Report on Mental Health in Health Impact Assessment · Health Impact Assessment (HIA) is a growing...
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Report on Mental Health in Health Impact Assessment A Resource for Health Impact Assessment Practitioners Prepared by Kelsey Lucyk and Habitat Health Impact Consulting November 2015 This report has been endorsed by the Society for Practitioners of Health Impact Assessment. For more information on the endorsement process, please contact [email protected]
Transcript of Report on Mental Health in Health Impact Assessment · Health Impact Assessment (HIA) is a growing...
ReportonMentalHealthinHealthImpactAssessmentAResourceforHealthImpactAssessmentPractitioners
Preparedby
KelseyLucykandHabitatHealthImpactConsulting
November2015
ThisreporthasbeenendorsedbytheSocietyforPractitionersofHealthImpactAssessment.Formoreinformationontheendorsementprocess,[email protected]
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Authors
KelseyLucyk,MScPhDCandidateinPopulation/PublicHealth,DepartmentofCommunityHealthSciences,CummingSchoolofMedicine,UniversityofCalgary
HabitatHealthImpactConsultinghttp://www.habitatcorp.com
SupportforThisProject
SupportforthisprojectwasprovidedbythePopulationHealthInterventionResearchNetwork,whichisfundedbytheCanadianInstitutesofHealthResearch.Thisreportrepresentstheoutputprojectfromtheauthor’sPopulationHealthInterventionResearchNetworkPolicyInternshipwithHabitatHealthImpactConsultants.
Acknowledgements
Thisreportwasproducedalongsideaworkingpapertheauthorisinvolvedin,whichsystematicallyreviewsandmapstheinclusionofmentalhealthincompletedhealthimpactassessmentreports,whichinformedthedevelopmentofthisreport.Specialthanksisgiventoco-authorsofthisworkingmanuscriptfortheircontributionstothedevelopmentofthisreport,aswellasthepatientandencouragingguidancetheyprovidedtotheauthor:
KimGilhuly,MPHProgramDirector,HumanImpactPartners
Ame-LiaTamburrini,MScVicePresident,HabitatHealthImpactConsulting
BethanyRogerson,MSSeniorAssociate,HealthImpactProject
SpecialthanksisalsogiventomembersoftheHabitatHealthImpactConsultingteam,fortheirinvaluablementorshipanddirectionthroughoutthedurationoftheauthor’sinternship:MarlaOrenstein,MurrayLee,EricaWestwood,AngelaAngel,andFolakeArinde.
Finally,thanksisgiventothesupportandresourcesprovidedbytheMentalHealthWorkingGroupoftheSocietyforPractitionersofHealthImpactAssessment.
Citationinformation:Lucyk,K.(2015).ReportonMentalHealthinHealthImpactAssessment.Calgary:HabitatHealthImpactConsultingCorp.Availableat:www.habitatcorp.com.
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ExecutiveSummary
HealthImpactAssessment(HIA)isagrowingfield,process,andmethodthatisincreasinglyusedtoinformpolicydecisionsinCanadaandabroad.Asthefieldexpands,sotooarethevariouswaysthroughwhichHIAcanbeutilized(e.g.,HIA,MentalHealthImpactAssessment,RapidHealthImpactAssessmentandHealthEquityImpactAssessment).WhiletheuptakeofHIAsuggestsapositiveshifttowardsimprovingpopulationandpublichealth,practitionershaveexpressedconcernthatthefieldhasbeenslowtoincorporatementalhealth.
Mentalhealthisawidespreadandcomplexstateofwellbeingthatshouldbeconsideredindecisionsthataffectthehealthandwellbeingofpopulations.ThisreportprovidesadescriptiveoverviewofhowmentalhealthiscurrentlyincludedinthefieldofHIA,whichissummarizedinthissection.
KeyTermsandKeyConcepts
Mentalhealthis“astateofwell-beinginwhicheveryindividualrealizeshisorherownpotential,cancopewiththenormalstressesoflife,canworkproductivelyandfruitfully,andisabletomakeacontributiontohisorhercommunity.”1
Mentalillnessisanimpedimentto“aperson’sabilitytocopewithdailylife”2thatmayoccurfrombiological,social,economic,genetic,orenvironmentalfactors.Itisoftenconsideredtobealackofmentalhealth,identifiedthroughsymptomsorpresenceofadiagnosablementalcondition.
TheMentalHealthContinuumconceptualizesmentalhealthasabalancebetweenpositiveandnegativefeelingsandfunctioning,withconsiderationthatthesemaymanifestassymptomsofmentalhealthordisorder.3Thiscontinuumallowsforvariousindividualswithmentalhealthproblemstostillbeconsideredashavingmentalhealth.
Populationmentalhealthisaperspectiveandfieldthatholdsmentalhealthasahumanright,endorsesuniversalaccesstomentalhealthservices,andworkstoimprovethementalhealthofentirepopulationssothateachindividualmayenjoylife,balanceitsdemands,anddeveloppsychologicalandemotionalresilience.4
WhyisitImportanttoIncludeMentalHealthinHIA?
ItisimportanttoincludementalhealthinHIAforanumberofreasons.First,theinclusionofmentalhealthrepresentsacomprehensiveapproachtohealththataccountsformultipleinfluencingfactors.Second,itrepresentsgrowingissuesinpopulationandpublichealth,whichmayenhancetheuptakeofrecommendationsbydecisionmakers.Third,theinclusionofmentalhealthinHIAmayrepresentconcernsofthepopulationstheyserve,especiallyforsubpopulationswhereindividualslivewithmentalillness.Finally,HIAmaybeoneofmanycomponentsinadecisionmaking
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process;thusmaybetheonlyforumforhealth(mentalorphysical)concernstobevoiced.
HowarePractitionersWorkingtoImprovetheInclusionofMentalHealthinHIA?
Inrecentyears,HIApractitionershavebecomeactivelyinvolvedinimprovingtheinclusionofmentalhealthintoHIA.ImportantadvancesincludethecreationofmentalhealthspecificformsofHIA,suchas:MentalWell-beingImpactAssessment,MentalHealthImpactAssessment,MentalHealthHIAToolkit,andtheCanadianRapidMentalHealthImpactAssessmentToolkit.WorkbymembersoftheMentalHealthWorkingGroupfromtheSocietyofPractitionersofHealthImpactAssessmenthasresultedinaworkingpapermappingthecurrentstateofmentalhealthinthefieldofHIA,aresourcesheetwithcommondefinitionsthatrelatetomentalhealth,andaguideforpractitionerstousewhendevelopingHIApathwaysthatincludementalhealth.
WhatdoHIAssayaboutMentalHealth?
ManyHIAsincludediscussionofmentalhealthasitrelatestothesocialdeterminantsofhealth.Inparticular,HIAshavebeeninterestedinshowingtheassociationbetweenmentalhealthandthebuiltenvironment,education,employment,foodinsecurity,income,housing,neighbourhood,socialcapital,socialcohesion,andsocialsupport.Otherfactorsidentifiedaspotentiallyimpactingmentalhealththatarediscussedinthisreportincludecommunityconflict,commutingtime,energyefficiency,gambling,industrializationandmodernization,noise,physicalactivity,publicart,andwayfinding.
HowdoHIAsMeasureMentalHealth?
MentalhealthoutcomesvariedwidelybyHIA,fromproblemsrelatedtomentalhealth(e.g.,domesticabuse)tospecificmentalhealthproblems(e.g.,depression).DifferentmentalhealthoutcomesfoundinHIAsvariedwidely,withover100differentoutcomesofinterest.TheseprovideanideaofthevastarrayofpotentialindicatorsavailabletopractitionerswhowishtoincludementalhealthintheirHIA,fromsenseofwellbeing,tobingedrinking,tomajordepressivedisorder,toviolence,amongothers.
WhatDataSourcesdoHIAsuseforMentalHealth?
HIAsuseanumberofdifferentdatasourcestocollectinformationonmentalhealth.Theseincludedprimaryandsecondarysources,inbothqualitativeandquantitativeforms.Examplesofprimarydatacollectedrangedfromqualitativesources,suchasfocusgroupsorkeyinformantinterviews,toquantitativesources,suchaseconomicanalysisortheadministrationofsurveys.Someexamplesofsecondarydatacollectedincludequalitativeformssuchasliteraturerevieworuseofcommunityreports,tothesecondaryanalysisofsurveysorpublichealthdatabases.
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WhatareSomeExamplesofHIAsthatIncorporateMentalHealth?
TwoexamplesofHIAsthatsuccessfullyincludedmentalhealththroughouttheirreportareprovided:theHOPEVItoHOPESFHIA5andtheTransitionalJobsProgramHIA.6Foreachexample,adescriptionisprovidedforhowmentalhealthwasmeasured,whatoutcomeswerelookedat,andwhatrecommendationspractitionerssuggestedtomitigatementalhealthimpacts.
HowcanweImprovetheInclusionofMentalHealthInHIA?
TherecommendationsfromthisreportaremeanttoguidepractitionerswhoaimtoincludementalhealthintheirHIAs.Recommendationsareposedasstraightforwardsuggestionstoincreasethepotentialformonitoringandevaluation,improvetheevidenceofclaimsmade,andencourageinclusionofmentalhealthinHIA.RecommendationsincludedrawingoncommunityengagementtoguidetheinclusionofmentalhealthinHIA,consideringmentalhealthinthescopingofanyHIA,maintainingtheconsistencywithwhichmentalhealthisdiscussedthroughouttheHIAreport,consideringhowmentalhealthmaychangeforsubpopulationsdifferently,drawingonthemultipledatasourcesavailabletoassessmentalhealth,andconsideringtheimpactofmentalhealthonphysicalhealthandofphysicalhealthonmentalhealth.
WhatisthePurposeofthisReport?
ThepurposeofthisreportistoprovidebasicinformationforpractitionerswhoareconsideringincludingmentalhealthintheirHIA.AnoverarchingandsecondarypurposeofthisreportistosupporttheworkcurrentlyunderwaybyHIApractitioners(seeabove),intheireffortstocollectandcompileinformationonHIAandmentalhealth.Whilethisreportiscomprehensive,itisnotexhaustive.ThefindingspresentedinthisreportarederivedfromthosereportedinHIAreports.Thisreportisthereforemeanttoserveasastartingdocumenttodirectpractitionerstoavailableresourcesandliterature.
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TableofContents
ExecutiveSummary.....................................................................................................ii
KeyTermsandKeyConcepts.......................................................................................1MentalHealthandMentalIllness........................................................................................1MentalHealthContinuum...................................................................................................2APopulationMentalHealthPerspective.............................................................................2
WhatisHealthImpactAssessment?............................................................................3
WhyisitImportanttoIncludeMentalHealthinHIA?..................................................3MentalHealthinHIA:SpecificTools....................................................................................6OtherTools........................................................................................................................6
HowArePractitionersWorkingtoImprovetheInclusionofMentalHealthinHIA?....7
HowDoHIAsMeasureMentalHealth?........................................................................9MentalHealthOutcomesIncludedinHIAs..........................................................................9
WhatDoHIAsSayAboutMentalHealth?..................................................................12SocialDeterminantsofMentalHealth................................................................................12BuiltEnvironment.............................................................................................................12Education..........................................................................................................................13Employment......................................................................................................................13FoodInsecurity..................................................................................................................14Income..............................................................................................................................14Housing.............................................................................................................................14NeighbourhoodConditions................................................................................................14SocialCapital.....................................................................................................................15SocialCohesion.................................................................................................................15SocialSupport...................................................................................................................15OtherFactorsthatAffectMentalHealth............................................................................16CommunityConflict...........................................................................................................16CommutingTime...............................................................................................................16Energy...............................................................................................................................16Gambling...........................................................................................................................16IndustrializationandModernization..................................................................................17Noise.................................................................................................................................17PhysicalActivity................................................................................................................17PublicArt...........................................................................................................................18Wayfinding/BeingLost......................................................................................................18
HowdoHIAsIncorporateMentalHealth?.................................................................18PrimaryDataSources.........................................................................................................18MethodsofPrimaryDataCollection...................................................................................19CommunityEngagement...................................................................................................19FocusGroups.....................................................................................................................19InformalPersonalCommunication....................................................................................21
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KeyInformantInterviews..................................................................................................21Surveys..............................................................................................................................21MethodsofDataAnalysis...................................................................................................23EconomicAnalyses............................................................................................................23SpearmanRankCorrelationCoefficients............................................................................23SomeSpecificTools............................................................................................................23HealthyDevelopmentMeasurementTool(see:SanFranciscoIndicatorProject)...............23IsolationIndex...................................................................................................................23SanFranciscoIndicatorProject..........................................................................................24SecondaryDataSources.....................................................................................................25MethodsofDataCollection................................................................................................25BehavioralRiskFactorSurveillanceSystem(BRFSS)...........................................................25BostonNeighborhoodSurvey............................................................................................26CaliforniaHealthInterviewSurvey(CHIS)..........................................................................26CaliforniaSchoolClimateSurvey(CSCS).............................................................................26CaliforniaHealthyKidsSurvey(CHKS)................................................................................26CaliforniaWorkandHealthSurvey(CWHS).......................................................................27ConnecticutEnergyEfficiencyFundSurvey........................................................................27DomesticWorkersUnitedSurvey......................................................................................27EnCanaSurveyofSubcontractors......................................................................................27LosAngelesCountyHealthSurvey.....................................................................................27MinneapolisParkFoundationSurvey................................................................................28NationalHealthandNutritionExaminationSurvey(NHANES)...........................................28NationalHealthInterviewSurvey(NHIS)...........................................................................28On-BoardTransitRiderSurvey...........................................................................................29PagedaleHouseholdSurvey...............................................................................................29SpokaneRegionalHealthDistrictSurvey...........................................................................29SurveyofHealthofAllthePopulationsandEnvironment(SHAPE)....................................29WisconsinFamilyHealthSurvey........................................................................................29Wisconsin’sTransitionalJobsProgramParticipantSurvey.................................................29YouthRiskBehaviorSurvey(YRBS)....................................................................................30LiteratureReview..............................................................................................................30ExamplesofDataSources...................................................................................................30Census...............................................................................................................................30CentersforDiseaseControlandPrevention(CDC).............................................................30CommunityHealthorVitalStatisticsReports....................................................................30CountyHealthRankings.....................................................................................................32HospitalData.....................................................................................................................32PublicHealthDepartmentsorAuthorities–VitalStatisticsandSurveillance.....................33OtherSources....................................................................................................................34
WhatareSomeExamplesofHIAsThatIncorporateMentalHealth?.........................41HOPEVItoHOPESF:PublicHousingRedevelopmentHIA...................................................41Background.......................................................................................................................41HowWasMentalHealthIncluded?....................................................................................41HowWasMentalHealthMeasured?.................................................................................42WhatRecommendationsWereMadeforMentalHealth?..................................................42WhyIsThisaGoodExample?............................................................................................43
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TransitionalJobsProgramHIA............................................................................................44Background.......................................................................................................................44HowWasMentalHealthIncluded?....................................................................................44WhatRecommendationsWereMadeforMentalHealth?..................................................45WhyIsThisaGoodExample?............................................................................................46
HowCanWeImprovetheInclusionofMentalHealthinHIA?....................................46Recommendations.............................................................................................................46
Summary...................................................................................................................49AppendixA........................................................................................................................50
Endnotes...................................................................................................................58
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KeyTermsandKeyConcepts
Thissectionprovidesbriefdescriptionsforkeytermsandconceptsusedinthisreport;namely,thedefinitionsformentalhealthandmentalillness.Thissectionalsoprovidesanorientationtoconceptssuchasthementalhealthcontinuum,populationmentalhealthperspective,andhealthimpactassessment.
MentalHealthandMentalIllness
Understandingsofmentalhealthvarybysocialandculturalcontext;however,inpopulationandpublichealthitismostcommonlyunderstoodinrelationtomentalwellbeingormentalillness.
TheWorldHealthOrganization(2006)definesmentalhealthas“astateofwell-beinginwhicheveryindividualrealizeshisorherownpotential,cancopewiththenormalstressesoflife,canworkproductivelyandfruitfully,andisabletomakeacontributiontoherorhiscommunity.”7Thisdefinitionrepresentsaholisticconceptualizationofmentalhealththatfocusesonunderstanding,improving,andpromotingmentalhealthbyconsideringitscomplexities.Influencingfactorsofmentalhealthvaryfrompersontopersonbutgenerallyincludeone’sstateofphysical,emotional,andspiritualhealth,aswelltheeffectsfromsocialdeterminantsofhealth,suchashousingoremployment.8Throughoutthisreport,theterms“mentalhealth”and“mentalwellbeing”willbeusedinterchangeably.
Asidefromtheholisticperspectiveofmentalhealthdescribedabove,mentalillnessrepresentsanotherwayofconceptualizingmentalhealth.Thelackofmentalhealthmaybeindicativeofmentalillness.MentalillnessisdefinedbytheCanadianMentalHealthAssociation(2009)asanimpedimentto“aperson’sabilitytocopewithdailylife,”thatmayoccurwhenbiological,social,economic,genetic,orenvironmentalfactorsinfluenceone’smentalhealth.9Mentalillnessisoftenunderstoodaccordingtothediagnosticcriteriausedbypsychiatristsandpsychologists,aslaidoutintheDiagnosticandStatisticalManualofMentalDisorders.Thus,mentalillnessrepresentsamorebiomedicalandbehaviouralperspectiveofmentalhealth,isnarrowerinscopethantheholisticperspective,andoperateswiththeprimaryfunctionofidentifying,preventing,andtreatingmentalillnessasameansofimprovingmentalhealth.Whilementalhealthandillnessaresomewhatdifferingconcepts,thereremainstheneedtoidentifyanddiscussmentalhealthproblemsforthepurposesofthisreport.Therefore,theterms“mentalillness”and“mentalhealthproblems”(i.e.,alesspathologizedformof“mentaldisorder”)willbeusedinterchangeably.
Thedifferencesbetweenmentalhealthandmentalillnessmaybestbeunderstoodthroughanillustrativeexample.Considerthefollowingtwomissionstatementsfortwonationalorganizationsaimedatimprovingmentalhealth.TheCanadianMentalHealthAssociationaimsbroadlyfor“mentallyhealthypeopleinahealthysociety”andincludesnomentionofillness,treatment,ordisease,thusimplying
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aholisticapproach.Incontrast,theAmericanNationalInstituteofMentalHealthdescribestheirmissionas“aworldinwhichmentalillnessesarepreventedandcured.”10Thissecondmissionstatementrepresentsamorebiomedicalperspectiveofmentalhealth,withexplicitreferenceofitsintenttopreventandcurementalillness.Whatremainsconstant,however,isthatattherootofboththeholisticandbiomedicalconceptualizationofmentalhealth,bothseektoimprovehealthandavoidharm.
MentalHealthContinuum
Athirdwayofconceptualizingmentalhealthisthroughrecognitionoftheoverlapandinterplaybetweenmentalhealthandmentalillness.AconceptthathasbeenrecentlyadoptedbythePublicHealthAssociationofCanadaandothersisthementalhealthcontinuum,whichwasoperationalizedbyCoreyKeyes.Keyes(2002)describesmentalhealthasabalancebetweenpositiveandnegativefeelingsandfunctioninginone’slife,withconsiderationfortheroleofsubjectivewellbeing,whichmaymanifestassymptomsofmentalhealthordisorder.11Figure1,reproducedwithpermissionfromaRapidMentalHealthImpactAssessmentproducedforPHAC,illustratesthiscontinuumofmentalhealth,withwellbeingrangingfromflourishingtolanguishing,andillnessrangingfromseveredisordertotheabsenceofdisorder.
Figure1.TheMentalHealthContinuum,adaptedfromKeyes(2002).
SevereMentalDisorder
OptimalMentalHealth(Flourishing)
AbsenceofMentalDisorder
OptimalCapacityforMH
OptimalCapacityforMH
MinimalCapacityforMH
MinimalCapacityforMH
MinimalMentalHealth(Languishing)
APopulationMentalHealthPerspective
Whenappliedtopopulations,differentunderstandingsofmentalhealthencompassapopulationmentalhealthperspective.Thisperspectiveworkstoimprovethementalhealthoftheentirepopulationsothateachindividualmayenjoylife,balanceitsdemands,anddeveloppsychologicalandemotionalresilience.12
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Oneimportantcomponentofpopulationmentalhealthisthesurveillanceofmentalhealthovertime,whichallowsfortheassessmentofmentalhealthconditionsandmonitoringofchangesorimprovementstomentalhealth.Aswillbediscussedthroughoutthispaper,thisholdsimportantimplicationsforthefieldofHealthImpactAssessment,particularlythescopingandassessmentportionsofthismethodology.
WhatisHealthImpactAssessment?
AsdefinedbytheWorldHealthOrganization,HealthImpactAssessment(HIA)is“acombinationofprocedures,methodsandtoolsbywhichapolicy,programorprojectmaybejudgedintermsofitspotentialeffectsonthehealthofapopulationandthedistributionofthoseeffectswithinthepopulation.”13ThefieldofHIAemergedinthelate1990s,withmethodsinformedbythepre-existingfieldofEnvironmentalImpactAssessment(EIA)andthepromotionofhealthypublicpolicythatwastakingplaceacrossNorthAmerica.14Today,oneofthekeywaysthatHIAcontributestopopulationhealthisbyinfluencingdecisionmakingsothatpolicies,programs,orprojectsdonotdamagehealthinpopulations.15HIAhelpstoinformdecisionmakersofpotentialphysical,social,oreconomicconsequencesthatapolicy,program,orprojectmayhaveonhumanhealth,whichincludesidentifyinggroupswhosehealthmaybemostaffected,andofferingrecommendationstomitigateoravoidpotentialharmstotheirhealththatmayoccur.16
TherearesixstepsconsistentamongthebroadwaysofconductinganHIA:screening(determineswhethertheHIAwillsucceedoraddvalue),scoping(createsobjectivesandoutlinesstepsfortheHIA),assessment(describesthebaselinehealthofpopulationaffectedandpredictspotentialhealtheffects),recommendations(identifiesmitigationstrategiesthatwillprotectandpromotehealthbasedonpredictedchanges),reporting(disseminatesfindingstodecisionmakers),andmonitoringandevaluation(considersthequality,impact,andoutcomeoftheHIAinrelationtodecisionmaking).17AdherencetothesesixstepshelpstoensurethatHIAisasystematicandrigorousprocesswithitsfindingsandrecommendationsbasedonevidence.
WhyisitImportanttoIncludeMentalHealthinHIA?
Increasingly,mentalhealthisgainingattentionbypolicymakersandhealthcaresystemsattheregional,national,andinternationallevel.Intheir2012mentalhealthstrategyforCanada,ChangingDirections,ChangingLives,theMentalHealthCommissionofCanada(MHCC)recognizedthatmentalhealthis“essentialtoourqualityoflife.”18SimilarrecognitionsweremadeintheUnitedKingdom(UK)andtheUnitedStatesofAmerica(US)instrategicplansformentalhealthpublishedfortheirgovernments:theUK’sNoHealthWithoutMentalHealth19andtheUS’sCentersforDiseaseControlandPrevention’s(CDC)PublicHealthActionPlantoIntegrateMentalHealthPromotionandMentalIllnessPreventionwithChronicDiseasePrevention.20Whileeachstrategydiffersbygeographicspecificity,ineachcasethesenationalplansseektopromotementalhealthandprevent/reducementalillness.Toprovidethe
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Canadian-specificcontext,asummaryofthestrategicdirectionsfromtheMHCCispresentedinTable1,below.
Table1.StrategicDirectionspresentedinChangingDirections,ChangingLives.
