Democratizing Data for Health: Lessons from health impact assessment at the local level

Rajiv BhatiaFounder, The Civic Engine

Visiting Scholar, UC Berkeley

In the late 1990s, San Francisco began repurposing historically industrial land for residential and office uses.

The city planned for the most intense development on its eastern side, in historically industrial and commercial districts with greater density and transportation services

The primary driver of development was housing demand; environmental quality and neighborhood infrastructure received scant attention.

Concerned that plans and existing environmental rules would not create healthy neighborhoods, many residents rallied against the growth plans.

In 2003, when a developer proposed to demolish the Trinity Plaza Apartments, he offered residents $1000 for relocation.

Tenants said that displacement would lead to stress, the loss of jobs, distance from friends and family, budget strain, and overcrowding.

One of the first Health Impact Assessments in the US was conducted for the planning department on behalf of tenants at the Trinity Plaza Apartments.

The HIA validated the residents’ concerns. The developer later ensured the tenants’ homes would be replaced in the new building.

Over the next few years, the San Francisco conducted other Health Impact Assessments resulting in city policy action on:

- affordable housing- concentrated poverty- traffic safety- parks and open space- quality schools- community facilities- labor laws

In 2004, the Departments of Health and Planning attempted a more pro-active approach to addressing the needs of health in development.

The city brought together non-governmental organizations, businesses, and public agencies to look critically at land use plans for growth from a health and equity lens.

A product of the city process was the Healthy Development Measurement Tool (later renamed the Sustainable Communities Index), a system of performance indicators to evaluate land use and growth plans.

Mapping indicators for health resources demonstrated that neighborhoods with planned growth excelled in some health resources but had significant gaps with others.

The data provided evidence for a policy response, including impact fees to build new infrastructure in communities undergoing growth.

Local scale air pollution modeling demonstrated “hot spots” of air pollution invisible to existing regional air pollution monitors.

This data justified new citywide health regulations requiring a higher standard of building ventilation in the hotspot zones.

Indicators also a disproportionate concentration of pedestrian injuries on a a minority of city streets.

This data led the city to re-prioritize engineering and enforcement resources to the high-injury corridors.

What made HIA and Community Indicators Work Effective in San Francisco?

Focused on existing policy and political priorities and controversies

Leveraged public health agency voice and authority

Leveraged existing regulatory and planning processes

Brought new human-scale data and solutions to development challenges

Demonstrated disproportionate impacts and solutions

Valued and enabled a participatory democratic process

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Pivoting Upstream: Focusing HIA on Policy, Unanswered Questions, and Emerging Issues

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Implications for HIA Practice HIA is a means not an end HIA needs to be embedded in policy

processes but as one of many tools to advance healthy development

HIA’s value is greatest when applied as a learning tool HIA is a powerful tool for civic engagement and

accountability HIA can be (should be) redundant in the context

of planning and design