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What was the Eastern Neighborhood Community Health Impact Assessment (ENCHIA)? What were the goals of ENCHIA? What was the impetus for ENCHIA? What is “Health Impact Assessment”? Why did you decide to use HIA? Who participated in your ENCHIA Community Council? What did ENCHIA accomplish? What were you not able to accomplish? What is the Healthy Development Measurement Tool (HDMT)? Who are the potential users and what are potential applications for the Tool? Does the Tool create any new regulations or requirements for development? Can other Cities use or adapt the HDMT? Where are you going now with ENCHIA and the HDMT? Where can I go for more information?
What was the Eastern Neighborhood Community Health Impact Assessment (ENCHIA)?
The Eastern Neighborhoods Community Health Impact Assessment (ENCHIA) was an 18-month long process (November 2004 – May 2006) to assess how land use development in San Francisco can best promote the conditions required for health. Convened and facilitated by the Program on Health, Equity, and Sustainability at the SF Department of Public Health, ENCHIA was guided by a multi-stakeholder Community Council of over 20 diverse organizations whose interests were affected by development processes. The assessment focused on health needs and assets in several San Francisco neighborhoods, including the Mission, South of Market, and Potrero Hill.
What were the goals of ENCHIA?
Build public dialogue about how land use planning affects the health of the city, its neighborhoods and its people.
Influence city land use policies and policy-making processes to account for long range health impacts.
Improve interdepartmental cooperation to achieve community health goals.
Support implementation of deliberative, consensus-building processes as a means of problem-solving community issues.
What was the impetus for ENCHIA?
Like many metropolitan areas, San Francisco contends with multiple, and often competing, interests and needs when it makes decisions regarding economic and land use development. Ideally, City decisions will strike the right balance among social, economic, and environmental interests. In order to do this, the public health effects of planning decisions should be included as considerations by policy makers.
The underlying aim of most public policies, laws and institutions, particularly those concerned with land use, transportation, and the environment, are to protect and promote public health and welfare. For example, the stated purpose of the San Francisco Planning Code is “….to promote and protect the public health, safety, peace, morals, comfort, convenience and general welfare…” ENCHIA aimed to complement the scope of issues being considered in the Eastern Neighborhoods planning process based on the experience of the Department of Public Health and community organizations in responding to community health needs. Some of these priority health needs included protection of from noise and poor air quality, assurance of adequate, safe, and affordable housing, protection from involuntary displacement, access to parks and recreational facilities, availability of nutritious food, safety from traffic hazards, security from crime and violence.
What is “Health Impact Assessment”?
Health Impact Assessment (HIA) refers to methods and tools used to inform policy-makers about how policies, plans, programs, or projects can affect health, health behaviors, and social resources necessary for health. HIA also refers to the process through which a health assessment is conducted and translated to decision-makers. Internationally, many countries and organizations use HIA to help direct public policy in ways that prevent disease and illness, potentially reducing significant economic costs of health care services. Health Impact Assessments have taken a variety of forms. Our assessment involved a facilitated process involving a Community Council representing diverse public and private organizations.
Why did you decide to use HIA?
Conducting a health impact assessment of development policies is feasible and supports a more successful balance of interests. HIA provides health evidence that can be considered as one lens in land use and transportation planning. For example, health evidence can support environmentally protective and resource-efficient land use strategies such as smart growth, transit-oriented and mixed-use development, and can also help focus attention on the design and infrastructure needs for healthy and active living. HIA can also facilitate public participation in policy, planning and decision-making.
Who participated in your ENCHIA Community Council?
SFDPH spent over a year actively recruiting diverse interests to participate in the HIA process. The Community Council consisted of public and private organizations selected by the Department whose interests may be affected by land use planning. Groups included residents, business-owners, community service providers, tenants, property owners and developers, schools and childcare providers, environmental, housing, bicycle, pedestrian, transportation, public health and parks advocates.
Several city agencies, including City Planning, MUNI, Department of Parking and Traffic, Police, Recreation and Parks, and the Redevelopment Agency, were also involved. The process had an external university-based evaluator, and the Center for Collaborative Policy at California State University Sacramento provided consultation on consensus-building methods.
What did ENCHIA accomplish?
The ENCHIA process resulted in a number of important outcomes. Among them were:
Producing a vision of a Healthy San Francisco;
Developing community health planning objectives to reflect that Health City Vision;
Identifying indicators to measure those objectives and vision;
Generating and presenting data on those objectives and indicators to assess how the
City was doing with respect to that Vision;
Developing research and forecasting tools to relate planning to health outcomes;
Developing a menu of urban policy strategies to advance those objectives; and,
Integrating all of the above products into the Healthy Development Measurement Tool
(HDMT), an evidence-based support tool for healthy planning and policy-making.
