Presented at "The Social Determinants of Urban Mental Health: Paving the Way Forward," hosted by the Adler School of Professional Psychology Institute on Social Exclusion, Sept. 19-20, 2012, Chicago.

1. Public Health and Transportation
Planning in Massachusetts
Institutionalizing HIA
The Social Determinants of Urban
Mental Health: Paving the Way
Forward
September 20, 2012
Suzanne K. Condon, Associate Commissioner Margaret Round, Senior Environmental Analyst
Director, Bureau of Environmental Health, MDPH MDPH/ Bureau of Environmental Health

2. Outline
I. Introduction
II. Healthy Transportation Compact
III. Interagency Working Group
IV. Health Impact Assessment Pilot Project
V. Summary
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3. I. Introduction
Transportation Reform Law
In June 2009 Governor Deval Patrick signed the
Transportation Reform Law – M.G.L. Chapter 6C
The primary goal was
to consolidate all
transportation
agencies in MA to
reduce duplicate
efforts and enhance
transportation
planning
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4. I. Introduction
• Under M.G.L. Chapter 6C, Section 33 the Healthy
Transportation Compact is directed to:
– (v) establish methods to implement the use of health
impact assessments (HIAs) to determine the effect of
transportation projects on public health and vulnerable
populations; and
– (x) institute a health impact assessment for use by
planners, transportation administrators, public health
administrators and developers.
• Transportation planning projects often have a
range of health implications that are not uniformly
considered
• MDPH was awarded funds from the Robert Wood
Johnson/Pew Charitable Trusts Health Impact
Project to conduct a transportation-related HIA
and develop an approach to institute a health
impact assessment 4

5. II. Healthy Transportation Compact
• M.G.L Chapter 6C also called for the establishment
of a Healthy Transportation Compact (HTC)
• The HTC shall be composed of:
– Secretary of Transportation (co-chair)
– Secretary of Health and Human Services (co-
chair)
– Secretary of Energy and Environmental Affairs
– Administrator of Transportation for Highways
– Administrator of Transportation for Mass Transit
– Commissioner of Public Health
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6. III. Interagency HTC Working Group
• Established Interagency Working
Group
• Members include:
– Senior staff from the Massachusetts Department
of Public Health Bureau of Environmental
Health and Bureau of Community Health Access
and Promotion
– Senior planning staff from MassDOT
– Senior Staff from the Executive Office of Energy
and Environmental Affairs
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7. III. Interagency Working Group
• Monthly meetings beginning in late 2009
• Discussions about:
– What is an HIA – do we need a MA definition?
– Need for cross agency framing to develop common
understanding and language
• Inventory by agencies related to transportation work
– What worked best?
– What hurdles were met?
• Greater clarity on what is involved in existing transportation
planning process
• Identification of a transportation project that could benefit
from early incorporation of HIA into decision making process
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8. IV. Health Impact Assessment Pilot
Project
• The goal of the proposed transportation-related HIA project
is to work together with MassDOT, EEA and other
community representatives to:
Pilot an HIA of a Serve as a vehicle Provide the
proposed for training staff framework for
transportation- responsible for developing methods
related project implementing the to determine which
HIA directives types of
transportation
projects might
benefit from an HIA
and the process to
make such
determinations
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9. IV. Health Impact Assessment Pilot
Project:
• Project underway by the MassDOT that the HIA will inform
is the “Grounding McGrath” Study in Somerville, MA
– Overall this transportation project aims to determine the
future of the Route 28 corridor
– MassDOT indicated that the size of the investment
necessary to restore the highway provided an
opportunity to evaluate the
feasibility, benefits, impacts, and costs of removing at
least a portion of the elevated structure on Route
28/McGrath Highway
– MassDOT’s existing study protocol lends uniquely to
the HIA process by establishing criteria to assess
impacts and benefits of alternative designs and
establishing an advisory group composed of community
representatives to provide recommendations throughout
study
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10. 10

11. 11

12. 12

13. Factors Responsible for Population Health
Health status is determined by:
genetics 20 – 30%;
health care 10%;
social, environmental conditions, and behavior 60 – 70%
J Health Affairs, 2002
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14. HIA Addresses Determinants of Health
How does the proposed affect
project, plan, policy
and lead to
health outcomes
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15. Steps of an HIA
Screening Identify and prioritize topics for HIAs
Scoping Identify health issues to be studied
Prioritize research questions
Assessment Conduct literature reviews
Research existing conditions data
Conduct surveys, interviews, focus groups
Conduct data analysis
Interpret and ground truth data
Recommendations Identify and prioritize recommendations
Reporting Write, review and edit final report
Develop a communication, media and advocacy
plan to report findings to decision-makers
Monitoring Collect data on impacts
Hold decision-makers accountable for decision
agreements and mitigations 15

