Building power: how a Health Impact Assessment can bring change
By Jonathan Heller
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.
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 3 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.” — World Health Organization
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.” — Paulo Freire