The HDMT is a comprehensive evaluation metric to consider health needs in urban development plans and projects. Evaluation of plans or projects against measurable indicators and development targets provides information about both the positive and negative ways in which health is impacted by a proposed development project. This helps to bring attention to the ways that development can improve population health, allowing those involved in policy- and decision-making to make more informed choices between development trade-offs.

The content of the HDMT primarily came from the Eastern Neighborhoods Community Health Impact Assessment (ENCHIA) – an eighteen month process designed to analyze how development in several San Francisco neighborhoods would affect attributes of social and physical environments that are most important to health. Facilitated and staffed by SFDPH, ENCHIA was guided by a multi-stakeholder Community Council of over 20 diverse organizations. The Council’s work and products contained a good deal of content on which to build a comprehensive evaluation tool. As a result, the experience and research from the ENCHIA process was synthesized into the Healthy Development Measurement Tool. For more information on the ENCHIA process, visit the ENCHIA website.

Some targets and indictors are borrowed from other indicators processes and criteria tools, such as the Healthy People 2010 objectives and the LEED-ND criteria. The HDMT attempts to avoid duplicating regulatory building design standards in existing codes and voluntary criteria such as the LEED green building standards. Some development targets or indicators used in the HDMT may be the subject of regulations not related to the HDMT.

As described above, the HDMT grew out of the Eastern Neighborhoods Community health Impact Process (ENCHIA), which commenced in November 2004. The HDMT website was launched in March 2007, and has undergone a number of instrumental changes. To learn more about the HDMTs first year, visit our HDMT Accomplishments

In urban areas, the HDMT is appropriate for new developments in residential, commercial, mixed-use and industrial sites. A large part of this tool may be relevant for evaluating land use development in other dense, socially and economically diverse cities. However, other locales may want to modify indicators and targets to reflect local needs.

The HDMT is not a new form of environmental regulation, and the development targets within the HDMT are not enforceable standards. Similar to tools like U.S. Green Building Council Leadership in Energy and Environmental Design (LEED) and the EPA Smart Growth Index, the HDMT is intended to encourage voluntary efforts to improve health-oriented development.

Good development will always represent an optimal balance between competing objectives. Therefore, a user of the HDMT should expect that for any given project, the HDMT will reveal particular advantages and disadvantages. The achievement of one or more targets alone does not signify good development and the non-achievement of one or more targets does not signal poor development. By providing information about both the positive and negative effects on health objectives, the HDMT helps to reveal trade-offs and aids those involved to make more informed choices with full-recognition of those trade-offs.

Several examples of the types of trade-offs one might expect in the evaluation of land use development projects are:

• Mixed-use developments and higher densities are associated with higher noise levels.
• Abiding by LEED or Energy Star standards increases the cost of the housing production.
• Development of green roofs may compete with the use of roofs for solar energy.
• Desegregating schools may conflict with promoting neighborhood-based education.
• Green space around schools may conflict with the ability of children to walk or bike to school if it necessitates schools being in urban neighborhoods.
• Development targets that decrease segregation and promote racial and economic integration can facilitate gentrification.
• Development impact fees or community benefits agreements may raise the cost of development which reduces developer desire or ability to pay for things like affordable housing or green building design.

The HDMT does not provide a means to weigh conflicting priorities and goals, nor does it advocate for or discourage any specific means of evaluating these trade-offs. The optimal use of the HDMT will occur in an open and transparent decision-making process.

How you select an application for analysis is dependent on a variety of reasons. Foremost in how you use the HDMT is the amount of time and energy you have to conduct an application. With respect to the types of applications, there are a number of examples:

• Community and residents organizations are concerned with the impacts of a large-scale development project in their neighborhood. You may want to use the HDMT to assess that specific project, to identify project benefits and burdens, and to identify potential project improvements.
• A developer is seeking to build support for a project. You may use the HDMT as a checklist to inform design choices and demonstrate the benefits of projects.
• The Planning Department has released a neighborhood Area Plan. To insure that long-range plans for that community provide the health resources needed for existing and future residents, you can apply the HDMT to assess whether the Plan addresses the range of HDMT objectives, to identify Plan deficiencies and to propose measurable objectives and policies/design strategies to advance Area Plan goals.

