









































November 2022 Volume  7 Issue 1

1

Haleigh Kampman, MPH; Annika Whitlock, BS; Heidi Hosler, MPH

HEALTH IMPACT ASSESSMENT:  THE IMPACTS OF INCREASING 
TREE CANOPY COVERAGE IN MARION COUNTY, INDIANA

Abstract

Background:  Urban tree canopies help to address issues of climate change related to all 
dimensions of health. Certain areas of the city of Indianapolis are more prone to the negative 
effects that lack of tree coverage can cause. This assessment explored the short term and potential 
long-term impacts of the efforts to increase the tree canopy coverage in vulnerable areas of 
Indianapolis. This effort was a collaboration of faculty members from the Indiana University Richard 
M. Fairbanks School of Public Health, Indianapolis Department of Public Works, Keep Indianapolis 
Beautiful, and the Indianapolis Office of Sustainability. 

Methods: Our team used the standard seven-step Health Impact Assessment (HIA) process to 
make the recommendations provided. Using direct observation of the neighborhood, secondary 
data collection, literature review, and a key stakeholder interview, we examined key dimensions of 
health including environmental, physical, and personal health outcomes resulting from increased 
tree canopy coverage within census tract 3505 of Marion County, Indiana.

Results: Increasing the percentage of tree canopy coverage in census tract 3505 – Crown Hill has 
significant positive health impacts with minimal negative outcomes. Such impacts may be, but are 
not subject to, lower temperatures, reduced cases of respiratory and cardiac infections/illnesses, 
promoting animal life, increasing neighborhood property values and filtering pollutants that result 
from human production activity.

Conclusions: Further implementation of the Thrive Indianapolis project has broad positive 
implications for the community members living in this area. While few negative implications were 
found, we make recommendations to mitigate these effects while attempting to supplement the 
current project plan with a focus on the effects to human health. 

Keywords:  HIA, Health Impact Assessment, Census Tract 3503, Crown Hill, Indianapolis, Marion 
County, tree canopy, Thrive Indianapolis, Keep Indianapolis Beautiful (KIB)  



Impacts of Increasing Tree Canopy Coverage Kampman; Whitlock; Hosler

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Introduction
As the climate patterns change across the 
world, there must be action taken within 
communities to adapt to these changing 
temperatures. In Indianapolis, extreme 
weather changes affect certain populations 
disproportionately and areas of high poverty are 
especially prone to the negative side effects of 
poor climate-centered infrastructure planning 
(Vilfranc, 2021). Tree canopy coverage in urban 
areas has many benefits to the health of the 
individuals who live and work there (Indianapolis 
Office of Sustainability, 2019).  

The local nonprofit organization, Keep 
Indianapolis Beautiful (KIB), has been 
working toward addressing this issue, along 
with numerous other nature related tasks 
in the community, for over 40 years (Keep 
Indianapolis Beautiful [KIB], 2022). In 2006 
KIB began an initiative in partnership with the 
Indianapolis Office of Sustainability to address 
the need for more tree canopy coverage in 
Indianapolis (Sheridan, 2021). This health 
impact assessment explores the reasoning 
behind this program, how the program was 
implemented, the successes of the program, 
and how it can be improved to better address 
the social determinants of health as identified.  
The primary objective of this assessment is to 
evaluate the Thrive Indianapolis program and 
provide recommendations to maximize the 
positive outcomes while minimizing the negative 
consequences of the program.

Project Under Assessment
An urban tree canopy is defined as the layer of 
leaves and the amount of coverage or shade 
that is provided by a tree to the ground below 
(U.S. Department of Agriculture, Forest Service, 
2019). Cities can assess the amount of coverage 
provided by a canopy and use this information 
to track the growth and progress of the canopy. 
These tree canopy projects are more than 

just an effort to beautify a community; they 
also assess and evaluate specific social and 
environmental health determinants in areas 
that are lacking resources (U.S. Department 
of Agriculture, Forest Service, 2019). After an 
assessment and analysis has been conducted 
on a specified area, stakeholders provide 
input on the best places to strategically plant 
trees to address the identified environmental, 
social, and health risks. In addition to the initial 
implementation of the tree plantings, continued 
short- and long-term monitoring of these 
canopies is vital to the project. The monitoring 
not only assesses the growth and progress 
of the canopy, but also the effectiveness of 
addressing the health impacts and goals initially 
intended. This HIA was conducted by graduate 
students at the Indiana University Richard 
Fairbanks School of Public Health. 

