A Health Impact Assessment (HIA) Of Park, Trail, And Green .
March 2013A Health Impact Assessment (HIA) ofPark, Trail, and Green Space Planningin the West Side of Greenville, South Carolina
HIA ParticipantsAdvisory CommitteeBetsy Beymer-Farris, PhDAssistant Professor of Sustainability ScienceFurman UniversityRene BlantonSocial Services CoordinatorSHARE Head StartStephanie Brundage, MD, MPHChief Medical OfficerNew Horizon Family Health Services, Inc.Kinneil Coltman, DHADirector, Diversity and Language ServicesGreenville Hospital System University Medical CenterBrad CuttinoRecreation Operations AdministratorParks and Recreation DepartmentCity of GreenvilleTracy DozierRepresentative of West Greenville Arts AssociationMarketing StrategistEconomic DevelopmentCity of GreenvilleEleanor DunlapLead FacilitatorLiveWell GreenvilleLillian Brock FlemmingCity Council District 2, Vice Mayor Pro TemGreenville City CouncilProfessional Employment RecruiterGreenville County School DistrictReverend J.M. FlemmingExecutive DirectorSouthernside Community CenterFounder & ManagerBrockwood Senior HousingBruce ForbesSpecial Projects ManagerSHAREPresidentGreenville Chapter of Upstate Homeless Coalition1Cynthia FryerManagerChildren’s Advocacy/Safe Kids UpstateDarrin Goss, Sr.Vice President, Community ImpactUnited Way of Greenville CountyLisa Scott HalloSustainable Communities Program DirectorUpstate ForeverJackie JonesData Integration and Receivables ManagerThe Phoenix CenterCommunity Representative – SouthernsideJil M. Littlejohn, MBACity Council District 3Greenville City CouncilExecutive DirectorYWCAMartin LivingstonExecutive DirectorGreenville County Redevelopment AuthorityHeather LoveCommunity Affairs and Public PolicyUnited Way of Greenville CountyJohnette McCarthyRepresentative of West End AssociationCustomer Relations CoordinatorCity of GreenvilleAdela MendozaExecutive DirectorHispanic AllianceTom MoranDirectorGreenville Hospital System ClinicsMary NealFounder/President of N.A.B.S.Community Representative –West EndOfficer Courtney PalmerCrime Prevention SpecialistGreenville Police DepartmentCity of Greenville
Scott Park, AICPPrincipal PlannerCounty of GreenvilleProject TeamIMPH StaffMatt Petrofes, MBAHealth Director – Region 2South Carolina Department ofHealth and Environmental ControlJeanette Ball, MSResearch AssociateSouth Carolina Institute of Medicine and Public HealthJennifer PiverExecutive DirectorMental Health America of Greenville CountyMaya Pack, MS, MPAAssociate Director, Research and Strategic InitiativesSouth Carolina Institute of Medicine and Public HealthKristy QuallsAdministratiave Assistant, Former TeacherA.J. Whittenberg Elementary SchoolConnections for Sustainability StaffJ. Kevin Robinson, AICPAssociate PlannerGreenville County Planning DepartmentKaty Smith, MSWExecutive DirectorPiedmont Health FoundationRussell StallExecutive DirectorGreenville ForwardJoelle TeacheyExecutive DirectorTreesGreenvilleTiffany WedmoreAssociate Transportation PlannerGreenville-Pickens Area Transportation Study (GPATS)Greenville County Community Planning andDevelopmentDale WestermeierDeputy DirectorParks and Recreation DepartmentDCity of GreenvilleKeith BrockingtonGreenville-Pickens Area Transportation Study (GPATS)Greenville County Community Planning and DevelopmentTee CokerAlignment ConsultantArnett Muldrow & AssociatesSarah CookGrant CoordinatorPublic Information and EventsCity of GreenvilleChrista JordanLivability Grant CoordinatorEconomic DevelopmentCity of GreenvilleWayne Leftwich, AICPCommunity PlannerCity of GreenvilleChris PettitAlignment Consultant-InternArnett Muldrow & AssociatesAmber WilliamsExecutive DirectorSafe States AllianceThis HIA is funded by the National Network of Public Health Institutes through support from the HealthImpact Project (a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts).We would like to thank the Oregon Public Health Institute for their invaluable technical assistancethroughout the project period. We also very much appreciate the partnership of the City of Greenvilleand the participation of the HIA Advisory Committee members.2
