Utilizing CDC Tracking Data in Health Impact Assessments
Toolkit: Using CDC Tracking Data to Inform Health Impact Assessment (HIA)
This toolkit is intended to assist public health practitioners and students in understanding and using data from the Environmental Public Health Tracking Network funded by the Centers for Disease Control and Protection (CDC) to inform HIA.
About the Environmental Public Health Tracking Network
Data is available on the network from the 25 states and one city the Centers for Disease Control funds to build and maintain local tracking networks as part of the National Tracking Network. These local networks may include data that are not on CDC's website, so be sure to check your state’s page as well. Some of these unique data also may be helpful for conducting HIAs. You can access the portals for all 26 state and local networks here. The portals are intuitive and easy to navigate. If you’d like a quick tutorial on downloading the data, the CDC has one on their site: Video: How to Use Tracking Data.
Phase by Phase Guide to Using Tracking Data for HIA
Tracking data may be used to inform any of the six phases of conducting an HIA. This resource will describe how tracking data can be used in each phase to support HIA. An additional resource for using tracking data is the Minnesota HIA Data User Guide.
The Screening phase is the first phase of an HIA process. It determines whether an HIA is feasible, timely and would add value to the decision-making process. The following elements should be evaluated during the Screening phase:
- Part of the screening process is to assess the potential for the proposed decision to result in substantial health effects. To determine whether health outcomes will change, you will need baseline data about the conditions which may be impacted by the decision which can be obtained from the tracking network.
- In the screening phase, you assess the potential for unequally distributed impact. For instance, using the tracking data you can determine the rates at which persons in each age group have gone to the emergency department due to asthma. This will show if different age groups or races/ethnicities are disproportionately affected.
- Assessing the availability of sufficient resources to conduct the HIA is also part of the screening process. This includes determining if the data needed to predict health impacts exists, if it is available and if it is available at the proper scale. Many data are only available at the county level, but in some cases, zip code level data is available. The scale varies by indicator, so be sure to check your particular state and the scale available to ensure that you can access the data you need at the appropriate scale or that some other way of getting to that data is designed into your methodology like a resident survey.
Scoping determines what health impacts are going to be studied, which populations will be included in the study, and the methods that will be used to conduct an HIA.
- A central task of the scoping phase is to determine how the decision or project can impact health. Pathway diagrams, which illustrate the impacts of the decision to short-, medium- and long-term health, are useful in identifying health effects and benefits. Tracking data can be used to assess these effects by providing baseline information about health status in a community or by predicting effects and benefits from a policy, plan, or project. See examples of how Tracking data can be used in three different domains of health impact assessment. The previous link also contains pathway diagrams for climate and health; transportation and land use.
- Identifying questions and data: A task of the scoping phase entails identifying the research questions, data sources, and analytic methods that will be used. The Tracking Network can be a source of data for this phase. Using the tracking network data to look at community health status before beginning the HIA is useful. Looking at specific underlying causes of death and health indicators that fall outside the “normal” range can help identify health impacts which might not have come up in the literature review. Because the tracking data is organized geospatially, the researcher can look at the “heat maps” created to see which areas have disproportionate impacts and underlying conditions which might make them more vulnerable to certain stressors.
Using tracking data is most intuitive in this phase because it is very data-driven. Tracking Network data may be used to evaluate the health effects and benefits of a plan, project, program, or policy by:
- Assessing baseline health conditions
- Identifying and characterizing vulnerable populations, health disparities, and health inequities
- Evaluating the direction and magnitude of potential health effects due to changes in exposure or actions to protect health
For example, HIA practitioners and communities may want to know more about asthma in a particular area. The Tracking Network can provide data about asthma hospitalizations and emergency department visits at state and county levels to establish a baseline health estimate and provide information on the region of interest. State and local tracking programs also may have asthma data at enhanced levels of geography, such as ZIP code or census tract.
Assessment also includes projections of health impacts to evaluate the direction and magnitude of potential health effects due to changes in exposure or actions to protect health. Tracking data may be used in quantitative or qualitative assessments to make informed projections based on trends over time.
Recommendations is the fourth phase of the HIA process. Recommendations are a way to suggest action that can enhance positive health effects and mitigate potential negative health effects related to the proposed plan/project/policy. Tracking data can be used to demonstrate the establish baseline data which can be used in modeling impacts of recommendations. For instance, if an HIA identifies that a transportation project will impact the instance of respiratory disease, tracking data can be used to establish the baseline number of persons with asthma or cardio-pulmonary disease and that data can be used in models to predict the number of persons who would be affected if different alternatives are implemented like planting trees.
Monitoring and Evaluation
The final two phases determine future health impacts resulting from policy changes and assesses the HIA process, results and lessons learned. Because the network data is updated on an ongoing basis, the data is especially useful for monitoring and evaluating actions and decisions over time. For example, use Tracking data to evaluate progress pre- and post-implementation of the HIA decision or action.
Examples of HIAs Conducted using Tracking Data
Environmental Public Health Tracking is being used to conduct successful HIAs. The studies below are examples of using tracking data, mostly in the scoping phase of the studies. If you have an example you’d like to submit, please email Programs@NEHA.org.
