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Massachusetts Department of Public Health

The Massachusetts Department of Public Health (MDPH) Healthy Community Design Program uses HIA and Health in All Policies approaches to build on its substantial work integrating land-use and transportation planning with health at the state, regional, and local levels. MDPH supports HIAs that focus on assessing policies, programs, and plans that influence the built environment, and uses the Massachusetts Healthy Community Design Toolkit: Leveraging Positive Change [PDF - 3.22 MB] as a Health in All Policies tool to integrate health into the routine work of regional planning agencies.

2014–2016 HIA Accomplishments

City of Chelsea Transit-Oriented Development Zoning

This rapid HIA examined the potential health impacts of new development and redevelopment, including providing public space in the transit station areas along the planned Chelsea Silver Line Extension, a new bus rapid transit (BRT) line. The assessment considered residents living within ½ mile of the four proposed BRT stations in the City of Chelsea. The city has a population of 31,000 people, of which 75% identify as nonwhite, 62% identify as Latino, and 24% live at or below the poverty level. Forty percent of households within ½ mile of the proposed transit stations do not have cars. The City of Chelsea is using the HIA findings and recommendations to guide their decisions about proposed zoning changes near transit stations.

HIA Sprints

MDPH is piloting HIA Sprints, a new method of conducting rapid HIAs structured around two brief HIA workshops. At the workshops, stakeholders will learn about the HIA assessment step, review baseline data and related scientific literature, identify potential impacts using pre-defined methods, learn about the HIA recommendations step, develop and rank recommendations, and outline a 3- to 5-page report. The Metropolitan Area Planning Council and MDPH are providing technical assistance to two regional planning agencies to complete rapid HIAs using the HIA Sprint model. The two HIA Sprint projects are described below.

  • Berkshire Regional Planning Commission: This rapid HIA will focus on implementing proposed Complete Streets improvements in Egremont and recommending potential projects for a future Massachusetts Department of Transportation Complete Streets prioritization plan.
  • Merrimack Valley Planning Commission: This rapid HIA will focus on redesigning the U.S. Route 1 traffic circle in Newburyport to improve bicycle and pedestrian travel in the City’s recently approved 40R smart growth district near the commuter rail station. The redesign plans include adding a bicycle and pedestrian connection between the existing Newburyport Rail Trail and the future Clipper City Rail Trail.

Northampton Pleasant Street Streetscape

This HIA assessed how proposed infrastructure investments could affect the health of current and future residents and users of Pleasant Street. One current resident described Pleasant Street as “ill-defined, bipolar, car-centric, and unpleasant.” The City of Northampton is in the process of taking over a portion of Pleasant Street from the state highway department and requested an HIA before beginning the street redesign work. This HIA, conducted by the Pioneer Valley Planning Commission in partnership with MDPH and the Metropolitan Area Planning Commission, assessed the potential health impacts of several streetscape design features, including increased pedestrian and bicycle infrastructure, low impact design storm water infrastructure, and parklets in crosswalk bump-outs. The city used the HIA recommendations to prioritize which aspects of the streetscape deserve the most budgetary and design attention based upon potential health impacts.

Primary Seat Belts

This HIA will support an MDPH policy statement and legislative proposal for a primary seat belt law. Massachusetts ranks very low in observed seat belt use (46th in the nation). Studies have shown that primary seat belt laws increase seat belt use and reduce injury. However, some lawmakers and community members have expressed concern that enforcing a primary seat belt law could possibly lead to racial profiling by law enforcement. To protect overall health, this injury prevention strategy must be balanced with an awareness of the chronic stress and anxiety sometimes associated with law enforcement strategies in minority communities. The HIA will collect information from stakeholder panels and informant interviews and provide evidence for the potential positive and negative health impacts of a statewide primary seat belt law on injury risk and chronic stress/anxiety associated with possible racial profiling by police when enforcing it.

