Geography Reference
In-Depth Information
that a HIA should also include four major elements: reviews of the evidence that
showed the effect of any new development policy or programme on the health of a
population; consideration of the opinions, expectations and experience of those af-
fected; recognition of the need for more informed understanding by both decision-
makers and the public of the effects of the proposed policies; and proposals for
adjustment or other options to maximize the positive effects of any policy, and to
minimize their negative consequences. These elements illustrate the seriousness of
the desire to take public opinion into account and to consider views from the vari-
ous stakeholders.
A review of 88 HIAs from 1996 to 2004 (Davenport et al.
2005
) revealed that
not all were successful. It was concluded that only when certain conditions applied
were they successful in influencing policy, namely: when there was institutional
support for solving health problems; when key decision-makers were involved in
the design of analyses; and when there was a statutory framework within govern-
ment procedures for using a HIA. Without these conditions, various bureaucratic
evaluation procedures just avoided the issues. Yet HIAs are now becoming as fa-
miliar as environmental reviews in some countries. A good example of the way in
which health concerns raised by a community obtained crucial institutional support
from a city's Public Health Department (PHD) can be seen in the Trinity Plaza
proposal in inner city San Francisco in 2003, although it was not technically a HIA.
The planning department supported the proposal for the redevelopment of the Trin-
ity Plaza area near downtown in 2003, which involved plans to convert 360 rent-
controlled housing units into 1700 market-rate units in several high rise towers. It
ignored the fact that the development was one of the latest gentrification projects
that involved a major displacement of low income people who had lived in the area
for decades (Corburn
2009
). The project led to a great deal of community anger and
a pressure group to oppose the proposals. The Mission Anti-Displacement Coalition
(MAC) created what they called a People's Plan to retain affordable family hous-
ing, preserve local jobs and asked for community oversight over land use changes.
Fortunately for the community's case the Public Health Department in the city had
moved away from only dealing with its traditional biomedical and sanitation fo-
cus and started to address the social determinants of health in the city, setting up
workshops to learn about community concerns and providing advice about ways
of improving areas. This led the PHD to intervene in the Trinity Plaza project on
the side of the community, supporting its view that the displacement of the existing
residents would cause financial hardship, given higher rents in other locations, and
ensure the loss of community relationships and stress to the individuals who would
be evicted, leading to increased levels of ill-health from these social determinants.
The gradual acceptance of the health consequences of this project eventually led to
discussions between the PHD, developers, planners and community activists, which
led to a revised proposal in which 12 % of the project would be allocated to below
market-rent housing, with existing occupants keeping their homes at current rates.
In Corburn's (2009, p. 130) succinct phrase: “
the Department of Public Health had
entered the world of urban development and staked-out a new space for human
health
”. Although there are still problems about the continued gentrification of the