Table of ContentsIntroduction5How This Report is Organized7Health Impact Assessment7Greenville, South Carolina8Key HIA Terms and Concepts9Health Equity10HIA Partners10Timeline10Screening11HIA Scope and Research Questions12Assessment and Causal Pathways for Health Determinants15Physical Activity (Priority A)15Social Cohesion/Capital (Priority A)21Community and Family Economic Stability (Priority A)25Food Access (Priority A)35Individual and Community Safety (Priority B)40Air and Water Quality (Priority B)41Recommendations42Appendices55References63List of Tables13Table 1: Self-Report Number of Days Exercising17Table 2: Self-Report Barriers to Exercising18Table 3: Greenville County: Inpatient and Emergency Department Visits by Residents18Table 4: Self-Report of Health Status19Table 5: Self-Report of Body Mass Index (BMI)19
Table 6: 2006-2010 Hospital Inpatient and Emergency DepartmentVisit Rate From Non-Fatal Injury Due to Sports/Recreation By Race and Gender20Table 7: West Greenville Community Center Programs: Fall 2011- Summer 201223Table 8: Self-Report of Feeling Depressed or “Blue”24Table 9: Percentage of Families and Individuals Whose Income in the Past 12Months is Below the Federal Poverty Level27Table 10: Percentage of Households with Access to a Vehicle27Table 11: Occupation (Civilians employed 16 years and over)28Table 12: Home Ownership30Table 13: Household Income Level33Table 14: Overnight Homeless Shelter Data, July 201234Table 15: Day Homeless Shelter Data, July 201234Table 16: Number of Food Sources in 201137Table 17: Number of Times a Week Children Eat Fast Food39List of MapsMap 1: Potential City Park6Map 2: Business Licenses in Greenville’s West Side: 2010 and 201129Map 3: Food Stores and Restaurants in the West Side38Map 4: Food Stores and Restaurants in the City of Greenville38AppendicesAppendix A: Map: Greenville’s West Side55Appendix B: Research Questions, Indicators, and Data Sources56Appendix C: Recreational Injuries57Appendix D: Housing Data and Rental Values57Appendix E: Demographic Data59Appendix F: Nutrition Environment Measurement Survey (NEMS) Maps61, 624
IntroductionThe Centers for Disease Control and Prevention (CDC) reports that in 2010, 36 states had an obesity rate of atleast 25 percent and 12 states had a 30 percent or higher obesity rate. South Carolina had a 31.5 percent obesityrate - the fourth worst rate in the country (CDC, 2012a). The 2010 Behavioral Risk Factor Surveillance System(BRFSS) data shows that in South Carolina 64 percent of white adults and 76 percent of African American adultsare overweight or obese. Twenty-seven percent of adults in South Carolina do not partake in any leisure timephysical activity (CDC, 2010). For Greenville County, the most current BRFSS data indicates that 50 percent ofadults do not participate in recommended amounts of physical activity, which is slightly less than the state levelof 54.6 percent of adults (BRFSS, 2009).In a study supported by the Piedmont Health Foundation and performed by Furman University and ActivateUpstate in 2008, the Greenville County School District collected Body Mass Index (BMI) data from students bycalculating their weight, height, and age to determine rates of overweight and obesity. The research concludedthat 26 percent of white, 44 percent of Hispanic, and 49 percent of African American children in GreenvilleCounty Schools were overweight or obese (Reed, 2012). A lack of regular physical activity for children inGreenville County contributes to high obesity rates. In order to help reduce obesity rates, alterations to the builtenvironment can be made to make it more conducive to physical activity. Providing areas for recreation suchas trails, parks, and open space not only aids in promoting physical activity but also helps the local economy(Reed, 2012).In Greenville, South Carolina, the City of Greenville is currently conducting a three-year comprehensiveplanning process called “Connections for Sustainability: Linking Greenville’s Neighborhoods to Jobs and OpenSpace” focusing on Greenville’s west side, which includes three economically challenged and physically fragileneighborhoods: West Greenville, West End, and Southernside. To assess the various health effects of potentialparks, trails, and green space, the concept of Health in All Policies was implemented through the use of a HealthImpact Assessment (HIA). For the HIA, the definition of the west side was expanded to include the surroundingarea (See Appendix A