In the musical chairs of urban planning, public health often finds itself left standing when the music stops. Often, by the time policymakers rouse support, local agencies rally funding, and land-use and transportation professionals exchange designs there's no one left to determine exactly how it will impact the health of those it's meant to serve in the first place.
That's where a "health impact assessment" comes in. An HIA, like an environmental review, evaluates the potential effects a major planning project might have on the public health of a surrounding community, and recommends certain actions needed to mitigate - or, in the case of health benefits, accelerate - those impacts.
The tool is used regularly in Europe and Canada [PDF], but it's beginning to gain some attention in the United States as well. A recent H.I.A. in northern California, for instance, pointed out that one potential barrier to public use of a walking-biking trail was safety, so it recommended proper lighting and the creation of a citizen watch group. A number of cities around the country have an H.I.A. planned, in progress, or recently completed.
Atlanta completed a two-year health impact assessment for its massive BeltLine project in 2007. The full report ran more than 200 pages [PDF], but a review of that effort, published in this month's issue of the American Journal of Preventive Medicine, offers a compact summary of the committee's recommendations. As that paper makes clear, the study team is confident their HIA will "promote the health of local residents" far more than if the BeltLine had been built without it.
"What the HIA does is focus explicitly on the question of improving health outcomes for people," says Catherine Ross of Georgia Tech, the principal investigator of the health assessment and lead author of the A.J.P.M. paper. "It crosses everything from prevention to cure. Unlike our approach historically, which is you feel bad so you go to the doctor, we're saying, before you get there, let's do this."
Any project as expansive as the BeltLine is bound to have some public health implications. The project will transform 22 miles of abandoned railroad near downtown Atlanta into 2,100 public parks, 33 miles of pedestrian and bike trails, 22 miles of public transit, and 6,500 acres of residential and commercial development. More than 200,000 people live within the BeltLine's immediate impact area:
Conducting the HIA required an interdisciplinary team of health professionals and planners to examine the BeltLine plans, compile all sorts of data on the community in the project's impact area, and compare these findings with existing public health literature. The HIA focused on several broad categories of health, from physical activity to access and equity to safety, and its 72 recommendations range from the broad and basic (Atlanta should speed up the BeltLine timeline) to the painfully specific (residential units should be at least 600 feet from high-volume roads to reduce impact of particulate matter).
Among its major conclusions [PDF], the assessment committee determined that the BeltLine needs more park acres to keep up with its promise of 10 acres per 1,000 residents. The minority, low-income Southwest part of the impact area, for instance, was on pace to have only 7.5 acres on average. The H.I.A. committee also recognized what Ross calls "food deserts" in certain parts of the impact area — places where residents didn't have access to grocery stores, and thus a healthy diet — and recommended better connectivity to existing stores, incentives for new grocers, and permits for fruit and vegetable vendors and farmer's markets.
Another recommendation came with regard to brownfields. Abandoned properties often contain environmental contamination, and these brownfield sites have been linked with illness in the health literature. In addition the committee found that non-white populations were far more likely to live within 500 feet of a brownfield in the BeltLine area, so it recommended the redevelopment of these sites. On the strength of this conclusion the Environmental Protection Agency awarded Atlanta $1 million in 2009 to restore ten BeltLine brownfield sites.
Broadly speaking the committee concluded that the BeltLine would have a "a largely positive impact of the health of Atlantans." Ross believes its use of a health impact assessment will serve as a model for other cities to use for major urban planning projects of their own.
"We believe it's a way to rethink American cities and make them attractive," says Ross of the potential of H.I.A.'s. "We have to re-think and re-make cities in a way that's healthier, that recognizes the constraints we have in the built environment, and create more opportunities to be a healthy America."