Health Impact Assessment Methodology
Our HIA sought to evaluate census tract 3505 
(the Crown Hill area) within Marion County, 
Indiana. The graduate student research team 
used the standard seven-step Health Impact 
Assessment (HIA) process adapted from Ross 
and colleagues (2014); the steps are outlined 
below:

1. Screening – determine if usefulness of 
HIA for the project

2. Scoping – plan the HIA
3. Assessment – identify immediate and 

long-term impacts of project
4. Recommendations – provide strategies to 

enhance the positive impacts of the project 
while minimizing any negative impacts

5. Reporting – communicate and disperse 
findings to stakeholders and community

6. Evaluation – understand the implications 
of the project

7. Monitoring – continue to track 
key metrics over time after project 
implementation

(Ross, Orenstein, & Botchwey, 2014)



Impacts of Increasing Tree Canopy Coverage Kampman; Whitlock; Hosler

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Screening
Due to time limitations, faculty members at the 
Indiana University Fairbanks School of Public 
Health conducted this step in the HIA process. 
Prior to student engagement, the faculty 
members identified project opportunities 
which allowed our team to proceed through 
the subsequent steps of a rapid HIA. Further 
discussion of the screening step included: 1) 
an evaluation of whether the project will affect 
a new population; 2) an evaluation of whether 
the decision makers are open to collaborating; 
and 3) an HIA, if there was a value-add to the 
decision and if there was sufficient information 
to conduct additional research (KA Hilts, 2022).

Scoping
Our team relied on literature reviews, secondary 
data collection, and a stakeholder interview 
to assist in the development of a scoping 
document to guide the execution of this HIA. 
Stakeholders were identified by the faculty 
members in the screening process of the 
HIA and included decision-makers from the 
Indianapolis Office of Sustainability, Department 
of Public Works, and Keep Indianapolis Beautiful. 
In our hour-long interview with the stakeholders, 
10 priority areas were identified to expand tree 
canopy coverage using the Key Neighborhood 
Identification Tool (KNIT). A KNIT score is 
derived using four major factors:

• Social Vulnerability Index (SVI) data
• Percent Canopy Coverage
• Concentration of litter and illegal dumping 

complaints
• KIB Program Score

(Adler, Kincius, & McReynolds, 2022)

One of the priority areas having a high KNIT 
score was selected by the graduate student 
research team for subsequent evaluation 
and is the focus of this HIA – census tract 
3505 in Marion County, Indiana. This census 

tract represents a 0.6 square mile area within 
Marion County, Indiana having a population 
of approximately 2,379 (U.S. Census Bureau, 
2022).  The team selected census tract 3505 for 
review due to time limitations.  Familiarity of the 
area, proximity, and background knowledge of 
inequities occurring in this area were additional 
contributors to the selection of this census 
tract.

After conducting a literature review, we 
developed a scoping document which outlines 
the goals of the HIA. These goals were 
extracted from action plans developed by 
various governing agencies with the intent of 
implementing the Thrive Indianapolis program:

1. Increasing community resilience through 
a focus on equity (Indianapolis Office of 
Sustainability, 2019)

2. 100% renewable energy use by 2028 
(WHO, 2022)

3. Achieve net zero greenhouse gas 
emissions in Marion County, Indiana by 
2050 (Indianapolis Office of Sustainability, 
2019)

4. Plant 30,000 native trees in Marion 
County, Indiana by 2050 (Indianapolis 
Office of Sustainability, 2019)

The above outlined goals are the principal 
drivers in the selection and subsequent 
assessment of further expanding tree canopy 
coverage in census tract 3505.