for a map). The geographic area of analysis was expanded because the effects of thepotential park could reach into surrounding neighborhoods and in order to increase the sample size of thecommunity-level data.In partnership with the City of Greenville, the South Carolina Institute of Medicine and Public Health (IMPH)integrated an HIA into the part of the comprehensive planning process that focused on parks, trails, and greenspace. The City’s planning process also includes considerations related to economic development, housing,and transportation. The HIA took place between May and December of 2012. During this time, the City begana planning process for a community park as a possible re-use of property currently used to house the PublicWorks department, which is sited in a flood zone. The map to the right demonstrates a potential outline ofthe park’s boundaries.5
Map 1: Potential City Park6
How This Report is OrganizedThis report begins with a brief overview of HIA practice, followed by a description of the setting andparticipants for this particular HIA project. Following reporting guidelines for HIAs, this report thendocuments the different phases of this project, starting with screening, and then moving in orderthrough scoping, assessment, and recommendations.1Health Impact AssessmentIncreasing evidence indicates that our health is not determined solely by our behavior, choices, and genetics.Health is determined by many different components including socio-economic status and where a person isborn, lives, and works. In order to ensure improvements in public health, health needs to be considered in nonhealth related projects, programs, plans, and policies. Non-health related organizations that influence healthinclude, but are not limited to, those working in transportation, housing, agriculture, and education (NationalResearch Council of the National Academies [NRCNA], 2011). The concept of bringing health to the forefront andstrengthening the consideration of health for policies in other sectors is best defined as a Health in All Policies(HiAP) approach. HiAP is a strategy that “focuses on particular social determinants of health through integratedpolicy response across relevant policy areas with the ultimate goal of supporting health equity” (EuropeanPortal for Action On Health Inequalities [EPAOHI], n.d., Definition, para,1). It strives to increase positive healthoutcomes through assessments that can be associated with certain policies, and thereby decrease negativehealth impacts (Rajott, Ross, Ekechi, & Cadet, 2011).HiAP is often implemented through a Health Impact Assessment (HIA). An HIA is a systematic assessment thatcombines scientific data, professional expertise, and stakeholder involvement to determine the effects that apotential policy, plan, program, or project might have on the health of a particular population (NRCNA, 2011).HIAs provide information to decision-makers that can help minimize the anticipated adverse health effectsand maximize positive health outcomes. It can be utilized across a number of sectors and can be applied at thefederal, state, tribal, and local levels (NRCNA, 2011). HIAs consist of six steps: screening, scoping, assessment,development of recommendations, reporting, and monitoring/evaluation.During screening, the proposed policy or program is reviewed to determine if it is a strong candidate for anHIA. Several aspects are considered; including feasibility, ability to inform the decision, and availability of botha sufficient timeframe to conduct an HIA and evidence related to the potential research questions. The scopingphase sets the boundaries and goals of the HIA, brings together interested stakeholders and partners, outlinesthe timeline, and determines the research questions. This phase also identifies health determinants that shouldbe analyzed and vulnerable populations that could be affected, such as low-income families and individuals,the disabled, children, the elderly, and racial and ethnic minorities (NRCNA, 2011). During the assessment phase,a literature review provides empirical evidence related to the research questions, and baseline demographic,17The final phase of the HIA—monitoring and evaluation—will be conducted following the publication of this report as resources allow.