16. Proposed Pathways for the Grounding
McGrath HIA
• Mobility and Connectivity
– Vehicle use
– Pedestrian/Bicycling Network
• Land Use and Economic Development
– Access to goods & services (e.g., prediction of
walk/bike to goods and services)
• Air Quality
– Air pollution from vehicles
– Proximity (200 meters) to roadways
• Public Safety
– Injuries and fatalities
– Crime and fear of crime
• Noise
– Noise from motor vehicle
– Impact from de-elevation
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17. 17

18. No-Build Research Alternative Research
Evaluation Criteria Possible Indicators
Questions Questions
Proximate Effects
Will changes to the corridor improve
Impacts of congestion What is the level of congestion?
congestion?
- Travel delay by car;
Will changes to intersections/
What is the access to corridor
Access around corridor via intersections/crosswalks?
crosswalks increase access by traffic, - Crossing speed
bus, walking, biking ?
How will changes to the corridor
What is the current pedestrian - Number of pedestrians and
Change in use bicycle infrastructure?
affect pedestrian/bicycle
bicyclists along corridor
infrastructure/?
Health Outcomes
What are the current rates of How will rates of disease change
CVD/Respiratory - Baseline respiratory and CVD rates
respiratory and cardiovascular from improving mobility/connectivity
in communities around the corridor
disease? of the corridor?
Mental Health How would changes in - Outpatient MH clinic visits;
What are the mental health
mobility/connectivity affect mental - Stress levels (due to traffic, noise,
outcomes?
health? congestion, lack of social support);
Physical Activity - Rates of physical activity;
What are the current rates of How will physical activity change due
- Percent of population
physical activity? to various factors related to changes
biking/walking for commute and
in the corridor structure?
non-commute
Vulnerable Pop
-Access within ¼ mile to goods and
Environmental Justice What is the accessibility and
services by ethnicity and income
traffic safety associated with the What changes to the corridor will
Areas, level;
corridor for specific vulnerable assist in the access of vulnerable
Elderly, Disabled - Fatalities and injuries from traffic
populations (e.g., elderly, populations?
collisions by ethnicity and income
disabled)
level

19. Examples of Baseline Health Data for Consideration
in HIA
Health Determinants Health Outcomes Data Sources
Air pollution – high gradient Respiratory disease/illness MDPH Bureau of
near roadways and scientific (e.g., asthma), cardiovascular Environmental Health
evidence that continues to disease (e.g., heart attack), all- Environmental Public Health
emerge regarding health cause mortality, certain cancers Tracking (EPHT) Portal
impacts http://matracking.ehs.state.ma.
us/
Access to active transportation Benefits for reducing obesity, MDPH Bureau of Community
and increasing physical activity diabetes, cardiovascular Health and Prevention
(e.g., access to sidewalks, disease, premature mortality,
bicycle paths) improved mental and physical
health
Access to public transit mobility Access to goods/services that MassDOT
for vulnerable populations support health, such as
(people with disabilities, groceries, clinics
elderly)
Traffic Safety Injury to pedestrians, vehicle MassDOT
drivers, and cyclists
Economic: vitality of small Multiple indirect impacts on Economist to be hired
businesses; property values health
and health care costs that
could be reduced based on HIA
outcomes
Environmental Justice Multiple indirect impacts on EEA/MDPH EPHT/MassDOT
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health

20. MA Environmental Justice Policy
• Environmental Justice (EJ) populations are
determined by identifying all Census block groups
that meet any of the following criteria:
- Households earn 65% or less of statewide
median household income
- 25% or more of residents include people of
color
- 25% or more of residents are foreign-born
- 25% or more of residents lack English
language proficiency

21. EJ Populations in Boston Region
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23. Summary
• HIAs are a useful tool to comprehensively
address public health and social
determinants of health
• Mitigating risks combined with health
promotion optimizes health benefits
• Need additional method(s) to assess
mental health impacts/benefits in HIA’s
• Important to build upon established EJ
indicators (e.g., education)
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