Regardless of the governing body involved, decisions are most often made with the best of intentions. Yet, sometimes these same decisions result in unintended consequences or are the beginning of even greater challenges, especially as it relates to issues of health.
"In a lot of cases, we make decisions first and then we look at the implications after the fact," said Tatiana Lin, senior analyst and strategy team leader at the Kansas Health Institute. "Examining possible outcomes in advance can be a benefit when decisions are made that will impact a number of people in a community or region."
One tool gaining popularity across the country is a health impact assessment or HIA. This tool is intended to offer policymakers projections of the impact–both positive and negative–of proposed policy. An HIA also provides practical and tangible recommendations for how proposed policy could be revised to help mitigate potential negative effects, as well as accentuate potential positive effects.
"More and more policymakers and communities are turning to HIAs as a useful way to build health into decisions in fields like transportation, agriculture, housing and economic development," said Aaron Wernham, director of the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts designed to promote the use of HIAs and support the growth of the field in the United States. "In 2007, there were 27 completed HIAs in the U.S. There are now over 200 completed and in-progress."
Now, with the recent release of the report, "Potential Health Effects of Casino Development in Southeast Kansas," the HIA process has made its way to Kansas. The Kansas Health Institute was awarded funding by the Heath Impact Project to complete the first HIA in the state.
"We feel that HIAs have much potential on a number of levels, and being selected for funding by the Health Impact Project was a major step in building our capacity to complete HIAs and making decision–makers in the state more aware of the potential of this tool," said Lin, who served as project director on the HIA.
According to Lin, the topic of casino development in southeast Kansas was chosen for many reasons. These included the fact that gaming issues are rarely examined through HIAs and the fact that gaming represents an issue of state-level policy. Additionally, a potential casino in southeast Kansas was examined as opposed to the existing casino in south-central Kansas because an HIA is meant to analyze an issue that is active or currently under review.
The HIA process also allowed for continual engagement with residents and stakeholders in southeast Kansas, a region with renewed energy around improving health outcomes and jumpstarting economic development. Multiple meetings were held in the region, drawing stakeholders from a number of surrounding counties.
"At every step of the HIA process, engagement is a major factor," Lin said. "It's engagement with legislators, engagement with health professionals, engagement with stakeholders. It's so important to come in contact with those who would be most impacted by whatever policy you're analyzing."
Lin said that during the initial meetings with area stakeholders, the HIA team faced some mixed reactions. Some were concerned that the study would focus only on the negative and would make it harder to attract a casino in the future. Others were unsure of the process and weren't aware of any possible benefits. Yet, Lin believes continued conversation and a steady stream of information helped make people more comfortable with the HIA process and its intentions.
For David Toland, executive director of Thrive Allen County, the HIA process was an important step in continuing the momentum for the region around its focus on health and wellness, especially as it relates to upcoming decisions on gaming.
"The Health Impact Assessment process was an eye-opener. It's hard to predict what the ultimate decisions will be, but there's no question that they will be better-informed decisions because we went through the process," Toland said. "Going in, I'm not sure that everyone appreciated the breadth of the health impacts of this one public policy decision, but they certainly did by the end."
True to form for the HIA process, the final report included both potential positive and potential negative effects.
The potential positive benefits centered on job creation and the financial well-being and health insurance opportunities that may come from that employment. All of these factors, including income generation, have strong positive links to health. On the flip side, some potential negative effects were identified, including those tied directly to increased access to gaming like nicotine dependence, depression or insomnia.
"What gives this type of assessment credibility among policymakers and the public is the ability to look at all perspectives of an issue," Lin said. "The report is not a political document and the intent of the HIA is not to say a certain decision should go this way or that way. The most desirable outcome is not to sway policymakers, but to have your recommendations considered as the decisions are made."
Now that the first HIA in Kansas has been completed, KHI has plans to do at least two more in the future, including one analyzing a public transit proposal in Wichita. These upcoming HIAs are being funded by the Kansas Health Foundation.
The complete report "Potential Health Effects of Casino Development in Southeast Kansas" is available here. KHI also has produced an issue brief, intended to explain how policymakers can use the assessments to aid the decision-making process, titled "Health Impact Assessments Help link Policy Decisions with Effects on Public Well-Being," which is available here.