No. StrategicDirection1 Promotementalhealthacrossthelifespaninhomes,schoolsandworkplaces,andpreventmental
illnessandsuicidewhereverpossible.2 Fosterrecoveryandwell-beingforpeopleofallageslivingwithmentalhealthproblemsand
illnessesandupholdtheirrights.3 Provideaccesstotherightcombinationofservices,treatmentsandsupports,whenandwhere
peopleneedthem.4 Reducedisparitiesinriskfactorsandaccesstomentalhealthservices,andstrengthenthe
responsetotheneedsofdiversecommunitiesandNortherners.5 WorkwithFirstNations,Inuit,andMétistoaddresstheirmentalhealthneeds,acknowledging
theirdistinctcircumstances,rightsandcultures.6 Mobilizeleadership,improveknowledge,andfostercollaborationatalllevels.
TheinclusionofmentalhealthinHIAisimportantforanumberofreasons.First,theinclusionofmentalhealthinHIArepresentscollaborativedecisionmakingforacomprehensiveapproachtohealth.AstheMHCChasnotedintheirstrategicplan,thepromotionofmentalhealthandtreatmentofmentalillnessoccursnotonlyinthehealthsector.Mentalhealthisinfluencedbymanydifferentsocialdeterminants,thusactionmeanttoimprovementalhealthorreducementalillnessrequirescollaborationofhealthandothersectors,suchasemploymentoreducation.HIAfacilitatescross-sectorcollaborationintheiradoptionofacomprehensiveapproachtohealthasacorevalue,asstatedbytheSocietyofPractitionersofHealthImpactAssessment(SOPHIA).21HIAprovidesanidealopportunitytofacilitatethecross-sectorandcollaborativedecisionmakingneededtoimprovementalhealthandreduce/treatmentalillness.IncreasedinclusionofmentalhealthinHIAcanhelpthoseacrosssectorsrecognizehowthephysical,social,andeconomicenvironmentsinfluencementalhealth.
Second,theinclusionofmentalhealthinHIArepresentsagrowingissueinpopulationandpublichealth.Increasingly,itisunderstoodthatphysical,social,environmental,andeconomicfactors(i.e.,thesocialdeterminantsofhealth)caninfluencethementalhealthofentirepopulations,inadditiontoindividuals.ItisimportantthatHIAunderstandthisinordertomaintainrelevancetotheissuesandconcernsthatarepresentinthepopulationstheyserve,aswellaspopulationandpublichealthpractice.Forexample,HIAcanhighlightthepotentialnegativeinfluenceofthesocialdeterminantsofmentalhealthandpotentialprotectivefactorsinwaysthatprotectandpromotepopulationmentalhealth.Therefore,byconsideringhowmentalhealthmaybeimpactedbyaproject,program,orpolicy,HIAwillremainnotonlyremainconsistentwiththepriorityareaofmentalhealthtopopulationandpublichealth,butwillalsoremainrelevanttoitspracticebyconsideringthepopulation-levelimpactsonmentalhealth.
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InCanada,nationalorganizationsareincreasinglyrecognizingthatmentalhealthisafar-reachingissueofgrowingimportance.StatisticsCanadareportedin2012thatapproximately10%ofCanadianrespondentsoftheCanadianCommunityHealthSurveyreportedsymptomsthatwereconsistentwithamentalhealthproblemorsubstanceabuse.22Furthermore,17%ofCanadiansreportedthattheyperceivedthemselvesasneedingmentalhealthcare(e.g.,counseling)inthepastyear.23TheCanadianMentalHealthAssociation(CMHA)hasestimatedthatapproximately20%ofCanadianswillpersonallyexperiencementalillnessintheirlifetime,withabout8%ofadultsexperiencingmajordepressionatsomepointintheirlives.24Theypurportthatmentalhealthisapopulation-levelconcernbecauseallCanadians(whetherexperiencingmentalillnessornot)willbeaffectedthroughfriends,familymembers,andcolleagues.25Aspartofacomprehensiveapproachtohealth;therefore,theinclusionofmentalhealthshouldbeconsideredinHIAasameansofassessingacomponentofhealththatisoftenoverlooked,butaffectsasignificantproportionofourpopulation.
Third,theinclusionofmentalhealthinHIAmayencourageincreasedrepresentationoftheconcernsofpopulationstheyserve,especiallythosewhomaybeunabletospeakforthemselves.DemocracyisacorevalueofHIA,forthefieldholdsthatpersonswhowillbeaffectedbyaproject,program,orpolicyhavearighttoparticipateintheformulationofthatdecision.26Unfortunately,theprocessofparticipationinHIAmayonlyextendtothosewhoarementallyorphysicallyable.Individualswhosufferfrommentalillnessmaynothavethesameconnectionstothecommunityasthosewhomayactivelytakepartininformingthedecisionmakingprocessbyattendingcommunitymeetings,focusgroups,orothercommunityengagementforums.Relatedtothepotentialtomisstheperspectivesofthoselivingwithmentalillness,personswithmentalhealthproblemsmaynotseekmentalhealthtreatmentforreasonsrelatedtotheirillness.Therefore,evenwhereHIAincludesinterviewswithkeyinformants,suchasdoctorsormentalhealthworkers,thevoicesofthoselivingwithmentalillnessmayremainunheard.Therefore,theroutineinclusionofmentalhealthinHIAmaybringrecognitiontopotentialmentalhealthimpactstothesevulnerablepopulations,inadditiontothegeneralpopulation.Assuch,HIAmaybeusedasapreventativemeasureofwhichitsrecommendationscouldbeusedtopromotementalwellbeingandameliorateillnesswithinthecommunitiestheyserve.
Buildingonpreviouspoints,afourthreasonwhyHIAshouldincludementalhealthisthatitmaybetheonlyopportunityformentalhealthtobeconsideredinaprogram,project,orpolicy.HIAisaversatiletoolusedtoinformawidearrayofproject,program,orpolicydecisions.Furthermore,anHIAmaybecommissionedoremployedasjustonecomponentamongstanumberofreviewdocumentsortools(i.e.,includedasonecomponentofanEnvironmentalImpactAssessment)thatarenotprimarilyabouthealth.
Consider,forexample,thePointThomsonProjectEnvironmentalImpactStatement27thatwascompletedin2012toinformthedecisionbytheUSArmyCorpsofEngineersonwhethertheyshouldgrantordenyapermitforExxonMobilCorporation’s
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applicationtoplacefillinUSwaters.TheStateofAlaskaHIAProgramconductedanHIAasonepartofthefinalEIS(includedinAppendixRofthereport),inwhichtheyincludedanassessmentofsuicideandsubstanceabuse(measuresofmentalhealthproblems)andalsothepsychosocialfactorsthatmayinfluencethem(e.g.,employment,family).TheinclusionofmentalhealthinthisHIArepresentsoftheonlyareawherementalhealthisincludedintheEIS,whichformallyreacheddecisionmakers.ThisisespeciallyimportantconsideringthelimitedattentiongiventoHIAamongtheplethoraofinformationforothercomponentsoftheproject,suchasoildischargeprevention,hydrologyanalysis,noisetechnicalreport,visualresourceassessment,biologicalassessments,andothers.28
Tosummarize,theinclusionofmentalhealthinHIAprovidestheopportunitytotakeacomprehensiveapproachtohealthinregardtoagrowingareaofpublichealthimportanceandrepresenttheconcernsofpopulations—especiallywhereotheropportunitiestodosomaynotbereadilyavailable.
MentalHealthinHIA:SpecificTools
Currently,twospecificformsofHIAexistwhichspecificallyaddresstheinclusionofmentalhealthintothisfield.ThefirstisMentalHealthImpactAssessment(MHIA).MHIAisatoolthatwasdevelopedbytheAdlerSchoolofProfessionalPsychologyandcommunitypartners.29ThistoolemploysthesamemethodologicalstepsasHIA(i.e.,screening,scoping,assessment,recommendations,reporting,monitoring/evaluation),butmoreexplicitlyintegratesconsiderationsrelatedtomentalhealth.AccordingtotheAdlerSchool,MHIA“isaninterdisciplinaryprocessdesignedtoassesstheimpactofpublicdecisionsonpopulationmentalhealth[…]bymoreexplicitlyintegratingmentalhealthconsiderations.”30ExpectedoutcomesofanMHIAincludeincreasedcommunitycohesion,awarenessofnon-healthdecisionsonpopulationmentalhealth,andgreateraccountabilityforpopulationmentalhealth.
AsecondformofHIAspecifictomentalhealthistheMentalWell-beingImpactAssessment(MWIA)developedbytheNationalMWIACollaborativeintheUnitedKingdom.TheMWIAwasdevelopedtoincreasefocusonpositivementalhealth,awayfromtheillnessfocusthatdevelopersperceivedasdominantinthefield.31TheMWIAfollowsthefirststepsofanHIAwithscreening,scoping,andappraisal,butdiffersslightlyinitsnextsteps,whichidentifyindicatorsthatmeasuretheimpactofmentalwellbeing,andformulaterecommendations,monitoring,andevaluatingofMWIA.32TheexpectedoutcomesfromanMWIAincludesthedevelopmentofrecommendationsthatarespecificallyintendedtomaximizepositiveimpactsandminimizenegativeimpactstomentalwellbeing.
OtherTools
ThereareothertoolsorformsofHIAthatarespecificallytailoredtomentalhealth,yetmaynotbewidelydisseminated.Oneexampleisthetwo-partscreeningtoolkitdevelopedbytheLewisham&LambethNeighbourhoodRenewalFund.33This
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MentalHealthHIAToolkitwasdevelopedin2004asawayofdetermininghowprojectsmightbesuitableforanin-depthMHIA,andtoimproveunderstandingofpotentialmentalhealthimpactsoftheLewisham&LambethNeighbourhoodRenewalStrategy.Thetoolkitconsistsoftwocomponents,aScreeningToolkitandRapidAssessmentToolkit.TheScreeningToolkitisintendedforoneortwopersonstouseinmakinganinitialassessmentofpotentialmentalhealthimpacts.Thesecondtool,theRapidAssessmentToolkitismeanttoinvolvestakeholderstotheprojectandleadtotheidentificationofindicatorsthatmeasurepotentialmentalhealthimpactsofaproject,policy,orprogram.
AnotherrelativelyunknowntooldevelopedspecificallyforHIA,istheCanadianRapidMentalHealthImpactAssessment(RHMHIA)Toolkit,whichwasdevelopedbyMarlaOrensteinforthePublicHealthAgencyofCanadain2012.TheobjectiveofthistoolkitwastoinformdecisionmakingtoimprovementalhealthforallCanadians.Itisintendedtobeusedbythosewithoutexpertiseinmentalhealth,completedwithinafewhoursduringtheearlystagesofpolicyorprogramdevelopment,andappliedtopopulationstoidentifypotentialbenefitsorharmstomentalhealthfromaproject,policy,orprogram.Itdiffersfromothertoolkits,becauseitisintendedforapplicationtoprojects,policies,orprogramsthatdonotexplicitlyaimtoaffectthementalhealthofapopulation.
Thesetoolkits,aswellastheMHIAandMWIA,areusefulinidentifyinghowmentalhealthmaybepotentiallyimpactedbyaproject,program,orpolicy.However,toolssuchastheMHIAandtheMWIAmaybemoresuitedtosituationswhereHIAsareconductedbythosewhospecializeinpopulationmentalhealthorwhoarefamiliarwithmentalhealthanditsoutcomes.ThispaperisconcernedwithimprovingtheinclusionofmentalhealthingeneralHIA,amongpractitionerswhoarenotonlyinterestedinmentalhealthimpactsoroutcomes.Therefore,thisreportfocusesontheinclusionofmentalhealthintogeneralHIA,hereinreferredtosimplyas“HIA.”
HowArePractitionersWorkingtoImprovetheInclusionofMentalHealthinHIA?
Inrecentyears,HIApractitionershavebecomeactivelyinvolvedinimprovingtheinclusionofmentalhealthintoHIA.AmajorstepinthisprocesshasbeentheattempttoidentifythescopeoftheproblemregardingthestatusofmentalhealthinHIA.A(2015)workingpaperbyLucyk,Gilhuly,Tamburrini,andRogerson34—whichreviewed156completedHIAreports—hasshownpreliminaryresultsthatjust73.1%ofHIAsincludementalhealthinscoping.OfthosethatincludedmentalhealthinthescopingoftheHIA,37.7%measuredmentalhealthproblemsatbaseline,ofwhich64%madepredictionsregardingchangesinmentalhealthastheresultofimplementingaproposedpolicy,plan,orprogram.35OftheHIAsthatmadepredictions,50.9%suggestedmitigationstrategiesforpotentialnegativechangestomentalhealth.36Thesefindings,whilepreliminary,quantifytheproblemthatmentalhealthisnotsufficientlyrepresentedin
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HIAs.Theyalsohighlighttheproblemthatwherementalhealthisincluded,itisnotreportedorfollowedforallstepsoftheHIA.Finally,thesesupporttheobservationbypractitionersthatitcanbedifficulttoidentifyandassessmentalhealthoutcomes.
Theproblemsdescribedabovewerevoicedin2013attheHIAoftheAmericasconference,whenmembersoftheSocietyofPractitionersofHealthImpactAssessment(SOPHIA)establishedaMentalHealthWorkingGroup.ThegroupfirstmettodiscusstheimportanceofintegratingmentalhealthconsiderationsintoHIAsandidentifyrelatedchallenges,andtoexploreoptionsforaddressingthosechallengesandmovingthefieldforward.Twomainchallengesdiscussedatthismeetingweretheneedforanagreeduponconceptualizationof“population-levelmentalhealth”andthelimitationsofdataandindicatorsavailabletomeasurementalhealth.Fivecallswereconductedwiththegroupoverthenexteighteenmonths,duringwhichtimethegroupagreedtoworktodevelopaseriesofresourcesheetssothatHIApractitionerswithoutabackgroundinmentalhealthcouldhavetheresourcestomoreconfidentlyincorporatementalhealthconsiderationsintotheirHIAs.Thisseriesofresourcesheetscouldeventuallybeconsolidatedintoawhitepaper.Theserieswouldcoverthefollowingtopics:
• CommondefinitionsHIApractitionerscanutilizewhenincorporatingmentalhealthintotheirHIAs
• Samplepathwaysexplainingtherelationshipbetweenthementalhealth-relatedconceptsdefinedinthepreviousresourcesheetandphysicalandmentalhealthoutcomes,
• Resourcesforassessment,includingindicatorstouseandavailabledatasources,• Samplerecommendationsthatcouldbeofferedtoaddressmentalhealth
impactsanddeterminants,• Reportingandcommunicationsguidanceonhowtotranslatementalhealthdata
intoaccessibleinformationforengagingdecision-makers,and• ReviewofthecurrentstatusofmentalhealthinHIAs.
Itwasdecidedtoreleaseallproductssimultaneouslytoenhancecohesivenessofthedocuments.
TheWorkingGroupthenmetagain,withnewmembersjoining,atthe2014HIAoftheAmericas.Participantscontinueddiscussionsabouttheimportanceofintegratingmentalhealthconsiderationsintohealthimpactassessments,revieweddraftsoftheworkthathadbeencompletedatthatpoint,andexploredcontentfortheremainingresourcesheetsidentifiedinthe2013session.
ThefirstresourceintroducedattheWorkingGroupwastheMentalHealthDefinitionsforHealthImpactAssessment,whichprovidedcommondefinitionstothefield,includingcommondeterminantsofmentalhealth.ThesecondresourcewastheMentalHealthPathwaysforHealthImpactAssessment,whichprovidespractitioners
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withguidanceastohowmentalhealthcanbeincludedinHIA.Thetoolguidespractitionerstoconsiderinputs,componentsofmentalhealth,andoutcomesthatmayberelevanttomentalhealthwhencreatingpathwaysintheearlystagesofanHIA.FactorsincludedPositiveFactors(Buffers)suchassocialconnection,trust,andsleep,andalsoNegativeFactors(Stressors)suchassocialexclusion,trauma,andcrime.Atestofthetoolwasundertakenbyparticipantsattendingthe2014WorkingGroup,andappliedtotwoexamplesofHIAprojects.Forbothexamples,HIApractitionerswereabletosuccessfullyincorporatementalhealthintheirconsiderationofhealthpathways.Bytheendofthesession,participantsagreedtocontinueworkontheremainingresourcesheets.
HowDoHIAsMeasureMentalHealth?
HIAsusedmultiplewaystomeasurementalhealthinpopulations,whichvariedbasedonoutcomes(i.e.,measuresofmentalhealthormentalhealthproblems)ofinteresttotheHIAandresourcesavailable.Indicatorsusedtomeasurementalhealthatthepopulationleveldifferedbyformofdatacollection(i.e.,primaryorsecondary),typeofdatacollected(i.e.,quantitativeorqualitative),andtypeofoutcomemeasured(e.g.,illness,hospitalization,perception).Asmentionedearlierinthisreport,themappingofmentalhealthinHIA—includingoutcomes,indicators,predictions,mitigations,andmeasures—iscurrentlyunderwayinaworkingpaperbyLucyk,Gilhuly,etal.(2015).Theinformationusedinthefollowingsectionswasderivedfromthesourcesusedinthisworkingpaper.Specifically,thisreportsonHIAsthatwereconductedintheUnitedStates,completedbetweenSeptember2013andJanuary2014,listedontheHealthImpactProjectdocumentlibrary1andidentifiedbyauthorsasincludingmentalhealth.
MentalHealthOutcomesIncludedinHIAs
MentalhealthoutcomesvariedwidelybyHIA,fromproblemslinkedtomentalhealth(e.g.,domesticabuse)tospecificmentalhealthproblems.ThissectionsummarizesdifferentmentalhealthoutcomesfoundinHIAs(seeTable2).Thislist,whilecomprehensive,isnotexhaustive.Rather,itismeanttogivepractitionersanoverviewofthetypesofmentalhealthoutcomesusedbyotherHIAs,astheyconsiderhowtheymightincludemetalhealthintheirownwork.
Mentalhealthoutcomesinthissectionrefertoanypossiblementalcondition,disorder,orstatethatcouldbeimpactedbyaproject,policy,orprogram.AsillustratedinTable2,below,therearemanydifferentwaystolookatmentalhealth.Forthepurposesofthisreport,mentalhealthoutcomes(i.e.,thehealthimpact)andmentalhealthindicators(i.e.,themeasureofthehealthimpact)aretreatedasoneandthesame.Thisisanattemptmadetobeascomprehensiveaspossible,withinthelimited
1CreatedthroughapartnershipbetweentheHealthImpactProject(acollaborationoftheRobertWoodJohnsonFoundationandThePewCharitableTrusts)andtheCentersforDiseaseControlandPrevention’sHealthyCommunityDesignInitiative.
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informationprovidedinHIAreports.Frequently,outcomesandindicatorswereusedinterchangeablyinHIAs,andnodistinctionwasmade.
Table2.MentalhealthoutcomesandindicatorsincludedinHIAs.
MentalHealthOutcomesIncludedinHIAsAddiction Dischargeofpatientswithpsychiatricillness(from
hospitalorpsychiatricfacility)Admissionofpatientsforpsychiatricillness(tohospitalorpsychiatricfacility)
Domesticabuse
Aggression DomesticviolenceAggressivebehaviours DrinkinganddrivingAlcoholconsumption DrugandalcoholadmissionsAlcoholordruguse/abuse DrugdependenceAlcohol-relateddeaths DruguseAlcohol-relatedincidents Drug-relatedhospitalizationsAlcohol-relatedviolence Emergencyroomvisitsformentalhealth-relatedincidentAlcoholism EmotionaldistressAnger Employers’concernsaboutemployeedrinkinganddrug
useAnnoyance FeelingmentallyunhealthyAnxiety Feelingsad,blue,ordepressedAnxietyinfamilymember FeelingsofcalmnessorpeacefulnessAttemptedsuicide FeelingsofhopefulnessinthefutureAttentiondeficitdisorder FeelingsofisolationBehaviouraldevelopment ForcedtohavesexualintercourseBingedrinking GamblingBingedrinkinginadolescents GoodmentalhealthdaysBloodpressure HospitalizationsinAlcoholandDrugTreatmentCentersBrainfunction HowmuchstressaffectsresidentsonadailybasisBullying IllegaldruguseBurdenofmentalhealth Importanceofparksinemotionalandpsychological
healthChildabuse/neglect Inabilitytowork,duetomentalhealthCollectiveefficacy JobstressCommunityengagement LifesatisfactionControlinlife MajordepressivedisorderCriminaloffenses,frompolice Mentalandbehaviouraldisorderduetopsychoactive
substancesDeathfromself-injury MentalconditionsDepression MentaldistressDepressioninfamilymember MentalfatigueDepressivedisorder MentalfunctioningDepressiveepisodeinpastyearamongyouth Mentalhealth(unspecified)Depressivesymptoms Mentalhealth,ascauseofdeath Mentalhealthissues(unspecified)
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Table2.MentalhealthoutcomesandindicatorsincludedinHIAs(continued).
MentalHealthOutcomesIncludedinHIAsMentalwellbeing SenseofwellbeingNotattendingschoolbecausefeelingunsafe SexualassaultNumberofalcohol-relatedmotorvehicleaccidents
Socialcapital
Occupationalstress SocialcohesionOutpatientsreceivingmentalhealthtreatment SocialisolationParanoia SocialparticipationParentalconcerns Social-domesticproblemsPathologicalgambling Staff-to-studentsupportPercapitaalcoholconsumption StressPerceivedcommunitytrust StressatworkPerceivedcrime StressfromtransitPerceiveddiscrimination Stress-relatedillnessPerceivedneighbourhoodsecurity StudentacademicperformancePerceivedsafety Studentswhofeelnervous,worried,orupsetmostorall
ofthetimePerceivedsafetyandcrime SubstanceabusePerformingmultiplejobsatwork Substanceuseinpastmonths,persons12yearsandolderPoliticalengagement SubstanceusePoormentalhealth SuicidalideationPoormentalhealthbybullying SuicidePoormentalhealthdays TensionPsychologicaldistress TrustPsychologicaldistressamongteens TrustinneighboursPsychologicaldistressinpastmonth UnhealthycopingbehavioursPsychologicalwellbeing ViolenceRace-relatedstress ViolentbehavioursRecurringdisciplineevent WorkdutiesRiskybehaviours WorkingforsomeoneotherthantheiremployerSadorhopelessfeelingsamongteens WorkingoutsidejobdescriptionSelfefficacy WorrySelfesteem YouthsuicideattemptsSelf-induceddeath Senseofcommunity
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WhatDoHIAsSayAboutMentalHealth?
HIAsareconcernedwithassessingpotentialhealthimpactsfromaproject,policy,or program; therefore, where HIAs included mental health, they discussed potentialmental health impacts from factors related to these projects, policies, or programs.Most often, this discussion of mental health and its related factors occurred in thescopingportionofanHIA,thoughthisvariedwidelyamongdifferentHIAs.Mostclaimsthat were made regarding potentially influencing factors to mental health weresubstantiatedbyacademicliterature.ThissectionprovidesanoverviewofthetypesofinfluencingfactorsthatHIAsexploredinregardtomentalhealth.Itincludesdiscussionof common social or other determinants named as influential to mental health, anddirects readers to the sources cited for each. This section is meant to direct HIApractitionerstoresourceswhenconsideringtheinclusionofmentalhealthintoHIA.Thisreport should not be used in evidentiary statements onmental health or in place ofciting original sources, as it is compiled from the findings reported in HIAs. Differentinfluencing factors within a determinant are bolded in purple.Where definitions areincluded,theyareboldedinblue.
