Tag Archives: Community

Heartbroken but determined

There’s no way around it: we are heartbroken. The election of misogyny, White supremacy, and LGBTQ hate into the White House in 2016 is a blow to our hearts, our minds, and our souls. We are in deep pain for the many who already live in trepidation of their rights, for our own families, and for ourselves. And yet—we know we must move past grief and into action.

We cannot compromise on dignity and humanity for all—regardless of gender, race, immigration status, religion, sexual orientation, involvement with the justice system, or able-ness.

In the face of what’s to come, it’s time for all of us to take stock: how does our work need to change to account for the reality before us? What is the role of public health to support and protect people’s lives? And for us at Human Impact Partners, how can we use the power of public health to further social justice?

We aren’t yet sure how to proceed but are eager to figure that out with many of you. What we know is that everyone across public health needs to be a part of driving down hate and dehumanization. It must not be allowed to operate in the light of day. It can’t be normalized. We must rally together on the front lines against hate!

Let’s all come back next week stronger, determined to take on whatever comes next.



Ana, Celia, Dawn, Gus, Holly, Jonathan, Kim, Logan, Lili, Mara, and Sara


Building Hope with Community: The Right to Affordable Housing in South Central Los Angeles

This week’s blog is a repost from Esperanza Community Housing. The post discusses the right to affordable housing in South Central Los Angeles and preliminary findings from HIP’s HIA on a development in the area

The narrative of South Los Angeles has been one of serial displacement. Community residents, primarily low-income people of color, have systematically been priced out of our homes and neighborhoods to make way for industry and for gentrifying trends. We’ve faced higher rents, skyrocketing property values, and a cost of living that has become unmanageable — even when working multiple jobs. This combination is a result of the city’s poor planning and spot-zoning policies, and the real estate development industry’s unchecked pursuit of profits without consideration of the human cost of housing, health, and security. This has put not only our homes at risk, but also our health, our identities, our livelihoods, and our environment. Read more…

Speak up! Health is created through collective efforts

This week’s blog was originally posted by The Pump Handle on September 21, 2015. In this post, HIP Co-Director, Jonathan Heller, reflects on how  collective efforts are necessary to improve our health and well-being. 

The dominant narrative in the United States is that, as individuals, we hold the key to our own success. We are told to pull ourselves up by our bootstraps and that if we just try hard enough, we’ll succeed. Read more…

It’s Time for a Feminine Perspective

Last year I wrote a blog about the stress response, explaining how chronically stimulating the fight-or-flight response to stress can have a host of impacts on health.

But there’s another, less well known, response to stress. In the animal world, females are often responsible for caring for the young. When threatened, they may not be strong enough to fight off the aggressor, and fleeing would mean leaving their young vulnerable to attack. So the females will often group together to surround the young, creating power in numbers to overcome the threat. Researchers have labeled this strategy tend-and-befriend.

This concept should be considered when we assess the impacts of policies. Whether you respond with fight-or-flight, or with tend-and-befriend, each option is a response to what your brain perceives as a threat. If you think about it, many policies are created in response to what some groups consider to be threatening situations or conditions.

Consider school discipline. Disruptions in the classroom, fights between students, bullying and other threats of violence are considered threats by many students and teachers. “Zero tolerance” policies that mandate suspension or expulsion of students who engage in these activities might be considered a fight-or-flight response, by fighting back.

On the other hand, restorative justice policies, which focus on repairing the harm caused by misbehavior and getting students to take responsibility for their actions, might be considered a tend-and-befriend response. These policies suggest that the threat of a lack of discipline (and potential violence) should be addressed by tending to those who are perpetrating the violence, as well as those who have experienced it, encouraging them to befriend each other. Research shows that this approach, and other trauma-informed approaches to improving education outcomes, are more effective – both in reducing the threats and also in improving health and education outcomes.

Let’s look at another example. Human Impact Partners recently assessed the potential health impacts of California Proposition 47, which proposed reducing six low-level, non-serious offenses of drug possession and various forms of petty theft from felonies to misdemeanors and redirecting resources to services to treat the mental health and substance abuse problems underlying many of these offenses. Labeling these behaviors as felonies is often seen as “tough on crime” – fighting the threat of criminal activity.