Assessment
Our team relied on stakeholder interviews, 
literature reviews, secondary data collection 
and direct observation of the area to develop 
baseline health, social and environmental 
metrics, and a community profile.  To aid in 
the prioritization of health-specific outcomes, 
we created a pathway diagram displaying how 
increasing tree canopy coverage in census tract 



Impacts of Increasing Tree Canopy Coverage Kampman; Whitlock; Hosler

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3505 would affect the three primary groups of 
social determinants of health (environment, 
individual/family, and institutional). The 
pathways diagram (Figure 1) further outlines 
the proximal, intermediate, and long-term 
effects that increasing tree canopy coverage 
might have. Our literature review also elicited 
the development of four research questions 
that this report further discusses in the results 
section:

1. What impact will an increase in tree canopy 
coverage have on premature deaths, 
hospitalization rates, and mental health 
outcomes?

2. What are the necessary requirements to 
reduce any negative outcomes related to 
increased   tree canopy coverage?

3. How will increasing tree canopies affect 
food insecurity, cost of living, and other 
equity-related issues?

4. How will increased tree canopies affect 
climate change challenges such as heat 
waves, droughts, and flooding? 

Figure 1: Pathways Diagram

Note: Arrows under the proximal outcomes section represent the direction (positive/negative) of 
the predicted outcomes



Impacts of Increasing Tree Canopy Coverage Kampman; Whitlock; Hosler

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Table 1: Demographic Characteristics and Composition of Census Tract 3505 Population

Results
Summary
We conducted three distinct analyses to develop 
a community profile and baseline health metrics 
worthy of further monitoring and evaluation. 
First, our team developed a community profile 
by reviewing publicly available data sets from 
SAVI, the Centers for Disease Control and 
Prevention (CDC), Environmental Protection 
Agency (EPA), and through direct observation 
of the neighborhood. These results are outlined 
in the sections below. Quantitative data were 
compared to Marion County, Indiana rates to 
comprehend possible disparities occurring in 
this area.

Community Profile – Quantitative Results
SAVI data were used to understand the 
demographic characteristics of the population 
in census tract 3505; results are presented 
in Table 1. As a benchmark, we used Marion 
County, Indiana to understand how census 
tract 3505 compares using the same metrics. 
SAVI data were also used to understand 
organizational resources currently available 
in this area; findings can be viewed in Table 2 
and Figure 2. Secondly, our team completed 
a windshield survey/direct neighborhood 
observation focusing on the housing 
characteristics, environmental infrastructure, 
resources, and neighborhood life to get a sense 
of this population’s living circumstances. 

Metric Census Tract 3505
Crown HIll Marion County, Indiana

Population 2,379 951,869

Unemployment Rate 13% 6%

Poverty 47 18

Per Capita Income 15,339 30,013

Violent Crime Rate Per 1,000 92 6

% African American 78% 28%

Median Age 35 34

Poverty (children under 18) 55% 24%

Poverty (65+ yo) 27% 10%

Educational Attainment - 
Bachelor's Degree

6% 32%

(SAVI, 2010; U.S. Census Bureau, 2022)



Impacts of Increasing Tree Canopy Coverage Kampman; Whitlock; Hosler

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Table 2: Organization Resources Available 
Within Census Tract 3505, Crown Hill

Figure 2: Organizational Resources of 
Census Tract 3505 Map

One member of our research team surveyed 
census tract 3505 – Crown Hill on a Thursday 
morning during the summer season; this 
Thursday morning was laden with heavy rain 
and thunderstorms with a temperature of 69 
degrees Fahrenheit. Photographs were taken 
to express housing characteristics, available 
open spaces, community resources, and the 
neighborhood life in the area.
Housing Characteristics

Per the U.S Census Bureau survey completed 
in 2020, there are a total of 1,235 housing units 
in this census block (Figure 2); 21% of these 

units are vacant which is nearly double the rate 
of Marion County, Indiana (11% vacancy) (U.S. 
Census Bureau, 2022). The number of housing 
units outweigh the number of households 
(seen in Figure 3) in this area – there are 973 
households with an average of 2.4 persons per 
household (U.S. Census Bureau, 2022). Majority 
of these households are owned by female 
members which is 1.5 times the rate of Marion 
County, Indiana (U.S. Census Bureau, 2022). It 
was also observed that numerous houses had 
boarded-up or broken windows, with a run-down 
appearance.