health, social, economic, and environmental data is collected. This information is utilized to analyze the positiveand adverse health effects of the proposed project or policy and specifically to examine the direction, intensity,magnitude, duration, and likelihood of impact (NRCNA, 2011).Recommendations are developed to maximize the positive health impacts of the proposed policy or projectand to mitigate potential negative health impacts that have been identified. These recommendations, typicallycreated and prioritized by an Advisory or Steering Committee, are based on the research collected as wellas community input and participation. Ideally, recommendations are cost-effective, practical, and politicallyacceptable. The reporting phase documents the process and its findings and establishes a dissemination planfor communicating the HIA findings and recommendations. A final HIA report and/or executive summary arethen provided to stakeholders, decision-makers, and members of the affected community. The final phaseof monitoring/evaluation can be conducted through three techniques: process, impact, and/or outcomeevaluation. Process evaluation determines if the HIA was implemented according to the original plan andfollowed best practices and standards that were set at the beginning. Impact evaluation tracks the impact ofthe HIA on the decision-making process. Outcome evaluation focuses on the changes in health status due tothe implementation of the project; this phase requires a large amount of time and resources and is thereforenot always included in HIAs (NRCNA, 2011).In the United States, the use of HIAs has increased significantly over the past ten years, and HIAs have beenimplemented on a variety of government levels to evaluate health impacts. Most HIAs to date focus on localcommunities and are associated with housing, transportation, or land use (NRCNA, 2011). A useful resourceon HIA is the Health Impact Project; please visit their website at www.healthimpactproject.org for moreinformation. In South Carolina, there has been one HIA completed that addressed the built environment and aproposed road re-design. “The HIA of Proposed ‘Road Diet’ and Re-Striping Project on Daniel Morgan Avenuein Spartanburg, South Carolina” was completed in April 2012. The report can be found in the publicationssection of www.imph.org.Greenville, South CarolinaThe HIA project area is located in Greenville, South Carolina, which is situated in the northwest corner of thestate (referred to as the Upstate). Greenville County has the largest population of any county in the state (451,225people), and the City of Greenville is one of the largest cities in the state (City of Greenville, 2012; U.S. Census,2010). Relocate America 2010 ranked Greenville in the ten top places to live in the U.S. for 2011, and Greenvilleis considered one of the best small cities for bike riding, according to Bicycling Magazine (2012). Along withbeing a bike-friendly area, Greenville is known for its parks (Falls Park ranked in the top 15 in the country by USAirways 2011 in-flight magazine) and for its outstanding art weekends, which ranked 46 out of a total of 600fine art shows nationally (Greenville Chamber of Commerce, 2012). The Greenville area also has a performingarts center and museums. Recently, the Great American Main Street Award was given to downtown Greenville(City of Greenville, 2012).When it comes to education, Greenville has the largest public school system within the state, with nine out ofthe 15 public high schools ranking in the top six percent nationally (Greenville Chamber of Commerce, 2012). Inthe county, there are 605 National Board Certified (NBC) teachers, which ranks the county 11th in the country fornumber of NBC teachers. For continuing education, there are more than ten colleges and universities located inor close by Greenville (City of Greenville, 2012; Greenville Chamber of Commerce, 2012).8
Over 250 international businesses from 26 nations have located headquarters or other offices in Greenville,such as BMW and Michelin (City of Greenville, 2012). Greenville was ranked in the top 30 best cities for jobs (TheDaily Beast, 2011) and the 46th best place in the U.S. for business and careers by Forbes in 2009. According tothe U.S. News 2009-2010 guide to America’s Best Hospitals, Greenville Memorial Hospital is ranked in the top 50hospitals in the country; its highest ranking (#24) is for diabetes and endocrine disorders (Greenville Chamberof Commerce, 2012).With all of these positive aspects of the community, it is important to note that there are vulnerableneighborhoods that need attention. The project area, Greenville’s west side, is an economically depressedcommunity with a population of about 16,583 people (U.S. Census, 2010). The community is comprised mostlyof minorities: African Americans comprise 37.6 percent of the population, and Hispanics comprise another 