A typical application of the HDMT is based on three steps that ask:

1)Does a place have healthy living and working conditions?

• To answer this question, use HDMT Indicator data to record and assess baseline conditions. Indicators are presented as maps, figures, tables, and statistics, often disaggregated at the neighborhood level

2)Does a plan or project advance health-related conditions?

• To answer this question, evaluate plan/project documents against HDMT Indicator data and Development Targets.

3)What recommendations for planning policies, implementing actions, or project design would advance community health objectives?

• To answer this question, identify or develop concrete and specific recommendations for plan/project improvements.

Click here to see the steps in applying the HDMT and an example of how it has been applied.

Since the launch of the HDMT in March 2007, staff have been working hard to apply the HDMT in a number of land use planning contexts in San Francisco – both to provide examples of how the HDMT could be applied as well as to improve the consideration of health in these large scale development processes.

Specifically, we completed HDMT applications to 1) the Executive Park Subarea Plan, 2) the Mission, East SoMa, and Potrero Hill / Showplace Square Area Plans, and 3) the Bernal Heights Preschool. We also are in the process of applying the HDMT to the Western SoMa Community Plan. Please visit our Case Studies to access applications reports and findings.

While in some cases, a lack of data about a certain aspect of a project or plan will prohibit the evaluation of an indicator or target, the HDMT is meant to be used comprehensively, by using all objectives and indicators. If not comprehensively used when called for, the HDMT may fail to highlight tradeoffs between objectives.

Every indicator or standard in the HDMT may not be reasonably affected by projects at every scale. A plan level analysis might be able to affect many indicators. A small project may not be able to affect indicators to the same extent as a large project. There may be little value in the application of the HDMT to a small project with effects on few objectives. An initial assessment of relevance between HDMT sections and the plan/project being reviewed will help to highlight what parts of the HDMT are relevant to your analysis. Different kinds of projects have different impacts – not every aspect of the HDMT can be applied across every project/plan. Note, however, that even if you do not use all sections of the HDMT, it is worth reading through the HDMT in its entirety in case there are other development targets, policy or design strategies that could be incorporated into your analysis. For example, you may be focusing on a new park analysis, but skimming through the public infrastructure section, you may realize there are development targets related to schools and to art/cultural facilities that are relevant for your parks analysis. If not comprehensively used when called for, the HDMT may fail to highlight tradeoffs between objectives.

he HDMT works best as a comprehensive preliminary survey tool – it does not provide for in depth rigorous or scientific forecasting of impacts. However, the HDMT may help to identify and prioritize issues to conduct further research on. The HDMT does not provide indicators for all outcomes related to health. The focus of the HDMT is on environmental, social and economic level factors that affect health at the population level. The HDMT does not include traditional behavioral health indicators nor does the HDMT assess factors modifiable at the household level such as environmental tobacco smoke exposure. Many concepts in the HDMT present challenges to measurement. For example, while we use distance as a proxy for accessibility, distance does not represent aspects of accessibility such as time, cost, and quality.

Research methods do not exist to quantify the effects of development plans or projects on every indicator. However, SFDPH does maintain a number of quantitative health impacts forecasting tools that can supplement an application of the HDMT, if needed. These include air quality modeling, noise modeling, pedestrian injuries forecasting, and income and health effects forecasting. The HDMT also provides demographic and health outcomes data to help provide an overall context for your application. Please visit our Application Resources to get more information on our forecasting tools and to access our demographic and health outcomes data.