Impacts of Increasing Tree Canopy Coverage Kampman; Whitlock; Hosler

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Figure 3: Housing Unit Located in census tract 3505 
– Crown Hill

Figure 4: Representative Household & Structure in 
census tract 3505 – Crown Hill

Open Spaces
While this area had open spaces, the appearance aligned with that of some of the housing 
characteristics. The state of the observed open spaces can be seen in Figure 5. There were a 
handful of empty gravel or concrete-paved lots not in use – some construction debris could be 
seen laying in these areas. The buildings in proximity to these lots had graffiti in addition to vacant 
buildings. 

Figure 5: Open Space Example Within Census Tract 
3505 – Crown Hill



Impacts of Increasing Tree Canopy Coverage Kampman; Whitlock; Hosler

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Community Resources
As discovered in our quantitative overview, 
it was found that this area has very limited 
resources; however, within near proximity 
outside the census tract boundaries, more 
resources can be found. Our team found no 
fire or police stations in the area although 
police presence was observed (Figure 6). 
One elementary school was found to be in the 
area. There are extreme limitations to food 
in the area – a Dollar General, McDonald’s, 
a few gas stations, and liquor stores were 
found in the area suggesting limited potential 
for obtaining healthy food options. Per SAVI, 
this census tract has been deemed a food 
desert (SAVI, 2018) and could benefit from 
alternative project options like a community 
garden or farmer’s market to provide healthy 
food options. This area has also been deemed 
a medically underserved area – meaning there 
are no hospitals or healthcare clinics. Due to 
this fact, we found it essential to prioritize 
baseline metrics including hospitalization rates 
due to inhaled air pollutants, rates of disease 
correlated with inhaled air pollutants including 
COPD, asthma, cardiovascular-related disease, 
and mental health-related disease. Finally, it was 
found that there are six churches in this census 
tract that could provide additional resources 
and feedback.

Neighborhood Life
Our team observed a largely African American 
population confirmed by our quantitative 
results that this area is 78% African American 
(U.S. Census Bureau, 2022). Although not 
observed at the time of the windshield 
survey, a member of our team has previously 
observed homelessness when driving through 
the area on sunny days. We suspect that no 
interaction was occurring from members of 
the neighborhood due to the rain in the area at 
the time of observation; previous sightings by a 
team member of neighborhood interaction had 
occurred outside of the survey timing.

Neighborhood Infrastructure
The observations in this section promote a 
significantly higher health risk for the members 
living in this census tract – in particular, 
members whose houses border major streets. 
This community is adjacent to a main highway, 
I-65; this community is also segregated by 
several major Indianapolis streets, including 
38th Street, Illinois Street, and Capitol Street. 
All these heavy traffic areas increase the 
citizen’s exposure to particulate matter, and 
toxic air pollutants. Furthermore, it was found 
that multiple major bus routes move through 
this area further increasing the chances of air-
pollutant related hospitalizations and disease 

prevalence (Figure 7). These bus routes 
serve as a point of transportation for the 
citizens living in this area; however, the 
risks of the bus routes may outweigh 
the benefits and further research 
would be necessary to determine this. 
Finally, the overall infrastructure was 
run-down, consistent with the housing 
characteristics. To better align this area 
with the goals outlined in the Thrive 
Indianapolis plan, funding to improve 
the built environment to include the 
displacement of debris-laden vacant lots 
with a community garden or plant native 

Figure 5: Open Space Example Within Census Tract
3505 – Crown Hill



Impacts of Increasing Tree Canopy Coverage Kampman; Whitlock; Hosler

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trees may improve the mental health of this area’s citizens and subsequently reduce the excessive 
prevalence of violent crimes by providing a more serene, aesthetically pleasing appearance (Park, 
et al., 2011).