Florida HIA on Extreme Flooding in Escambia County
This HIA was conducted by the Florida Department of Health’s Environmental Public Health Tracking Program in partnership with the University of West Florida and the Florida Department of Health in Escambia County. The team used the Health Impact Assessment (HIA) Framework to examine adverse health outcomes that may be related to an extreme flooding event in Pensacola, Florida (Escambia County) during April 30—May 3, 2014. In this 2014 flooding event, Pensacola received more than 15.5 inches of rain in a single day. Infrastructure impacts from this extreme event included destroyed bridges and roads, and the failure of many sewage lift stations. To determine if there were associated increases in injury, illness, and death, data on reportable diseases, hospitalizations, emergency department (ED) visits, and deaths that occurred during the impact period were compared to a control period in 2008. The results of this comparison were mixed, with some Escambia County ZIP Codes showing increased hospitalizations and ED visits, and some ZIP Codes showing a decrease. However, county-wide, there were increases in the proportion of both injury and respiratory related hospitalizations and ED visits during the impact period. The report also looked at infrastructure impacts and their influence on health including flooding of lift stations and surface water contamination.
Recommendations of the HIA include developing guidance for cleanup activities and a suggestion to raise the electric panels on lift stations above the flood elevation, in order to keep them operational during extreme rainfall events.
Assessing the Health Impacts and Benefits of Regional Climate Action Plan Strategies in Western Massachusetts
This HIA represents a collaborative effort by the Massachusetts Department of Public Health (DPH), the Pioneer Valley Planning Commission (PVPC), and the municipalities of Springfield and Williamsburg. The climate action strategies are based on the regional Pioneer Valley Climate Action and Clean Energy Plan (PV Climate Action Plan) completed by the PVPC in 2013. The aim of that plan was to promote greater understanding of the causes and consequences of climate change in PVPC’s service region (which includes Springfield and Williamsburg) and to identify a set of actions that local governments and other partners could consider to mitigate and adapt to climate effects. Data from the Environmental Public Health Tracking network used include baseline data assembled during the scoping phase such as demographics of the target area, prevalence of diseases including pediatric asthma, lung, and bronchial cancer. Tracking data was also used to inform the identification of vulnerable populations. Recommendations of this study include the establishment of an emergency plan to fuel regional cooling centers in case of power failure, community-scale mitigation strategies like green infrastructure and incentives to drive energy efficiency in government buildings.
Health Impact Assessment of the Massachusetts Department of Transportation Grounding McGrath Study
This HIA was conducted jointly by the Massachusetts Department of Transportation and the Massachusetts Department of Public Health Bureau of Environmental Health to examine the possible health impacts of the alternatives for McGrath Highway in Somerset. Key features in analyzing the impacts/benefits of alternative designs included conducting air dispersion modeling to assess changes in potential exposure to vehicle-related air pollution concentrations in the study area, conducting a screening analysis of vehicle-related noise, and evaluating the influence of multimodal connections, a proposed bike path, and green space to promote increased physical activity. This HIA used tracking data were used in the scoping phase to supply baseline data on demographics and health conditions related to transportation like asthma as well as to identify populations of concern.
Gateway Gold Line Bus Rapid Transit: A Closer Look at Health and Land Use
This HIA examined the impacts of Minnesota’s first rapid bus transit line with a dedicated traffic lane the Washington County, Minnesota. The team was made up of staff from the Washington County Department of Public Works, the Washington County Public Health and Environment, and Saint Paul—Ramsey County Public Health. The study looked at connectivity, housing, jobs, and safety along the corridor. They used tracking data to support their baseline assessment of demographics and health conditions. This is a comprehensive HIA and its recommendations are wide-ranging. Examples include: changing the zoning code to support land use densities that promote transit; strategies that support economic development in the corridor and to make housing more affordable.
Connecting Health to Transportation
In 2015, the Minnesota Department of Health partnered with the Minnesota Department of Transportation to ensure that health was being considered in the 2017 revision of the Statewide Multimodal Transportation Plan (SMTP). The SMTP is the highest-level transportation plan in the state. MDH and DOT performed a Health Impact Assessment to identify how proposed changes in the SMTP could impact health and offer recommendations that better support health. This HIA used tracking data in the scoping phase in the baseline health assessment to identify trends in demographics and to demonstrate inequities.
Other Data Resources for HIA:
- U.S. Environmental Protection Agency - Environmental Justice Screening and Mapping Tool (EJSCREEN)
EJSCREEN is based on nationally consistent data and an approach that combines environmental and demographic indicators in maps and reports.
- Census Reporter
As a Knight News Challenge-funded project, this site uses information from the U.S. Census Bureau to provide a user-friendly interface for navigating data.
- Design for Health (DFH) - Tools, Research, and Resources
DFH bridges the gap between the emerging research base on community design and healthy living and local government planning. One of its four primary avenues to provide evidence-based tools for conducting HIAs.
- The American Communities Survey
The American Community Survey (ACS) is an ongoing survey that provides vital information on a yearly basis about our nation and its people. Information from the survey generates data that help determine how more than $675 billion in federal and state funds are distributed each year. Through the ACS, we know more about jobs and occupations, educational attainment, veterans, whether people own or rent their home, and other topics.