SocialDeterminantsofMentalHealth
BuiltEnvironment
Thebuiltenvironmentrefersgenerallyto“thephysicalenvironmentthatisconstructedbyhumanactivity.”37Thisincludeselementssuchasland-usepatterns,transportationsystem,sidewalks,andurbandesign,amongothers. ManyHIAshaveconsideredtheimpactthatthebuiltenvironmentcanhaveonmentalhealth,foraplethoraofevidenceexistsshowingthatthebuiltenvironmentcaninfluencethephysicalandmentalhealthofindividualsandtheircommunities.38Forexample,thewalkabilityofaneighbourhoodhasbeenshowntoresultinhighercommunityparticipationandsocialcapital,whichcouldpromotementalhealth.39
Thepresenceofgreenspacehasalsobeenshowntobebeneficialtomentalhealth.Forexample,theexposuretotreesandparkshasbeenshowntohaverestorativeeffectsonthebrainandmayhelppeoplerecoverfromstress,fatigueanddepression,andincreaseattentionspan.40Ontheotherhand,thosedissatisfiedwithgreenspacewerereportedashaving2.4timeshighertheriskformentalhealthissues.41Parksandgreenspacehavealsobeenreportedtofacilitatethesocialinteractionsthatarecriticaltomaintainingcommunitycohesion,communitypride,andsocialcapital.42Similarly,parksandopenspacewerealsoreportedtoreduceirritabilityandimpulsivityandpromoteintellectualdevelopmentinchildrenandteenagers,43andimprovefunctioningofchildrenwithAttentionDeficitDisorder.44Positivementalhealtheffectsfrombeingoutdoorshavebeenreportedtopotentiallyreducestress,depression,anxiety,attentiondeficit,andhyperactivity.45Timespentoutdoorswasreportedasreducingaggressivenessandviolence46andbenefittingchildrenacademically,socially,
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andpsychologically.47Walkingorrunninginnaturehasbeenshowntoimprovepsychologicalrestorationandreducementalfatigue,48whilesimplyhavingnatureclosewasshownasimportanttomentalwellbeing.49Education
Education(i.e.,theprocessofreceivingsystematicinstruction)50isasocialdeterminantofhealththathasbeenassociatedwithmentalhealth.Thisincludesfactorssuchaseducationlevel,earlychildhoodeducation,andqualityofeducation.
Higherlevelsofeducationhavebeenassociatedwithhigherlevelsofself-ratedmentalhealth.51Likewiseschooleducationhasbeenshowntoreducelevelsofantisocialbehaviourandimprovedsocialadjustmentforchildren.52Participationinafterschoolprogramsmayimprovechildren’sadjustmenttoclassroomenvironments,anddecreasethemanifestationoftheiremotionalandbehaviouralproblemswheninclass,providedthroughsocialsupport.53Recently,psychologistshaveindicatedthatgraderetentionmaypredicttheoccurrenceofdroppingoutofschool,ordevelopingmentalhealthproblemslaterinlife.54Graderetentionreferstowhenastudentisheldbacktorepeatacourseorgrade.Criticsofthispracticediscourageretentioninfavourofsocialpromotion,sothatstudentscanremainwiththeirsame-agepeerstoavoidpotentialproblemswithbehaviouralorsocialdevelopment.
Employment
Employmentstatus(i.e.,employed,unemployed,transitioning)andworkingconditionsaresocialdeterminantsofhealththathavebeenshowntoshapementalhealth.55Workingconditionsproventobegoodformentalhealthincludemorecontroloverdecisionmaking,receivinghigherrewardsforhardworkandsupportfromcolleagues.56Likewise,re-employmentwhenanindividualhasexperiencedaperiodofunemploymenthasbeenshownasbeneficialtomentalhealth.57
Conversely,unemploymenthasbeenrelatedtopoorpsychologicalwellbeing58withnegativeimplicationsformentalhealth.59Specifically,unemploymenthasbeenlinkedtoincreasedanxiety,depression,substanceabuseandothermentalhealthoutcomes,60alongsideprecariousorunstableemployment.61Unemploymenthasalsobeenconnectedtoincreasedsubstanceabuse,whichmaybeintensifiedfromthedistresscausedbylosingone’sjob.62
Occupationalstress(i.e.,stressinvolvingworkanditsrelateddemandsandresponsibilities)mayhavenegativephysicalandmentalhealthimpacts.Forexample,highworkingdemands,lowcontrolinworkingdecisions,andjobinsecuritymayincreasetheriskfordepressionandanxiety.63Occupationalstressmaybecausedbyfactorssuchasheavyworkloads,infrequentrestbreaks,longworkinghours,hecticorroutinetasksthatdonotutilizeworksskills.64Anothersourceofoccupationalstressmaybecausedbyworkingextrahourstomakeupfortimelost,whichmaygenerate
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psychosocialstressthatleadstocompromisedrelationshipsorconflict.65Occupationalstressmayresultinlittlesenseofcontrol,excludeworkers’voicesindecisionmaking,fosterapoorsocialenvironmentatwork,orresultinconflictingexpectationsbetweenworkersandmanagement.66
Sleep(i.e.,thestateofrestingbodyandmindforseveralhourswherethenervoussystemisrelativelyinactive)iswidelyacceptedasaninfluentialfactorformentalhealthonitsown,67(especiallywheresleepdeprivationoccurs)68andisalsorelatedtooccupationalstresswhenone’sworkinterfereswiththeirsleepingpatterns.Forexample,thosewhoworkextrashifts,doubleshifts,orshiftworkhaveincreasedriskfordepressionandanxiety.69
FoodInsecurity
Foodinsecurity,whereadequatequalityandquantityofdietisunavailable,hasbeenshowntoleadtobehaviorproblems,decreasechildren’smentalhealthandwellbeing,decreasededucationalperformance,andincreasedaggressionandanxiety.70
Income
Personalandhouseholdincomehavebeenlinkedtomentalhealthinanumberofways.Forinstance,financialstrainhasbeenshowntobeinfluentialinthedevelopmentofdepression.71Specificeffectsincludelinkagesoffinancialhardshipandlowsocioeconomicstatuswithdepression.72Similarly,householdincomehasbeenshowntoaffectemotionalwellbeing—negativelyforthosewithless.73Negativechangestohouseholdincomehavealsobeenassociatedwithhigherratesofsuicideattemptsandlifetimementalhealthproblem.74Finally,incomeinequalityatthestatelevelhasbeenassociatedwithanincreasedriskofdepressionamongwomen(especiallymothers).75
Housing
HousingwasanotherissuethatmanyHIAsaddressed,althoughitwasrarelytiedspecificallytomentalhealth.Measuresofhousingmayincludelivingconditions,perceivedvalueofproperty,affordableorinsecurehousing,orthenumberofpersonssharingadwelling.Perhapspredictably,poorqualityhousinghasbeenshowntocausestressanddecreasementalhealth.76Similarly,affordablehousinghasalsobeentiedtocreatingconditionsthatinfluencementalhealth.Forexample,rentcontrolledhousingmayprotectlow-incomerentersfrompotentialdisplacement(throughhighrent),whichmayinturnprotectneighbourhoodsfromeconomicandracialsegregationandavoidapotentialdeclineofsocialcohesion.77
NeighbourhoodConditions
Neighbourhoodconditionsareanothersocialdeterminantofhealththathasbeenextensivelylinkedtomentalhealth.Occurrencessuchasgentrification,
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displacement,orperceivedcrimemaybestressfulforlong-termresidentswhofeelunabletocontroltheeventsaroundthem.78Displacementwasalsofoundtodiminishsocialcapital,79whichmaybestressfulforlong-timeresidents.80Likewise,livinginpoororwealthyneighbourhoodscanhavementalhealthoutcomes.81Girlslivinginnon-poorneighbourhoodswereshowntohaveimprovedmentalhealthstatus.82Aswell,parentswhomovedawayfromhigh-povertyneighbourhoodsexperiencedfewerdistressanddepressivesymptoms,whichtheirchildrenbenefitfrom.83
Crimeandperceivedcrimeisanotherfactoroftenrelatedtoone’sneighbourhood.Thosewhofearcrimemayhavepoorermentalhealth,inpartduetoreducedphysicalactivityfromstayingindoors,astheresultoftheirfearandstressofbeingintheirneighbourhood.84Witnessingorexperiencingactsofviolencewasalsoshownaspotentiallyimpactingmentalhealth.85
SocialCapital
Socialcapitalrefersto“thefeaturesofsocialorganization,suchascivicparticipation,normsofreciprocity,andtrustinothersthatfacilitatecooperationformutualbenefit.”86Somestudieshaveshownthatpeoplewithgreatersocialcapitalhavemoreself-esteem,self-image,andself-worth,87improvedmentalhealth,88betterpsychologicalandphysicalhealth,89andmorecollectiveefficacy.90Ontheotherhand,lowersocialcapitalmayincreaseone’sriskforpoorphysicalandmentalhealth.91Socialcapitalhasbeenlinkedtofactorsthatseparatethecommunity,suchasnegativeeffectsfromlivingonstreetswithhightrafficvolume.92Additionally,socialcapitalhasbeensaidtodecrease10%per10-minutecommuteamongstworkers.93
SocialCohesion
Socialcohesion,wherepresent,referstoasocietythatisinclusive,trustpromoting,fightsmarginalization,andworkstowardsthewellbeingofallmembers,includingtheopportunityforupwardmobility.94Socialcohesionisconcernedwithelementssuchassocialinclusion,socialcapital,andsocialmobility.Peoplewholiveinsociallycohesivecommunitieshavebeenshownmorelikelytobehappythanthosewhodonot.95Muchlikesocialcapital,socialcohesionmayimpactmentalhealththroughtraffic-inducedsocialexclusion,whichcouldalsobringcauseforsafetyconcernforcommunitymembers,andcannegativelyaffectqualityoflife.96
SocialSupport
Socialsupport,whetherperceivedorprovided,hasbeenreportedasabletobufferstress,preventfeelingsofisolation,andcontributetohighself-esteem.97Strongsocialtieswerereportedtobufferagainstdepression.98Aconnectedandsupportivecommunityhasalsobeenshowntomitigatetheimpactofsomementalhealthdisorders.99
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OtherFactorsthatAffectMentalHealth
CommunityConflict
Communityconflictmayresultwhereaproject,program,orpolicy(e.g.,environmentalandnaturalresourcedisputes)100createsstresswithinacommunity.Persistentfeelingsofanxietyorlackofcontroloveraproject,orrepeatedexposurestostressfulsituationscouldpotentiallymanifestaslong-termchronicstress.101Stresshasbeenshowntoincreasevulnerabilitytoenvironmentalstressorsbyloweringresponseratestonoiseorpollution,102triggerorworsenmentalhealthproblem(particularlyanxietyanddepression),103andaffectanumberofadditionalmentalandphysicalhealthconditionsdiscussedextensivelyinthecorpusofstressliterature.Communityconflictmayresultfromcontroversialsitingofaproject,tensionsbetweenlocalrisksandglobalbenefits,mistrustofprojectdevelopersorowners,orlimitedopportunitiesforcommunitymemberstoinfluencethedecisionmakingprocess.104Thefearofvictimizationfromaproject,policy,orprogrammayleadtopsychologicaldistress,sotoocanthefearofdisplacementfromaresidentialdevelopmentorplanningphase.105
CommutingTime
Commutingtime,thatisthetimespenttravellingfromone’shometoplaceofwork,wasreportedasafactorinfluentialtomentalhealthinmanyHIAs—particularlythoseinthetransportationsector.Forinstance,itwasreportedthatshortertransitcommutetimesmightincreasesocialcapitalandimprovementalhealththroughincreasedcommunityconnectedness.106RailcommutersinNewYorkandNewJerseywerealsoshowntohavelessstressandfewernegativemoodsthanthosewhodidnotcommutebyrail,107whereasautomobilecommutersexperiencedhighlevelsofself-reportandphysiologicalindicatorsofstress.108Longcommutetimeshavebeenassociatedwithincreasedstress,109whereasreductionsinmotorvehicletripsandmilestravelledmaydecreasestresslevels.110
Energy
Cleanenergy(i.e.,sustainable,renewableenergysuchaswindenergy)hasbeendiscussedinthecontextofpotentiallyreducingthecostsofhousingandpsychologicalstress.111Also,energyefficientlightingwasidentifiedasimprovingattentionandlearning.112Gambling
Problemorpathologicalgambling(i.e.,wheregamblingcontinuesdespiteharmfulconsequences)hasbeenlinkedtoanumberofmentalhealthoutcomes.SomethatwereidentifiedintheSoutheastKansasCasinoHIA113werechildabuse,neglect,domesticviolence,suicide,unsafesex,andalcoholabuse,whichcouldleadtoattemptedsuicide,depression,anxiety,orfurtheralcoholabuse.114
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IndustrializationandModernization
Industrializationandmodernization,whichreferstosocialandeconomicdevelopmentsthatareoftenrelatedtochangesintechnology,havebeenlinkedtomentalhealthinanumberofways.Forexample,theindustrializationandmodernizationofacommunitymayincreasehospitalizations,mortality,alcoholanddrugabuse,risk-taking,andsuicidalbehaviour.115Similarlysuicide,alcoholism,criminalactivity,anddivorcemaypotentiallyincreaseinboomtowneconomies.116Disruptionsinsocialcohesionmayoccurwherenew-comersandold-timersresideinthesamearea,whichcouldaddtolevelsofstress,worry,orsatisfactionexperiencedbytheindividualslivinginacommunity.117 RapideconomicgrowthinIndigenouscommunitieshasbeenassociatedwithalcoholanddrugabuse.118Developments,suchasmining,maycontributetodifferentsocial,cultural,oreconomicpatternswithimplicationsformentalhealth.Earnedwagesfromindustry-relatedjobsmaybespentontobacco,alcohol,orillicitdrugs.119Shiftworkassociatedwiththesejobscouldresultinlongperiodsawayfromhome,whichmaycausemaritaldiscordorfamilydysfunctionfromstressbroughtonbyre-integratingfamilieswhenemployeesreturnhome.120Specifictonaturalgasdevelopmentandproduction,theburdenofsubstanceabuseincommunitiesmayincrease,121aswellasillegalsubstanceactivity.122Economicdisparitiesbetweenthoseearningindustrialwagesandotherscouldincrease,whichmayaltertraditionalsharingnetworks.123Noise
ManyHIAsreportedpotentialmentalhealthimpactscausedbynoise,mostoftenheightenedduringtheperiodofaproject’sconstruction.Noiseannoyancecanoccurfromroadtraffic,amajorconsiderationintransportationHIAs.124Someofthefindingsrelatedtomentalhealthassociatedwithnoiseincludethepotentialreductionofcognitiveabilities,andincreasedamountsofstress,vis-à-vissleepdisturbance.125Otherimpactsincludetheannoyancecausedbynoise,whichmayalsohavenegativeimplicationsforstressormood.126Specifically,noisepollutionhasbeenshowntoincreaseanxiety,stress,nervousness,nausea,headache,emotionalinstability,argumentativeness,changesinmood,andincreasedsocialconflicts,neurosis,hysteria,andpsychosis.127Excessivenoisewasalsofoundtohaveadverseeffectsonchildren’slearningandacademicperformance.128
PhysicalActivity
InmanyHIAs,physicalactivity(e.g.,exercise)wasnamedasaninfluentialfactortomentalhealth.129Somepotentialeffectsreportedformentalhealthfromphysicalactivitywereincreasedcognitivefunction,130preventionandalleviationofdepressionandanxiety,131andlowerlevelsofstressbywalkingandcycling.132Physicalactivitywasalsoreportedtohavepositiveeffectsonself-concept,physicalself-acceptance,global
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self-acceptanceandself-esteem,133aswellasimprovechildren’sacademicperformancecapacitytolearn,memory,attention,andgeneralcognitivefunctioning.134
PublicArt
PublicartwasbrieflymentionedashavingpositivementalhealthimpactsintheI-710ExpansionHIA135inLosAngeles,California.136
Wayfinding/BeingLost
Wayfindingreferstotheeasewithwhichonecanorientthemselvesinaphysicalspaceandnavigatetheirway.137Wayfindingwasmentionedasfactorthatcouldimpactmentalhealth,forpeoplemayexperiencementalstress,feelingsofhostility,oranxietywhenfeelinglost.138Conversely,personsincontroloftheirsurroundingsmayhavebettermentalhealth.139InoneHIA,140practitionersreportedthattransitridersexperiencedincreasedstresswhereroutesweredisconnectedandlesspredictable.141
HowdoHIAsIncorporateMentalHealth?
MentalhealthwasincorporatedinHIAsinanumberofdifferentways.Forsome,thisconsistedofcollectingprimarydataandanalyzingittodeterminebaselinemeasuresofmentalhealthortopredictfuturechangesinthepopulation.OtherHIAsusedsecondarydatatoderivesimilarfindings.Inthissection,wereviewsomeofthemethodsofdatacollectionandanalysis,aswellasspecifictoolsthathavebeendesignedtomeasurecertainconceptsrelatedtomentalhealth.Asinthesectionbeforethisone,thedescriptionsprovidedaremeanttobecomprehensivebutnotexhaustive.Theyareintendedtoserveasaresourceforpractitioners,todirectthemtodifferentdatasources,methods,andtoolsthatcanbeusedandwheretheycanbefound.Itshouldalsobenotedthatdatasourcesandtheircategorizationssometimesoverlap.ThisisdueinparttothelimiteddescriptionofthesourceprovidedinanHIAandalsobecauseitwasnotalwaysclearwheredatawashoused,whomaintainedit,orwhatitincluded.Itissuggestedthatfutureworkexplorethesedatasourcesmorecompletelyandcategorize,astheydeemappropriate.
PrimaryDataSources
Primarydatareferstotheinformationthatiscollectedthroughdirectinteractionwithhumans,suchastheconductionofinterviews,questionnaires,measurements,observations,ormedicalrecordabstraction.142Forprojectsthatcollectprimarydata,theresearcherandtheirteamcollectthisinformationthemselves,andtheinformationisuniquetotheirproject.143Forthissection,datasourcesarelistedwhereinformationwascollectedsolelyfortheHIA(asindicatedwithinanHIAreport).
Primarydata(orsecondarydata,describedinthefollowingsection)canbe
qualitative,quantitative,oramixofboth.Qualitativedatareferstodatathatismaderatherthancollected.Typesofqualitativedataincludeinterviews(structured,
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unstructured,orsemi-structured)orfocusgroupstranscripts,observationsintheformatoffieldnotes,ordocumentsorphotographs.Quantitativedatareferstodatathatiscollectedforvariablesdeemedrelevanttoaresearchquestion.144Someexamplesofquantitativedataincluderatesofmortalityorprevalenceofamentalillness.Bothquantitativeandqualitativedatasourcesareusedtoreportandpredictonresearchoutcomesandpotentialmentalhealthimpacts.Withquantitativedata,thismayincludepredictingpotentialchangesregardingmentalhealthormentalhealthproblemsthroughdesigningastatisticalmodelwithvariablesofinteresttotheproject.Withqualitativedata,thismayincludedrawingonfindingsfrompreviouslyconductedstudiestopredictcommunityfeedbackregardinganHIA.
MethodsofPrimaryDataCollection
CommunityEngagement
CommunityengagementisintegraltoHIA,foritrepresentsanopportunityfordemocracyamongthoseimpactedbyaproject,policy,orprogram.Communityengagementisnotonlyusedforassessment,butisimplementedthroughouttheHIAprocess.TheknowledgeandexperienceofthepublicisactivelyincludedinHIAsbypractitioners,toinformtheirevaluationofpotentialimpactsorpoliciesorprograms.Often,communityengagementisaninteractiveprocessinformedbyqualitativeresearchmethods(e.g.,focusgroups,interviews),howeveritcanalsooccurthroughotherforums,suchaspubliccommentperiodsoronlineforumsforcommunityinput.Itprovidesawayforpractitionerstoidentifypreviouslyunheardaspectsofaprojectfromresidentsandothercommunitymembers.Forexample,intheArcticOuterContinentalShelfOilHIA145andGasMultipleLeasingSaleEnvironmentalImpactHIA,146practitionersidentifiedatensionbetweenthoseonopposingsidesofpotentialoffshoreexploration.Theyanticipatedthatthisconflictcouldmanifestasincreasedstressandtensioninthecommunityfurtheralong,fromrapidsocioeconomicchanges,alteredavailabilityofsubsistenceresources,andinfluxofoutsideoilandgasworkersenteringthecommunity.
FocusGroups
Focusgroupsareoneformofcommunityengagementwherepersons(usually6to8)gathertodiscusstopicschosenbyafacilitator.147Focusgroupsareusedtogeneratedataaboutatopic,butalsotorevealhowparticipantsrelatetothetopicandeachother.148Focusgroupshelppractitionerstounderstandthepotentialimpactsapolicy,program,orprojectmayhaveonaspecificgrouptodetermineifitsupportsorrefutesfindingsfromrelevantliterature.SomeexamplesofhowfocusgroupshavebeenusedinHIAstoshedlightonmentalhealthareprovidedbelow.
IntheCaliforniaPaidSickDaysHIA,149practitionersconductedtwofocusgroups,
each90minuteslong,withLatinaresidents.Thisenabledthemtogainapersonalunderstandingoftheeffectsthatlostwagesorjoblossduetocallinginsickcouldhaveforpersons.Inparticular,residentsidentifiedjoblossorlostwagesascausingstressand
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tension.Workersfoundthatabenefitthatprotectedwagesiftheyweresickwould“alleviatemuchofthisfearandstress–astheywouldnotbeforcedtochoosebetweentheirincomeandhealth.”150
TheMassachusettsPaidSickDaysHIA151isarelatedprojectthatusedfocus
groupstoidentifymentalhealthconcerns.Forexample,residentstoldHIAfocusgroupfacilitatorsthatnotgoingtoworkduetosicknesscouldcausestress(particularlyfromlostwages),whichcouldeventuallyleadtomoresickness,likedepression.Whilethisfindingiswellrepresentedinacademicliterature,thereisgreatvalueinshowingthattheseconcernsarepresentinthepopulationofinterest.
FocusgroupswerealsoconductedfortheRentalAssistanceDemonstration
ProjectHIA.152Forthisproject,theyhelpedtoillustratetheproblemsandstressesfacedbyresidentsofpublichousing.Forexample,practitionerswereabletoidentifythatevenwiththerentalassistanceprogram,thingswerenotgettingbetterformanyresidentsinpublichousing.Residentsreportedlivingintheirrun-downneighbourhood“likeabiggarbage,”depressing,andstressful.Theyalsosharedthattheirstresswasworsenedfromnearbycrimeanddrugactivity.Residentswerealsoabletoidentifycausesforstresstopractitionersthatwerespecificallytiedtotheproject,suchasnewmanagementstructureswithinpublichousing,newstandards,concernswithviolatingrulesofthehousingprogram,orpotentialdisplacementfromhavingtomovetoobtainpublichousing.
IntheTrinityPlazaHousingRedevelopmentHIA,153twofocusgroupswereheld
withresidentswhowerelivingattheTrinityPlazaApartmentsinSanFrancisco.Themesderivedfromfocusgroupsessionsgaveevidenceforhowredevelopmentwouldaffectthesocialdeterminantsofmentalhealth,namelysocialcohesion.Residentsexpressedtheimportanceofbuildingnetworkswithlocalmerchantsandservices,andfeelingastrongconnectionwiththeneighbourhoodandcommunityactivities.However,theyalsoexpressedfearfrompotentialdisplacement,whichtheyidentifiedcouldcausethemhurtorstress,frustration,anxiety,orevengivethemahernia.
