Health Impact Assessment: Wisconsin Capacity Building Initiative

When Fellow Paula Tran Inzeo looks at buildings, highways, agriculture, and housing, she sees public health. Her work with Health Impact Assessments gives public health a seat at the table when it comes to planning and understanding impacts of policies and projects.

She writes, "The health impacts of the built environment are a growing concern for Wisconsin’s communities. While Wisconsin’s public health agencies have some existing capacity, a clear and coordinated strategy for keeping public health at the forefront of urban growth and land-use policies is lacking. The Bureau of Environmental and Occupational Health (BEOH) within the Division of Public Health (DPH) is integrated into a number of collaborative projects involving land redevelopment initiatives and has established excellent working relationships with state agencies, internal and external to public health. Therefore, BEOH applied for funding from the Association of State and Territorial Health Officials to continue development and implementation of strategies to engage with local partners, build capacity, and address the health consequences of built environment projects and policies at the state and local level through Health Impact Assessment (HIA).

HIA is a combination of procedures, methods and tools that systematically judges the potential, and sometimes unintended, effects of a policy, plan, program or project on the health of a population and the distribution of those effects within the population. HIA identifies appropriate actions to manage those effects. HIA includes five major steps: screening, scooping, assessment, reporting, and monitoring.

Determines the need and value of a HIA
Determines which health impacts to evaluate, methods for analysis, and a workplan
Provides: 1) a profile of existing health conditions, 2) evaluation of potential health impacts, 3) strategies to manage identified adverse health impacts
Includes: 1) development of the HIA report and 2) communication of findings & recommendations
Tracks: 1) impacts on decision-making processes and the decision and 2) impacts of the decision on health determinants

BEOH learned a great deal from our efforts to build capacity statewide to integrate health into the decision-making processes where such conversations had not previously been had. Below is a summary of the key lessons learned which could be considered recommendations for best practices for HIA capacity building at the state level.

1)       Successful development of a Health Impact Assessment Program at the state level must build off of existing programs or projects as funding for HIA projects is fleeting and often inadequate to support independent staff positions. Program staff must be grounded in other areas.

2)       Capacity building efforts are enhanced when promotion of the HIA framework can be erected in unison with existing initiatives and with the support of functional, interdisciplinary groups.

3)       Establishing connections and information exchange with other states or organizations building HIA programs or implementing the HIA framework, such as other ASTHO grantees, serves as an excellent resource for linking with new partners, circumventing barriers, and leveraging efforts.

4)       With trainings as the centerpiece of capacity building efforts, develop an engaging curriculum that can be catered to the issues and concerns of participants’ communities. Trainings must be introduced and advertised well via multiple marketing outlets, including surveys, listservs, conferences seminars, and poster sessions. However, the value of personal contact can not be underestimated.

5)       Trainings must be practical and relevant for participants, and sensitive to the potential limitations of rural health departments or understaffed organizations or agencies. Scaffolding the HIA framework and highlighting resources within the community that can alleviate time or staffing restraints increases the perceived feasibility of employing HIA.

6)       Multidisciplinary training experiences are preferable to targeting only LHDs. Participants should represent diversity in professional fields of expertise but also in level of management.

7)       Participation in HIA capacity building efforts and conducting HIAs requires managerial or supervisory staff to buy-in to the initiative. Since current staff resources for HIA must draw upon existing programs, upper-level consent for use of time and resources for HIA is imperative.

8)       It is critical to capitalize on training momentum by establishing and maintaining regular communication with emerging HIA practitioners."