Developing the HDMT has been a collective learning process. The HDMT is a living tool, and is continually being revised and updated to reflect the state of our knowledge. Many changes come from applications to various projects and plans. The HDMT will continue to undergo peer review by national experts in the fields of public health, planning, environmental protection, and social indicators. New research findings and newly available technologies for measurement and assessment will be incorporated appropriately into the HDMT.

The first version of the HDMT website was launched in March 2007. Since then, a number of revisions were made to the website to improve its content, look and feel. These included a significant revision to existing indicators and development targets based on our application findings in August 2007; adding a "Neighborhood Profiles" section to the website to highlight HDMT neighborhood indicator data in a more accessible way; and, finally, adding a "short-form" or "rapid" development checklist that makes application of the HDMT development targets more user-friendly.

SFDPH staff is committed to one annual mass update to the HDMT website, primarily focusing on revising indicators, data and development targets. This update generally occurs after a large application of the HDMT is completed, as plan/project evaluations often highlight aspects of the HDMT that can be improved. Major re-organizations to the website also occur during this "update" period. Throughout the year, however, indicators that do not have data associated with them may be updated outside of the annual update. In addition, the policies and design strategies, research citations, and established standards referenced throughout the HDMT are updated at all times throughout the year.

We welcome feedback on how to improve the HDMT.

The majority of HDMT indicators that use U.S. Census data rely on data from the 2000 Census, obtained from the GeoLytics® CensusCD® Neighborhood Change Database (NCDB) 1970-2000. In Spring 2008, some HDMT indicators using Census-based population and household denominator data were updated with new 2007 data released by Applied Geographic Solutions (AGS) in an attempt to reflect the changing population demographics of San Francisco. Unfortunately, AGS does not provide updated estimates for all Census variables used in the HDMT. As a result, HDMT indicators are based on a combination of both 2000 and 2007 data, as noted on the individual indicator pages. We anticipate making one annual update to the HDMT and revising all Census -based estimates every three years. Throughout the year, however, indicators that do not have data associated with them may be updated outside of the annual update.

SFDPH respectfully requests that if you are planning on applying the HDMT to a land use/development plan or project, that you notify us of your intention to do so. As we present the HDMT to a range of interested parties, we would like to track how the HDMT is used, the types of projects that are evaluated, findings that are generated, and ultimately, how the results are used. As we revise the HDMT periodically to reflect lessons learned, sharing your application will help us in this process.

"Application" of the HDMT means the evaluation of particular land use plan or project against our development targets and making a general assessment of the "healthfulness" of a plan/project. We do not consider the use of the indicator data, research citations, standards, or development targets as reference material in your work or in developing evaluation materials to be an "application."

Please visit our Notification Requirements to understand more about what this means or to see examples of when we would like to be notified.

The HDMT articulates a vision for growth and development in San Francisco that can accommodate a wide range of plans and projects. While the HDMT can be used to evaluate those plans/projects against that vision for growth, SFDPH is not in a position to endorse specific development plans or projects. Use of the HDMT is meant to highlight the positive and negative impacts of a project/plan and its potential trade-offs, with the ultimate goal of recommending opportunities for improving that project/plan. We generally do not take positions on whether a project should be built, but rather seek to provide mitigations to make a project more "healthful." For those constituencies interested in using the HDMT to evaluate a plan/project on their own, (please read Notification Requirements) such a review does not constitute a SFDPH stamp of approval.

Please visit our Endorsement Disclaimer to learn more.

Of course! We welcome opportunities to discuss the HDMT, train interested parties and provide any additional information. Feel free to send us a message to discuss this further.

Often, an intense amount of resources and time is needed to comprehensively apply the HDMT to a plan or project. This will be determined individually across applications and based on need.

Also, how deep one goes in conducting an application is difficult to standardize across applications, HDMT sections and individuals conducting an application. For example, determining how much qualitative research to conduct and whom to target is difficult to predetermine at the outset. Deciding to apply a forecasting model may need to be assessed based on preliminary findings, and based on what you have prioritized in your application.