FocusgroupswerealsoconductedaspartoftheSchoolDisciplinePoliciesHIA,154wherestudentsandparentsspokeoftheirconcernsrelatedtoexclusionarydiscipline(e.g.,expulsionorsuspension).Thishelpedtoshedlightonhowstudentsperceivedthediscipline(i.e.,fun)andinformedthebrainstormingofpotentialalternatives.
AyouthfocusgroupwasheldfortheAlcoholOutletDensityinMendocinoCountyHIA.155Thisallowedpractitionerstotalktoyouthaboutalcoholabuse,alcohol-relatedviolence,aggravatedassault,violence,underagedrinkingandriskybehavioursinasettingthatfeltsafeandcomfortableforthem(i.e.,noparents).
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InformalPersonalCommunication
Informalpersonalcommunications,suchasemails,conversations,orletterscanhelptoidentifyconcernsthatmaynotbecapturedinfocusgroups,orstructuredinterviews.Forexample,intheCoalandCleanEnergyOptionsinKentuckyHIA,156practitionersconductedinterviewswithcommunityresidentsandfoundthattheyexpressedconcernsaboutminingexplosions,whichcausedthempsychologicalstress.Residentssharedthefearandanxietytheyexperiencedconcerningexplosionsbeneaththeirhomesandpotentialdamagetotheirhomes.
KeyInformantInterviews
Keyinformantinterviewsareinterviewswithselectindividuals,whoareabletospeakin-depthaboutasocialprogram,problem,orinterestgroup.157Individualschosenforinterviewsareoftenconsideredcommunityorgrouprepresentatives,duetotheirvastunderstandingofasituationandthesensitivityofatopicthatmayprovedifficulttodiscussinagroupsetting.SomeexamplesofhowkeyinformantinterviewswereusedtoidentifymentalhealthoutcomesinHIAsarediscussedbelow.
IntheHOPEVItoHOPESFHousingHIA,158practitionersusedinformantinterviewstogetatissuesthatwerenotpresentintheliterature,orwerenotrepresentedindatasources.Forexample,theyfoundthatresidentswereafraidofbreakingtherulesoftheirpublichousingprogram,whichcreatedmentalstressforresidents.Residentsalsoidentifiedcommunityresourcesasapositiveforceinthecommunity,wherepeoplefrequentlywenttoforassistance,andsubsequentlyreceivedaid.Thisallowedforpractitionerstomakeconcreterecommendationstailoredtothecommunity’sneedsthatbuiltonexistingresources.Thesearediscussedfurtherinthesection“Whataresomeexamplesofmentalhealthmitigationstrategies?”
InformantinterviewswerealsousedIntheSchoolDisciplinePoliciesHIA,159whereinterviewswereheldwiththeschoolsuperintendentandthedirectorofrestorativejustice.Thesehelpedtoillustrateproblems,whichtheseadministratorsfelt,couldmanifestfromseverediscipline.Theseincludedmentalhealthproblemsstemmingfromembarrassment,stress,rejection,oralienationfromexclusionarydisciplinepractices.Surveys
SomeHIAsconductedtheirownsurveysregardingthehealthandfeelingsofthoseimpactedbyaproject,program,orpolicy.Whilenoneofthesespecificallyfocusedonmentalhealth,somedidincludequestionsspecifictomentalhealth.Examplesincludethecomputer-assistedsurveyofresidentsconductedfortheAdvancedMeteringInfrastructure–ChicagoHIA.160Practitionerssurveyedresidentstounderstandtheissuestheyfacedregardingadvancedenergymeteringinfrastructure,andenergymoregenerally.Theyfoundthatresidentsfrequentlyworriedaboutpaying
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forbills,whichmanifestinstressthatrequiredtrade-offs(i.e.,closingoffroomstoheatahouse,goingwithoutfoodtopayenergybill).
AnotherexampleistheresidentsurveyadministeredfortheHOPEVItoHOPESF
HousingHIA.161Inthissurvey,practitionerssurveyedresidentsandlearnedthatresidentsexperiencedstresswhentheyhadtomovetootherhousingprojectsduringredevelopment,findnewschoolsfortheirchildren,andliveawayfromthecommunitytheywerelivingin.Theyalsofoundthatresidentsexperiencedstressfromre-integratingandmovingbackintoacommunity,whentheyhadbeenawayforaperiodoftime.
TheConcordNavalWeaponsStationReuseProjectHIA162developeda
communitysurveyfortheirproject,entitledtheContraCostaInterfaithSupportingCommunityOrganization(CCISCO):ConcordNavalWeaponsStationsurvey.Thissurveycontainedquestionsdirectlyrelatedtomentalhealth,suchaswhetherrespondentsorafamilymemberhaddepressionoranxiety,butthesefindingswerenotincludedinthisHIA.
Anotherproject-specificsurveysistheCodmanSquareNeighborhood
DevelopmentHealthImpactAssessmentResidentSurveyin2012,whichwasadministeredbypractitionersfortheOasisonBallouHIA.163Residentswereaskedquestionsaboutperceivedsafetyandcrimeandtrustinneighbors.Thisdatawasthencombinedwithdatafromlawenforcement,comparingperceivedcrimewithactualoffenses.ThecommunitysurveyadministeredtoaconveniencesamplefortheArrestRecordsinEmploymentDecisionsHIA164inChicagoisanotherexampleofproject-specific,primarydatacollection.Thissurveywasconductedtogainanunderstandingofthedemographicsforthoselivinginthearea,aswellastheirperceptionofthepsychologicalsenseofcommunity,collectiveefficacy,race-relatedstress,perceiveddiscrimination,psychologicaldistress,depression,andlifesatisfaction.
TheParentSurveyconductedinLosAngelesbyHumanImpactPartners(HIP)
andCommunityAssetDevelopmentRe-definingEducation(CADRE)wasadministeredtolocalparentswithyouthingrades6to12.Ithelpedtoidentifytheissuesthatparentsweremostconcernedaboutstemmingfromexclusionarydisciplinepolicies.Mentalhealth,particularlyanxietyanddepression,weremainareasofconcern.ThissurveywasdevelopedfortheSchoolDisciplinePoliciesHIA.165
ThePaidSickDaysSurveywasconductedbytheHumanImpactProjectandSanFranciscoDepartmentofPublicHealth.166Itwasaweb-basedsurveyinSpanishandEnglish,administeredtorespondentsusingSurveyMonkey.Thissurveyincludedinformationonself-reportedstressaswelltosupporttheargumentforpaidsickdaysininMassachusettsandacrosstheUnitedStates.
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Project-specificsurveysallowHIApractitionerstoaskquestionsdirectlyrelatedtotheirHIA,whichhelpedthemtomakeconcreterecommendationstailoredspecificallytotheneedsoftheaffectedpopulation.Someexamplesarediscussedfurtherinthesection,“Whataresomeexamplesofmentalhealthmitigationstrategies?”
MethodsofDataAnalysis
EconomicAnalyses
OneformofdatathathasbeenusedtodeterminepotentialmentalhealthimpactsistheeconomicanalysesthatsomeHIAshaveconducted.Forexample,theCityandCountyofSanFranciscocommissionedaneconomicanalysisbySanFranciscoStateUniversitytodeterminetheeffectofaminimumhourlywageof$11.00fortheSanFranciscoLivingWageOrdinanceHIA.167Thisallowedpractitionerstoquantifytherelationshipbetweenincomeandmentalhealth.Theanalysisfoundthatforfull-timeemployeeswithafamilyincomeof$20,000,depressivesymptomswouldmoderatelydecrease.168 TheSugarhouseCasinoHIA169alsoconductedaneconomicanalysisoftheestimatedannualhealthandhumanservicescostsofadditionalpathological/problemgamblersassociatedwithSugarHouseCasino.Theyanticipatedthattheestimatedcostwouldincrease$935annuallyforeachproblemgambler,and$1,570foreachpathologicalgambler.TheyadaptedtheirmeasurementfromareportbyCommunityResearchPartners.170SpearmanRankCorrelationCoefficients
ThismeasurewasusedintheNewBritain-HartfordBuswayProjectRapidHIA171toquantifyrelationshipbetweenmentalhealthandothervariables.TheSpearmanRankCorrelationCoefficientsprovidesp-valuesandcorrelationmeasuresofrelationships.
SomeSpecificTools
HealthyDevelopmentMeasurementTool(see:SanFranciscoIndicatorProject)IsolationIndex
TheisolationindexwasdevelopedforandusedintheHumboldtCountyGeneralPlanHIA.172Itisaconglomerationofpsychologicaldistress,suicide,mentalhealthtreatment,substanceabusetreatment,crimeandcivicengagementdata.Italsoincludedinformationoncountysuiciderates,andadmissionsdatafordrugandalcoholtreatment.
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SanFranciscoIndicatorProject
TheSanFranciscoIndicatorProject(formerlytheHealthyDevelopmentMeasurementTool)isanevidence-basedtooldevelopedbytheSanFranciscoDepartmentofPublicHealth.Itprovidesawayofevaluatingland-useplanningandurbandevelopment,toshowhowthebuiltenvironmentinfluenceshumanhealth.173IthasbeenusedasameasureofsocialcohesioninHIAs,suchasintheSycamoreLightRailStationHIA174andtheHumboldtCountyGeneralPlanHIA,175asitmapscommunityresourceswithinahalf-milefromtheprojectsite.MoreinformationcanbefoundontheSanFranciscoDepartmentofPublicHealth’swebsite.176
Table3.SummaryofthewaysprimarydatawasincorporatedinHIA(collectedspecificallyfortheHIA)
WaysofIncorporatingPrimaryData TopicArea ExampleHIAsMethodsofDataCollection
FocusGroups Jobloss CaliforniaPaidSickDaysMassachusettsPaidSickDays
Publichousing RentalAssistanceDemonstrationProjectRedevelopment TrinityPlazaHousingRedevelopmentSchooldiscipline SchoolDisciplinePoliciesAlcoholabuseanddrinking AlcoholOutletDensityinMendocinoCounty
Informalpersonalcommunications
Concernsaboutmining CoalandcleanEnergyOptionsinKentucky
KeyInformantInterviews Publichousingrules HOPEVItoHOPESFHousing
Administrativeproblemswithschooldiscipline
SchoolDisciplinePolicies
Surveys(conductedfortheproject)
Issueswithenergyuse,billing,andadvancedmetering
AdvancedMeteringInfrastructure–Chicago
Effectsofredevelopment HOPEVItoHOPESFHousing
Communitysurvey,includingmentalhealthquestions
ConcordNavalWeaponsStationReuseProject
Safety,crime,trustinneighbours
OasisonBallou
Perceptionofcommunity,racerelations,mentalhealth
ArrestRecordsinEmploymentDecisions
Issuesrelatingtoexclusionarydiscipline
SchoolDisciplinePolicies
Paidsickdays PaidSickDaysMethodsofDataAnalysis
EconomicAnalysis Impactofminimumhourlywage
SanFranciscoLivingWageOrdinance
Healthandhumanservicescostsofadditionalgamblers
SugarhouseCasino
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Table3.SummaryofthewaysprimarydatawasincorporatedinHIA(cont’d)
WaysofIncorporatingPrimaryData TopicArea ExampleHIAsIsolationIndex Combineddatafor:
psychologicaldistress,suicide,mentalhealthtreatment,etc.
HumboldtCountyGeneralPlan
SpecificTools SanFranciscoIndicatorProject(formerly:HealthDevelopmentMeasurementTool)
Socialcohesion SycamoreLightRailStationHumboldtCountyGeneralPlan
SpearmanRankCorrelationCoefficients
Relationshipbetweenmentalhealthandotherfactors
NewBritain-HartfordBuswayProjectRapid
SecondaryDataSources
Secondarydatareferstodatathathasbeencollectedandpublishedpreviouslyforanotherprojectorpurposeandisavailabletoothersforsecondaryanalysis.177HIAresearchersdonotcollectthisdatathemselvesandmayhavetorequestpermissiontouseitfromthedataowner.178Likeprimarydata,secondarydatamayalsobequalitativeorquantitative,althoughdataismostoftenquantitativeregardinghealthinformation.Secondarydataprovidesapracticalsolutionforpractitionerswhofacetimeandresourceconstraintsandareunabletocollectprimarydata.Formanysources,thereisoverlapbetweencategories,regardingwhetheradatasourceis“vitalstatistics/surveillance”dataor“hospital”data.CategorizationsreflecttheinformationreportedinHIAs.SecondarydatasourcesandtheirmeasuresofmentalhealthormentalhealthproblemsaresummarizedinTable4,whichincludesexamplesofHIAsthatarecitedinthetext.AppendixAincludesaversionofthistablethatisorganizedbymentalhealthindicators.
MethodsofDataCollection
Surveys
BehavioralRiskFactorSurveillanceSystem(BRFSS)
TheBehavioralRiskFactorSurveillanceSystem(BRFSS)isatelephonesurveyconductedintheUnitedStatesbytheCenterforDiseaseControlandPrevention.Itcoversall50states,withcorequestionsonhealthtopics(e.g.,carsafety,obesity).Dataiscompiledatthestateandcountylevel.
OnemeasureincludedintheBRFSSispoormentalhealthdays,whichmeasures
the“numberofdaysintheprevious30dayswhenapersonindicatestheiractivitiesarelimitedduetomentalhealthdifficulties.”179ThiswasoneofthemostwidelyusedmentalhealthindicatorsinHIAs.SomeHIAsthatusedthisincludedthePortlandCity
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Council’sRentalHousingInspectionsProgramforMultnomahCountyHIA,180StateRoute520BridgeHIAinWashington,D.C.,181ArrestRecordinEmploymentDecisionsHIA182inChicagotodeterminecity-leveldata,andtheCapitalAreaRegionalPlanningCommissionFutureUrbanDevelopmentAreaHIA.183
OtherexamplesthatusedtheBRFSSincludetheIceAgeTrailExpansionMarquetteCounty,WisconsinHIA184thatmeasuredratesofsubstanceabuseandstress-relatedillness.ThePortlandCityCouncil’sRentalHousingInspectionsProgramHIA185usedtheBRFSStodetractbloodpressureratesforMultnomahCounty,whichtheymentionedcouldbeindicativeofstress.TheAlcoholOutletDensity–MarathonCounty,Wisconsin186measuredthefrequencyofadultbingedrinking.ThePierceCountyinSouthHillRedevelopmentHIA187reporteddataforthepercentofadultsfeelingsad,blue,ordepressed,whiletheOasisonBallouHIA188lookedatmentalhealthdataspecificallyforthecityofBoston.TheSoutheastKansasCasinoHIA189usedtheBRFSStodeterminethepercentageadultswhohavegambled,forwhomithasledtofinancialproblemstodeterminepotentialmentalhealthimpactsfromopeninganewcasino.
BostonNeighborhoodSurvey
TheBostonNeighborhoodSurveywasconductedin2008,andusedbytheOasisonBallouHIA190teamtocreatetheirNeighborhoodDevelopmentHealthImpactAssessmentResidentsurvey.
CaliforniaHealthInterviewSurvey(CHIS)
TheCaliforniaHealthInterviewSurveyisabiennial,statewidesurveyofCaliforniansconductedbytheUniversityofCalifornia,LosAngeles.AnumberofHIAsusedthistomeasurevariousmentalhealthoutcomes,including:numberofdaysunabletoworkduetomentalhealth,sadorhopelessfeelingsamongteens,psychologicaldistressamongteensbytheSanDiegoBusRapidTransitStationHIA,191senseofwellbeingbytheOasisonBallouHIA,192and(implied)socialcapitalfortheAndroscogginGreenwayPlan.193
CaliforniaSchoolClimateSurvey(CSCS)
TheCaliforniaSchoolClimateSurveyisanelective,web-basedsurveyofferedtostaffworkingingrades5to12inschoolsthatparticipateintheCaliforniaHealthyKidsSurvey.Itincludesquestionsonstaff-to-studentsupport,studentacademicperformance,schooldisciplineenforcement,andstudentalcoholanddruguse.ItwasusedintheSchoolDisciplinePoliciesHIA.194
CaliforniaHealthyKidsSurvey(CHKS)
TheCaliforniaHealthKidsSurveywasdesignedandadministratedbyWestEdinthe2005/6and2007/8schoolyears.Thesurveywasadministeredforkidsinodd-
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numberedgradeyears(5,7,9,11)thatwereconsideredtobetransitionalyearsforyouth.Interviewquestionsincludequestionsregardingstudents’anxiety,sadness,ordepressionthataffectedtheirnormalactivities.ItwasusedintheSchoolDisciplinePoliciesHIA.195
CaliforniaWorkandHealthSurvey(CWHS)
TheCaliforniaWorkandHealthSurveywasalongitudinalsurveyofCaliforniaadultsconductedin2000bytheSanFranciscoDepartmentofPublicHealth.Questionsaskedincludedwhetherrespondentshadonejob,workedforsomeoneelse,orwerepaidforsickdays.ThisdatasourcewasusedbytheCaliforniaPaidSickDaysHIA196togainanunderstandingoftheoccupationalstressthatCaliforniansfacedintheirjobs.
ConnecticutEnergyEfficiencyFundSurvey
TheConnecticutEnergyEfficiencyFundadministeredthissurveytoConnecticuthouseholds2011.DatafromthissurveywasusedintheHIAofUtilityRulemakingonConnecticut’sPublicBenefitFund197togainanunderstandingofsocialisolationamongstitscustomers.
DomesticWorkersUnitedSurvey
DomesticWorkersUnitedadministeredtheDomesticWorkersUnitedSurveybetween2003and2004inNewYork.ItwasusedintheCaliforniaDomesticWorkerEquality,Fairness,andDignityActHIA198foritsmeasuresofoccupationalstress.ThisHIAreportedthepercentofworkersreportingstressatwork,thoserequiredtoperformmultiplejobs,thoseworkingoutsideoftheirjobdescription,orworkingforsomeoneoutsideoftheiremployer.
EnCanaSurveyofSubcontractors
IntheHIAforBattlementMesa,GarfieldCountyColorado,199practitionersuseddatafromasurveyofsubcontractorsconductedbyEnCanatogainanunderstandingofmethamphetamineandalcoholusebytheiremployees.Theywereabletoidentifythat66.3%ofsubcontractorswereconcernedaboutmethamphetamineuseamongtheiremployees,and68.9%concernedabouttheirheavydrinking.200
LosAngelesCountyHealthSurvey
TheLosAngelesCountyHealthSurveyisapopulation-basedtelephonesurvey,administeredtoadultslivingthroughouttheLosAngelesCountybytheHealthAssessmentUnitoftheCountyofLosAngelesPublicHealthDepartment.Itasksquestionsregardingaccesstohealthcare,healthstatusandbehaviours,andhealthutilization.ItwasusedbytheFarmer’sFieldRapidHIA201toreportdepressionratesfortheprojectarea.202
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MinneapolisParkFoundationSurvey
TheMinneapolisParkFoundationadministeredasurveytoMinneapolisresidentsthataskedabouttheirperspectivesontheparksystem,aswellastheirsupportfordifferentservices.ThissurveywasusedasadatasourceintheCityofMinneapolisAbovetheFallsMasterPlanHIA,203toshowthatresidentsfeltparksplayanimportantpositiveroleintheemotionalandpsychologicalhealthofcityresidents.
NationalHealthandNutritionExaminationSurvey(NHANES)
TheNationalHealthandNutritionExaminationSurvey(NHANES)isaprogramofstudiesdesignedtoassessthehealthandnutritionalstatusofadultsandchildrenintheUnitedStates.TheCentersforDiseaseControlandPreventionadministersitannually.Thesurveyisuniqueinthatitcombinesinterviewsandphysicalexaminations.WhilenotincludedinHIAsexaminedforthisreport,itdoescontainsomedatasourcesrelevanttomentalhealthanditssocialdeterminants.Fortheyears1999-2004,theNHANESaskedparentsof8to19yearoldsaboutthepresenceofattentiondeficithyperactivitydisorders,conductdisorders,andeliminationdisorders.Italsoaskedchildren8to19yearsofageaboutanxiety,depression,eatingdisorders,panicdisorder,andadultsaboutgeneralizedanxietyandpanicdisorder.204Thesurveyhascontinuedtoincludeaquestionaboutdepressioninadultssince1999tothepresent(2014)cycle.205Regardingthesocialdeterminantsofmentalhealth,thesurveyincludesmeasuresofearlychildhood,physicalactivity,occupation,socialsupport,foodsecurity,healthinsurance,housingcharacteristics,income,andothers.
NationalHealthInterviewSurvey(NHIS)
TheNationalHealthInterviewSurvey(NHIS)hasmonitoredthehealthofthenationsince1957.NHISdataonabroadrangeofhealthtopicsarecollectedthroughpersonalhouseholdinterviews.Forover50years,theU.S.CensusBureauhasbeenthedatacollectionagentfortheNationalHealthInterviewSurvey.Surveyresultshavebeeninstrumentalinprovidingdatatotrackhealthstatus,healthcareaccess,andprogresstowardachievingnationalhealthobjectives.Whilenotusedtomeasurementalhealthoutcomes,theNHISwasusedintheNationalPaidSickDaysHIA.206Thesurveydoesincludesomequestionsonmentalhealthconditions,forexample:(1)whatconditionsprovideyouwithdifficulties?,whichlistsdepression/anxiety/emotionalproblemsasanoption;(2)howlonghaveyouhaddepression,anxiety,oranemotionalproblem?;(3)informationonhealthbehaviours(e.g.,alcoholconsumption);(4)informationonhealthservicesutilization(e.g.,“haveyouspokentoahealthcareprovideraboutyourmentalhealth?”withtheoptiontoselectpsychiatrist,psychologist,clinicalsocialworker,orpsychiatricnurse).207
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On-BoardTransitRiderSurvey
ThissurveyisperiodicallyconductedbytheAlamedaContraCostaTransitDistricttogatherinformationaboutthedemographicandtravelcharacteristicsofitsriders.IntheSanFranciscoBayAreaRegionalTransportationPlanHIA,208thisdatasourcewasusedtoderivehowmanyridersreportedexperiencingstressoranxietyfromtheirtrip.
PagedaleHouseholdSurvey
ThePagedaleHouseholdSurveywasusedinthePageAvenueRevitalizationHIA209tomeasuresenseofsocialcohesion,socialparticipation,communityengagement,andpoliticalengagement.BeyondHousingandWashingtonUniversityadministeredthishouseholdsurveyinSt.Louisin2009.Questionsaskedaboutpersonalsafety,neighbourhoodsecurity,andcommunitytrust,amongothers.Interviewswereconductedwith155headsofhouseholds.
SpokaneRegionalHealthDistrictSurvey
TheSpokaneRegionalHealthDistrictSurveywasaseriesof3surveysthatwereadministeredin2012.Surveysweredistributedtoresidents,businesses,andregionaluniversitystudents.FindingsfromthissurveywereusedintheDivisionStreetGatewayHIA210toreportonmentalhealthinthelast30days,andalsotheamountofdaysthatweregoodandhowmuchstressaffectsrespondentsonadailybasis.
SurveyofHealthofAllthePopulationsandEnvironment(SHAPE)211
SHAPEisanongoingsurveillanceandassessmentprojectconductedbytheHennepinCountyHumanServicesandPublicHealthDepartment.Itreportsonthehealthofchildrenandadults.SHAPEdatawasusedbytheCityofMinneapolisAbovetheFallsMasterPlanHIA212tocomparedifferentareasinthecounty’sratesofpsychologicaldistressinthepast30days.
WisconsinFamilyHealthSurvey
Thisisarandom-samplesurveyconductedannuallybytheWisconsinDepartmentofHealthServices,administeredtooneadultperhouseholdabouttheirhealthstatus.ItwasusedintheCapitalAreaRegionalPlanningCommission(CRPC)FutureUrbanDevelopmentArea(FUDA)HIA213todeterminebaselinehealthstatus.
