Healthy Waterways:

1. Healthy Waterways: Katrina Smith Korfmacher, PhD Associate Professor of Environmental Medicine Director, Community Outreach and Engagement Core University of Rochester Incorporating Health into Rochester’s Local Waterfront Revitalization Program

2. Overview • Health in All Policies (HiAP) • Health Impact Assessment (HIA) • Rochester’s Local Waterfront Revitalization Program (LWRP) • Healthy Waterways Project • Lessons 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 Policies • Many 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

5. Health Impact Assessment (HIA): a framework for Health in All Policies DEFINITION: “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… Farm Policy Incarceration Development Immigration Ports 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 HIA

9. 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)

10. WHO does HIAs? • Health Departments (state and local) • City governments • Transportation • Consultants • Community Groups • Academics • ….but few in New York State

11. HIA in Monroe County • Initiated by Dr. Andrew Doniger, Health Director (2009) • HIA learning group (Jan 2011) • Training/education • Mapping • Case 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

12. 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

14. Rochester’s LWRP … …must address 13 NYS coastal policies and develop sub-policies, where necessary Foster appropriate development patterns* Preserve historic resources Protect scenic resources / visual quality Minimize flooding/erosion impacts Protect/improve water quality and supply* Protect the waterfront ecosystem Protect/improve air quality* Minimize solid/hazardous waste impacts Provide public access to and recreational use of the waterfront* Protect/promote water-dependent uses Promote sustainable use of resources Protect agricultural lands 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

16. “ 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

17. 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 Plan NOTE: 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 CenterCommunity Outreach and Engagement Core • Kerry Ivers, Consultant • Partners • City of Rochester • Monroe County Department of Public Health • Non-governmental stakeholders • Support: The Health Impact Project A collaboration between the Robert Wood Johnson Foundation and The Pew Charitable Trusts

20. Healthy Waterways: How might the LWRP impact health? • 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 Communications Bureau, City of Rochester

21. Assessment Methods • Literature review • publications, reports, HIAs • Stakeholder input • meetings, individual • Local data • State/County health department, City • Data 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. Waterfront Trails Injury Death Beach Redevelopment and Management Diabetes Obesity Heart Disease Respiratory Health Mental Health Built Environment Water-based Recreation Overall Health Mental Health Stormwater Management Waterborne Illness LWRP Elements Health Determinants Health Outcomes Physical Safety Physical Activity Health Supportive Resources Water Quality

24. Assessment Example: Beach Redevelopment and Management

25. BEACH REDEVELOPMENT AND MANAGEMENT Why focus on beaches? LWRP POLICY Protect/improve water quality and supply • 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 POTENTIAL LWRP PROJECT Install algae pump at Ontario Beach HEALTH DETERMINANTS Physical activity, water quality, and health-supportive resources, risk of injury (drowning/disease) HEALTH OUTCOMES Diabetes (i),obesity (i), heart disease (i), water-borne illness (ih), respiratory health (h), mental health (h), drowning? disease?

26. 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?

27. 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

28. 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)

29. Who

30. How often

31. Where from (distance) • 94% of all visitors travelled by car

32. What

33. Water quality • The beach is often closed because of poor water quality

34. 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

35. 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 • Policies • Projects • Programs • Communication • Monitoring

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 Redevelopment • Policies: “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

40. 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

41. 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

42. 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”

43. 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?