Priority Mapping Process in Massachusetts

The Commonwealth of Massachusetts’ “Plan Ahead for Growth” process identifies areas for growth or preservation, referred to as “Priority Development Areas (PDA)” and “Priority Protection Areas (PPA),” respectively. This HIA focused on potential health impacts of PDA and PPA designations for the Pioneer Valley Planning Commission Region, which is made up of 43 cities and towns with a total population of 625,000 people. The HIA recommends enhancing the PDA/PPA mapping process. Before finalizing the HIA report, MDPH is waiting to learn whether the new state administration plans to continue the “Plan Ahead for Growth” process so the report and recommendations can be framed appropriately.

South Hadley Development Standards

This HIA will examine the impacts of proposed development regulations in South Hadley, MA, including significant revisions to the town’s subdivision regulations and design guidelines for a newly-created smart growth district. The proposed regulations will shape most future development in the town, including urban infill, new neighborhoods, multi-family housing, and commercial development. The HIA will assess the health impacts related to active transportation, safety from traffic, green space, and emergency response. In partnership with MDPH, the Pioneer Valley Planning Commission is collaborating with the town’s planning director, Department of Public Works director, and health director to conduct the HIA and ensure the findings will influence decision making.

2011–2014 HIA Accomplishments

Determination of Need Community Health Initiatives Program

Under Massachusetts regulation, the MDPH Determination of Need (DoN) program must review applications from health care facilities that are planning substantial capital expenditures or changes in service. As part of this process, applicants provide plans for providing primary care and preventive services, known as Community Health Initiatives (CHI). The MDPH Commissioner requested an HIA of the DoN–CHI program. The purposes of the HIA were to assess the effectiveness of the DoN-CHI program, discover opportunities for alignment with other department and state initiatives, and recommend ways to enhance the program’s impact on community health. The HIA determined that the DoN-CHI program is an effective way to invest in community health and identified several areas for improvement. Based on the HIA recommendations, MDPH developed new guidance for the DoN-CHI program and worked to integrate DoN with the Attorney General’s Community Benefits Program.

Fitchburg Vacant Lots

The Montachusett Regional Planning Commission, in conjunction with the Montachusett Opportunity Council (MOC) and with support from MDPH, conducted an HIA on the City of Fitchburg’s proposals for redeveloping vacant lots under 5,000 square feet. The HIA examined the health effects of three strategies to transform vacant lots into community and cultural play spaces, urban agriculture sites, or off-street parking. MOC used the HIA findings as a foundation for identifying and prioritizing appropriate sites for redevelopment. In addition, MOC included the HIA findings in a successful funding application that earned them a US Environmental Protection Agency (EPA) environmental justice grant in 2014. One aspect of the funded project will convert a city-owned vacant lot into a “green infrastructure outdoor museum” to educate community members about methods for mitigating stormwater pollution.

Healthy Neighborhoods Equity Fund

The Conservation Law Foundation and the Massachusetts Housing Investment Corporation proposed creating a private equity fund, called the Healthy Neighborhoods Equity Fund (HNEF), to support transit-oriented development (TOD) projects. MDPH, the Conservation Law Foundation, and the Metropolitan Area Planning Council conducted an HIA to describe the potential health outcomes commonly associated with TOD. This HIA examined three TOD projects in the Roxbury neighborhood of Boston (Bartlett Place, Madison Park/Tropical Foods, and Mission Hill/Parcel 25) as case studies to define health metrics for the HNEF. Based on the HIA recommendations, the Conservation Law Foundation selected 10 health metrics that they will use to select HNEF projects and to evaluate and monitor the health impacts of funded projects. In addition, the Conservation Law Foundation is using health data provided by MDPH to identify neighborhoods that will be benefit the most from future HNEF development projects.

