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Board member Sandra Kiely Kolb discusses how a 2011 community revitalization grant from Saint Luke’s Foundation can impact public policy regarding urban agriculture and ultimately, improve lives for Greater Cleveland’s inner-city populations.




“Traditionally, health has been viewed through the lens of health care. But that underscores a troubling irony here in Northeast Ohio,” says Martha Halko, MS, RD, LD, Deputy Director, Prevention and Wellness for the Cuyahoga County Board of Health (CCBH). “Out of 88 Ohio counties, Cuyahoga County ranks seventh for clinical care; yet it ranks 65th in overall health outcomes. That tells us that we must look beyond access and build policies that provide urban residents with equal opportunities to access essential resources for a high quality of life.”

In 2006, Halko and CCBH joined with like-minded colleagues to establish the Cuyahoga County PLACE MATTERS team, a local group affiliated with the national efforts of the Joint Center for Political and Economic Studies - Health Policy Institute, which focuses on engaging community stakeholders in making informed, inclusive decisions that foster sustainable, vibrant communities. Today, one of PLACE MATTERS’ key priorities is developing policies that integrate health and equity considerations into land use and community design in Cuyahoga County. Now, through a grant from Saint Luke’s Foundation, the PLACE MATTERS team has the training and know-how to leverage a valuable tool for this purpose: the Health Impact Assessment (HIA).

An HIA is a holistic process that yields evidence-based recommendations designed to maximize a given policy, program or project’s positive health impacts, and minimize its negative health impacts.

For example, the proposed construction of a new manufacturing facility would historically include an environmental impact study for the affected areas. Yet studies like these gave little consideration to the potential health effects of the proposed facility on the community, or communities, that would be directly impacted by its presence.

Now, an HIA can help quantify and qualify a facility’s potential effect on water and air quality for a specific community. It can determine how a facility will impact residents’ access to green space, areas for physical activity, and healthy foods. The HIA process itself can be a complex endeavor; but the benefits it offers to all members of a community are unmistakable.

HIAs originated as public policy tools in the United Kingdom and have since been employed successfully by a number of U.S. locations, including but not limited to Portland, Oregon, Baltimore, Maryland and Alameda County, California. It is estimated by leaders in the field that nearly 120 HIAs have been completed or are in progress in 24 states.


The Grant: HIA Training

The Foundation’s 2011 grant to CCBH funded HIA webinar training for the PLACEMATTERS team, followed by an intensive two-day team training led by Human Impact Partners that included hands-on development of case examples from a wide range of disciplines throughout the county.

Kim Gilhuly, Project Director for Human Impact Partners, conducted the training and was impressed by the team’s broad vision for HIAs. “The PLACE MATTERS team brought a real commitment to institutionalizing the impact of health in all policies. Their success in this training is evidenced by the two HIAs that are now underway.”


Impact: Expertise AND Real-World Application

Through training and subsequent development of real-world HIA case examples, a multi-sector core team emerged (Northeast Ohio Health Impact Assessment Partnership) that is vested in capacity building and practice. Utilizing that training and case example data as a baseline, the core team embarked on two pilot HIA projects during 2012 that can positively impact two key initiatives in Cleveland: An Urban Agriculture Overlay Zoning District (“Urban Ag Overlay”) currently pending in Cleveland City Council, and the City of Cleveland’s Complete and Green Streets ordinance.

“Once completed, these pilot HIAs will be used to shape land use policy around these issues. But the benefits of this Saint Luke’s Foundation grant run deeper,” says Halko. “HIA is a tool that moves us toward a broader way of considering health and equity in all our policy and decision making. Certainly, HIA is important for capacity building; but the goal is not to do HIA after HIA. Rather, we first want to establish criteria for when and why we accept an HIA. Then, we can establish criteria for measures that fit directly within a planning and development system."

HIAs provide another crucial benefit: the opportunity for citizens to participate in community-level decision making. “When a policy, plan or project is being considered, we shouldn’t assume that we know what the critical issues are in relation to it. HIAs intentionally engage the community in the selection and prioritization of the key issues to be considered,” says Halko. “By doing so, you have walked with the community through this process, community stakeholders have engaged with decision makers, and it creates a sense of empowerment.”

Gilhuly agrees. “The training creates knowledge and competency around HIA development. But in a larger sense, the process helps to build a discussion, citywide and countywide, around strategies for improving health,” she says. “So for the PLACE MATTERS team, moving forward with the HIAs has improved their ability to conduct HIAs – and it has enhanced the broader conversation as well.”


Reflecting on Shared Culture and Values

Facilitation of the Health Impact Assessment grant will benefit Greater Cleveland’s urban communities on many levels in the years ahead. Halko believes that support and guidance from Saint Luke’s Foundation throughout the course of this initiative is critical to ensuring success.

“What stands out to me about Saint Luke’s Foundation is its total commitment to serving vulnerable populations and addressing inequities in our society," says Halko. "When a foundation infuses its values throughout its culture and its organizational practice, it influences grantmaking profoundly. This grant reflects the Foundation’s culture and values in every way.”


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