20.6percent (U.S. Census, 2010). Only 30.8 percent of residents age 25 years and over have a high school degree,with only 11.3 percent having any education after high school (American Community Survey [ACS], 2005-2009).Another important aspect of the community is its low home ownership rate (ACS, 2005-2009).In Greenville’s west side, Legacy Charter School has made changes to better the health of its students byrequiring physical activity every school day. This is the only public school in South Carolina to have this typeof policy in place. Other schools in Greenville County only require 30 minutes a week of physical activityfor kindergarteners, physical education once a week for first through fifth grade, one semester of physicaleducation a year for middle school students, and one physical education class for high school students over afour-year period. Benefits to increasing students’ physical activity level to five days a week include improvedcognitive ability, lowered risk of infection, and decreased risk of cardiovascular disease, depression, anxiety, andtype 2 diabetes (Lee, 2012).Key HIA Terms and ConceptsHealth:A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.2Health Impact:Any change in the health of a population or any change in the physical, natural, or social environment that hasa bearing on public health.3Health Impact Assessment:HIA is a systematic process that uses an array of data sources and analytic methods in addition to input fromstakeholders to determine the potential effects of a potential policy, plan, program, or project on the healthof a population and the distribution of the effects within the population. HIA provides recommendations onmonitoring and managing those effects.4Stakeholders:Individuals or organizations who are affected by the policy, plan, or project under consideration; havean interest in the health impacts of the policy, project, or plan under consideration; and/or have director indirect influence on the decision-making and implementation process of the policy, project, or planunder consideration.
Mar 01, 2013 · Greenville county school district reverend J.m. Flemming executive director southernside community center Founder & manager Brockwood senior Housing . Food stores and restaurants in the city of Greenville 38 appendices Appendix A: map: Greenville’s West side 55 Appendix
Practitioners of Health Impact Assessment (SOPHIA); 2) members of organizations involved in conducting or supporting the HIA field in the United States and abroad (e.g., Health Impact Partners; Human Impact Partners; Habitat Consulting; Georgia Health Policy Center; Centre for Health Equity Training, Research,
What is a Health Impact Assessment? A Health Impact Assessment (HIA) is a process that helps support the required review and analysis of potential health effects of a plan, project, or policy before it is built or implemented. An HIA can provide recommendations for increasing positive health outcomes and minimizing adverse health outcomes. [1]
Health and Wellness (LMPHW) conducted a Health Impact Assessment (HIA) to review the influence that changes to KRS Chapter 431, Kentucky's existing expungement policy, would have on health. Health Impact Assessment, or HIA, is a process to inform decision-makers about the potential health impacts of proposed decisions, including those related to
ensuring the inclusion of health and well-being as a key component of policy development in all sectors (the Health in All Policies (HiAP) approach) has been emphasized as the best way to approach these challenges. As a tool to this end, health impact assessment (HIA) can be used to determine the potential . Health impact assessment (HIA .
EPHIA European Policy Health Impact Assessment EU European Union ExIA Extended impact assessment HIA Health impact assessment HiAP Health in All Policies IA Impact assessment IAIA International Association for Impact Assessment IDB Inter-American Development Bank IFC International Finance Corporation
sector policy decisions. Health impact assessment (HIA) is a structured approach that is a very useful part of a 'health in all policies' approach. The Scottish Health and Inequalities Impact Assessment Network - SHIIAN - has promoted and supported the development of HIA in Scotland since 2001.
A Health Impact Assessment (HIA) is a process which ensures . "whether and how to introduce health impact assessment for policy decisions - for example on planning and transport". In 2014, a HIA Steering Group was set up to champion and disseminate the use of HIAs. The Group is chaired by the Public
Health Impact Assessment HIA is a community engaged process to assess positive and negative health impacts that could result from a proposed plan, policy, or project. Once the potential health impacts are assessed, recommendations are made to maximize health benefits and mitigate health threats. HIA typically involves six steps:
