Q&A with Albert Iannacone on Health Impact Assessments

At the Terwilliger Center for Housing’s Housing Opportunity 2014 conference in Denver, one session focused on policy initiatives that help create healthy communities. As part of this session, environmental epidemiologist Albert Iannacone of the Knox County Health Department made a key presentation on his work on the Knox County Health Impact Assessment (HIA). The actual HIA was completed several years ago and now some of its recommendations are at the very early stages of implementation.

An HIA is an investigative tool used to determine the health impact of any project, even if it isn’t inherently connected to healthcare. The Knox County HIA was conducted to assess the impact of Plan East Tennessee (PlanET), a collaborative effort by five counties in East Tennessee to look at interconnected growth trends and how they will affect the community in the coming decades. The goal of the HIA was to describe baseline conditions and the potential health impacts of the region’s current growth pattern, as well as the benefits and drawbacks of alternative growth models. Safe, affordable housing and development planning were among the factors that were reviewed in the HIA.

Some of the housing-related recommendations from the final report include:

• Mixed-use planning could increase the region’s population density in a way that would support a robust public transit system, reduce auto dependency, and contribute to improved health outcomes.
• Providing a range of affordable housing options closer to jobs and improving transportation options reduces cost-burdened household conditions, which contributes to poor health outcomes.
• The relatively high transportation costs and distance between homes and jobs or services can be addressed by a multi-pronged strategy that improves the proximity of homes to jobs, betters access to public transit and localizes essential services in town centers.
• In a region where 80 percent of households have difficulty with housing costs, affordable mixed-use planning and improved transportation can provide residents with opportunities to purchase or rent homes closer to jobs and services.

How Housing Matters spoke with Al Iannacone about the value of the PlanET health impact assessment.

How Housing Matters: How did the HIA come about?

Al Iannacone: The HIA was part of a broader effort. The Metropolitan Planning Commission (MPC) had received a grant to project 30 years into the future to see what our counties were going to look like if we continued on the path of typical sprawling urban growth and also explore alternative paths of development. If you don’t plan, the default ends up being sprawling growth and has a number of effects on people’s health, such as sedentary lifestyles and more air pollution.

The MPC gave some of the grant funds to the health department to look specifically at the health implications of different models of development. We looked at three models: The sprawl model; a model where you would create incentives and zoning to focus the development downtown in the urban core; and an intermediate model where you might encourage development along transportation routes to make it more feasible to expand the bus lines. We worked with the local transportation office to figure out what the implications of those models would be for traffic levels, which we used to project the air pollution levels. From there, we could say which of the various models might be better for peoples’ health from an air emissions standpoint, as well as other health factors and endpoints.

The problem in our region is that we’re situated in a bowl topographically. On one side we have the Great Smoky Mountains and the National Park and then on the other side there’s a large plateau that runs all the way across the state to Nashville. The river valley that we’re in—especially in the summer—can trap air pollution and we’re always constantly on the borderline of achieving the air quality goals set by the Environmental Protection Agency. There’s a general recognition that this is a problem here and we wanted to see how we could grow in a way that minimizes the problem as much as possible.

HHM: What are some of the other health factors that the HIA investigated?

Iannacone: The HIA looked at a few other health implications, such as mixed-use planning—which gives you a much greater opportunity for people to get exercise and lead a more active lifestyle. When a store, library or movie theatre is close enough that people can walk to it and a car is not necessarily so pivotal to your life, physical activity increases and health improves. Right now, unless you’re someone that’s living right in downtown Knoxville, your neighborhood wasn’t developed that way. So, we’re thinking about how can we deal with what we have now and try to retrofit it into more of a mixed-use model that would lead to healthier lifestyles

HHM: What were some of the key takeaways from the HIA?

Iannacone: From the health department’s perspective, it really increased our awareness of all these issues around the built environment and framed zoning as a public health issue. People involved in every aspect of community building and development are coming to understand that zoning the built environment is integral to public health. It’s a matter of designing our habitat in a way that is helpful for us to live.

So, I think that awareness has grown within the health department. We’re collaborating more with people who are working on other health issues, like reducing food deserts. Those lines of communication didn’t exist five years ago, but now we’re all networking as we’re coming out of our silos. It’s helping us identify opportunities for future growth of the community that is better informed to grow in a healthy way.