultant reported on the health impacts and the evidence-based recommendations to support better access and healthier lifestyles for the South Lincoln residents. The project’s vision was to transform South Lincoln into a green, healthy, desirable, and safe neighborhood that achieves multiple health related objectives including reducing noise, increasing physical activity, and providing social support.
The HIA made a series of detailed series of recommendations—such as pedestrian-level lighting to improve safety, low impact stormwater management techniques, noise barriers, improved bike lanes and sidewalks, and spaces for a farmers’ market and community garden—many of which were incorporate into the master plan.

<h3>Outcome</h3>
The HIA process resulted in the identification and adoption of 37 (health-related) recommendations for the South Lincoln Homes redevelopment site, now called Mariposa. Implemented recommendations for Mariposa include: the addition of striped bike lanes or sharrows, improved lighting and street crossings to access grocery/markets, improved pedestrian spaces/closed streets/added street trees.

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This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.