Wisconsin’sTransitionalJobsProgramParticipantSurvey
ThissurveywasconductedbytheWisconsin’sTransitionalJobsProgram214tosurveyindividualswhohadbeeninvolvedintheTransitionalJobsProgram.Whilethesurveydidnotdirectlyaskaboutparticipants’mentalhealth,itdidincludeameasureofself-efficacy.Atleast46%ofparticipantsreportedincreasesinfeelingmorehopefulfor
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thefuture,moreincontroloftheirlives,morecalmandpeaceful,lessdepressedoranxious,withincreasedconfidenceinapplyingforjobs.
YouthRiskBehaviorSurvey(YRBS)
TheCentersforDiseaseControlandPreventionconductstheYouthRiskBehaviorSurvey(YRBS)every2yearstoasampleofchildrenin9ththrough12thgrades.IndicatorsusedfromthisdatasourceintheNorthCarolinaSenateBill731HIA215includedfeelingsofsadnessorhopelessness,suicideattempts,poormentalhealthbybullying,domesticabuseorsexualassault,notattendingschoolbecauseoffeelingunsafe,andforcedtohavesexualintercourse.DatawastakenforresultsspecifictoNorthCarolinain2011.216TheAlcoholOutletDensity–MarathonCounty,WisconsinHIA217usedtheYRBStomeasurebaselineofalcoholuseamonghighschoolstudents.IntheRochesterWaterfrontRevitalizationPlanHIA,218practitionersusedthissurveytoreportonsuicideinyouthandmentalhealthproblemsinMonroeCounty.
LiteratureReview
ThiswasthemainsourceusedbyHIAstodiscussorincludementalhealthinscoping,assessmentorreporting,aswellasjustifypredictionsmade.Findingsfromtheliterature,includinglinkstothesourcesusedaresummarizedearlierinthisreport,inthesectionentitled“WhatDoHIAsSayAboutMentalHealth?”
ExamplesofDataSources
Census
Whilenotspecificallyasourceofpublichealthdata,censusinformationmaybeusedtoprovidesomeindicationofmentalhealth.CensusdatawasusedintheAlcoholOutletDensity–MarathonCounty,WisconsinHIA219toderivepercapitaconsumptionofalcoholforthestateandalsointheUS.220
CentersforDiseaseControlandPrevention(CDC)
IntheOregonFarmtoSchoolHIA,221practitionersuseddatatheyhadobtainedfromtheCentersforDiseaseControlandPrevention,toreportstate-levelsuiciderates.222FortheTreatmentAlternativetoPrisonHIA,223practitionersusedtheSMART:BehavioralRiskFactorSurveillanceSystem,whichismaintainedbytheCDC,toreportonselectedsubstancesinthepastmonthamongpersons12yearsofageandolder,currentdepressionamongadults,burdenofmentalhealth,andillegaldruguse.Theyreportedtheseatboththecityandstatelevel.
CommunityHealthorVitalStatisticsReports
Reportsproducedbystate,county,orlocalpublichealthagencies,educationalinstitutions,orbycommunitieswereusedbymanyHIAstoreportmeasuresofmentalhealthormentalhealthproblems.Usually,thesereportscontainsummariesofavailable
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publichealthdataforagivenyearinaspecificregion.Sometimes,communitiesproducedreportsonthegrowinghealthorsocialneedsinthearea,whichwereusedbypractitionerstohelpdeterminehealthconcernsinthescopingportionofanHIA.
Oneexampleofhowacommunity-producedreportwasused,isbytheHaywood
CountyBCComprehensiveBikePlanHIA,224wherepractitionersusedtheHaywoodCountyHealthPrioritiesReportfor2009-2012tojustifymentalhealthasanissueofconcerntothecommunity.InthePittsburgRailroadAvenueTransit-OrientedDevelopmentHIA,225practitionersusedtheCommunityHealthIndicatorsforContraCostaCountyfromContraCostaHealthServicestoreportonbaselinemeasures,whichincludedsomeformentalhealth(e.g.,psychologicaldistressinpastyear,takenprescriptionmedicineforemotional/mentalhealthissueforatleast2weeks,bingedrinking,illicitdruguse,andsubstanceabuse).Baselinedatawasalsoreportedforillegaldruguse,bingedrinking,andbingedrinkinginadolescentsforthePointThomsonOilandGasLeasingEISHIA226fromTheRegionalHealthProfileoftheArcticSlopeproducedbytheAlaskaNativeEpidemiologyCenter.
Communityorcounty-produceddatacanalsobeusedtoprovidemeasuresofmentalhealthforassessment.Forexample,intheRedDogMineExtensionHIA227inAlaska,practitionersreportedsuicidemortalityratesthatwerederivedfromAlaskaDepartmentofCommerce,Community,andEconomicDevelopmentCommunityProfiles.TheRochesterWaterfrontRevitalizationPlanHIA228alsousedtheMonroeCountyAdolescentHealthReportCardtoshowbaselinementalhealthintheircounty.229Thereportcardusesarea-specificmeasuresfromtheYouthRiskBehaviorSurveyandStatewidePlanningandResearchCooperativeSystem(SPARCS)andincludesemergencydepartmentvisitsandhospitalizationsrelatedtomentalhealth,suiciderate,feelingsadorhopeless,consideringsuicide,alcoholanddruguse,self-injury,disorderedeating,andyouthadmittedtosubstanceabusetreatmentprograms.230
Likewise,inthePlanningforParks,GreenSpace,andTrailsinGreenville’sWest
SideHIA,231baselinedatawascollectedfromtheCommunityHealthNeedsAssessmentinGreenvilleCountyfor2008and2012.Dataofinterestincludedthosewhodidnotfeeldepressedorwhofeltdepressedfor1day,2to7days,oraweekormore.Thisinformationwasusedtohelppredictthatthecreationofparks,trails,andgreenspacecoulddecreasedepressionduetopositivementalhealthbenefitsbasedonfindingsfromtheirliteraturereview.
NationalandstatereportswereusedintheAlcoholOutletDensity–Marathon
County,WisconsinHIA232reportonunderagedrinkinginformedmanyoftheclaimsmadeaboutyouthdrinking.233OtherreportstheylookedatweretheNationalSurveyonDrugUseandHealthReport(e.g.,includesinformationonmentalillnessandsubstanceuse,treatment/counseling,majordepressiveepisode,suicide,andseriouspsychologicaldistressforadultsandyouth),234DrunkenDrivingreportfromtheWisconsinDepartmentofTransportation(e.g.,includesalcohol-relatedcrashes,
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convictionsfordrunkendriving,adultsadmittingdrunkendriving),235andtheUnderageDrinkinginWisconsinReportfromthePacificInstituteforResearchandEvaluation(e.g.,includescostsassociatedwithunderagedrinking,problemsassociatedwithunderagedrinkingsuchasfetalalcoholsyndrome,psychoses,high-risksex,trafficcrashes,andalcoholconsumption).236AnotherexampleofanationaldatareportthewasusedwastheBehindBarsII:SubstanceabuseinAmerica’sPrisonPopulation237producedbytheNationalCenteronAddictionandSubstanceAbuseatColumbiaUniversity(CASAColumbia).ThisreportwasusedintheTreatmentAlternativestoPrisonHIA238toreportonbaselinesubstanceabuseanddiagnosisofmentalillnessinAmerica’sprisonpopulation.
FortheTempeModernStreetcarHIA,239practitionerslookedatmentalhealth
casesfromhospitalizationsobtainedbytheMaricopaCountyPublicHealth,whichtheythendiscussedwithrelevancetopotentialdeterminants.Someofthedatatheyusedweresuicides,self-induceddeaths,andalcohol-induceddeathsinTempe,Arizona.Whileitisnotmadeexplicitwhichdatasourcestheyusedforwhichindicators,theyderivedtheirfindingsfromVitalStatisticsandareportoncharacteristicsofemergencyroomvisitsanddischargesfromtheArizonaDepartmentofHealthServices.
CountyHealthRankings
TheUniversityofWisconsinPopulationHealthInstitutecompilesCountyHealthRankingsfornearlyallcountiesacrosstheU.S.fromnationalandstate-leveldatasources(e.g.,BRFSS).Thesearethenranked,toshowwherecountiesrankinrelationtooneanother,andhowhealthisimprovingwithinandbetweencounties.
OnemeasureofinteresttomentalhealththatiscontainedinCountyHealthRankingsisthemeasureforpoormentalhealthdays.ThiswasusedbyanumberofHIAs,includingtheColumbiaTransitSystemExpansionHIA,240theI-710ExpansionHIA241inLosAngeles,andtheDanielMorganAvenueRoadDietHIA.242Socialsupportwasanothermeasureofinterest,whichwasusedintheIceAgeTrailExpansionHIA243forMarquetteCounty,Wisconsin.Finally,theHoodRiverFarmlandRezoneHIA244reportedyouthsuicideattemptsfromthecountyhealthrankingsintheirHIA.
HospitalData
ManyHIAsusedhospitaldatatheyobtainedfrompublichealthagencies.Hospitaldatarefersspecificallytotheadministrative,clinical,anddemographicdatacollecteduponapatient’sadmissiontoordischargefromahospital.Regardingmentalhealth,informationofinterestmayincludeadmissionstopsychiatricinstitutions,oradmissiontohospitalswherethemaindiagnosiswaspsychiatricillness.Mostoften,publichealthdepartmentsmaintainhospitalizationdata.Thereisthereforesignificantoverlapbetween“vitalstatisticsandsurveillance”dataand“hospital”data.SomeexamplesofhowthisdatawasusedinHIAsarediscussedbelow.
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IntheRochesterWaterfrontRevitalizationPlanHIA,245mentalhealthdatawasderivedfromtheNewYorkStateDepartmentofHealth.Theseincludeddrug-relatedhospitalizations,suicideandmortalityrates.TheHIAthencomparedtheseratesforMonroeCountywiththoseforNewYorkState.HospitaldatawasalsoobtainedfortheAerotropolisAtlantaHIA246fromtheGeorgiaDepartmentofCommunityHealth,DivisionofPublicHealth.ThisHIAlookedatdataforhospitaldischarges,deaths,andemergencyroomvisits.OutcomesofinterestforthisHIAincludedmentalandbehavioraldisordersduetopsychoactivesubstances,emergencydepartmentvisitsrelatedtomentalhealth,andallothermentalandbehaviouraldisorders(e.g.,Alzheimer’s).
InLosAngeles,theI-710ExpansionHIA247usedhospitalizationrecordsfor
psychiatricadmissions,whichtheyidentifiedusingICD-9codes.Similarly,theRedDogMineExtensionHIA248collectedinformationforhospitalizationsfromalcohol-relatedincidentsfromtheCenterforDiseaseControlandPrevention.IntheNorthCarolinaSenateBill731HIA249practitionersusedhospitalizationsinstatepsychiatrichospitals,aswellasthosehospitalizedinAlcoholandDrugTreatmentCenters,whichtheyretrievedfromtheNorthCarolinaStateCenterforHealthStatistics.250Asafinalexample,theEastBayGreenwayHIA251useddatafromtheAlamedaCountyPublicHealthDepartment’sCommunityAssessment,Planning,EducationandEvaluationUnittoreportdepression-relatedhospitalizationsatbaseline.
PublicHealthDepartmentsorAuthorities–VitalStatisticsandSurveillance
ManyHIAsuseddatatheyhadobtainedfromlocal,county,orstatepublichealthdepartments.Datasourcesvaried,fromstatisticscompiledfromsurveydata(seeabove),vitalstatisticsinformation,orsurveillancedata.OneexampleisthevitalstatisticsdataobtainedfromtheCaliforniaStateDepartmentofHealth,whichwereusedintheFarmer’sFieldRapidHIA252toreportcausesofdeath,includingsuicideandmentalhealthforthosewithzipcodesintheLosAngelesarea.TheAlcoholOutletDensity–MarathonCounty,WisconsinHIA253alsouseddeathdata,byobtainingdeathcertificaterecordsfromthecountypublichealthdepartmenttodeterminenumberofalcohol-relateddeaths.254Ratesofdeathfromself-injury(e.g.,poisoning,self-harming,suicidalbehaviour)wereusedintheBernalilloCountyPedestrianandBicyclistSafetyActionPlanHIA,255withdataobtainedfromtheNewMexicoDepartmentofPublicHealth.SuiciderateswerealsoderivedfromOnlineAnalyticalStatisticalInformationSystem(OASIS),asurveillancedatabasemaintainedbytheGeorgiaDepartmentofPublicHealthfortheCityofDecatur.Suicideisameasureofmentalhealthbecauseitmaybeindicativeofaseverementalhealthproblem,suchasdepression,schizophrenia,orsubstanceabuse.
TheOregonHealthAuthority’s(OHA)StateEpidemiologicalOutcomes
Workgroup,AddictionsandMentalHealthDivisionprovidedtheHoodRiverFarmland
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RezoneHIA256withdatareportingthepercentofeighthandeleventhgraderswhohadadepressiveepisodeinthepastyear.Thisincludedmajordepressivedisorderanddepressivedisorder.257TheOHAalsoprovidedthePortlandCityCouncil’sRentalHousingInspectionsProgramHIA258withepidemiologicdatafromregardingbaselineconditionsrelatedtomentalhealth.Theseincludedalcoholuse,druguse,mentalhealth,andgambling.Inanotherstate,theMichiganDepartmentofCommunityHealthprovidedpractitionersofthePayEquityHIA259(“HealthImpactAssessmentofGenderPayInequity”)withdataforriskfactorsandhealthindicatorsrelatedtomentalhealth,suchassubstanceabuse.
IntheArrestRecordinEmploymentDecisionHIA,260theIllinoisDepartmentof
PublicHealthprovideddataoncasestreatedinoutpatientsettings—mentalhealthclinics,hospitals,andoutpatientmedicalclinics.HospitalizationsofinterestincludedthoseforMajorDepressiveDisorder,DysthymicDisorder,BipolarDisorder,andSubstanceRelatedDisorders.
TheLosAngelesCountyDepartmentofPublicHealthprovidedsuicideratesfor
theHarborHealthDistrict’stheCaliforniaCapandTradeRulemakingHIA.261ThisdatasourcewasalsousedintheLongBeachDowntownPlanHIA262toreportonthosewhowerefeelingmentallyorphysicallyunhealthy,ratesofdepression,oriftheyconsideredtheirneighbourhoodtobesafefromcrime.263IntheStateEducationIntegrationTaskForceRecommendationsRapidHIA,264practitionersincludedinformationonmentalhealthstatusforstudentsofcolorfromtheMinnesotaDepartmentofHealth.Thisincludedthenumberofstudentswhofeltnervous,worried,orupsetmostorallofthetime.265DataheldbyFultonCountyHealthandWellnessintheOnlineAnalyticalStatisticalInformationSystemDatabasewasusedintheAtlantaBeltlineHIA266toreportdeathratesfromsuicides.Asafinalexample,whilenotapublichealthorganization,theNationalInstituteofMentalHealthmayalsobeusedtoprovideinformationandstatisticsonmentalhealthandmentalhealthproblemsintheUS.
OtherSources
Asidefromthehealthspecificsourcesthatwereusedtodeterminementalhealthdata,othersourceswerealsousedtogainanunderstandingofapopulation’smentalhealthstatus.
Forexample,intheSoutheastKansasCasinoHIA,267practitionersreportedthenumberofmotorvehicleaccidentsduetoalcoholinFordCountybeforeandaftertheopeningofacasino,whichtheyobtainedfromtheKansasDepartmentofTransportation.Practitionersalsoreportedandcomparedtheratesofalcohol-relatedmotorvehicleaccidentsbeforeandaftertheopeningoftheBootHillCasinoin2009,toshowthatalcohol-relatedaccidentshadincreasedfollowingitsopening.Thishelpedinformulatingandsubstantiatingpredictionsregardingthementalhealthimpactsofopeninganewcasino.UsingvitalstatisticsdatafromtheKansasDepartmentofHealth
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andEnvironment,theyalsofoundthatsuicidesincreasedafterthecasinoopened.TheAlcoholOutletDensity–MarathonCounty,WisconsinHIA268alsouseddatafromtheWisconsinDepartmentofTransportationtoreportonthenumberofalcohol-relateddeathsformmotorvehiclecrashes.Motorvehicleaccidentsmaybeindicativeofunderlyingsubstance-abuseproblemsinapopulation.
IntheCaliforniaCapandTradeRulemakingHIA,269practitionersuseddatafromtheBureauofLaborStatisticstoreportthestateemploymentrateofindividuals16andover,whichtheydiscussedasasocialdeterminantofmentalhealth.DatafromtheBureauofJusticewasobtainedbypractitionersfortheTreatmentAlternativestoPrisonHIA270toreportdruguseanddependence.IntheOasisonBallouHIA,271practitionersobtaineddatafromtheBostonPoliceDepartmenttocomparehowactualoffensesreportedorknownbypolicecomparedtoperceptionsofcrimeinthearea.
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Table4.SummaryofexamplesofdatasourcesusedtoincorporatementalhealthinHIA(secondaryanalysisbyHIA)
DataSource MeasuresofMentalHealthorMentalHealthProblems
ExampleHIAs
CensusU.S.CensusBureau Percapitaconsumptionofalcohol AlcoholOutletDensity–MarathonCounty,
WisconsinDatabases(explicitlyidentified)
OASIS:OnlineAnalyticalStatisticalInformationSystem(GeorgiaDept.PublicHealth)
Suiciderate AtlantaBeltline
SMART:BehavioralRiskFactorSurveillanceSystems
-Burdenofmentalhealth-Depression-Illegaldruguse
-OregonFarmtoSchool-TreatmentAlternativetoPrison
HealthReports(compiledfromvariousdatasources)AlaskaDepartmentofCommerce,Community,andEconomicDevelopmentCommunityProfiles
Suicidemortalityrate RedDogMineExtension
BehindBarsII:SubstanceabuseinAmerica’sPrisonPopulation
-Alcoholordrugusedisorder-Co-occurringdisorders-Diagnosisofmentalillness-Substanceusedisorder
TreatmentAlternativestoPrison
CommunityHealthIndicatorsforContraCostaCounty
-Bingedrinking-Illicitdruguse-Psychologicaldistressinpastyear-Substanceabuse-Takenprescriptionmedicineforemotional/mentalhealthissue
PittsburgRailroadAvenueTransit-OrientedDevelopment
CommunityHealthNeedsAssessmentforGreenvilleCounty
Feelingsofdepression PlanningforParks,GreenSpace,andTrailsinGreenville’sWestSide
DrunkenDrivingReport -Adultsadmittingdrunkendriving-Alcohol-relatedcrashes-Convictionsfordrunkendriving
AlcoholOutletDensity–MarathonCounty,Wisconsin
HaywoodCountyHealthPrioritiesReportfor2009-2010
-Qualitativeperceptionsofproblems-Substanceabuse-Suicidedeathrate
HaywoodcountyBCComprehensiveBikePlan
MonroeCountyAdolescentHealthReportCard
-Admissionstosubstanceabusetreatmentprograms-Alcoholanddruguse-Consideringsuicide-Disorderedeating-Emergencydepartmentvisitsorhospitalizations(mentalhealthrelated)-Feelingsadorhopeless-Selfinjury-Suiciderate
RochesterWaterfrontRevitalizationPlan
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Table4cont’d.SummaryofdatasourcesusedintoincorporatementalhealthinHIA
DataSource MeasuresofMentalHealthorMentalHealthProblems
ExampleHIAs
MonroeCountyAdult/OlderAdultReportCard
-Accomplishmentsrelatedtoemotionalproblems-Alcohol/Drugsrelateddeaths-Feelingcalmorpeaceful-Feelingdownheartedordepressed-Self-InflictedInjuries(hospitalization)-Self-reportfrequentmentaldistress-Suicidemortalityrate-Workrelatedtoemotionalproblems
N/A
RegionalHealthProfileoftheArcticSlope
-Bingedrinking(adultsandadolescents)-Illegaldruguse
PointThomsonOilandGasLeasingEIS
UnderageDrinkinginWisconsinReport
-Alcoholconsumption-Associatedharms(e.g.,youthinjury,youthalcoholtreatment,fetalalcoholsyndrome,poisoningsandpsychoses,youthpropertycrime,high-risksex,youthtrafficcrashes)-Costsassociatedwithunderagedrinking
AlcoholOutletDensity–MarathonCounty,Wisconsin
SurveysBehavioralRiskFactorSurveillanceSystem(BRFSS)
Poormentalhealthdays
-PortlandCityCouncil’sRentalHousingInspectionsProgramforMultnomahCounty-StateRoute520Bridge-ArrestRecordinEmploymentDecisions-CapitalAreaRegionalPlanningCommissionFutureUrbanDevelopmentArea(Chicago)
-Stress-relatedillness-Substanceabuse
IceAgeTrialExpansioninMarquetteCounty,Wisconsin
Bloodpressure(stress) PortlandCityCouncil’sRentalHousingInspectionsProgramforMultnomahCounty
Adultbingedrinking AlcoholOutletDensity–MarathonCounty,Wisconsin
Feelingsad,blue,ordepressed(adults) -PierceCountyinSouthHillRedevelopment-OasisonBallou(Bostondataonly)
Problemgambling SoutheastKansasCasinoBostonNeighborhoodSurvey OasisonBallouHIACaliforniaHealthInterviewSurvey(CHIS)
-Numberofdaysunabletoworkduetomentalhealth-Psychologicaldistress(teens)-Sadorhopelessfeelings(teens)
SanDiegoBusRapidTransitStation
Senseofwellbeing OasisonBallouSocialCapital AndroscogginGreenwayPlan
CaliforniaSchoolClimateSurvey(CSCS)
-AcademicperformanceStaff-to-studentsupport-Studentalcoholanddruguse
SchoolDisciplinePolicies
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Table4cont’d.SummaryofdatasourcesusedintoincorporatementalhealthinHIA
DataSource MeasuresofMentalHealthorMentalHealthProblems
ExampleHIAs
CaliforniaHealthyKidsSurvey(CHKS)
-Anxiety-Depression-Sadness
SchoolDisciplinePolicies
CaliforniaWorkandHealthSurvey(CWHS)
Occupationalstress CaliforniaPaidSickDays
ConnecticutEnergyEfficiencyFundSurvey
Socialisolation UtilityRulemakingonConnecticut’sPublicBenefitFund
DomesticWorkersUnitedSurvey
Occupationalstress CaliforniaDomesticWorkerEquality,Fairness,andDignityAct
EnCanaSurveyofSubcontractors
-Alcoholuse-Methamphetamineuse
BattlementMesa,GarfieldCountyColorado
LosAngelesCountyHealthSurvey
Depressionrate Farmer’sFieldRapidHIA
MinneapolisParkFoundationSurvey
Perspectivesonparksandsupportfordifferentservices
CityofMinneapolisAbovetheFallsMasterPlan
NationalHealthandNutritionExaminationSurvey(NHANES)
-Attentiondeficithyperactivitydisorders(children)-Conductdisorders(children)-Eatingdisorders(adults)-Eliminationdisorders(children)-Generalizedanxiety(adults)-Panicdisorders(adults)
N/A
NationalHealthInterviewSurvey(NHIS)
-Alcoholconsumption-Depression,anxiety,oremotionalproblems-Mentalhealthservicesutilization
N/A(usedinNationalPaidSickDaysforotherinformation)
NationalSurveyonDrugUseandHealthReport
-Anymentalillness-Co-occurringdisorders/substanceuse-Levelofmentalillness-Majordepressiveepisode-Mentalhealthtreatment(type,location,sourceforpayment,perceivedneed)-Seriousmentalillness-Seriouspsychologicaldistress-Substancedependenceoruse-Suicide(thoughts,behavior,treatment)-Youthmentalhealth(hospitalization,majordepressiveepisode)
AlcoholOutletDensity–MarathonCounty,Wisconsin
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Table4cont’d.SummaryofdatasourcesusedintoincorporatementalhealthinHIA
DataSource MeasuresofMentalHealthorMentalHealthProblems
ExampleHIAs
On-BoardTransitRiderSurvey(AlamedaContraCostaTransit)
Stressoranxietyfromtrip SanFranciscoBayAreaRegionalTransitPlan
PagedaleHouseholdSurvey
-Communityengagement-Politicalengagement-Socialcohesion-Socialparticipation
PageAvenueRevitalization
SpokaneRegionalHealthDistrictSurvey
-Dailystress-Goodmentalhealthdays-Mentalhealthinpast30days
DivisionStreetGateway
SurveyofHealthofAllthePopulationsandEnvironment(SHAPE)
Psychologicaldistressinpast30days CityofMinneapolisAbovetheFallsMasterPlan
WisconsinFamilyHealthSurvey -Demographics-Healthinsurancecoverage-Poverty
CapitalAreaRegionalPlanningCommission(CRPC)FutureUrbanDevelopmentArea(FUDA)
Wisconsin’sTransitionalJobsProgramParticipantSurvey
Self-efficacy(e.g.,control,hopeforfuture,depressedoranxious,calmorpeaceful)
Wisconsin’sTransitionalJobsProgram
YouthRiskBehaviorSurvey(YRBS)
-Alcoholuse-Domesticabuseorsexualassault-Feelingunsafeatschool-Feelingsofsadnessorhopelessness-Poormentalhealthbybullying-Suicideattempts
-RochesterWaterfrontRevitalizationPlan-AlcoholOutletDensity–MarathonCounty,Wisconsin-NorthCarolinaSenateBill731
CountyHealthRankings CountyHealthRankingsandRoadmaps
-Alcoholuse-Druguse-Poormentalhealthdays-Socialsupport-Youthsuicideattempts
-ColumbiaTransitSystemExpansion-I-710Expansion-DanielMorganAvenueRoadDiet-IceAgeTrailExpansion-HoodRiverFarmlandRezone
HospitalizationData(mayoverlapwithvitalstatistics/surveillancedata)AlamedaCountyPublicHealthDepartment’sCommunityAssessment,Planning,EducationandEvaluationUnit
Depression-relatedhospitalizations EastBayGreenway
CenterforDiseaseControlandPrevention
Alcohol-relatedincidents RedDogMineExtension
GeorgiaDepartmentofCommunityHealth,DivisionofPublicHealth
-Behavioraldisorders-Deaths-EmergencyRoomvisitsrelatedtomentalhealth-Hospitaldischarges-Mentalhealthandbehavioraldisordersduetopsychoactivesubstances
AerotropolisAtlanta
DepartmentofPublicHealth,LosAngeles
Psychiatricadmissions(ICD-9codes) I-710Expansion
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Table4cont’d.SummaryofdatasourcesusedintoincorporatementalhealthinHIA
DataSource MeasuresofMentalHealthorMentalHealthProblems
ExampleHIAs
NewYorkDepartmentofHealth -Drug-relatedhospitalizations-Mortalityrate-Suicide
RochesterWaterfrontRevitalizationPlan
NorthCarolineStateCenterforHealthStatistics
-Hospitalizationsforalcoholanddrugtreatmentcenters-Hospitalizationsforstatepsychiatrichospitals
NorthCarolinaSenateBill731
VitalStatistics/SurveillanceData(mayoverlapwithhospitalizationdata)CaliforniaStateDepartmentofHealth
-Causesofdeath-Mentalhealth-Suicide
Farmer’sFieldRapidHIA
GeorgiaDepartmentofPublicHealth
Suiciderates
IllinoisDepartmentofPublicHealth -Bipolardisorder-Dysthymicdisorder-MajorDepressivedisorder-Substance-relateddisorders
ArrestRecordinEmploymentDecision
DepartmentofPublicHealth,LosAngeles
-Depressionrate-Feelingmentallyorphysicallyunhealthy-Perceptionofneighborhoodcrime-Suiciderates
-CaliforniaCapandTradeRulemaking-LongBeachDowntownPlanHIA
MarathonCountyHealthDepartment
Alcohol-relateddeaths AlcoholOutletDensity–MarathonCounty,Wisconsin
MaricopaCountyPublicHealthandArizonaDepartmentofHealthServices
-Alcohol-induceddeath-EmergencyRoomvisits-Self-induceddeaths-Suicides
TempeModernStreetCar
MichiganDepartmentofCommunityHealth
Substanceabuse PayEquity
MinnesotaDepartmentofHealth Numberofstudentsfeelingnervous,worried,orupset
StateEducationIntegrationTaskForceRecommendationsRapidHIA
NewMexicoDepartmentofPublicHealth
Deathfromself-injury BernalilloCountyPedestrianandBicyclistSafetyActionPlan
OregonHealthAuthority(OHA)StateEpidemiologicalOutcomesWorkgroup,AddictionsandMentalHealthDivision
-Alcoholuse-Depressivedisorder-Druguse-Gambling-Majordepressivedisorder-Percenteighthandeleventhgraderswithdepressiveepisode
-HoodRiverFarmlandRezone-PortlandCityCouncil’sRentalHousingInspectionsProgram
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WhatareSomeExamplesofHIAsThatIncorporateMentalHealth?
ThissectionprovidestwoexamplesofHIAsthatincorporatedmentalhealththroughouttheHIAprocessandincludesadescriptionofhowmentalhealthwasmeasured,whatoutcomeswerelookedat,andwhatrecommendationsweremadetospecificallyaddresspotentialmentalhealthimpacts.
HOPEVItoHOPESF:PublicHousingRedevelopmentHIA
Background
TheUniversityofCaliforniaBerkeleyHealthImpactGroupandHumanImpactPartnersconductedtheHOPEVItoHOPESF:PublicHousingRedevelopmentHIA272in2009.TheHIAlookedretrospectivelyattheeffortsmadebytheUSDepartmentofHousingandUrbanDevelopmentintheir1999initiative,HousingOpportunitiesforPeopleEverywhere(HOPEVI),sothatlessonslearnedcouldinformtheHOPESanFrancisco(HOPESF)redevelopmentwhichwasunderwayforfivepublichousingsites.
HOPEVIappliedfederalfundstoreconstructhousingprojects,createanewpracticeofhousingmanagement,andprovidevoucherstosubsidizeresidentswhohadbeendisplacedandneededtofindalternativeaccommodations.Additionally,twentypercentofprogramfunds($300million)weresetasideforcommunitybuildinginitiatives.TheHOPEVIprogramaimedtodecentralizepovertybycreatingnewmixedincomeandmix-usecommunities.
HowWasMentalHealthIncluded?
MentalhealthisimplicitlyincludedthroughoutthisHIA,namelythroughtheattentionpaidtosocialcohesionbypractitioners.Socialcohesionwasidentifiedinthescopingasahealthissueofinterest,throughinterviewsanddiscussionswithcommunitypartners.
Inthepathwaydiagramforhousingandhealth,thisHIAshowsmanydifferentwaysthroughwhichmentalhealthoutcomes(e.g.,depression,stress)canbeinfluencedbysocial,macro-environmental,ormicro-environmentalfactorswithinaneighbourhoodorhousingproject.Thiswashelpfulinillustratinghowmicro-levelhousingfactors(e.g.,presenceofacommonspace)mayhelpleadtodeterminingfactors(e.g.,socialinteraction)thatinfluencementalhealth(e.g.,depression).
Mentalhealthwasmainlyaddressedinaseparatechapteronsocialcohesion;however,mentalhealthoutcomeswereincludedwherevertherewasarelevantassociation.Forexample,inthechapteronhousing,practitionersusedmentalhealth-relatedinformation(collectedforthepurposeofmeasuringsocialcohesion)tointroducereaderstothestressesthatnewmanagementandrulestructureswithinthehousingredevelopmentwascausing.
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HowWasMentalHealthMeasured?
Themainsourceofinformationpractitionersusedtodiscusspotentialmentalhealthimpactswascollectedthroughopen-endedandstructuredsurveyresponseswithresidentslivingintwooftheredevelopedhousingprojects.Inparticular,thissurveyprovidedinsighttosocialcohesion,withthefollowingquestions:
• Whatdoyoulikethemostaboutyourcommunity?• Whatwouldyouchangeaboutyourcommunity?• Ifyouwereherebeforetheredevelopment,whatdoyouthinkhas
changedthemostbecauseofit?
Inaddition,morespecificquestionsrelatedtosocialcohesionwereaskedaswell,suchas:
• AfterredevelopmentIknowmoreofmyneighboursthanbefore(disagree,agree,neutral)
• Howoftendoyourunintoyourneighbours(always,sometimes,rarely)?• Likelihoodofstoppingtotalkwithneighboursoutsidecomplex(always,
sometimes,rarely)
Practitionersusedsurveyresponsestoquantifytheextenttowhichsocialcohesionexistedbeforeandafterredevelopment,andalsousedqualitativedatatoshowhowresidentsfeltandperceivedthesituation.Potentialimpactstomentalhealthwereincludedthroughpractitioners’conceptualmodelofdirectandindirecthealthconsequencesorbenefitsfromdifferentlevelsofcommunityparticipation(e.g.,stress,depressionfromnon-participation),273literaturereview(e.g.,distressanddepressivesymptomsfromrelocatingneighbourhoods),274andsecondarydataanalysis(e.g.,higherlevelsofdepressedfeelingsinaBostonpublichousingproject,comparedtothoselivingelsewhere).275
WhatRecommendationsWereMadeforMentalHealth?
AnumberofrecommendationswereincludedinthisHIAforwaystomitigatepotentialimpactstomentalhealth,particularlythroughincreasingormaintainingsocialcohesion.WhiletheserecommendationsarespecifictotheHOPEVItoHOPESFHIA276site,fiveexamplesareprovidedheretoshowhowpractitionerswereabletomakecomplexconceptsandimpactsintotangiblerecommendations.
1. ToaddresshighlevelsofstressthatexistedinHOPEVI(andwereworseforlowerincomeresidents)duetohousingandmaintenanceconcerns,practitionersrecommendedoutreachtolocalclinicstopromotebetteruseofavailableservices.277Otherrecommendationsforreducingstressthispointincludedhavingtheexplicitparticipationofresidentsandstakeholdersaspartoftheredevelopmentplanningprocess,278andallowingpublicparticipationfrompublichousingaswellasresidentsfromotherneighbourhoodsinthisprocess.
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2. Tospecificallyaddressthestressandanxietycausedbyfearsofbreakingnewmanagementrules(andsubsequenteviction),practitionersrecommendedthathousingmanagementfindawaytoenforceruleswhilebeingopentoresolvingdisputesandclarifyingmattersbeforeeviction.279
3. Toaddressstress,anxiety,andchangesinmoodamongresidentswhohadtomoveorrelocate,practitionersrecommendedtalkingcirclesormentalhealthresourcesforresidentstodiscussexperiencesandseekappropriatecare.280Thisway,betterandmorecomprehensivesupportcouldbeprovidedtofamiliesastheyundergostress.
4. Toimproveuponsocialcohesionbyincreasingsocialinclusionandsocialinteraction,practitionersrecommendedincreasedfundinganduseofexistingresourcecenters,residentaccessandmanagementofcommunityspaces,communicationwithmanagement,interactionwithdifferentculturesandethnicities,amongothers.Foreachrecommendation,specificexamplestailoredtothecommunity(oftensuggestedbyitsmembers)wereincluded.
5. ParticipationintheTenant’sAssociationandResidentialCouncilwereseenas
importantfactorstoimprovingsocialcohesionwithinandoutsideofunits.RecommendationstoincreaseparticipationintheTenant’sAssociationincludedthetrainingofresidentsinterestedinbeinginvolved,involvingresidentsinnewrulereview,consideringsomeformofresidentmanagement,andreachingouttoresidentswhenentrepreneurialopportunitiesbecameavailable.Again,specificexampleswereincludedforeach.
WhyIsThisaGoodExample?
TheHOPEVItoHOPESFHIA281isanexcellentexampleofhowmentalhealthimpactsanddeterminantscanbeincludedinageneralHIA.MentalhealthwasincludedthroughouttheHIA,fromscopingtoassessmenttorecommendations.Practitionersselectedsocialcohesionasahealthconcern(anddeterminantofmentalhealth),whichenabledthemtodevotethesameattentiontomentalhealthasphysicalhealthconcerns.Theentirechapteronthisdeterminantallowedforin-depthandcomprehensiveconsiderationofpotentialissuesthatmayarise.Mostimportantly,practitionersworkedwiththecommunitythroughouttheirHIA.Thishelpedtoidentifysocialcohesionasaconcerninthefirstplace,butalsohelpedtodeveloptangiblerecommendationsuniquelytailoredtothecommunity.Finally,practitionerscollectedtheirowndatawhereothersourceswerenotavailable.ForthisHIA,theuseofasemi-structuredsurveyallowedpractitionerstogainbothquantitativeandqualitativedataregardingsocialcohesionandparticipation,whichgreatlyenrichedthefindings,claims,andrecommendationsthatweremade.
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TransitionalJobsProgramHIA
Background
TheUniversityofWisconsin’sPopulationHealthInstituteconductedtheTransitionalJobsProgramHIA282in2013toassesshowgovernment-sponsoredemploymentprogramshaveimpactedthehealthoftheirparticipants,inresponsetothestatewideexpansionoftheTransitionalJobsDemonstrationPrograminWisconsin.ThisHIAwasconductedtoinformthedecisionofwhetherornottofundanewWisconsinTransitionalJobsprogramforMilwaukeeCountyandtoevaluatethepotentialhealthimpactsthatmayoccur.
HowWasMentalHealthIncluded?
MentalhealthwasincludedinthescopingportionoftheHIA,asmembersofadvocacyorganizations,communityorganizations,andexecutiveagenciesidentifieditasalong-termoutcome.Practitionersincludedasimple,easytounderstandlogicmodel,whichillustratedhowimprovedmentalhealthcouldbeapotentiallong-termoutcomeforimprovedincome,socialcohesion,stateorlocalfiscaleffects,orprivatesectoreffects.Practitionersselectedhealthfactorsbasedonthequalityofevidencebetweenemploymentandaparticularhealthoutcome.Asemploymentiscloselytiedtomentalhealthinpopulations,practitionersselectedmentalhealthrelatedindicatorssuchasself-efficacy,socialcapital,familycohesion,andalcoholuse,amongothersindicatorsformorephysicalhealthoutcomes.
PractitionersincludedmentalhealthintheassessmentportionoftheirHIAbyfirstprovidinganoverviewoftheassociationsbetweenemploymentandmentalhealth(generally),andemploymentandsubstanceabuse,asindicatedintheliterature.283Theythenshowhoweachindicatorcanbeinfluencedbyemployment,andthenhowtheindicatorcanimpactahealthoutcome.Thisstraightforwardprocesswaseasytounderstand,andclearlyshowedhowmentalhealthandchildmentalhealthwerelikelytoincreaseiftheTransitionalJobsprogramexpandedormaintaineditscurrentlevel.
Inadditiontousingtheliteraturereviewtoshowrelationshipsbetweenmentalhealthindicatorsandemploymentorhealthoutcomes,thisHIAalsouseddatafromasurveytheyhadadministered(inpartnershipwiththeWisconsinDepartmentofChildrenandFamilies)toparticipantsoftheTransitionalJobsDemonstrationProgram.Surveyquestionsrelatedtomentalhealthincluded,amongothers:
• SinceIstartedtheTJProgramIfeel…[Checkboxesforalotmore,alittlemore,thesame,alittleless,alotless]:
o Hopefulforthefuture…o Depressedoranxious…o Incontrolofmylife…o Calmandpeaceful…
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• WhichofthefollowingsupportservicesdidyoureceivefromtheTJprogram?[Amongotheroptions,included:]
o Personalcounselingo Drug/alcoholcounseling
• SinceIstartedtheTJProgram…[Checkboxesforalotmore,alittlemore,the
same,alittleless,alotless,ordoesnotapply]:o Ihavetroublefallingorstayingasleep…o Idrinkalcohol(beer,wine,hardliquor)…
Surveyresponses—whichspoketoemployment,demographics,andself-reportedpersonalhealth—providedinsightintotheassociationsidentifiedbetweenemployment,mentalhealthindicators,andmentalhealthoutcomesidentifiedintheliterature.Practitionerscollectedthisinformationbecausenopreviousdatawasavailable.Thisallowedthemtogainarichunderstandingoftheirparticipantsbeyondthedemographicfactorscollectedbytheprogram.
WhatRecommendationsWereMadeforMentalHealth?
Practitionersincludedthreeupstreamrecommendationsthatbroadlyaddressedalloftheirhealthindicatorsofinterest.Theyalsoincludedimplementationideasforlegislators,implementingagencies,andcontractors.Onlythosespecifictomentalhealthwillbereviewedhere.
1. TomaximizethepositivementalhealtheffectsprovidedfromtheTransitionalJobsprogram,practitionersrecommendedthatopportunitiesbeextendedtothelargestpotentialpoolofeligibleapplicants.Specificsuggestionsforimpactingalargernumberofpeopleincluded:increasingthethresholdhouseholdincomerequiredtoprovidefamiliesagreatersafetynet,eliminatetherequirementthatparticipantsbeineligibleforemploymentinsurance,andprovideincentivestoemployerswhohirelargegroupsofworkers.284
2. Tocreatelastingemploymentoutcomesforparticipantsaftersubsidizedemploymentends.Specificimplementationideaspractitionersincludedwere:providingincentivesforplacementslastingbeyondthesubsidyperiod,requiringtraininginskillsforwhichthereisagrowingdemandintheprogramarea,orleveragingparticipants’workexperienceintocredentials,certificates,orreferences.
3. Toassureprioritytoprogramapplicantswithchildren,withoutmakingparenthoodaneligibilityrequirementoftheprogram.Justificationforthisrecommendationwasthatthebenefitsaccruedbyprogramparticipantstransferstotheirchildrenandfamilies.Practitionerssuggestedthattheprogramrevisititseligibilitycriteria,whichatthetimestatedthatparticipantsoverthe
46
ageof25hadtobeparents.Thislikelypreventedfullerparticipationintheprogramfromparticipantswhowerenotparents.
WhyIsThisaGoodExample?
TheTransitionalJobsProgramHIA285isathoughtfulandrelevantexampleofhowcertainindicatorsmaypotentiallyimpactmentalhealth.ThisHIAconcernedemployment,thuspractitionerswereabletodrawonthevastamountofliteraturepublishedonemploymentandhealth;specifically,theeffectofemploymentonmentalhealthanditsdeterminingfactors.ThisHIAincludedmentalhealthconsistentlythroughouttheirreport.ThisallowedreaderstoseetheprocessatplaybehindtheHIA(i.e.,howdidtheyselectindicators,howdidtheyderivehealtheffects).ThisHIAalsoincludedrecommendationsthatweresuggestedtofitthecontextoftheprogramanditsparticipants,whichweregreatlyinformedbytheirfindingsformentalhealth.Practitionersalsoinvolvedcommunitymembers(programparticipants)throughouttheirHIA,andincludedtheirsurveyresponsesinrelationtoeachhealthindicatorofinterest.
AsupplementalstrengthofthisHIAwasitsuseofstraightforward,easytounderstandfiguresandtables.Theseillustrationshelpedtoshowhowhealthisinfluencedbymultiplefactors,whichwasespeciallyusefulinconsideringhowmentalhealthwouldbeimpacted.Finally,thisHIAincludedastrongevaluationcomponent.Practitionersrankedthestrengthofeachdatasourceused,andreportedontheassociationbetweenemploymentandahealthindicatororoutcome.Thiswasvaluableinshowingreadershowaliteraturereviewcanbeusedasastrongsourceofevidencetoincludementalhealth,whereotherformsofdatamaynotbeavailable.Importantly,theyalsoincludedmeasuresbywhichthesuccessoftheprogramcouldbemonitored.
HowCanWeImprovetheInclusionofMentalHealthinHIA?
ManystepshavebeentakentoimprovetheinclusionofmentalhealthinHIA;however,barriersstillremain.TherecommendationsfromthisreportaremeanttoguidepractitionerswhoaimtoincludementalhealthintheirHIAsintheimmediatefuture.Theserecommendationsarestraightforwardsuggestionstoincreasethepotentialformonitoringandevaluation,improvetheevidenceofclaimsmade,andencourageinclusionofmentalhealthinHIA.
Recommendations
Recommendation1:DrawoncommunityengagementtoguidetheinclusionofmentalhealthinHIA.
ManyHIAsreportedtheiridentificationofmentalhealththroughcommunityengagementinterviewsorworkshopsconductedduringthescopingportion.Communitymembersareabletoprovidealocalperspectiveonthesocialandculturalconditionsthatshapethehealthandmentalhealthoftheirneighbourhoods.Thismay
47
includetheidentificationofspecificproblems(e.g.,substanceabuse,problemgambling)thatarenotreportedintheliteratureorotherdatasourcesthatareusedtogatherinformationonbaselinehealthconditions.Engagingwithcommunitymembersalsoprovidestheopportunitytoaskquestionspractitionersmayhavespecifictomentalhealth.Forexample,inspeakingwithalocalhealthworker,practitionersmaygaininsighttonewdatasources(e.g.,localhospitalizationrecords,communityreports,etc.)thatmayassistinassessingmentalhealth.Communitymemberswerealsoshowntobeinvaluableindevelopingrecommendationstomitigatepotentialimpactsonmentalhealth.TheinvolvementofcommunitymembersinHIAmayalsohelptomitigatestressesassociatedwiththeproject,policy,orprogram.Focusgroups,meetings,orinterviewsmayprovidestakeholderswiththeopportunitytoexpresstheirconcerns,andhavethemheardbypractitioners.TheWindEnergyHIA286inOregon,forexample,providesadiscussionoftherolecommunityengagementandparticipationcanplaytomitigatecommunityconflict.
Recommendation2:ConsidermentalhealthwhenconductingthescopingofanyHIA.
Mentalhealthisonecomponentofhealthandwellbeing.Therefore,togainacomprehensiveunderstandingofhealthinapopulation,practitionersshouldatleastconsidertherolethatmentalhealthmightplay.ThismaymanifestdifferentlyfordifferentHIAs;mentalhealthmaybeidentifiedasafactorthatinfluenceshealthoutcomes,orasaspecificoutcomeitself.Evenoutcomesmaydifferwidely,fromcomplexconcepts,suchassocialcohesion,tomoreconcreteandmeasurableoutcomes,suchasdepression.Additionally,asadecisionmakingtoolthatencouragesthemonitoringandevaluationofprojectindicatorsfollowingcompletion,HIAprovidestheopportunitytocontributetotheevidencebaseregardingpotentialmentalhealthimpactsfromspecificprojects,policies,orprograms.
AllHIAsarelimitedtosomeextentbytime,resources,orotherfactors.Assuch,itmaynotbefeasibleforHIAstofocusonmentalhealthasadiscretehealthoutcome.However,theremaybewaystoincludementalhealthimplicitlythroughouttheHIA.Forexample,HIApractitionersmayconsiderincludingsomediscussionofhowhealthoutcomesmaybeinfluencedbymentalhealth.TheMentalHealthWorkingGroupisdevelopingatooltoassistpractitionersinincludingmentalhealthintheirpathways,astheybegintheirHIA.Thistoolwillillustratehowmentalhealthisinfluencedbymanyofthesamesocialdeterminantsthataffectphysicalhealth.Itmayprovidesomeguidanceforhowmentalhealthcanbeincludedinacomplexpathwaydiagram.
