Health Impact Assessments

Neal Kaufman, M.D.

'm a pediatrician. I work at Cedar Sinai. I'm also part of the UCLA School of Public Health. We've been looking at how to improve neigbohoods and communities for young children. I'm also on the First 5 LA tax commission. We take tobacco tax and try to improve outcomes for young children. For example, in the next 6 years in L.A. County alone, we'll spend $1.2 billion. Our major emphasis is to assure that every four-year-old has a pre-school experience, that every child has health insurance and that we identify high risk families to try to prevent child abuse.

I keep hearing about how we need a healthy ecosystem, we need a healthy environment. Well, we need healthy people and people are only as healthy as the families in which they live and the families are only as healthy as the communities in which they find themselves, the communities are only as healthy as the society in which they find themselves. We called that the ecological approach to child health.

The question becomes how do you do that? We have to make a major transformation. During the first 50 years of this century, we focused on infectious diseases, did a lot of good there -- sanitation, immunizations. For the next 50 years we focused on chronic disease; NIH, Medicare, etc.

Over the next 50 years we should think of health as a resource for living. Health is something that we all should be able to have so that we can do the things we want to do. The question is how do you make that happen?

To me you have to start with a couple of simple rules. The first is that relationships are key -- relationships among individuals, communities, organizations. The next is information flow -- timely and accurate information, knowledge and wisdom need to flow between each of us. It's essential that service and support are integrated, coordinated, comprehensive, and that the built space supports all of those things.

ow does it do that? Well, that happens when we have the proper policies and practices to make it happen. One approach is being done by a group called New Schools, Better Neighborhoods. In California we're going to have a once-in-two-generation opportunity to spend $40 billion on school construction, $13 to $15 billion in L.A. County alone in the next 6 to 7 years. They're going to be in the inner suburban and inner city areas and we want schools to be centers of neighborhood vitality. We want the schools to be co located with parks and libraries and low-income housing and health facilities and other things that need to be done.

Here's a quick example. There was a property that was going to be low income housing but the school district wanted it and they were just going to take it, through eminent domain. New Schools, Better Neighborhoods came in and now on that same site they're going to have as much low-income housing plus a school, a child development center and open space -- all in the middle of downtown Los Angeles because joint master planning was done.

ou all do environmental impact assessments. I think you should also be doing health impact assessments. That's actually a specific term, but regardless of the term, it means that when you're about to build something, or when you're planning a part of a city, you should consider what's the impact on the health of the individuals who are going to live, work and play in that new environment.

Health impact assessment is designed to look at what's the impact on the health of the individuals, the population and the public relative to a policy or construction activity. It helps to identify a way to predict before hand and measure outcomes overtime.. It also helps to mitigate the mistakes you made and learn for the next one.

There are best practices that tell you if you build things in certain ways people will be healthier and that there will be greater social connections. Social support is the wonder drug of the 21st century and if we can figure out how to get people to be better connected, our children won't be dying from lack of connections and instead they'll be much healthier and more productive members of society.