1

HEALTHY WATERWAYS:Incorporating Health into Rochester’s Local Waterfront Revitalization Program

Katrina Smith Korfmacher, PhDAssociate Professor of Environmental MedicineDirector, Community Outreach and Engagement CoreUniversity of Rochester

2

OVERVIEWHealth in All Policies (HiAP)Health Impact Assessment (HIA)Rochester’s Local Waterfront

Revitalization Program (LWRP)Healthy Waterways ProjectLessons Learned/Next Steps

3

FACTORS RESPONSIBLE FOR POPULATION HEALTH

Health status is determined by: genetics (5%), health care (10%), behavior (30%), Social Conditions (55%)

- WHO Commission on the Social Determinants of Health (2008)

4

HEALTH IN ALL POLICIESMany public decisions affect health - not just public health decisions

Few public decisions explicitly consider health outcomes

How can we better promote health through non-health policies? “Health in All Policies” (HiAP)

Predict policies’ impact on health.Health Impact Assessment

HEALTH IMPACT ASSESSMENT (HIA): A FRAMEWORK FOR HEALTH IN ALL POLICIESDEFINITION: “A combination of procedures, methods and tools that systematically judges the potential, and sometimes unintended, effects of a policy, plan, program or project on the health of a population and the distribution of those effects within the population. HIA identifies appropriate actions to manage those effects.” -International Association for Impact Assessment, 2006

FOR MORE INFORMATION:Human Impact Partners (www.humanimpact.org)Health Impact Project (www.healthimpactproject.org)

6

INCORPORATING HEALTH INTO DECISION MAKING:HEALTH IMPACT ASSESSMENT (HIA)

HIA has looked at health impacts of decisions on…

Development

Immigration

Farm Policy

Ports

Incarceration

Education

7

BUT WHAT IS HIA???

An ANALYSIS that…•Clarifies health effects of a proposed project, plan or policy•Includes quantitative and/or qualitative information•Highlights health disparities; makes health impacts explicit•Considers multiple health outcomes•Provides recommendations•Shapes public decisions & discourse A PROCESS that…

Engages & empowers community Builds consensus

Builds relationships & collaborations

8

STEPS OF A HIAScreening Determines the need and value of a HIA

Scoping Determines which health impacts to evaluate, methods for analysis, and a workplan

Assessment & Recommendations

Provides: 1) a profile of existing health conditions2) evaluation of potential health impacts/alternatives 3) strategies to manage identified adverse health impacts

Reporting Includes: 1) development of the HIA report 2) communication of findings & recommendations

Monitoring Tracks: 1) Process: impacts on decision-making processes and the decision2) Outcomes: impacts of the decision on health determinants

HOW DO HIAS ASSESS HEALTH IMPACTS?• Conduct a literature review • Find out about other communities’ experiences• Gather existing data or conduct new analysis on health,

environmental and social indicators• Compare data to existing regulatory criteria & standards• Utilize community expertise - e.g., focus groups, surveys• Apply specialized data collection tools for observational

data, forecasting, and modeling• MAP environmental, social, health data• NOT “new research” (usually)

9

WHO DOES HIAS?• Health Departments (state and local)• City governments• Transportation• Consultants• Community Groups• Academics

• ….but few in New York State

10

HIA IN MONROE COUNTY Initiated by Dr. Andrew Doniger, Health Director (2009) HIA learning group (Jan 2011)

Training/educationMappingCase studies

Speakers, training sessions, possible HIA topics Many ideas = city policies; partner with health dept. Wrote proposals to fund an HIA Pew Health Impact Project funding: Healthy Waterways

APPLYING HIA TO ROCHESTER’S LOCAL WATERFRONT REVITALIZATION PROGRAM

13

NEW YORK STATE’S LOCAL WATERFRONT REVITALIZATION PROGRAM

Develop long-term plan for waterfront

Guides decisions at all levels of government

Opportunities for public involvement

13 policy statements

Many relate to health

Not required to consider health

ROCHESTER’S LWRP ……must address 13 NYS coastal policies and develop sub-policies, where necessary

(1) Foster appropriate development patterns*(2) Preserve historic resources(3) Protect scenic resources / visual quality(4) Minimize flooding/erosion impacts(5) Protect/improve water quality and

supply*(6) Protect the waterfront ecosystem(7) Protect/improve air quality*(8) Minimize solid/hazardous waste impacts(9) Provide public access to and recreational

use of the waterfront*(10)Protect/promote water-dependent uses(11)Promote sustainable use of resources(12)Protect agricultural lands(13)Promote development of energy

resources

*Most relevant to health

15

ROCHESTER’S LWRP 1990 LWRP; drafted update in 1999 Revision underway; expected completion

Dec. 2013 Waterfront Advisory Committee (WAC) Next steps: public information meetings,

focus groups, web site/survey, presentations, hearing

Communications Bureau, City of Rochester

“ BENEFITS OF AN LWRP” (NYSDOS OFFICE OF COMMUNITIES AND WATERFRONTS)

Clear direction - An LWRP reflects community consensus and can significantly increase a community’s ability to attract appropriate development that will respect its unique cultural and natural characteristics.

Technical assistance - An LWRP establishes a long-term partnership among local government, community based organizations, and the State, providing a source of technical assistance to prepare and implement a local program.

State and federal consistency - State and federal permitting, funding and direct actions must be consistent, to the maximum extent practicable, with an approved LWRP. This “consistency” provision is a strong tool that helps ensure all government levels work in unison and cooperate to build a stronger economy and a healthier environment.

Financial assistance – An LWRP presents a unified vision; it therefore increases a community’s chances to obtain public and private funding for projects. Funding for development and implementation of LWRP’s is available through New York State Environmental Protection Fund grants as well as from other sources.

www.dos.ny.gov/communitieswaterfronts/WFRevitalization/LWRP.html

ROCHESTER’S LWRP UPDATE:PRELIMINARY ISSUES/OPPORTUNITIES

Brownfield Opportunity Areas (BOA’s)

Center City Master Plan / Aqueduct Plan

City/County Parks Master Plans

City Quadrant Plans

Genesee River Trail Development/Connections

Erie Canal Redevelopment and “Harbor”

U of R Campus Master PlanNOTE: Harbor Management Plan = separate but coordinated process

18

HEALTHY WATERWAYS:WHY AN HIA OF ROCHESTER’S LWRP? Ongoing City planning process with

compatible timeline and partners Potential funding source (Pew) Narrow geographic scale, but broad scope Many decisions have the potential to affect

health; but LWRP does not require considering health

“Learning (HIA) by doing”: can HIA affect decision making in ways that promote community health?

19

PROJECT INVOLVEMENT Staff

University of Rochester Medical Center Environmental Health Sciences Center

Community Outreach and Engagement Core Kerry Ivers, Consultant

Partners City of Rochester Monroe County Department of Public Health Non-governmental stakeholders

Support: The Health Impact ProjectA collaboration between the Robert Wood Johnson Foundation and The Pew Charitable Trusts

20

What are the biggest health issues in Rochester?

How do these relate to the waterfront?

How could waterfront changes affect health?

Goal: Make policy and planning recommendations to minimize health risks and maximize benefits in LWRP

HEALTHY WATERWAYS: HOW MIGHT THE LWRP IMPACT HEALTH?

Communications Bureau, City of Rochester

21

ASSESSMENT METHODSLiterature review

publications, reports, HIAsStakeholder input

meetings, individualLocal data

State/County health department, CityData collection

trail, beach, and community surveys

22

LWRP “ELEMENTS” ASSESSED Waterfront trail development Beach redevelopment and management Built environment

(residential/commercial/public) Water-based recreation Stormwater management (water quality)

23

LWRP Elements Health Determinants Health Outcomes

Beach Redevelopment and Management

Stormwater Management

Waterfront Trails

Water-based Recreation

Built Environment

Overall HealthMental Health

DiabetesObesityHeart DiseaseRespiratory HealthMental Health

InjuryDeath

Waterborne Illness

Physical Activity

Health Supportive Resources

Physical Safety

Water Quality

24

ASSESSMENT EXAMPLE: BEACH REDEVELOPMENT AND MANAGEMENT

Why focus on beaches?

• Beach use can promote health• Physical activity• Stress reduction• Community building

• But…water use at beaches can pose health risks• Drowning/injury• Water-borne disease

LWRP POLICYProtect/improve

water quality and supply

POTENTIAL LWRP PROJECTInstall algae pump at

Ontario Beach

HEALTH DETERMINANTSPhysical activity, water quality,

and health-supportive resources, risk of injury (drowning/disease)

HEALTH OUTCOMESDiabetes (i), obesity (i),

heart disease (i), water-borne illness (ih), respiratory health (h), mental

health (h), drowning? disease?

BEACH REDEVELOPMENT AND

MANAGEMENT

What did we want to know?

• Who is using the beach?• How often do they visit?• What do they do at the beach?

(Exercise?)• What might make them visit more?

