Tag Archives: National HIA meeting

Reflections on the National HIA Meeting

Two weeks ago I took a trip to a fun city, reconnected with old friends and made some new ones, and came back rejuvenated, inspired, and ready to get back to work. But I wasn’t on vacation. I was at a conference, and definitely not the boring, stuffy event you might think of. This year’s National HIA Meeting, Sept. 26-28 in Washington, D.C., was the second time practitioners from all over the country have gathered to discuss our work. It was my first, and to me it felt like a lovefest. Here are three reasons why:

Keynote Address by Councilman Joe Cimperman of Cleveland. Cimperman’s moving and inspiring address made me want to jump out of my seat and move to Cleveland right then and there. He discussed the importance of health and equity in his city, and the success of HIA in bringing health into decision-making and generating recommendations for improving health. He also talked about HIA as a tool for creating grassroots support and building relationships. Here is a great interview with Cimperman.

As a participant, my favorite breakout session was “Achieving Health and Equity in Education HIAs.” To my knowledge, the HIAs discussed in this panel are the only education HIAs ever completed in the US. Panelists included Phyllis Hill from ISAIAH in Minnesota, Susana Morales-Konishi and youth researcher Asha Simpson from Youth UpRising in Oakland, and Maisie Chin from CADRE in Los Angeles. These inspiring women represent community-based organizations that prioritize health and equity in their work. Community organizations are a growing group of HIA practitioners, but were under-represented at the conference, so these women brought fresh voices. Asha Simpson and her young colleagues, who were also in the room during the session, are the first youth team to conduct an HIA.

In the final minute of this session, an audience member asked a provocative question: “What about the fact that qualitative, community-generated data is not legitimate?” We didn’t have time to tackle it from the podium, but later talked privately and decided the real question should be: “Has the community legitimized your data?” Many HIAs are conducted without taking into account community knowledge and lived experience, and panelists agreed that practicing HIAs like this raises the red flag of illegitimacy more than the opposite approach. This episode and subsequent discussion really illuminated for me the value that community organizations bring, not just to an HIA but also to conferences like this one. This conversation should definitely be continued at the next national meeting.

My very favorite highlight was the people who came together from around the country and the world to make the conference happen. I never stopped running into old friends I’ve gotten to know over the last five years of doing HIAs. Just as often, I met new people and heard new stories about fascinating HIA projects and other health and equity work. (I guess you call this networking, but that word is too boring for describing the passion people brought to these conversations.)

Now I’m back home and ready to apply my renewed enthusiasm to a couple of new projects. But also excited for the next opportunity to meet with the 450-strong (and counting) national HIA community. The 3rd National HIA meeting is tentatively scheduled for Spring 2015 in Washington, DC.

How Does HIA Bring Change?

There is a dirty little secret among HIA practitioners: We don’t all agree about what makes the work we are doing effective and about how doing HIA will lead to change. This became clear to me during conversations that started during the “Advocacy and Objectivity in HIA” panel at HIA of the Americas earlier this year. But these differences crystalized for me flying home last week from the National HIA Meeting.

The terms advocacy, bias and subjective have been thrown around a lot lately in the HIA field – terms that reveal deep differences among practitioners. I think there are at least three distinct theories of change held among our community.

1. Data alone.  Subscribers to this theory of change believe all HIA practitioners need to do is to provide decision makers with data about health and health disparities. Armed with that data, decision makers will make better decisions.

2. Data and consensus. Subscribers to this theory believe that the best way to make change is to reach out to stakeholders with diverse views, which usually include community members and, depending on the HIA, could include people from different agencies, project proponents, and decision makers from across the political spectrum. With data and good facilitation, consensus can be reached regarding the impacts, recommendations, and report. That process and the findings will lead to decision makers making better decisions.

3. Data and Power. Subscribers to this theory believe that change is most likely to come from strong data combined with an HIA process that is used to build power in disenfranchised communities that face inequities. With this increased power and strong data, the voices of those most impacted will be heard and decision makers will make better decisions.

Each of these theories has its merit and each may have its time and place. Each has examples it can hold up that show that it leads to decisions that improve health.

But, in our experience, if HIA is really a tool to achieve health and reduce inequities, combining data and power is the most effective way of getting there. History shows that the other two are challenging ways to truly change policies, plans, and projects that create inequities, especially if those in power don’t have the will to do so or if there is ideological tension around the proposal my ding. Those in power, in favor of a status quo that benefits them and is harming the disenfranchised, are simply not willing to yield power in the face of mere data.  And the compromises that result from consensus building between those who have power and those who do not usually support at best a middle ground that does not significantly benefit those most harmfully effected by decisions.

This is why at Human Impact Partners we do our HIAs in partnership with community organizing groups whose focus is building leadership in low-income communities and communities of color, lifting the voices of populations left out of decision-making discourse, and building the power of those communities.

We know the data and power theory works. With our partners, we’ve used it over the last couple of years to win over $40 million in affordable housing in South Los Angeles (our USC Specific Plan HIA and Farmers Field HIAs), substantial increases in funds for alternatives to incarceration in Republican-controlled Wisconsin, and better policies for racial integration of schools in Minnesota. We’ve used it to raise awareness about the harmful impacts of detentions and deportations on immigrant children and families. And, through those processes, we’ve left behind not just awareness and better policies, but more importantly, a community that is more engaged in our democracy and more empowered to fight on their own behalf in the future.

In Closing the Gap in a Generation, the World Health Organization Commission on the Social Determinants of Health declared: “Any serious effort to reduce health inequities will involve changing the distribution of power within society and global regions, empowering individuals and groups to represent strongly and effectively their needs and interests and, in so doing, to challenge and change the unfair and steeply graded distribution of social resources (the conditions for health) to which all, as citizens, have claims and rights.” The great Brazilian philosopher and educator Paulo Freire said it more simply: “Washing one’s hands of the conflict between the powerful and the powerless means to side with the powerful, not to be neutral.”