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The Doctor Is Out (In the Community)

posted on Mon, Jul 11 2011 1:29 pm by Aaron Wernham

As a doctor, I’ve often seen children with asthma that doesn’t improve because they live in housing with mold and bad ventilation. I’ve seen diabetics who have a hard time following my diet recommendations because they live in neighborhoods with fast food outlets on every corner, but no grocery store for miles. And, while narrowly dodging traffic on Washington, D.C.’s chaotic streets, I’ve sometimes questioned if biking to work is really the healthiest choice, or if I’m trading exercise for an increased risk of injury.

Many of the most urgent health problems facing the nation—like diabetes, asthma, obesity and injuries—are shaped by conditions in the places where we live, work and play.

The United States spends more money on health care per person than any other country—$2.5 trillion in 2009, yet our health statistics consistently lag behind other developed nations.

If our nation is going to reduce medical costs and build healthier communities, we need to take health into account when making the decisions that shape the world outside the doctor’s office.

One tool that can find hidden opportunities to improve health is a health impact assessment (HIA). An HIA is a type of study that helps policy-makers identify the likely health impacts of a decision in another field, like building a major roadway, planning a city’s growth or developing a school curriculum. HIAs can help decision makers identify unintended risks, reduce unnecessary costs, find practical solutions and leverage opportunities to improve the wellness of the community in which the project or policy is proposed.

For example, building a new roadway could affect health by increasing the amount of air pollutants and the resultant risk of asthma for people living nearby. It could also increase (or decrease) the risk of traffic-related injuries, or cut off popular walking routes and make it harder for residents to get exercise. An HIA on this proposed road might include practical recommendations, like a plan to include safe places to cross the street, wider sidewalks and better air filtration in buildings whose residents might be exposed to increased air pollution.

Although the use of HIAs is common with large industry and government in other parts of the world, it’s just catching on in the United States. Four years ago, there were fewer than 30 completed assessments in this country. Now, there are well over 100 completed and in-progress HIAs. (You can see a searchable map of all HIAs in the United States.)

The Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, was established to support this growing field. The project has funded 13 demonstration grants addressing the health impacts of a wide range of policy decisions, including a Farm to School bill in Oregon, the state budget in New Hampshire and a plan to re-develop an old automobile factory site in Atlanta, and we’re in the process of reviewing proposals for a second round of demonstration grants.

With interest in HIAs increasing so rapidly, the Health Impact Project is receiving more and more requests for training or expertise. The demand for well-trained HIA practitioners is outstripping the supply. To tackle this problem, we recently announced a collaboration with the National Network of Public Health Institutes that will help create new regional training centers around the country.

We also house a resource library with:

HIAs offer state, local and federal officials opportunities to help stem the rising tide of illness and its associated costs. The assessments can help policy-makers spend limited resources wisely, which is timely given the budget crises happening around the country from Capitol Hill to our town halls. The fact-based approach can help decision makers do what they want to do, but better, by building health considerations into the policies that shape our homes, streets and cities. Just what the doctor ordered.

This information was developed by Aaron Wernham, M.D., director of the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts.

The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.
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