Recommendation3:MaintainconsistencythroughouttheHIAwherementalhealthisidentifiedasahealthoutcomeofinterest.
Wherementalhealthisidentifiedasanoutcomeofinterest(usuallyinscoping)toanHIA,oftenitdoesnotreappearinrelationtoassessment,recommendations,reporting,ormonitoringandevaluation.Ifmentalhealthisidentifiedasanoutcomeorindicatorofinterest,itshouldbeaddressedineverystageoftheHIA.Ifforsomereason
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theHIAteamandstakeholdershavehadtodeprioritizementalhealthintheirHIA,reasoningforthisshouldbetransparentlyexplainedintheHIAreport.HIAsareconductedwiththeintentionofimprovingpopulationhealth;therefore,wherepotentialharmstomentalhealthareidentifiedinanHIA,itshouldalsoincluderecommendationstomitigatesaidharms.Insomecases,itmayactuallybeharmfulforthementalhealthofpopulationstoidentifybaselineproblemsorpotentialimpactsofaproject,withoutsuggestingrecommendationsormitigationstrategies.Communitiesmaybesubjecttostressorfeelingsofhopelessnesswhereproblemsaresimplyidentifiedandnotaddressed.
Recommendation4:ConsiderhowmentalhealthmayimpactgroupsdifferentlywhenincludingmentalhealthinanHIA.
Inequitiesinmentalhealthmayormaynotberepresentedindatasourcesavailabletopractitioners.Itisthereforeimportantforpractitionerstoconsiderhowmentalhealthmightbeimpacteddifferentlyfordifferentgroups,fortheHIAmaybetheonlyforuminadecisionmakingprocesswheretheseconcernsarevoiced.
Recommendation5:Drawonmultipledatasourcestoassessmentalhealth,andusethosemostappropriatetothehealthoutcomesofinterest.
Mentalhealthiscomplexandcanmanifestismanydifferentways.Practitionersshouldtakecaretoensurethattheyareassessingmentalhealthinawaythatspeaksrelevancetothehealthoutcomesofinterest.Forexample,itmaynotproveusefultoreportnationalratesofdepressionandanxietywhenthecountyisworriedaboutincreasedalcoholuse.Bettersourcesofdatamaycomefromunconventionalplaces,suchasthenumberofmotorvehiclecrashesduetoalcohol-relatedincidents,aswasusedintheSugarHouseCasinoHIA.287Practitionersmightconsiderdrawingontheconnectionstheyhavewiththoseworkinginothersectors,whenbrainstormingwheretofinddatathatmaymeasurementalhealth.Theresourceslistedinthisreportareintendedtoprovidepractitionerswithastartingpointofpotentialdatasources.
PrimarydatamaybeafeasibleoptionforsomeHIAs.Ifmentalhealthisnotcapturedbyanyexistingdatasources,practitionersmightconsidercollectingtheirowndatatoinfermentalhealthconditionsinthepopulationofinterest.Datacollectionmayoccurindifferentways.Forexample,thismightincludeadministeringasurveytocommunitymemberswithquestionsthatspeakdirectlyorindirectlytomentalhealthoutcomesofinterest.Alternatively,practitionersmaywishtogatherqualitativeinformationfromcommunitymembers.Thismayincludeaskingaspecificquestionorprompttokeyinformantsabouttheirperceptionsofmentalhealthinthecommunity,whichcanlaterbeintegratedintotheHIAassessment.
Regardlessofwhatdatasourceisused,itisimportantthatpractitionerscitewhatinformationorindicatorscamefromwhatdatasources.Whilethisseemsintuitive,manyHIAsdidnotmakenoteofthedatasourcestheyanalyzedorincludedintheirliteraturereview,whichquestionscredibilityofclaimsmaderegardingmentalhealth.
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Morerobustresearchpracticeswillimprovethefieldinanumberofways.First,consistentreferencingwillhelpotherpractitionerstodrawfromcompletedHIAsthatincludedmentalhealthintheirowneffortstoincludementalhealth.Second,referencingdatasourceswillenhancethequalityofHIA,bysubstantiatingtheclaimtodecisionmakers,communitymembers,andotherpractitionersthatrecommendationsareevidencebased.Finally,referencingofindicatorswillfacilitatemonitoringandevaluationofhealthoutcomes.ThisisespeciallyimportantasthefieldofHIAmatures,sothatconcreterecommendationsaboutmentalhealth(i.e.,whatisworking,whatcanbeimproved)canbemade.
Recommendation6:Considertheimpactofmentalhealthonphysicalhealthandtheimpactofphysicalhealthonmentalhealth.
Itiswellunderstoodthathealthandmentalhealthareinextricablyconnected.Therefore,itisimportantthatpractitionersreflectthisunderstandingintheirHIAstothegreatestextentpossible.Thiswillallowforamorecompleteunderstandingofhealthincommunities,withinthecontextoftheholisticdefinitionofhealththatHIAadopts.
Summary
AsthefieldofHIAgrows,itisimportantthatitmaintainspacewithpopulationhealthconcernsandpriorities.MentalhealthisoneareawhereHIApractitionershaveindicatedthatthefieldfallsshort.RecentworkdonebythemembersoftheMentalHealthWorkingGroupofSOPHIAhasprovidedanexcellentstartingpointtoadvancetheinclusionofmentalhealthinHIAandhasservedastheinspirationforthisreport.TherearemanydifferentwaysofincludingmentalhealthinHIA,whichhavebeenprovidedasexamplesinthisreport.Thisincludesdifferentdatasources,mentalhealthoutcomesofinterest,andthedegreetowhichmentalhealthisconsistentlyincludedinHIA.
ThisreportisintendedtoserveasastartingpointforpractitionersseekingordevelopingresourcesofhowtoincludementalhealthintheirHIA.Therefore,therecommendationsprovidedarederivedfromobservationsthattheauthoridentifiedasparticularlychallenginginherreviewofHIAsfortheirinclusionofmentalhealth.Whilestraightforward,thesearemeanttoencouragebetterinclusionofmentalhealthinHIA,moreconsistencywithinHIAs,andmoreexplicitdiscussionofthedataused.These,amongotherfactorswillfacilitatefuturemonitoringandevaluationregardingmentalhealthinHIAsoothersmayconcludewhatisworking,whatisnot,andwhatcanbeimproved.
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AppendixA
TableofmentalhealthindicatorsanddatasourcesusedinHIAsreviewed.
MentalHealthIndicator DataSource(s) ExampleHIAsAcademicperformancestaff-to-studentsupport
• CaliforniaSchoolClimateSurvey(CSCS)
SchoolDisciplinePolicies
Accomplishmentsrelatedtoemotionalproblems
• MonroeCountyAdolescentHealthReportCard
N/A
Admissionstosubstanceabusetreatmentprograms
• MonroeCountyAdolescentHealthReportCard
RochesterWaterfrontRevitalizationPlan
Adultbingedrinking • BehavioralRiskFactorSurveillanceSystem(BRFSS)
AlcoholOutletDensity–MarathonCounty,Wisconsin
Adultsadmittingdrunkendriving
• DrunkenDrivingReport AlcoholOutletDensity–MarathonCounty,Wisconsin
Alcoholconsumption • UnderageDrinkinginWisconsinReport
AlcoholOutletDensity–MarathonCounty,Wisconsin
Alcoholordrugabuse • BehindBarsII:SubstanceabuseinAmerica’sPrisonPopulation
• CommunityHealthIndicatorsforContraCostaCounty
• HaywoodCountyHealthPrioritiesReportfor2009-2010
• MonroeCountyAdolescentHealthReportCard
• BehavioralRiskFactorSurveillanceSystem(BRFSS)
• MichiganDepartmentofCommunityHealth
-TreatmentAlternativestoPrison-PittsburgRailroadAvenueTransit-OrientedDevelopment-HaywoodcountyBCComprehensiveBikePlan-RochesterWaterfrontRevitalizationPlan-IceAgeTrialExpansioninMarquetteCounty,Wisconsin-PayEquity
Alcoholuse • EnCanaSurveyofSubcontractors• NationalHealthInterviewSurvey
(NHIS)• YouthRiskBehaviorSurvey(YRBS)• CountyHealthRankingsand
Roadmaps• OregonHealthAuthority(OHA)State
EpidemiologicalOutcomesWorkgroup,AddictionsandMentalHealthDivision
-BattlementMesa,GarfieldCountyColorado-RochesterWaterfrontRevitalizationPlan-AlcoholOutletDensity–MarathonCounty,Wisconsin-NorthCarolinaSenateBill731-ColumbiaTransitSystemExpansion-I-710Expansion-DanielMorganAvenueRoadDiet-IceAgeTrailExpansion-HoodRiverFarmlandRezone-PortlandCityCouncil’sRentalHousingInspectionsProgram
Alcohol-induceddeaths • MaricopaCountyPublicHealthandArizonaDepartmentofHealthServices
TempeModernStreetCard
Alcohol-relatedcrashes • DrunkenDrivingReport AlcoholOutletDensity–MarathonCounty,Wisconsin
Alcohol-relatedincidents • CenterforDiseaseControlandPrevention
RedDogMineExtension
Alcohol/Drugrelateddeaths • MonroeCountyAdolescentHealthReportCard
• MarathonCountyHealthDepartment
AlcoholOutletDensity–MarathonCounty,Wisconsin
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TableofmentalhealthindicatorsanddatasourcesusedinHIAsreviewed(cont’d)
MentalHealthIndicator DataSource(s) ExampleHIAsAnxiety • CaliforniaHealthyKidsSurvey(CHKS)
• NationalHealthandNutritionExaminationSurvey(NHANES)
SchoolDisciplinePolicies
Anymentalillness • NationalSurveyonDrugUseandHealthReport
AlcoholOutletDensity–MarathonCounty,Wisconsin
Associatedharms(e.g.,youthinjury,youthalcoholtreatment,fetalalcoholsyndrome,poisoningsandpsychoses,youthpropertycrime,high-risksex,youthtrafficcrashes)
• UnderageDrinkinginWisconsinReport
-AlcoholOutletDensity–MarathonCounty,Wisconsin
Attentiondeficithyperactivitydisorders(children)
• NationalHealthandNutritionExaminationSurvey(NHANES)
N/A
Behavioraldisorders • GeorgiaDepartmentofCommunityHealth,DivisionofPublicHealth
AerotropolisAtlanta
Bingedrinking • CommunityHealthIndicatorsforContraCostaCounty
• RegionalHealthProfileoftheArcticSlope
-PittsburgRailroadAvenueTransit-OrientedDevelopment-PointThomsonOilandGasLeasingEIS
Bipolardisorder • IllinoisDepartmentofPublicHealth ArrestRecordinEmploymentDecisionBloodpressure(stress) • BehavioralRiskFactorSurveillance
System(BRFSS)PortlandCityCouncil’sRentalHousingInspectionsProgramforMultnomahCounty
Burdenofmentalhealth • SMART:BehavioralRiskFactorSurveillanceSystems
-OregonFarmtoSchool-TreatmentAlternativetoPrison
Causesofdeath • CaliforniaStateDepartmentofHealth Farmer’sFieldRapidHIACo-occurringdisorders • BehindBarsII:Substanceabusein
America’sPrisonPopulation• NationalSurveyonDrugUseand
HealthReport
-TreatmentAlternativestoPrison-AlcoholOutletDensity–MarathonCounty,Wisconsin
Communityengagement • PagedaleHouseholdSurvey PageAvenueRevitalizationConductdisorders(children) • NationalHealthandNutrition
ExaminationSurvey(NHANES)N/A
Consideringsuicide • MonroeCountyAdolescentHealthReportCard
RochesterWaterfrontRevitalizationPlan
Convictionsfordrunkendriving • DrunkenDrivingReport AlcoholOutletDensity–MarathonCounty,Wisconsin
Costsassociatedwithunderagedrinking
• UnderageDrinkinginWisconsinReport
AlcoholOutletDensity–MarathonCounty,Wisconsin
Dailystress • SpokaneRegionalHealthDistrictSurvey
DivisionStreetGateway
Deathfromself-injury • NewMexicoDepartmentofPublicHealth
BernalilloCountyPedestrianandBicyclistSafetyActionPlan
Deaths • GeorgiaDepartmentofCommunityHealth,DivisionofPublicHealth
AerotropolisAtlanta
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TableofmentalhealthindicatorsanddatasourcesusedinHIAsreviewed(cont’d)
MentalHealthIndicator DataSource(s) ExampleHIAsDemographics • WisconsinFamilyHealthSurvey CapitalAreaRegionalPlanningCommission
(CRPC)FutureUrbanDevelopmentArea(FUDA)
Depression • SMART:BehavioralRiskFactorSurveillanceSystems
• CommunityHealthNeedsAssessmentforGreenvilleCounty
• CaliforniaHealthyKidsSurvey(CHKS)• LosAngelesCountyHealthSurvey• NationalHealthInterviewSurvey
(NHIS)• DepartmentofPublicHealth,Los
Angeles
-OregonFarmtoSchool-TreatmentAlternativetoPrison-PlanningforParks,GreenSpace,andTrailsinGreenville’sWestSide-SchoolDisciplinePolicies-Farmer’sFieldRapidHIA-CaliforniaCapandTradeRulemaking-LongBeachDowntownPlanHIA
Depression-relatedhospitalizations
• AlamedaCountyPublicHealthDepartment’sCommunityAssessment,Planning,EducationandEvaluationUnit
EastBayGreenway
Diagnosisofmentalillness • BehindBarsII:SubstanceabuseinAmerica’sPrisonPopulation
TreatmentAlternativestoPrison
Disorderedeating • MonroeCountyAdolescentHealthReportCard
RochesterWaterfrontRevitalizationPlan
Domesticabuseorsexualassault
• YouthRiskBehaviorSurvey(YRBS) -RochesterWaterfrontRevitalizationPlan-AlcoholOutletDensity–MarathonCounty,Wisconsin-NorthCarolinaSenateBill731
Drug-relatedhospitalizations • NewYorkDepartmentofHealth RochesterWaterfrontRevitalizationPlanDysthymicdisorder • IllinoisDepartmentofPublicHealth ArrestRecordinEmploymentDecisionEatingdisorders(adults) • NationalHealthandNutrition
ExaminationSurvey(NHANES)N/A
Eliminationdisorders(children) • NationalHealthandNutritionExaminationSurvey(NHANES)
N/A
Emergencydepartmentvisitsorhospitalizations(mentalhealthrelated)
• MonroeCountyAdolescentHealthReportCard
• GeorgiaDepartmentofCommunityHealth,DivisionofPublichealth
• MaricopaCountyPublicHealthandArizonaDepartmentofHealthServices
-RochesterWaterfrontRevitalizationPlan-AerotropolisAtlanta-TempeModernStreetCar
Feelingcalmorpeaceful • MonroeCountyAdolescentHealthReportCard
N/A
Feelingdownheartedordepressed
• MonroeCountyAdolescentHealthReportCard
N/A
Feelingmentallyorphysicallyunhealthy
• DepartmentofPublicHealth,LosAngeles
-CaliforniaCapandTradeRulemaking-LongBeachDowntownPlanHIA
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TableofmentalhealthindicatorsanddatasourcesusedinHIAsreviewed(cont’d)
MentalHealthIndicator DataSource(s) ExampleHIAsFeelingsadorhopeless • MonroeCountyAdolescentHealth
ReportCard• CaliforniaHealthInterviewSurvey
(CHIS)
-RochesterWaterfrontRevitalizationPlan-SanDiegoBusRapidTransitStation
Feelingsad,blue,ordepressed(adults)
• BehavioralRiskFactorSurveillanceSystem(BRFSS)
• CaliforniaHealthInterviewSurvey(CHIS)
-PierceCountyinSouthHillRedevelopment-OasisonBallou(Bostondataonly)-SanDiegoBusRapidTransitStation
Feelingunsafeatschool • YouthRiskBehaviorSurvey(YRBS) -RochesterWaterfrontRevitalizationPlan-AlcoholOutletDensity–MarathonCounty,Wisconsin-NorthCarolinaSenateBill731
Feelingsofsadnessorhopelessness
• YouthRiskBehaviorSurvey(YRBS) -RochesterWaterfrontRevitalizationPlan-AlcoholOutletDensity–MarathonCounty,Wisconsin-NorthCarolinaSenateBill731
Gambling • OregonHealthAuthority(OHA)StateEpidemiologicalOutcomesWorkgroup,AddictionsandMentalHealthDivision
-HoodRiverFarmlandRezone-PortlandCityCouncil’sRentalHousingInspectionsProgram
Goodmentalhealthdays • SpokaneRegionalHealthDistrictSurvey
DivisionStreetGateway
Healthinsurancecoverage • WisconsinFamilyHealthSurvey CapitalAreaRegionalPlanningCommission(CRPC)FutureUrbanDevelopmentArea(FUDA)
Hospitaldischarges • GeorgiaDepartmentofCommunityHealth,DivisionofPublicHealth
AerotropolisAtlanta
Hospitalizationsforalcoholanddrugtreatmentcenters
• NorthCarolineStateCenterforHealthStatistics
NorthCarolinaSenateBill731
Hospitalizationsforstatepsychiatrichospitals
• NorthCarolineStateCenterforHealthStatistics
NorthCarolinaSenateBill731
Illegaldruguse • SMART:BehavioralRiskFactorSurveillanceSystems
• BehindBarsII:SubstanceabuseinAmerica’sPrisonPopulation
• CommunityHealthIndicatorsforContraCostaCounty
• RegionalHealthProfileoftheArcticSlope
• CountyHealthRankingsandRoadmaps
• OregonHealthAuthority(OHA)StateEpidemiologicalOutcomesWorkgroup,AddictionsandMentalHealthDivision
-OregonFarmtoSchool-TreatmentAlternativetoPrison-PittsburgRailroadAvenueTransit-OrientedDevelopment-PointThomsonOilandGasLeasingEIS-ColumbiaTransitSystemExpansion-I-710Expansion-DanielMorganAvenueRoadDiet-IceAgeTrailExpansion-HoodRiverFarmlandRezone-PortlandCityCouncil’sRentalHousingInspectionsProgram
54
TableofmentalhealthindicatorsanddatasourcesusedinHIAsreviewed(cont’d)
MentalHealthIndicator DataSource(s) ExampleHIAsLevelofmentalillness • NationalSurveyonDrugUseand
HealthReportAlcoholOutletDensity–MarathonCounty,Wisconsin
Majordepressivedisorder • IllinoisDepartmentofPublicHealth• OregonHealthAuthority(OHA)State
EpidemiologicalOutcomesWorkgroup,AddictionsandMentalHealthDivision
-ArrestRecordinEmploymentDecision-HoodRiverFarmlandRezone-PortlandCityCouncil’sRentalHousingInspectionsProgram
Majordepressiveepisode • NationalSurveyonDrugUseandHealthReport
AlcoholOutletDensity–MarathonCounty,Wisconsin
Mentalhealth • CaliforniaStateDepartmentofHealth Farmer’sFieldRapidHIAMentalhealthandbehavioraldisordersduetopsychoactivesubstances
• GeorgiaDepartmentofCommunityHealth,DivisionofPublicHealth
AerotropolisAtlanta
Mentalhealthinpast30days • SpokaneRegionalHealthDistrictSurvey
DivisionStreetGateway
Mentalhealthservicesutilization
• NationalHealthInterviewSurvey(NHIS)
N/A
Mentalhealthtreatment(type,location,sourceforpayment,perceivedneed)
• NationalSurveyonDrugUseandHealthReport
AlcoholOutletDensity–MarathonCounty,Wisconsin
Methamphetamineuse • EnCanaSurveyofSubcontractors BattlementMesa,GarfieldCountyColoradoMortalityrate • NewYorkDepartmentofHealth RochesterWaterfrontRevitalizationPlanNumberofdaysunabletoworkduetomentalhealth
• CaliforniaHealthInterviewSurvey(CHIS)
SanDiegoBusRapidTransitStation
Numberofstudentsfeelingnervous,worried,orupset
• MinnesotaDepartmentofHealth StateEducationIntegrationTaskForceRecommendationsRapidHIA
OccupationalStress • CaliforniaWorkandHealthSurvey(CWHS)
• DomesticWorkersUnitedSurvey
• CaliforniaPaidSickDays• CaliforniaDomesticWorkerEquality,
Fairness,andDignityActPanicdisorders(adults) • NationalHealthandNutrition
ExaminationSurvey(NHANES)N/A
Percapitaconsumptionofalcohol
• U.S.CensusBureau AlcoholOutletDensity–MarathonCounty,Wisconsin
Perceptionofneighborhoodcrime
• DepartmentofPublicHealth,LosAngeles
-CaliforniaCapandTradeRulemaking-LongBeachDowntownPlanHIA
Perspectivesonparksandsupportfordifferentservices
• MinneapolisParkFoundationSurvey CityofMinneapolisAbovetheFallsMasterPlan
Politicalengagement • PagedaleHouseholdSurvey PageAvenueRevitalizationPoormentalhealthbybullying • YouthRiskBehaviorSurvey(YRBS) -RochesterWaterfrontRevitalizationPlan
-AlcoholOutletDensity–MarathonCounty,Wisconsin-NorthCarolinaSenateBill731
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TableofmentalhealthindicatorsanddatasourcesusedinHIAsreviewed(cont’d)
MentalHealthIndicator DataSource(s) ExampleHIAsPoormentalhealthdays • BehavioralRiskFactorSurveillance
System(BRFSS)• CountyHealthRankingsand
Roadmaps
-PortlandCityCouncil’sRentalHousingInspectionsProgramforMultnomahCounty-StateRoute520Bridge-ArrestRecordinEmploymentDecisions-CapitalAreaRegionalPlanningCommissionFutureUrbanDevelopmentArea(Chicago)-ColumbiaTransitSystemExpansion-I-710Expansion-DanielMorganAvenueRoadDiet-IceAgeTrailExpansion-HoodRiverFarmlandRezone
Poverty • WisconsinFamilyHealthSurvey CapitalAreaRegionalPlanningCommission(CRPC)FutureUrbanDevelopmentArea(FUDA)
Problemgambling • BehavioralRiskFactorSurveillanceSystem(BRFSS)
SoutheastKansasCasino
Psychiatricadmissions(ICD-9codes)
• DepartmentofPublicHealth,LosAngeles
I-710Expansion
Psychologicaldistressinpast30days
• SurveyofHealthofAllthePopulationsandEnvironment(SHAPE)
CityofMinneapolisAbovetheFallsMasterPlan
Psychologicaldistressinpastyear
• CommunityHealthIndicatorsforContraCostaCounty
• CaliforniaHealthInterviewSurvey(CHIS)
-PittsburgRailroadAvenueTransit-OrientedDevelopment-SanDiegoBusRapidTransitStation
Qualitativeperceptionsofproblems
• HaywoodCountyHealthPrioritiesReportfor2009-2010
HaywoodcountyBCComprehensiveBikePlan
Sadness • CaliforniaHealthyKidsSurvey(CHKS) SchoolDisciplinePoliciesSelfinjury • MonroeCountyAdolescentHealth
ReportCardRochesterWaterfrontRevitalizationPlan
Self-efficacy(e.g.,control,hopeforfuture,depressedoranxious,calmorpeaceful)
• Wisconsin’sTransitionalJobsProgramParticipantSurvey
Wisconsin’sTransitionalJobsProgram
Self-induceddeaths • MaricopaCountyPublicHealthandArizonaDepartmentofHealthServices
TempeModernStreetCar
Self-inflictedinjuries(hospitalization
• MonroeCountyAdolescentHealthReportCard
N/A
Self-reportfrequentmentaldistress
• MonroeCountyAdolescentHealthReportCard
N/A
Senseofwellbeing • CaliforniaHealthInterviewSurvey(CHIS)
OasisonBallou
Seriousmentalillness • NationalSurveyonDrugUseandHealthReport
AlcoholOutletDensity–MarathonCounty,Wisconsin
Seriouspsychologicaldistress • NationalSurveyonDrugUseandHealthReport
AlcoholOutletDensity–MarathonCounty,Wisconsin
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TableofmentalhealthindicatorsanddatasourcesusedinHIAsreviewed(cont’d)
MentalHealthIndicator DataSource(s) ExampleHIAsSocialcapital • CaliforniaHealthInterviewSurvey
(CHIS)AndroscogginGreenwayPlan
Socialcohesion • PagedaleHouseholdSurvey PageAvenueRevitalizationSocialisolation • ConnecticutEnergyEfficiencyFund
SurveyCaliforniaPaidSickDays
Socialparticipation • PagedaleHouseholdSurvey PageAvenueRevitalizationSocialsupport • CountyHealthRankingsand
Roadmaps-ColumbiaTransitSystemExpansion-I-710Expansion-DanielMorganAvenueRoadDiet-IceAgeTrailExpansion-HoodRiverFarmlandRezone
Stressoranxietyfromtransittrip
• On-BoardTransitRiderSurvey(AlamedaContraCostaTransit)
SanFranciscoBayAreaRegionalTransitPlan
Stress-relatedillness • BehavioralRiskFactorSurveillanceSystem(BRFSS)
IceAgeTrialExpansioninMarquetteCounty,Wisconsin
Studentalcoholanddruguse • CaliforniaSchoolClimateSurvey(CSCS)
SchoolDisciplinePolicies
Substanceusedisorder • BehindBarsII:SubstanceabuseinAmerica’sPrisonPopulation
• NationalSurveyonDrugUseandHealthReport
-TreatmentAlternativestoPrison-AlcoholOutletDensity–MarathonCounty,Wisconsin
Substance-relateddisorders • IllinoisDepartmentofPublicHealth ArrestRecordinEmploymentDecisionSuicide(thoughts,behavior,treatment)
• NationalSurveyonDrugUseandHealthReport
AlcoholOutletDensity–MarathonCounty,Wisconsin
Suicideattempts • YouthRiskBehaviorSurvey(YRBS) -RochesterWaterfrontRevitalizationPlan-AlcoholOutletDensity–MarathonCounty,Wisconsin-NorthCarolinaSenateBill731
Suiciderate • OASIS:OnlineAnalyticalStatisticalInformationSystem(GeorgiaDept.PublicHealth)
• AlaskaDepartmentofCommerce,Community,andEconomicDevelopmentCommunityProfiles
• HaywoodCountyHealthPrioritiesReportfor2009-2010
• MonroeCountyAdolescentHealthReportCard
• NewYorkDepartmentofHealth• CaliforniaStateDepartmentofHealth• GeorgiaDepartmentofPublicHealth• DepartmentofPublicHealth,Los
Angeles• MaricopaCountyPublicHealthand
ArizonaDepartmentofHealthServices
-AtlantaBeltline-RedDogMineExtension-HaywoodcountyBCComprehensiveBikePlan-RochesterWaterfrontRevitalizationPlan-Farmer’sFieldRapidHIA-CaliforniaCapandTradeRulemaking-LongBeachDowntownPlanHIA-TempeModernStreetCar
57
TableofmentalhealthindicatorsanddatasourcesusedinHIAsreviewed(cont’d)
MentalHealthIndicator DataSource(s) ExampleHIAsTakenprescriptionmedicineforemotional/mentalhealthissue
• CommunityHealthIndicatorsforContraCostaCounty
PittsburgRailroadAvenueTransit-OrientedDevelopment
Workrelatedtoemotionalproblems
• MonroeCountyAdolescentHealthReportCard
N/A
Youthmentalhealth(hospitalization,majordepressiveepisode)
• NationalSurveyonDrugUseandHealthReport
AlcoholOutletDensity–MarathonCounty,Wisconsin
Youthsuicideattempts • CountyHealthRankingsandRoadmaps
-ColumbiaTransitSystemExpansion-I-710Expansion-DanielMorganAvenueRoadDiet-IceAgeTrailExpansion-HoodRiverFarmlandRezone
58
Endnotes
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NationalMentalHealthDevelopmentUnit.(2009).CommissioningPopulationMentalHealthandWell-Being:ALeadershipBriefingForBoardsandSeniorManagers—TheRoleOfWell-BeingandMentalHealthPromotioninAchievingWholeSystemImprovement(DRAFT).TamworthBoroughCouncil:GovernmentoftheUnitedKingdom.Retrievedfrom,http://www.tamworth.gov.uk/pdf/Agenda%20part3.pdf.