But providing treatment instead of incarceration tends to the needs of those with mental health and substance abuse problems rather than harshly criminalizing them. Again, research shows that providing mental health and substance abuse services is more effective in reducing crime, as well as improving physical and mental health outcomes.

There are many other examples. For instance, it often costs less and is more effective to take care of people by providing paid sick days, protecting against wage theft, and keeping families intact – tending to their needs – than to deny access to resources or enforce harsh immigration policies and then deal with the domino effect of more expensive public resources required afterward.

Tend-and-befriend policies, reflecting a traditionally feminine perspective, can be equally, if not more, effective than the flight-or-fight approach. If we’re truly interested in improving health outcomes, we should look to them more often.

The Complexity of Considering Both Mental and Physical Health in an HIA

Earlier this year the World Health Organization (WHO) released The Social Determinants of Mental Health, which outlines the connections between social factors and mental disorders, and describes how taking a lifespan approach to addressing inequality is the best strategy to impact mental health and well-being. The authors have this to say about the connections between a healthy mind and a healthy body:

The social determinants of health shape and profoundly influence both mental and physical health. Furthermore, the relationship between physical and mental health indicates that poor physical health can cause mental disorders, and vice versa. Reducing inequalities in mental health cannot be achieved without reducing inequalities in physical health. Therefore, a social determinants of health approach should consider both mental and physical health implications within all actions to tackle health inequalities.

This is common sense: The relationship between mental and physical health has been described by researchers and validated by people’s real-life experience. But as an HIA practitioner, how do you address both at the same time?

You only have to start to outline a scoping pathway to see the difficulty in considering both mental and physical health impacts of an action at the same time. For example, a decision to increase recreational opportunities could impact both the risk of cardiovascular disease and stress or anxiety levels. The circularity between mental and physical health defies the linear relationship HIA traditionally calls for. If chronic disease and mental disorders are engaged in a dance, with either partner leading at a given time, how can we predict which will impact the other?

This question is probably more significant for HIA practitioners who feel they have little understanding of mental health and well-being to begin with. After all, there is not much direction on how to measure population mental health outcomes, and mental health data is either lacking or nonexistent. For those reasons the Adler School of Professional Psychology’s Institute on Social Exclusion decided to focus primarily on mental health in our Mental Health Impact Assessment. We wanted to include a more thorough understanding of mental health and well-being, and consider how community mental health processes like collective efficacy impact individual mental health outcomes. It was our goal to expand the HIA field to provide a model showing how mental health is broader than just mental disorders and illness.

While there are a growing number of HIAs with mental health considerations, there haven’t been many examples where the circular relationship with chronic disease has been acknowledged. This is why the Society of Practitioners of HIA (SOPHIA) has a workgroup on incorporating mental health into HIA, which you can find more about here. Through the workgroup we are producing resources to assist practitioners interested in applying a more comprehensive view of health, including both mental and physical health impacts. While considering both mental and physical health impacts in an HIA is complex, it’s also profoundly important. Stay tuned for more resources from our workgroup to help you address mental health as well as physical health in your assessments.

Tiffany L. McDowell, PhD, is the Executive Director for the Institute on Social Exclusion at the Adler School of Professional Psychology in Chicago. She can be reached at tmcdowell[at]adler[dot]edu. 

Advice for New HIA Practitioners Interested in Equity

Why do some workers get paid sick leave, while 85% of food preparers have to choose between coming to work sick or losing a day’s wages? Why do fewer than 1 in 10 African Americans live in a census tract that has a supermarket, compared to almost one-third of whites? Why do we send drug offenders to jail when it’s cheaper and more effective to send them to treatment? How do these inequities affect health for all of us?

As HIP and others conduct innovative research that highlights the health issues inherent in all policy decisions, we are seeing an emergence of new public health professionals who are interested in Health Impact Assessment (HIA) and Health in All Policies (HiAP) research as tools to advance health and equity. In the first two years of HIP’s Health and Equity Fellowship, we have had 90 applicants from across the country, and with a diverse range of personal and professional backgrounds.

