Parks and Trails Health Impact Assessment Toolkit

Introduction

Well-designed parks and trails are valued parts of our environment. Research examining the connection between parks, trails, and health has helped identify the value that parks provide to people. Parks and trails can promote physical activity and community engagement; and provide both environmental and mental health benefits. When well-designed, parks have been shown to reduce stress and foster community interaction. They can also protect sensitive lands such as flood plains and steep slopes.

Parks and trails can provide resources most communities need when addressing many of today’s public health problems. And when questions arise about community policies or projects related to parks and trails—particularly, how to maximize their positive impact on public health—a health impact assessment (HIA) can provide answers.

Health Impact Assessment and Parks and Trails

• What is a Health Impact Assessment?
• What is the Burden of Disease?
• Parks and Health
• Why Do a Park or Trail HIA?
• Points of Intervention
• The Toolkit

What is a Health Impact Assessment?

A health impact assessment (HIA) is “a combination of procedures, methods, and tools by which a policy, program, or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population.” ¹

An HIA evaluates objectively the potential health effects of a policy or project before it begins. An HIA can recommend measures to increase positive health outcomes and decrease adverse health outcomes. The HIA framework can bring potential public health effects and considerations into the decision-making process for plans, projects, and policies that fall outside of traditional public health arenas, such as parks and trails. The U.S. Department of Health and Human Services recommends the HIA as a planning resource.

The major steps in conducting an HIA are:

• Screening—would an HIA be useful? If all the decisions have been made, an HIA probably is not appropriate. If HIA findings most likely would not change any decisions, an HIA would not be useful.
• Scoping—identify which health effects to consider and by what methods.
• Assessing risks and benefits—identify who might be affected and how they might be affected. Use data and research to determine the likelihood, direction, magnitude, and distribution of potential health effects.
• Developing recommendations—suggest changes to proposals to promote positive health effects or minimize adverse health effects.
• Reporting—present the results to decision makers and the public.
• Evaluating—determine whether the HIA will affect public health decisions and the actual effects of those decisions.

What is the Burden of Disease?

Parks can affect a range of public health issues, including injuries, mental health, and pollution exposures. An important interaction between parks and health is through physical activity. In the United States, most people do not get enough physical activity The Centers for Disease Control and Prevention (CDC) recommends that children have at least 60 minutes of physical activity per day. Yet, more than 80 percent of adolescents in the United States do not achieve this minimum, and more than 25 percent of adults report no leisure-time physical activity. ²

For all weight levels, physical activity alone can improve health outcomes. In addition, physical activity can help prevent obesity. In the 1960s, obesity rates for children 6 to 11 years old were around 4 percent ³. By 2010, obesity rates had increased to 18 percent ⁴. This is not just a childhood problem; in 2010 more than 69 percent of the United States adult population was overweight ⁵.

Physical inactivity and obesity are independent risk factors for many of the same diseases, including

- Cancer
- Diabetes
- Heart disease
- Stroke
- Joint and bone disease
- Depression ^{6, 7, 8}

Parks and Health

Parks and trails can improve health in several ways including:

• Increased physical activity- walkable access to appropriate sites motivates people to participate in physical activity and to do so more frequently;
• Improved mental health- parks can serve as a venue for stress reduction;
• Environmental benefits- parks can reduce air and water pollution, protect hazard areas (e.g., flood plains, unstable slopes) from inappropriate development, and mitigate urban heat islands;
• Community interaction- parks can provide meeting places for neighbors;
• Reduce injury- parks and trails can provide safe spaces for people to play and exercise, away from busy streets and commercial zones.

People who are exposed to the greenest environments also have the lowest levels of health inequality among low-income households. Physical environments, like parks and trails, that promote good health might be important to reduce socioeconomic health inequalities. ⁹

Even though parks can be important health-promoting components of communities, they can also create community concerns. In some places, parks can be viewed as a place for crime or illegal activity; there may be concerns about injuries at the park or by people traveling to the park; or there may be competing development interests. All of these issues are important to consider and can be informed by an HIA.

Why Do a Park or Trail HIA?

Parks are relatively large investments that serve multiple purposes, including health promotion. Identifying how a park can most effectively improve health could lead to a more efficient use of resources. Health impact assessment can help. Trails are one example:

• If the community has hiking trails, the trails can encourage physical activity that can help improve cardiovascular health.
• If the trails provide a means of pedestrian travel away from traffic, the design may also help reduce exposure to air pollution and decrease the risk of injury.
• Trail design can help protect streams and improve water quality by capturing the first flush runoff from low-level storms and filtering non-point source pollutants.
• Setting aside space for canopy trees can reduce some of the effects of urban heat islands.

A health impact assessment can help policymakers appreciate and address the potential health effects of a proposed policy or plan before it’s put into practice or of a project before it’s built. That parks and trails promote public health is generally understood—an increasing volume of research supports that understanding. So why conduct an HIA? Because it can answer questions such as:

• How can we design park and trail policy, planning, and project decisions to promote health as much as possible?
• What is the health impact of not accomplishing the project or carrying out the policy?
• What happens when parks and trails are not accessible to vulnerable populations?
• Do some park or trail features provide greater public health benefits than others?
• What are the barriers to park or trail initiatives that might prevent them from supporting health?
• As an initiative moves forward, what are its most important public health outcomes?
• Which features should be priorities?

Understanding a community’s background and its health issues can help target community resources. An HIA can uncover potential barriers to realization of full positive health impacts and suggest alternatives. An HIA can help address concerns about safety and management. And an HIA can promote a health culture. Such a health culture could help implement practices to assure that everyone— regardless of age, ethnicity or race or income or ability—can enjoy parks and trails frequently, easily, and safely.

Points of Intervention

Planning for a healthier community can involve many stages. Below are some points of intervention when community decisions that affect parks may be made:

• Comprehensive plans, also called general plans, set the community’s vision for development over 10 to 50 years.
• Capital improvement budgets identify projects funded and constructed within a specific funding cycle.
• Park and trail master plans and park design initiatives respond to specific opportunities.
• Park advisory board and advocacy group meetings offer opportunities for the discussion of the health impacts of parks and trails.

An HIA can inform a decision at any one of these stages. The HIA process can encourage all stakeholders to work together to reduce negative outcomes and to promote positive changes.

The Toolkit

This toolkit can assist in the development of HIAs with park and trail components. It provides a framework for public health departments, city planners, project managers, and other stakeholders to work together. The HIA process identifies possible stakeholders, lists possible baseline datasets, and compiles potential recommendations from existing HIAs, linking them to cited evidence.

Bringing information from different disciplines into one document can assist decision-makers who wish to use the HIA process to evaluate a policy, plan, or project that includes a park or trail. It can support the scoping, assessment, and recommendation steps.

The toolkit is divided into four sections:

• 1. Section A: Stakeholders – Subject Matter Experts — lists categories of people who might be included as stakeholders or subject matter experts.
• 2. Section B: Data — suggests types of baseline data that might be included and where they can be obtained.
• 3. Section C: Common HIA Recommendations — is based on a review of 11 HIAs that addressed park and/or trail development and lists common HIA recommendations for health issues associated with park and trail projects. The section includes references and studies that support these recommendations.
• 4. Section D: Additional Topic Areas — includes extra topics and resources that may provide background for future HIAs. Communities may want to consider these additional recommendations that were not included in the eleven source HIAs.

Appendices

• Appendix A– Method used to develop toolkit content
• Appendix B - Health Impact Assessments reviewed for the HIA Parks and Trails HIA Toolkit