Health Impact Assessments + Enterprise Green Communities

​​The Executive Summary of the WELL Building Standard states, “We believe that the time has come to elevate human health and comfort to the forefront of building practices and reinvent buildings that are not only better for the planet, but also for the people.” WELL is the first standard of its kind to focus exclusively on health and wellness within the built environment. With its growth, our industry is beginning to start a new dialogue. How can we design and construct buildings to enhance our wellbeing? How can we put people at the center of design? How do we go about creating healthy environments – and maintaining those spaces?

With programs like WELL, it has become apparent that we need to look at the life-cycle cost of a building both in terms of the environmental and the health impacts it will have on its community. In the latest version of Enterprise Green Communities, I believe they have taken an admirable step in this direction. The standard has already helped to transform the affordable housing market into one where green building is the norm and not the exception. Now, Enterprise Green Communities is also helping to bring health and wellness into the forefront.

Enterprise is doing this by requiring all projects seeking certification to ‘Design for Health.’ One of the mandatory criteria for the program is to research potential health factors and address these in the building design. Health is not determined by genetics and behavior alone; there are several determinants, including the social, economic and physical environment. Enterprise Green Communities wants the project team to engage with community stakeholders so they can understand the impact the project may have on the community. It is highly recommended to involve local health departments in this process.

Once the team has finalized its local health findings, it needs to determine what Resident Health Campaign fits the community’s needs the best. There are five campaigns to choose from:

   1 Injury and Accessibility

   2 Asthma and Respiratory Health

   3 Cardiovascular Disease, Diabetes (Type II) and Obesity

   4 Cancer and Health Outcomes Related to Toxin Exposure

   5 Mental Health

Each of these campaigns has associated design strategies. For example, obesity can be combatted with providing access to safe, affordable places to be active (both indoor and outdoor). This design strategy is addressed in Criteria 7.12 Active Design: Promoting Physical Activity within the Building and 7.14 Interior and Outdoor Activity Spaces for Children and Adults.

Determining the factors of health and incorporating mitigating strategies into the design is all that is required for the mandatory criteria within Enterprise Green Communities. However, there is also an optional Criteria, 1.2b, Resident Health and Well-Being: Health Action Plan, where teams can take that assessment one step further. To achieve credit for the Health Action Plan, teams need to have public health professionals involved at design, construction and operations. The team, along with the health professionals and community members, must extend upon the research done in the Design for Health Criteria. There needs to be an analysis of the positive and negative impacts that the project may have in terms of social, environmental and economic. Will certain groups be disproportionately affected? What will happen to the baseline health of community groups? How significant will the effects be on health and equity? How feasible are the design strategies and how responsive are they to community concerns? After studying these questions, a Health Action Plan is drawn up. This plan needs to include a description of the following items:

   1 Key health issues (determined in Design for Health Criteria)

   2 How engaging with the community and public health professionals informed that list

   3 The participants involved

   4 The potential actions

   5 The selected interventions and why those actions were selected

   6 A monitoring plan that includes performance metrics for design, operations, and health

The standard references several resources to use to help with this assessment. It suggests using sources like County Health Rankings, the Center for Disease Control’s Field Guide for Community Needs Assessment, or working with a local university or college. However, very similar types of assessments are already being done across the country by local health departments – they are called Health Impact Assessments. A Health Impact Assessment is “a process that helps evaluate the potential health effects of a plan, project, or policy before it is built or implemented. It brings potential positive and negative public health impacts and considerations to the decision-making process.”* The steps involved in a Health Impact Assessment are:

   1 Screening (identifying whether an assessment will be useful)

   2 Scoping (planning and identifying what health benefits and risks to consider)

   3 Assessment (determining what populations will be affected and how significantly)

   4 Recommendations

   5 Reporting (presenting results to decision makers, communities, other stakeholders)

   6 Monitoring and Evaluation

Enterprise Green Communities does not include all the steps of a Health Impact Assessment, but there is a clear overlap. The main components of the Health Impact Assessment are all there in the Health Action Plan. With that said, it seems like reaching out to the local public health department should be a first step for all Enterprise Green Communities Design Teams. Our public health professionals are a great resource for us on the design and construction side of the industry.

If you want to see examples of what some of these Health Impact Assessments look like, go to

http://www.pewtrusts.org/en/multimedia/data-visualizations/2015/hia-map

This map contains several assessments from across the country. It is not only a great resource to see what work has been done in your community, but can also be a great guide in how we can approach all of our projects. How can we put people at the center of design and create healthy environments? Well, I think this is an essential first step.

*https://www.cdc.gov/healthyplaces/hia.htm