We asked Fabiola Santiago, who recently completed our first Health & Equity Fellowship: What advice do you have for emerging public health and HIA practitioners who are interested in health & equity research?


HIP’s Health and Equity Fellow is responsible for initiating and leading a new and innovative HIA or HiAP project that aims to advance the consideration of health and equity in decision-making. For my primary project, I led an HIA focused on proposed legislation to address wage theft, the nonpayment or underpayment of wages rightfully owed to employees.

In working on the wage theft HIA, I found that health and equity are still relatively new concepts for many organizations. Throughout this experience, I was simultaneously learning and teaching these concepts and the HIA steps. Patience is key. As someone with a strong background in social justice issues and an ardent inclination towards public health, the link between social determinants of health and health outcomes is evident to me, but it’s not necessarily explicit in research. Extra research is often needed to form predictions in areas where a health lens is not available. Budget additional time for each HIA step, and still expect delays.

During my fellowship, I also worked on a Health in All Policies project – the Local Control Funding Formula. This project involved a broad set of partnerships. I learned that each organization and individual may have a different agenda, some will be more equity focused, others more on health, and still others on other issues. Being mindful of these differences, yet staying focused on the overall goal can reduce confusion, but innovative ideas can emerge from the conversations. Communicating findings will generate more partnerships and garner more support in issue areas. Not everyone may use the same language, but the goals may be similar. Paying attention to these nuances has the potential to create new relationships.

For all the projects I worked on, I found it important to be flexible yet firm. As you embark on your project and especially while working with people and organizations you’re close to, it’s important to be flexible to their needs. But it’s also important to make sure that the project does not fall too far behind. Respect their feedback, incorporate their suggestions, but remember to value your professional expertise as well. As an emerging professional, it can be hard to make executive decisions, but it’s important to your development as a leader.

The purpose of the HIA is to first and foremost increase the consideration of health and equity in decision-making. However, if the HIA does not succeed in influencing decision makers, it does not mean it failed. Hearing, “Thanks so much for your work. I can’t believe we haven’t looked at how wage theft impacts health” is a sign that the overall purpose of the HIA is heading in the right direction. Additionally, when I conducted focus groups, seeing how candid participants were, and creating a space for them to vent was also a sign of success because it illustrated how much their working conditions impacted their daily lives.

Social determinants of health and community are key. Addressing health problems from their root causes will inevitably take longer, but in the long run will have a much greater effect. Changing the social determinants that influence people’s health has the potential to prevent and alleviate the most pressing health problems. Additionally, the field of public health must lead in elevating community voices—especially from those whom are most affected.

Am I a Scientist or an Activist?

For a recent graduate of a master’s in public health program, Human Impact Partners’ Health and Equity Fellowship was a golden opportunity to put those three little letters at the end of my name to good use. Health Impact Assessment combines both analytic rigor and a participatory, community-driven approach to promote health, equity and justice. So on my first day at the HIP office, I had to ask myself: Am I a scientist or an activist?

As a biology undergrad researching the genetics of virulence in human-parasite interactions, I was squarely in the scientist camp. As a public health graduate student, participating in city council meetings to support changes to Oakland’s rent ordinance to protect low-income tenants, I was treading into activist territory. At various points I’ve identified more strongly as one or the other as these split personalities played a constant tug-of-war.

Now, almost two months into the fellowship, it seems that these two sides of me are pulling in the same direction. Health Impact Assessment – the HIP way – is both science and activism.

Public health has always been a complex field, but in the last decade our definition of public health has expanded so rapidly that it seems to burst at the seams every few years, challenging us to adopt ever more expansive and rigorous frameworks to address the full scope of the issues it encompasses. Public health’s scope has expanded from contagion control to prevention to behavior change and more recently to social justice. Given these changes, it seems that the reach of science is simply no longer expansive enough to encompass that scope on its own. Nor are traditional scientific approaches rigorous enough. Public health needs to look more like advocacy and community organizing to remain relevant to the populations it seeks to benefit.

In graduate school at UC Berkeley, I found myself working to promote the health of undocumented immigrant Latino day laborers. I did this in part through ethnographic research, direct services to help meet day laborers’ basic needs and educational sessions on occupational health — all part and parcel of traditional public health practice. But that alone was not enough. It was only a start.

