A Rutgers University-led initiative, “Advancing Integration of Health and Community Engagement in Pre-Disaster Recovery and Resilience Planning: Opportunities for Health Impact Assessment,” explored how the practice of health impact assessment (HIA) can be applied in post-disaster recovery and pre-disaster resilience planning in two case study communities.
Health impact assessment is a fast-growing practice in the U.S. that provides practitioners and policymakers with a tool to measure the health outcomes of decision.
“The initiative included two place-based HIAs along with an examination of the value of HIA more generally in the context of disaster recovery and resilience planning,” said Jeanne Herb, project coordinator and associate director of the Environmental Analysis and Communications Group at the Edward J. Bloustein School of Planning and Public Policy. “Insights from this initiative point to the conclusion that HIA is a promising innovation with potentially large benefits, namely, improving health for people in disaster-impacted communities and improving the process of pre-disaster resilience planning to ensure engaged communities and sustainable solutions.” The case studies were conducted in Mystic Island and Hoboken, N.J.
The Mystic Island HIA sought to assess the physical and mental health outcomes associated with the implementation of voluntary buyout scenarios. An unincorporated, mostly residential community within Little Egg Harbor Township, Ocean County, Mystic Island’s geography and topography make it highly vulnerable to repetitive flooding; Hurricane Sandy flooded much of the area with almost seven feet of water, damaging more than 4,000 homes containing approximately 10,000 residents.
The HIA affirmed that living in this flood prone area causes anxiety and stress related to lifestyle disruption, perceived cost of damage repair, exposure to hazards and toxins, injury and illness, and infrastructure and power outages; strong mental health impacts related to financial difficulties, especially among the elderly and those with lower incomes; and that a range of options will be needed to build resilience and sustainability. Recommendations of a voluntary buyout program include:
- Clustering buyouts in a geographic area that result in greatest potential to reduce storm-related impacts. (i.e., most vulnerable to storm impacts and fewest elevated homes);
- Improved social services, particularly access to mental health services, as a complement to a buyout program and targeted to lower income, less educated populations;
- Buyout programs should be funded and readily activated and offered to residents quickly after storm-related disasters occur; and
- Considering uses for the new open space that will provide physical health benefits and gathering places for community-building and public events.
Researchers noted that areas of future study may include the effects of post-disaster recovery on specific vulnerable subpopulations; the prioritization of buyout areas based on health and risk reduction, considering socially vulnerable populations; the impact of buyouts on neighborhood quality of life factors; and the effects of resiliency strategies on local/regional economy.
Hoboken, a historic, densely populated city in urbanized Hudson County, was once an island and today parts of the city remain near or below sea level. During severe weather and high tides, the combination of wastewater and storm water entering the sewer system can exceed the capacity of the treatment plant, resulting in back-ups that flood city streets and private property and discharge untreated wastewater directly into the Hudson River.
The HIA was designed to examine the potential positive and negative health effects of a decision by the city to adopt amendments to its Stormwater Management Plan and ordinances that would implement recommendations of the Hoboken Green Infrastructure Strategic Plan. The plan recommends the most effective types of green infrastructure projects for the city, including constructing wetlands in low-lying areas, harvesting rainwater, creating bioswales, and building green roofs and stormwater planters.
Researchers found that resident concerns about implementation of a green infrastructure plan include the overall cost of such projects, including possible higher taxes; on-going maintenance of projects, such as eliminating standing water and the possible increase in mosquitos and vermin; increased allergies; loitering and crime; and the overall reduction in parking. In light of these concerns, the HIA recommended that the city:
- Carefully manage the design, monitoring, and a robust on-going maintenance program to ensure the longevity of benefits as well as public safety and enjoyment;
- Ensure that green infrastructure benefits accrue evenly throughout the city;
- Leverage investment in green infrastructure construction, operations and maintenance to create jobs and career pathways for city residents, especially low-income populations;
- Magnify benefits by expanding green infrastructure throughout the North Hudson Sewerage Authority service area; and
- Expand public outreach and education to ensure more residents are aware of the City’s efforts to expand green infrastructure and understand potential benefits and risks.
In addition to the two place-based HIAs, James K. Mitchell, professor emeritus in the Rutgers Department of Geography, led an effort to track the two HIA case studies, consult with health, disaster recovery and resilience thought leaders, and review national experiences with HIA. These efforts were conducted to provide a comprehensive set of recommendations on strategies to effectively use HIA to integrate health into disaster recovery and resilience planning as well as to improve those planning processes through enhancing community engagement, which include:
- Raising awareness by publicizing HIAs among target user groups in communities of hazard and health professionals that have responsibilities, skills and/or interests in disaster recovery;
- Inserting HIAs into the disaster recovery decision-making system at key points of application;
- Conducting a systematic analysis of the health impacts of the full range of disaster recovery alternatives, with a view to providing a databank of information about their comparative health outcomes as well as other consequences;
- Providing decision-makers and HIA users with better guidance for choosing among different kinds of HIAs in post-disaster contexts;
- Providing appropriate technical support for local advocacy groups that seek to use HIAs for the joint reduction of health inequities and disaster vulnerabilities; and
- Encouraging research organizations to develop methods for integrating health impact assessments with economic and environmental impact assessments.
Led by the Bloustein School with support from the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, stakeholder engagement support was provided by New Jersey Future in cooperation with the municipalities of Mystic Island and Hoboken. The Georgia Health Policy Center provided technical assistance on HIA methodology. The views expressed are those of the author[s] and do not necessarily reflect the views of the Health Impact Project, the Robert Wood Johnson Foundation or The Pew Charitable Trusts.
The final report and the findings of each case study may be found at http://phci.rutgers.edu/post-disaster-recovery-resilience-planning/. Materials from a public briefing on project outcomes are also available. For more information about the project or HIA, please contact Jeanne Herb jherb@ejb.rutgers.edu.