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190Martin,A.,Polletta,V.,Scherb,A.,Stillman,L.(2012).OasisonBallou:HealthImpactAssessmentReport.MassachusettsDepartmentofPublicHealth,CDCHealthyCommunityDesignInitiative:HealthResourcesinAction.191SanDiegoAssociationofGovernments,CountyHealthandHumanServicesAgency,HumanImpactPartners,andSafeandHealthyCommunitiesConsulting.(November2012).I-805BRT/47thStreetTrolleyStationAreaPlanning:AHealthBenefitsandImpactsAnalysis.SanDiego,California.192Martin,A.,Polletta,V.,Scherb,A.,Stillman,L.(2012).OasisonBallou:HealthImpactAssessmentReport.MassachusettsDepartmentofPublicHealth,CDCHealthyCommunityDesignInitiative:HealthResourcesinAction.193MaineNetworkofHealthCommunities.(2012)AndroscogginGreenwayPlan.Topsham,Maine.194HumanImpactPartners.(May2012).HealthImpactAssessmentofSchoolDisciplinePolicies:AHealthImpactAssessmentofStatus-QuoDiscipline,PositiveBehavioralInterventionsandSupports,andRestorativeJusticePoliciesinThreeCaliforniaSchoolDistricts.TheCaliforniaEndowment.195HumanImpactPartners.(May2012).HealthImpactAssessmentofSchoolDisciplinePolicies:AHealthImpactAssessmentofStatus-QuoDiscipline,PositiveBehavioralInterventionsandSupports,andRestorativeJusticePoliciesinThreeCaliforniaSchoolDistricts.TheCaliforniaEndowment.196McLeanSalls,A.,Wilson,J.,Tohn,W.,Snyder,L.(April2013).RapidHealthImpactAssessment:WeatherizationPlusHealthinConnecticut.NewOpportunities,Inc.197McLeanSalls,A.,Wilson,J.,Tohn,W.,Snyder,L.(April2013).RapidHealthImpactAssessment:WeatherizationPlusHealthinConnecticut.NewOpportunities,Inc.198Gaydos,M.,Hoover,C.,Lynch,J.,Weintraub,J.,Bhatia,R.(May2011).AHealthImpactAssessmentofCaliforniaAssemblyBill889:TheCaliforniaDomesticWorkEmployeeEquality,Fairness,andDignityActof2011.SanFranciscoDepartmentofPublicHealth:ProgramonHealth,Equity,andSustainability.199Witter,R.,McKenzie,L.,Towle,M.,Stinson,K.,Scott,K.,Newman,L.,AdgateJ.(September2010).HealthImpactAssessmentforBattlementMesa,GarfieldCountyColorado.Denver,Colorado:UniversityofColoradoDenver,ColoradoSchoolofPublicHealth.200WhiteRiverCounseling.CompanyManagementtoPreventEmployeeAlcoholandDrugAbuse.In;2006.(AscitedintheBattlementMesaHIA).201Lucky,J.,Satinsky,S,Nasser,E.(July2012).FindingsandRecommendationsoftheRapidHealthImpactAssessmentoftheProposedFarmersFieldDevelopment.LosAngeles:HumanImpactPartners.202LosAngelesCountyDepartmentofPublicHealth.(2007).LosAngelesCountyHealthSurvey.OfficeofHealthAssessmentandEpidemiology.203MinneapolisHealthDepartment.(May2013).AbovetheFallsHealthImpactAssessment:EnsuringHealthEquityinDecision-Making.Minneapolis,Minnesota.204NationalCenterforHealthStatistics.(2014).NationalHealthandNutritionExaminationSurvey:1999-2014SurveyContentBrochure.Retrievedfrom,http://www.cdc.gov/nchs/data/nhanes/survey_content_99_14.pdf205Ibid.206Cook,W.,Heller,J.,Bhatia,R.,Lili,F.onbehalfofHumanImpactPartnersandSanFranciscoDepartmentofPublicHealth.(September2009).AHealthImpactAssessmentoftheHealthyFamiliesActof2009.Oakland,California.
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207CentersforDiseaseControlandPrevention.(2015).NationalHealthInterviewSurvey:Questionnaires,Datasets,andRelatedDocumentation1997tothePresent.Retrievedfrom,http://www.cdc.gov/nchs/nhis/quest_data_related_1997_forward.htm#2015_NHIS.208AlamedaCountyPublicHealthDepartment.(May2013).GettingonBoardforHealth:AHealthImpactAssessmentofBusFundingandAccess:AStudytoInformtheSanFranciscoBayAreaRegionalTransportationPlan.209Hoehner,C.,Rios,J.,Garmendia,C.,Baldwin,S.,Lesorogol,C.,Kelly,C.,GunnMcClendon,G.,Knights,D.(2010).PageAvenueHealthImpactAssessment.St.Louis,Washington.210Dewey,H.,Dominguez,A.,Satterfield,B.,Summers,A.,Wallace,E.,Wittstruck,M.(May2012).DivisionStreetGateway:HealthImpactAssessment.Spokane,Washington:SpokaneRegionalHealthDistrictandtheCityofSpokane.211HennepinCountyHumanServicesandPublicHealthDepartment.(2011).SHAPE2010AdultDataBook,SurveyoftheHealthofAllthePopulationandEnvironment.Minneapolis,MN.212MinneapolisHealthDepartment.(May2013).AbovetheFallsHealthImpactAssessment:EnsuringHealthEquityinDecision-Making.Minneapolis,Minnesota.213Attard-Sacco,Inzeo,P,Moran,C.,WisconsinPublicHealthAssociationHealthImpactAssessmentSection.(July2012).NorthYaharaFutureUrbanDevelopmentAreaHealthImpactAssessment.DaneCounty,Wisconsin.214Feder,E.,Moran,C.(2013).TransitionalJobsPrograms:AHealthImpactAssessment.UniversityofWisconsinPopulationHealthInstitute.215DavidsonDesignforLifeCommittee,DavidsonDesignforLifeRegionalAdvisoryCommittee.(November2012).HealthImpactAssessment:SB731Zoning/DesignAestheticControls.Davidson,NorthCarolina.216CentersforDiseaseControlandPrevention.(2011).NorthCarolina2011andUnitedStates2011Results.YouthOnline:HighSchoolYRBS.217MarathonCountyHealthDepartment.(May2011).HealthImpactAssessmentReport:AlcoholEnvironment–VillageofWeston,WI.Weston,WI.218Korfmacher,K.,Garrison,V.(May2013).HealthyWaterways:AHealthImpactAssessmentoftheCityofRochester,NewYork’sLocalWaterfrontRevitalizationProgram.Rochester,NewYork.219MarathonCountyHealthDepartment.(May2011).HealthImpactAssessmentReport:AlcoholEnvironment–VillageofWeston,WI.Weston,WI.220LaVallee,R.,Yi,H.,CSR,Inc.ApparentPerCapitaAlcoholConsumption:National,State,andRegionalTrends,1977-2010.USDepartmentofHealthandHumanServices:NationalInstituteonAlcoholAbuseandAlcoholism.Retrievedfrom,http://pubs.niaaa.nih.gov/publications/Surveillance95/CONS10.htm.221UpstreamPublicHealth.(May2011).HB2800:OregonFarmtoSchoolandschoolGardenPolicy:AHealthImpactAssessmentDetailingthePotentialImpactsofOregon’s2011FarmtoSchoolandSchoolGardenLegislation.Portland,Oregon.222NationalCenterforHealthStatistics.(2009).Deaths,PercentofTotalDeaths,andDeathRatesforthe15LeadingCausesofDeath:UnitedStatesandEachState,1999-2006.NationalVitalStatisticsSystem,CentersforDiseaseControlandPrevention.223HumanImpactPartnersandWISDOM.(November2012).HealthierLives,StrongerFamilies,SaferCommunities:HowIncreasingFundingforAlternativestoPrisonWillSaveLivesandMoneyinWisconsin.
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224BicycleHaywoodNC,HaywoodCounty.(November2011).HaywoodCountyCompregensiveBicyclePlan.HaywoodCounty,NorthCarolina.225HumanImpactPartners.(2008).PittsburgRailroadAvenueSpecificPlanHealthImpactAssessment.Oakland,California.226AlaskaDepartmentofHealthandSocialServices,DepartmentofNaturalResources.(July2012).PointThomsonProjectEIS,FinalEnvironmentalImpactStatement.Kaktovik,Alaska:USArmyCorpsofEngineers.227ManiilaqAssociation,AlaskaNativeTribalHealthConsortium,AlaskaDepartmentofHealthandSocialServices,AgencyforToxicSubstancesandDiseaseRegistry,andUSCentersforDiseaseControlandPrevention.(2009).RedDogMineExtensionAqqalukProjectFinalSupplementalEnvironmentalImpactStatement.Alaska:USEnvironmentalProtectionAgency.228Korfmacher,K.,Garrison,V.(May2013).HealthyWaterways:AHealthImpactAssessmentoftheCityofRochester,NewYork’sLocalWaterfrontRevitalizationProgram.Rochester,NewYork.229MonroeCountyDepartmentofPublicHealth.(2013).HealthReports/HealthAction.Retrievedfrom,http://www2.monroecounty.gov/health-healthdata.php(accessed5/1/2013).230MonroeCounty.(2015).HealthReports/HealthAction.Retrievedfrom,http://www2.monroecounty.gov/health-healthdata.php.231SouthCarolinaInstituteofMedicineandPublicHealth.(March2013).AHealthImpactAssessmentofPark,Trial,andGreenSpacePlanningintheWestSideofGreenville,SouthCarolina.Greenville,SouthCarolina.232MarathonCountyHealthDepartment.(May2011).HealthImpactAssessmentReport:AlcoholEnvironment–VillageofWeston,WI.Weston,WI.233WisconsinDepartmentofTransportation,Safety&ConsumerProtection.(June2010).DrunkenDriving.Retrievedfrom,http://www.dot.wisconsin.gov/safety/motorist/drunkdriving/index.htm.234NationalSurveyonDrugUseandHealth.(2008).StateEstimatesofPersonsAged18orOlderDrivingundertheInfluenceofAlcoholorIllicitDrugs.Rockville,MD:SAMHSA.235WisconsinDepartmentofTransportation,Safety&ConsumerProtection.(June2010).DrunkenDriving.Retrievedfrom,http://www.dot.wisconsin.gov/safety/motorist/drunkdriving/index.htm.236PacificInstituteforResearchandEvaluation.(November2009).UnderageDrinkinginWisconsin,TheFacts.OfficeofJuvenileJusticeandDelinquencyPrevention.237NationalCenteronAddictionandSubstanceAbuseatColumbiaUniversity.(2010).BehindBarsII:SubstanceAbuseandAmerica’sPrisonPopulation.Retrievedfrom,http://www.casacolumbia.org/addiction-research/reports/substance-abuse-prison-system-2010.
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242Pack,M.,Ball,J.(April2012).HealthImpactAssessmentofProposed“RoadDiet”andRe-StripingProjectonDanielMorganAvenueinSpartanburg,SouthCarolina.Spartanburg,SouthCarolina.243WisconsinBureauofEnvironmentalandOccupationalHealth,WisconsinDivisionofPublicHealth.(May2011).MarquetteCountyIceAgeTrailExpansionHealthImpactAssessment.Madison,Wisconsin.244Meja,N.(June2011).HoodRiverCountyHealthDepartmentHealthImpactAssessmentfortheBarrettProperty.HoodRiver,Oregon.245Korfmacher,K.,Garrison,V.(May2013).HealthyWaterways:AHealthImpactAssessmentoftheCityofRochester,NewYork’sLocalWaterfrontRevitalizationProgram.Rochester,NewYork.246CenterforQualityGrowthandRegionalDevelopmentattheGeorgiaInstituteofTechnology.(December2011).AerotropolisAtlantaBrownfieldRedevelopmentHealthImpactAssessment.Atlanta,Georgia.247Harris,C.,Heller,J.,Purciel-Hill,M.,Tsui,C.,Banay,R.,Hill,P.,Begstad,L.(April2013).FindingsandRecommendations:RapidHealthImpactAssessmentofSchoolIntegrationStrategiesinMinnesota.Minnesota:HumanImpactPartnersandISAIAH.248ManiilaqAssociation,AlaskaNativeTribalHealthConsortium,AlaskaDepartmentofHealthandSocialServices,AgencyforToxicSubstancesandDiseaseRegistry,andUSCentersforDiseaseControlandPrevention.(2009).RedDogMineExtensionAqqalukProjectFinalSupplementalEnvironmentalImpactStatement.Alaska:USEnvironmentalProtectionAgency.249DavidsonDesignforLifeCommittee,DavidsonDesignforLifeRegionalAdvisoryCommittee.(November2012).HealthImpactAssessment:SB731Zoning/DesignAestheticControls.Davidson,NorthCarolina.250NorthCarolinaStateCenterforHealthStatistics.(2011).HealthProfileofNorthCarolinians:2011Update.Retrievedfrom,http://www.schs.state.nc.us/schs/pdf/HealthProfile2011_WEB.pdf251Heller,J.,Bhatia,R.(September2007).TheEastBayGreenwayHealthImpactAssessment.AlamedaCounty,California.252Lucky,J.,Satinsky,S,Nasser,E.(July2012).FindingsandRecommendationsoftheRapidHealthImpactAssessmentoftheProposedFarmersFieldDevelopment.LosAngeles:HumanImpactPartners.253MarathonCountyHealthDepartment.(May2011).HealthImpactAssessmentReport:AlcoholEnvironment–VillageofWeston,WI.Weston,WI.254WisconsinDepartmentofPublicHealth.Wisconsinresidentdeathcertificates.WisconsinDepartmentofHealthServices255BernaliloCountyPlaceMattersTeam,MountainViewElementarySchool’sCommunityActionTeam,MountainViewNeighborhoodAssociation,andVecinosdeMountainView.(June2012).HealthAssessmentontheImpactoftheBernalilloCountyPedestrianandBicyclistSafetyActionPlan:AccessibilityandSafetyonMountainView’sSecondStreet.Bernalillo,NewMexico.256Meja,N.(June2011).HoodRiverCountyHealthDepartmentHealthImpactAssessmentfortheBarrettProperty.HoodRiver,Oregon.257StateEpidemiologicalOutcomesWorkgroup,AddictionsandMentalHealthDivision,OregonHealthAuthority.(2010).HoodRiverCounty’sEpidemiologicalDataonAlcohol,Drugs,andMentalHealth.Salem,Oregon:OregonHealthAuthority.258White,S.,McSharryMcGrath,M.(August2012).RentalHousingandHealthEquityinPortland,Oregon:AHealthImpactAssessmentoftheCity’sRentalHousingInspectionsProgram.Portland,Oregon:HealthImpactProject.
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259WayneCountyDepartmentofPublicHealth,HumanImpactPartners.(April2011).HealthImpactAssessmentofGenderPayInequity.Oakland,California:HumanImpactPartners.260Todman,L.,Taylor,J.S.,McDowell,T.,Driscoll,M.,Cooper,D.,KimE.(April2013).USEqualEmploymentOpportunityCommissionPolicyGuidance:AMentalHealthImpactAssessment.AdlerSchoolofProfessionalPsychology,InstituteonSocialExclusion.261CaliforniaDepartmentofPublicHealth.(December2010).HealthImpactAssessmentofaCap-and-TradeFramework.California.262HumanImpactPartners,EastYardCommunitiesforEnvironmentalJustice,CaliforniansforJustice.(April2011).ARapidHealthImpactAssessmentoftheLongBeachDowntownPlan.LongBeach,California.263LosAngelesDepartmentofPublicHealth.(2007).LosAngelesCountyHealthSurvey,2007:AverageNumberofUnhealthyDays(Mentaland/orPhysical)inthepast30daysReportedbyAdults(18+yearsold).Retrievedfrom,http://publichealth.lacounty.gov/ha/LACHSDataTopics2007_rev.htm.264Harris,C.,Heller,J.,Purciel-Hill,M.,Tsui,C.,Banay,R.,Hill,P.,Begstad,L.(April2013).FindingsandRecommendations:RapidHealthImpactAssessmentofSchoolIntegrationStrategiesinMinnesota.Minnesota:HumanImpactPartnersandISAIAH.265CentreforHealthStatistics.(2012).TheHealthandWellbeingofMinnesota’sAdolescentsofColor:ADataBook.Minnesota:DivisionofHealthPolicy,MinnesotaDepartmentofHealth.266Ross,C.(June2007).AtlantaBeltline:HealthImpactAssessment.Atlanta,GA:GeorgiaInstituteofTechnology’sCenterforQualityGrowthandRegionalDevelopment.267Lin,T.,Shoults,C.,Williams,I.,McMurtry,C.(October2012).PotentialEffectsofCasinoDevelopmentinSoutheastKansas:KansasHealthImpactAssessmentProject.Topeka,KS:KansasHealthInstitute.268MarathonCountyHealthDepartment.(May2011).HealthImpactAssessmentReport:AlcoholEnvironment–VillageofWeston,WI.Weston,WI.269CaliforniaDepartmentofPublicHealth.(December2010).HealthImpactAssessmentofaCap-and-TradeFramework.California.270HumanImpactPartnersandWISDOM.(November2012).HealthierLives,StrongerFamilies,SaferCommunities:HowIncreasingFundingforAlternativestoPrisonWillSaveLivesandMoneyinWisconsin.271Martin,A.,Polletta,V.,Scherb,A.,Stillman,L.(2012).OasisonBallou:HealthImpactAssessmentReport.MassachusettsDepartmentofPublicHealth,CDCHealthyCommunityDesignInitiative:HealthResourcesinAction.272UCBerkeleyHealthImpactGroup.(2009).HOPEVItoHOPESF,SanFranciscoPublicHousingRedevelopment:AHealthImpactAssessment.Berkeley,CA:UniversityofCalifornia.273Ibid.,SC-5.274Ibid.,SC-2-4.275Ibid.,HHEH7.276Ibid.277Ibid.,CHNC-19.278Ibid.279Ibid.,HHEH-19.280Ibid.,D-10.281Ibid.
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282Feder,E.,Moran,C.(2013).TransitionalJobsPrograms:AHealthImpactAssessment.UniversityofWisconsinPopulationHealthInstitute283Ibid.,23-4.284Ibid.,57.285Ibid.286Joshi,S.,Douglas,J.Hamberg,A.,Teshale,S.,Cain,D.,Early-Alberta,J.(2012).StrategicHealthImpactAssessmentonWindEnergyDevelopmentinOregon[Publiccommentrelease].Oregon:HealthImpactAssessmentProgram,OregonHealthAuthority.287Purtle,J.(2010).GamblingontheHealthofthePublic:ARapidHealthImpactAssessmentforanUrbanCasino.[PosterpresentedattheAPHAAnnualMeeting].APHA.