How do you take control of your own well-being when your health is hugely influenced by a city ordinance that prevents you from seeking work and wages to support your basic needs and those of your family? How do you ensure on-the-job safety when your labor is simultaneously a highly sought-after commodity and a political lightning rod for anti-immigrant sentiment?

These issues, and many others like them, are complex and yield no easy answers. HIP’s combination of public health and social justice frameworks help us ask better questions and use the evidence to tip decisions in the direction of health and social equity, and to empower communities to make change happen.

I’m humbled at the challenge of working with the talented team of smart, motivated professionals at HIP — already, I have learned so much, and hope I can contribute as much as I receive. And I’m privileged to work in solidarity with communities and be a part of movements to make good on the promise of health for all.

HIP is pleased to welcome Darío Maciel as HIP’s 2014-2015 Health and Equity Fellow. As one of our strategies to advance health and equity in decision-making, HIP offers a yearlong, fulltime Fellowship for an emerging public health professional, with a goal of increasing the racial and ethnic diversity among practitioners of Health Impact Assessment and Health in All Policies approaches.

HIP’s Emerging Leaders in Health and Equity

In our research on issues like paid sick leave, alternatives to incarceration, and immigration policy, HIP has been a leader in advancing the ways Health Impact Assessment (HIA) can be a tool for equity. HIA practitioners face common challenges when working to advance equity, especially for those with limited familiarity with equity issues or vulnerable communities.

Part of HIP’s strategy for advancing health and equity in decision-making is diversifying the field of HIA practitioners. HIP’s Health and Equity Fellowship was established in 2013 with the goal of increasing the racial and ethnic diversity of emerging professionals who are committed to promoting the consideration of health and equity in decision-making through Health Impact Assessment and Health in All Policies (HiAP) approaches. The fulltime fellowship, offered to one candidate each year, includes ongoing education and training in the practice of HIA and other approaches to integrating health into policy planning decisions.

HIP’s first Health and Equity Fellow, Fabiola Santiago, reflects on the values and experiences that drew her to this work and the fellowship. We are pleased to announce that Fabiola has joined the HIP staff as a Research Associate.

Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.– Audre Lorde

Fabiola Santiago
Fabiola Santiago

First and foremost I was drawn to HIP’s mission of transforming the places and policies people need to live healthy lives. Too often we blame people for their poor health status; rarely do we consider the larger systems and polices that affect health. Leading an HIA and working on issues affecting communities seemed like an ideal starting point. I also thought I could apply my community research experience, while learning from professionals with extensive HIA experience.

The other thing that drew me in was HIP’s unique focus on equity. Marginalized communities continually face the burden of unjust polices, projects, and programs. HIP places a priority on equity, and as a woman of color from a low-income and formerly undocumented background, I could not be more satisfied with an organization and fellowship that elevates the voices of the most vulnerable. My academic training taught me different ways of thinking and essentially a new language but also limited my contact with vulnerable communities. Collectively working with individuals and organizations that are likely to be affected by polices and programs is needed in order to prevent and mitigate negative health consequences.

My involvement in the student immigrant rights movement showed me how policy changes, even within one institution, can make a difference in health. The organization I was involved with successfully put changes in place that made school less stressful. For example, garnering support from our counselors, professors, administrators, and staff led to establishment of a food pantry for undocumented students and a payment plan for students who could not pay full tuition.

Overall, HIP’s Health and Equity Fellowship mirrors my personal values: health, equity, community, and redistribution of power. The fellowship seamlessly bridged my public health background with my interest in working with low-income communities. We cannot advance in issues of social justice without first tending to our health. Good health is the strongest tool for justice.

The Three Mile Island You’ve Never Heard Of

In 1979, a dam broke at a uranium mill near Church Rock, N.M., releasing more than 1,100 tons of mining waste and 100 million gallons of radioactive water. It was the second largest radioactive materials accident in U.S. history, resulting in contamination worse than the nuclear reactor meltdown at Three Mile Island that same year. But unlike Three Mile Island, chances are you’ve never heard of it.