Oasis on Ballou

The Codman Square Neighborhood Development Corporation (CSNDC) asked MDPH to conduct an HIA to examine the potential health and equity impacts of the proposed site design for the “Oasis on Ballou” project. The project involved transforming several vacant adjacent land parcels at 100 Ballou Avenue in Boston’s Dorchester Codman Square neighborhood. The HIA found that the proposed multi-use site design would positively affect food access, physical activity, and safety among nearby residents. CSNDC purchased the land from the City of Boston in 2014 to develop the site based on the HIA recommendations.

Quequechan River Rail Trail Extension

The City of Fall River asked MDPH to conduct an HIA on Phase II of the Quequechan River Rail Trail extension project. The HIA specifically focused on the following health impacts: physical activity, safety from collisions, crime, economic development, air quality, and social cohesion. Recommendations from the HIA addressed the engineering, design, and maintenance of the trail to improve city and regional connectivity and to maximize health benefits. Work on Phase II of the Quequechan River Rail Trail Project is on track for completion in the summer of 2016.

Regional Climate Action Planning

This pilot HIA was a collaboration between MDPH and the Pioneer Valley Planning Commission (PVPC). The HIA explored ways to incorporate the public health effects of climate change into existing municipal and regional planning efforts. The HIA advisory committee chose to focus the HIA on two of the 19 strategies from the Pioneer Valley Climate Action Clean Energy Plan: (a) providing cooling centers and assisting vulnerable populations during heat events and (b) implementing energy efficiency measures in city buildings. Local health officials have used the HIA findings to develop comprehensive adaptation plans to prevent and mitigate climate change-related health impacts in their communities.

School Building and Health

MDPH and the Metropolitan Area Planning Council conducted an HIA to examine the connections between health and school building design and construction. In the feasibility phase of the HIA, the team identified school building projects and chose the Plymouth South High School redevelopment project as a case study. The purpose of the HIA was to inform school districts and local Mass in Motion (MiM) coalitions about ways to integrate health considerations into the local planning process to build or reconstruct schools. MDPH presented the HIA recommendations to the Massachusetts School Building Authority (MSBA), the Plymouth School District, and community members prior to the design plans being finalized. The HIA also presented a healthy school building framework that MSBA, school districts, designers and architects, and community stakeholders can use as a resource. The framework recommends ways to incorporate health at various stages of the school building process to create healthy school environments for students, staff, and community residents.

Speed Limit Bill

MDPH, in partnership with the Metropolitan Area Planning Council, examined potential health impacts of proposed state legislation that would lower the default speed limit on all local roads in Massachusetts from 30 mph to 25 mph. The HIA found that the proposed change in speed limit could prevent an estimated 2,200 crashes, 18 fatalities, and 1,200 injuries per year, translating into $210 million annual savings in medical payments and work loss. The HIA received much attention from decision makers and other stakeholders, leading to a day-long speed limit forum where researchers, transportation officials, and legislators discussed the wide-ranging impacts of speed on local residents and communities.

Union Hill Revitalization

The City of Worcester brought together multiple city departments to develop a comprehensive neighborhood revitalization strategy for the distressed Union Hill neighborhood. Worcester Division of Public Health (DPH), in cooperation with other city agencies and with support from MDPH, conducted a rapid HIA of the proposed revitalization strategy for Union Hill. The HIA examined six health factors (community violence, social cohesion, housing safety, traffic safety, access to parks, and physical activity) linked with four revitalization strategies (housing, code enforcement, infrastructure, and public safety). Worcester DPH presented the HIA to the city council and other stakeholders and is using the HIA recommendations to support health-promoting activities in the distressed neighborhood of Union Hill. The city plans to refine the revitalization strategy and apply it to other Worcester neighborhoods.

Tools and Resources for HIA Practitioners

The MDPH Healthy Community Design Program developed


  • Built Environment Community of Practice
  • Health Resources in Action
  • Massachusetts Association of Councils on Aging
  • Massachusetts Association of Regional Planning Agencies
  • Massachusetts Department of Housing and Community Development
  • Massachusetts Department of Transportation
  • Massachusetts School Building Authority
  • Metropolitan Area Planning Council
  • Pioneer Valley Planning Commission