The following case study is presented to illustrate the use of impact assessments in a community setting and the processes through which policies or issues are analyzed and of the outcomes from these analyses.

Project: San Francisco Housing Authority Flooring Policy

Group Involved: Property Managers, Tenants, and Asthma Advocates

Background

The dust mite is a common allergen and an asthma trigger. Carpeting and other fabric-covered furniture serve as nesting environments for dust mites in the home. Research has indicated that the removal of carpeting along with other physical remediation efforts have an affect on the dust mite allergen levels. Although rigorous daily vacuuming can reduce the level of dust mite allergens, most health experts recommend smooth flooring as a substitute for carpeting. For many families in San Francisco, obtaining smooth flooring can be a challenge because most of them are renters, who have minimal control over the flooring in their units.

Families with asthma who live in public housing have limited financial resources and often become victims of a shortage of affordable housing. Furthermore, these families often are not given sufficient information and resources to create healthier environments. So it is imperative that they have an opportunity to voice their concerns.

As a part of the San Francisco’s on-going efforts to reduce asthma episodes in San Francisco, Asthma Relief for Kids (ARK), a parent-directed asthma advocacy group, along with the American Lung Association, and DPH successfully urged the Board of Supervisors to pass a resolution urging the San Francisco Housing Authority (SFHA) to adopt and implement a policy to provide an education program on asthma control and prevention and to allow tenants to request for smooth flooring as a reasonable accommodation. The Board further resolved that the SFHA develop and implement the flooring policy through an inclusive public planning process. The Department of Public Health was named by the Board as a partner to the SFHA for the implementation of the resolution, thus providing the opportunity to employ the Health Impact Assessment model.

The Impact Assessment

Identifying and Assessing a Target Issue

Older SFHA properties do not have carpeting, but carpeting is planned for all new developments, (i.e, HOPE VI developments); some of these HOPE VI complexes are only at the beginning of the development process. The HIA offered SFHA the opportunity to make adjustments to its flooring policy that will maximize the beneficial effects on all future renovation projects and minimize any harmful effects on health.

In order to direct the focus on the HIA discussions, the participants were asked to consider the potential social, physical, economic, and health impact of:

Removing or not installing carpeting upon request form tenants, or

Not installing carpeting in portions of the new units, or

Not installing carpeting in any of the new units, or

Any other strategies that might be helpful in remediating the dust mites in carpeting

The impact assessment was extended beyond identifying and analyzing the health impact of a flooring policy for two reasons:

In order for the participants to appreciate the breath and the depth of the policy being discussed, and

Immediate economic, social, and physical impacts can ultimately result in health impacts (e.g., non-budgeted dollars being spent in removing carpeting could have been used to remediate mold problems, or the lack of a sound barrier can cause stress to tenants on the lower floors)

Since the goal of the HIA was not only to assess the health impact of a flooring policy but to draft a flooring policy that would accommodate asthmatic families, the HIA included a time where the participants voiced the values that they bring to the table. Some of the values raised by the group included: equity, sustainability, cost effectiveness, health promoting, desirability to tenants, standardized, preventative, within reason, right for tenant to make informed choices, participation by children, fear of tenants exploiting policy, and taking into account the culturally-diverse values that tenants bring.

Identifying Multi-Level Impacts

The most significant impact of the IA process was on the participants themselves. The property managers, the property development and maintenance staff, and the tenants support staff learned about the potential health impacts of carpeting from asthmatic tenants, asthma advocates, and the health experts. The tenants learned about the complexities involved in removing or not installing carpeting in the new units. For example, one of the concerns for having designated units without carpeting is the re-occupation of those units once the current asthmatic tenant has moved out—how will the non-carpeted units be allocated?

One of the most surprising findings is that carpeting is the industrial standard that is required by the funders for a HOPE VI developments. Funders for other projects have rejected proposals where carpeting was not included because housing without carpeting was considered sub-standard housing. Therefore, flooring policies may affect funding. In an indirect manners, the funders of the HOPE VI developments may learn about the effects of carpeting on asthma because the SFHA will be designating units where carpeting will not be installed.

The parties who will be affected by the IA will include all those who are involved in the development and occupation of the HOPE VI units; these parties range from the architects, to the funders, to the ADA staff at the SFHA, to the tenants.

Outcomes

SFHA Flooring Policy

As a result of the IA process, the participants agreed upon two flooring policies to be recommended to the director of SFHA. They are comprehensive flooring policies that included both HOPE VI units that are not yet constructed and those that have already been built with carpeting.

1. A reasonable proportions of the new units in each HOPE VI complex will built without carpeting.

2. SFHA will increase the staff’s and the tenants’ awareness on the availability and the use of the Reasonable Accommodation Policy for removing carpeting in existing units.

An implementation plan with a timeline was also established by the HIA participants. In the Resolution, the Board of Supervisors requested an annual progress report from SFHA. SFHA will use the need to present this report to the Board as its accountability factor for implementing the flooring policy recommendations.

Lessons Learned From the Impact Assessment Process

The process of equal participation and decision-making was observed to be hindered by health advocates. It was difficult to transition out of the role of being an advocate into the role of an informant, allowing the whole group to advocate for what the group believed to be the best policy.

The consensus-building approach to drafting the recommended policies does not ensure the implementation, the actualization of the policy recommendations. A form of accountability seemed to be necessary to ensure that the recommendations become implemented policies at the SFHA.

Although the participants, especially the tenants, were very interested in establishing policies, the process of arriving at recommendations was too lengthy. Commitment to the process till the very end was difficult. It appeared that participants needed to be educated about the importance of the components of the process.