Recently, my HIP colleague Sara Satinsky and I visited the Red Water Pond community, a Navajo community near the site of the spill. We joined a caravan of 14 cars, led by Jordon Johnson of the McKinley Community Place Matters team, to the home of Bertha Nez. We ate dinner under a home made shaded area, sitting on benches and folding chairs, while Bertha, Tony Hood, and Philmer Bluehouse told us their stories.

They showed us pictures of hillsides that used to have trees until one of many clean up processes began to remove contaminated soil and uplifted their roots. Their family members are buried under the trees.

They talked about people being sick from cancer and respiratory diseases. They told us about the goat that was born with no hair and died within 30 minutes of being born, about the sheep they slaughter for food being yellow inside.

They told us about working in the mine, about a manager who kept yellowcake (concentrated uranium powder) on his desk, about not understanding the risks they were taking. They pointed to a Hogan (a traditional Navajo house) no one could live in because the hearth had been built with contaminated soil.

Tony explained to us that a Hogan is built to honor the four directions. Philmer sang us a song and prayer in Navajo and showed us the area where they will build a new Hogan to offer healing to the people. He showed us how to enter such a place – with the leaders entering first, then the women, then the men, all circling the perimeter in a clockwise direction.

When they told us their stories, they all cried. And as we listened to them, so did we. The people living in this community don’t want to leave the area – the place blessed by their elders, the place where they were born, where their loved ones are buried. They asked us for nothing – no request to sign a petition, make a donation, or organize a protest. They only wanted us to hear them, to be witnesses to their struggles.

So we did. We listened. We witnessed. And we are sharing their story with others.

Human Impact Partners is providing training and technical assistance to the McKinley Community Place Matters Team via the New Mexico Health Equity Partnership to conduct a Health Impact Assessment on a proposed moratorium of uranium mining for the county.

Gentrification: A Public Health Crisis

Spike Lee calls it “the Christopher Columbus Syndrome– the “discovery” of lower-income, racially diverse urban neighborhoods by a richer, whiter influx of new residents who drive up the cost of housing, squeezing out working-class folks, and transforming the neighborhood. The debate over gentrification rages among academics, cultural critics, and of course, to those of us who find ourselves living it. (I’m a twenty-something who has recently moved to the San Francisco Bay Area, gentrification ground zero.)

But what about the perspective of the people being displaced? In a new report, Causa Justa :: Just Cause provides much-needed insight from the perspective of the residents of Bay Area communities most heavily impacted, providing vivid evidence that gentrification is not just an amoral process of change but a public health problem – as sociologist John Joe Hickman says, “the most pressing issue as we become an urban world.”

The report – Development Without Displacement: Resisting Gentrification in the Bay Area – defines gentrification as

a profit driven race and class remake of urban, working class communities of color that have suffered from a history of disinvestment and abandonment. This process is driven by private developers, landlords, business, and corporations and supported by the state, through both policies that facilitate the process and funding in the form of public subsidies.  Gentrification happens in areas where commercial and residential land is cheap relative to other areas in the city and region, and where the potential to turn a profit, either through re-purposing existing structures or building new ones is great.

The pace and scope of gentrification in the Bay Area is alarming. Causa Justa :: Just Cause’s analysis shows that there are no remaining neighborhoods in Oakland that are not already gentrifying, susceptible to gentrifying, or already wealthy. Working-class communities of color in San Francisco are in a similar position, especially in the Mission district, where no-fault evictions are at the highest levels since the dot-com boom of the early 2000s.

Displacement has been linked with a myriad of stressors, including financial hardship, disruption of social networks, loss of access to health services, even homelessness.  Stress, in turn, is linked with poorer health outcomes. The fact that gentrification literally makes residents of displaced communities sick is not an inevitable effect of morally neutral market forces, but a fundamental injustice.

But gentrification is not inevitable. The report provides specific policy recommendations that can prevent displacement from beginning and halt its progress in areas where it is already occurring.  Health impact assessments can help local governments and public health officials to promote economic development without displacement. Causa Justa :: Just Cause says the key factor in turning the tide is honoring the voices of communities as partners in development and planning processes that affect their future.  Only then will current residents stand to benefit from the renewed wave of investment coming to the neighborhoods they call home.