ENCHIA has also resulted in a number of process outcomes. These include achieving an increased understanding of the human health impacts of development; the use of public health rhetoric and evidence in public policy dialogues and debates; new working relationships among Council members with complementary interests; and, a broadening of the horizons of a government agency.
What were you not able to accomplish?
Our original intention was to conduct a health impact assessment of a proposed rezoning. However, while ENCHIA was in the process of developing objectives and indicators, and collecting data, the formal rezoning process slowed down. The SF Planning Department shifted its focus to developing Area Plans before coming up with new zoning recommendations. Given this shift in focus, ENCHIA was not able to conduct an HIA on the rezoning. Instead, the group integrated its experience and research into the Healthy Development Measurement Tool (see below) which may be later used to evaluate the Eastern Neighborhoods plans when complete ENCHIA also conducted policy research in efforts to identify a set of economic, land use, transportation, social and environmental policies to promote the health of present and future San Francisco residents and workers. We hope that the identified community health objectives, related data, policies and the Tool are used by the Department of City Planning in the development of Area Plans and final zoning controls.
What is the Healthy Development Measurement Tool (HDMT)?
The experience and research of ENCHIA is now being integrated into a Healthy Development Measurement Tool (HDMT) to support more accountable, evidence-based, and health-oriented planning and policy-making. In its current form, components of the Tool include:
Community Health Objectives that, if achieved, would result in greater and more equitable health assets and resources for San Francisco residents.
Measurable Indicators for each of the objectives to help measure progress towards the objectives and evaluate the benefits of projects, plans, and policies.
Established Standards which, when available, have been established by other sources as a means to advance health.
Baseline Data for each indicator to inform us how we are doing today.
Development Targets to provide specific planning and development criteria that advance community health objectives.
Evidence-based Health Justifications that provide a rationale for why achieving each target would improve human health.
Who are the potential users and what are potential applications for the Tool?
We envision that the Tool might ultimately be used by many City agencies in land use and transportation planning, in plan and project review, and in agency specific planning and budgeting. Note that the Tool is meant to be used in a comprehensive way using all objectives and indicators.
City agencies can use the Tool to:
Provide a checklist or screening tool to help evaluate projects, identify benefits and needs for improvement, and guide staff reports;
Provide a measurable set of health objectives and indicators to guide planning goals and evaluate their impacts;
Provide useful monitoring indicators for success and progress; and,
Guide infrastructure budgeting to priority.
Neighborhood planning groups can use the Tool to help residents evaluate the merits and health impacts of development projects and plans.
Community planning processes can use the Tool to provide a measurable set of health objectives and indicators to guide planning goals and evaluate impacts.
Developers can use the Tool to inform design choices and to demonstrate benefits of projects.
Everyone can use the Tool as a way to gain consensus and a unified position among interests.
Does the Tool create any new regulations or requirements for development?
No. The Tool is intended to provide voluntary guidance for health-oriented development. It is not intended as a regulation mandating specific design strategies or outcomes, but rather a way to evaluate a plan or project against broad set of health goals, measure progress towards those goals, and highlight where conflicts exist between goals.
Can other Cities use or adapt the HDMT?
This Tool is likely to be most relevant for land use development in a context similar to San Francisco, a dense, socially and economically diverse city situated in a large metropolitan area. Other cities or neighborhoods may want to modify indicators and targets to reflect local and neighborhood needs. This Tool will also undergo ongoing peer review and revision by national experts in the fields of public health, planning, environmental protection, and social indicators. New research findings and newly available technologies for measurement and assessment will be incorporated appropriately into the Tool.
Where are you going now with ENCHIA and the HDMT?
The ENCHIA public process is formally complete. The Community Council no longer meets and staff efforts are focused on finalizing and applying the Healthy Development Measurement Tool. Next steps include:
Writing the ENCHIA Final Report;
Producing a working final version of the Healthy Development Measurement Tool, incorporating comments/edits from local agencies and national experts;
Pilot testing the Tool on appropriate and constructive opportunities in land use and transportation planning in San Francisco;
Developing a User Guide based on pilot testing of the HDMT;
Developing the HDMT into as web-based application for user-friendly, universal access and dissemination;
Developing and conducting training on the HDMT for potential users; and,
Informing City agencies and non-ENCHIA organizations about HDMT and its potential uses.
Where can I go for more information?
The ENCHIA website contains information related to the process. All documents shared and reviewed at public meetings are posted, as well as specific products that the group developed.
The Healthy Development Measurement Tool website is currently under development. Basic information regarding the Tool can be found on the ENCHIA site. Please contact Lili Farhang, Project Coordinator, at lili.farhang@sfdph.org or 415.252.3988 for more information.
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