What we did

• 10 minute survey of beach visitors

• Ontario and Durand, open/closed conditions

• Asked about:• Demographics• Frequency of visits and activity• Water quality• Preferences about possible changes

Beach use

• More people visit/swim at Ontario than Durand

• There were 119,371 visitors to Durand in 2012 (21% were counted as bathers at the guarded beach)

Ontario Beach

Durand Beach

Bather count 54,000 24,951Scheduled open days 81 72Visitors who planned to swim 32% 57%

Who

Ontario Beach

Durand Beach

City of Rochester

White 94% 83% 46%Black or African American

5% 10% 41%

Other 2% 7% 13%Hispanic or Latino 14% 9% 16%

Income less than $35,000 28% 27% 56%

How often

Ontario Beach Durand BeachDid not visit last summer 25% 35%

Visited 1-4 times last summer 41% 33%

Visited 5 or more times last summer 34% 33%

Length of visit(average hours) 3.28 3.57

Where from (distance)

Ontario Beach Durand BeachMedian miles 11.00 9.00Mean miles 16.72 20.08

• 94% of all visitors travelled by car

What

Ontario Beach Durand BeachSwimming 32% 57%Picnicking 8% 16%Walking 17% 24%Sunbathing 76% 47%Sports 3% 0%Other 18% 8%

Water quality

Ontario Beach

Durand

BeachDays closed because of water quality 54% 19%

Would visit more often if quality improved 91% 65%

Visitors who planned to swim 32% 53%Were affected by beach closings 45% 32%Check closings before visiting the beach 45% 49%

• The beach is often closed because of poor water quality

Key findings

• For many, the beach is an important health resource

• Mental health • Social capital• Physical health

• Many use the beach, but not very often

• Beaches would be visited more often if improvements were made

Key findings

• Water quality is only one reason beach use is low

• Maintenance• Safety

• Monitoring matters• Bather and visitor

counts• Surveys

• User fees (parking) would affect low income visitors more

“The beaches could be made more

safe.”

“People are sketchy.”

36

HIA RECOMMENDATIONS Based on assessment/findings Reviewed by stakeholders “Overarching” recommendations Element-specific recommendations

PoliciesProjectsProgramsCommunicationMonitoring

37

OVERARCHING RECOMMENDATIONS Add community health to the 2013 LWRP Vision

Statement

Add community health to list of the 2013 LWRP Goals

Include information on health and demographics in the LWRP background and inventory

Incorporate community health into the Department of State’s policy guidelines for all LWRPs.

Promote HIA in future city and county decision making processes

38

ELEMENT-SPECIFIC RECOMMENDATIONSEXAMPLE: BEACHFRONT REDEVELOPMENTPolicies: “Prioritize projects that promote physical

activity at beachfront areas”

Projects: “Add land-based physical activity resources, such as a pool, spray park, or exercise equipment”

Programs: “Expand programming to promote safe and healthy beach use by diverse populations”

Communication: “Promote beach as a safe and accessible place for free physical activity and recreation.”

Monitoring: “Conduct annual beach user surveys”

39

NEXT STEPS City including HIA data in LWRP “Inventory

and Analysis” Adding “sub-policies” to promote health Community groups using HIA to show

people how LWRP affects their interests, encouraging involvement

Emphasize neighborhood involvement, impacts, and equity in recommendations

SUGGESTIONS FOR FUTURE HIAS IN ROCHESTER Safe routes to school Demolition plan for vacant buildings Low emission school bus purchases College Town Local waterfront revitalization plan Brownfields redevelopment

BALTIMORE HEALTH DEPT. AND HIA Too many policies to “do” full HIA Encouraging referral of more policies to

Health Department for comment Technical support/mapping for relevant

health information Full HIA on few projects

www.BaltimoreHealth.org; www.facebook.com/BaltimoreHealth

SUMMARY: IMPACTS OF HEALTH IMPACTS ASSESSMENTS?

• “Brought health concerns into the discussion; decision-makers now routinely thinking about health”

• “Addressed community concerns”• “HIA recommendations were 100% adopted into the growth

plan”• “Influenced the final design of the project”• “Educated decision-maker about how a policy that seemed to

have nothing to do with health, actually has health consequences”

• “Culture change: planning department is now routinely considering health”

• “Health is now a part of the EIS process” • “New partnerships between health and other agencies”• “Built a strong coalition of stakeholders who are now active in

the planning process”

DISCUSSION In WHAT programs/projects/policies might

HIA help improve environmental health at the county level?

WHO should be involved? HOW could HIAs be conducted/funded/lead? WHAT ROLE might the county

environmental health departments play? What OPPORTUNITIES do Community

Health Assessments provide?