Equitable Adaptation Legal & Policy Toolkit


Public Health Planning Tools

For purposes of this chapter, planning tools come in two different types. First, public health agencies can address climate and health challenges through engaging in their own planning processes, designed to identify populations and communities that are on the front line of climate impacts and most in need of interventions, in order to ensure that any strategies employed are equitable both in outcomes and in process. This type of planning can consist of literally mapping a community’s sensitivities to climate change, using physical data such as temperatures; demographic data including age, income level, and race; and health data including rates of chronic diseases.See footnote 1 By mapping this data, local communities can identify the frontline communities for various health impacts and better target efforts to ensure equitable outcomes. These public health planning tools are discussed in more detail in the Public Health Tools section of this chapter. Community-based organizations can participate in or even lead these processes, given that many of those organizations are already well familiar with which community members are most disadvantaged.

Second, public health agencies and advocates can participate in planning processes that other agencies are managing: for example, comprehensive planning and transportation planning, among others. Bringing a public health perspective to those planning processes helps to ensure that the health consequences are fully integrated into decisionmaking and that equity is fully incorporated in addition to the primary mission of that agency.See footnote 2 Health impact assessments (HIAs) are a key tool for public health agencies to participate in other agencies’ planning processes. HIAs allow a community to fully assess the impacts of a particular built environment project on the health of the people living and working in the project’s neighborhood and surrounding area, as well as to recommend changes to that project in order to minimize negative health impacts and maximize positive health impacts.See footnote 3 Oregon Health Authority’s HIA, discussed below, enabled the agency to identify the positive climate and health effects of a particular transportation project and even to quantify the positive health effects that would result from increased active transportation capacity, for example.See footnote 4 This analysis can help make the case to spend infrastructure or other funds in a climate-smart way and ensure that frontline communities achieve better health outcomes. Fully engaging communities in those planning processes also ensures that the entire project, from concept to design to construction and beyond, fully considers community priorities and knowledge, strengthening the end result.

Public health agencies’ coordinating with other agencies to consider health outcomes can be both time-consuming and challenging. Partner agencies may sometimes be reluctant to engage in a process that may add planning time to an already lengthy review and approval process, and agencies can sometimes be uncomfortable with intrusions into areas that are under their jurisdiction. Both agencies will need to adjust to the sometimes-increased time that full community engagement takes. In places where those barriers have been overcome, however, by developing common goals to work toward, ultimately taking the public health equity perspective can result in both better health outcomes and in strong and more enduring support for climate-beneficial policies such as active transportation or clean energy.

Considerations of Planning Tools for Public Health


  • Planning tools like HIAs can incorporate broader economic considerations such as positive health effects into planning processes, improving many climate-smart projects’ cost-benefit analyses, and allowing jurisdictions to justify the added costs of climate-smart practices.


  • Planning tools can help to build support for climate-smart policies by, for example, incorporating positive health effects into the cost-benefit analysis of those policies, which can cost incrementally more than traditional practices.


  • Planning tools give health agencies an opportunity to bring a frontline community and equity focus to processes that can be heavily focused on engineering and physical impacts.
  • Health impact assessments, in particular, are designed to protect the health of a jurisdiction’s most disadvantaged residents and populations and to make recommendations to increase health equity.See footnote 5 


  • Incorporating health impacts can increase the amount of time taken to approve a project, but can increase its effectiveness and positive impacts.
  • Public health agencies in most places do not have direct decisionmaking authority over built environment planning and construction projects. They must, therefore, engage those partner agencies to bring a critical public health and equity lens to that planning process.


  • Planning tools such as HIAs do not require legal authorization to be used.
  • Several states and local jurisdictions, however, require their use.See footnote 6

Lessons Learned

  • Regional collaboration, in addition to collaboration across sectors, can increase capacity and increase the reach of a particular policy or strategy.
  • By incorporating health effects as well as traditional environmental and climate impacts, more-expensive practices can have a more positive cost-benefit balance than they would otherwise, increasing the likelihood that those practices will be accepted.


Related Resources

Bay Area Regional Health Inequities Initiative’s (BARHII) Climate Change Quick Guides

BARHII is a collaborative of 11 cities and counties in the Bay Area in California that works to incorporate principles of health equity into land use and transportation planning, while putting climate change front and center in those planning processes. The collaborative, begun formally in 2002, actively focuses on the upstream conditions and societal inequalities that overwhelmingly affect health outcomes such as housing affordability, economic inequality, and climate change, among other things. BARHII has created five Quick Guides to highlight climate change as a health equity issue, with Guides covering the health co-benefits of fighting climate change and how local public health departments can get involved in climate efforts. BARHII’s climate efforts are currently focused on a project called Adapting to Rising Tides, which focuses on East Contra Costa County and East Palo Alto to explore how climate change intersects with existing inequalities such as poverty and homelessness, and to create strategic investments to increase resilience in an equitable manner. For this project, BARHII is collaborating with other regional planning agencies in the Bay Area such as the Bay Area Regional Collaborative. A regional approach guarantees that any successful strategies can quickly be replicated in multiple jurisdictions in the area.

Oregon Health Authority Climate Health Impact Assessments

Oregon Health Authority (OHA), Oregon’s state public health agency, conducted three climate-focused Health Impact Assessments (HIAs) between 2011 and 2014 in order to determine the potential health benefits of greenhouse gas reduction projects. Requested by Metro, Portland’s regional planning authority for transportation and land use, OHA’s HIA found that adopting the climate strategies proposed by Metro could reduce heart disease, stroke, and diabetes 2-4% by improving air quality and increasing active transportation. The HIAs also focused on the inequities of disease burden based on proximity to high volume roads, leading to increased injuries and respiratory disease, among other things; increasing active transportation and reducing the number of vehicles on the road could help to reduce this inequity.  This series of HIAs posited that implementing these strategies could also save over $100 million annually in health care costs. The 39-member advisory committee that helped shape and give feedback to the HIA included some community representatives and a representative from the Oregon Health Authority’s Office of Equity and Inclusion but was primarily made up of local and regional government representatives.

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