Figure 7: Bus Routes Moving Through Census Tract 
3505 – Crown Hill

Baseline Health Status
We reviewed various health, behavioral, and environmental metrics to evaluate the inequities 
occurring in census tract 3505 – Crown Hill. Disease prevalence and health risk behavior data 
were obtained from the PLACES database – these data are a combination of the Behavioral Risk 
Factor Surveillance System (BRFSS) and census data  (CDC, 2022). The environmental metrics are 
a combination of data from the Environmental Protection Agency’s (EPA) Environmental Justice 
Screening and Mapping Tool (EPA, 2022) and Thrive Indianapolis action plan reports. Baseline 
metrics were prioritized by us to express potential disease exacerbations directly correlated with 
exposure to poor air quality as well as the underlying mechanisms of stress influencing poor mental 
health status. The selected rates are displayed in Table 3 comparing census tract 3505 to Marion 
County, Indiana.



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Metric Census Tract 3505 - 
Crown Hill Marion County, Indiana

Baseline Health Metrics

High Blood Pressure 52% 35%

COPD 13% 7%

Asthma 14% 10%

Stroke 8% 4%

Heart Disease 10% 6%

Diabetes 25% 13%

Depression 21% 20%

Obesity 48% 34%

Baseline Health Behavioral Metrics

Physical Inactivity 51% 34%

Sleep < 7 hours 48% 38%

Mental Health Status (“not 
good” for >=14 days)

23% 16%

Physical Health Status ("not 
good" for >=14 days)

23% 13%

Environmental

Respiratory Risk due to 
cumulative air toxics

0.472 - 0.777 N/A

Summertime Maximum Daily 
Temperature

97.1 - 98 Degrees N/A

Social Vulnerability High N/A

Percent Tree Cover 5 - 15% N/A

Table 3: Baseline Metrics of Census Tract 3505 – Crown Hill Compared to Marion County, 
Indiana: Disease Prevalence Rates, Behavioral Risk Factor Rates, and Environmental Metrics



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Outcome Likelihood Magnitude Additional Considerations & Details

High Blood 
Pressure

Likely
Small to 

Moderate

Literature suggests more green space may lower the odds of 
hypertension, diabetes and cardiovascular disease

(Astell-Burt & Feng, 2019)

COPD Likely
Small to 

Moderate

Certain trees are associated with higher levels of allergens 
(Sousa-Silva, et al., 2021). Allergies have the potential to 
exacerbate symptoms for those with COPD (Gayle, et al., 
2020). Exacerbation of symptoms could be minimized by 

planting trees approved by those directly affected.

Asthma Likely
Small to 

Moderate

Certain trees are associated with higher levels of allergens, 
it would be essential to seek guidance from community 

members where trees will be placed to ensure increased 
asthma-related conditions are mitigated

(Sousa-Silva, et al., 2021)

Stroke Likely
Small to 

Moderate
Those living in greener areas had a lower risk of death in 

those having a prior stroke (Kondo, et al., 2020)

Heart Disease Likely
Small to 

Moderate

Literature suggests more green space may lower the odds of 
hypertension, diabetes and cardiovascular disease

(Astell-Burt & Feng, 2019)

Diabetes Likely Small
Literature suggests more green space may lower the odds of 

hypertension, diabetes and cardiovascular disease
(Astell-Burt & Feng, 2019)

Depression Likely
Small to 

Moderate
Higher levels of green space are associated with lower 

depressive symptoms, anxiety and stress (Beyer, et al., 2014)

Obesity Likely Small
Increasing tree canopy coverage shows an increase in 

physical activity thereby having the potential to reduce rates 
of obesity (Wolf, et al., 2020)

Physical 
Inactivity

Likely Small

Increased heat is directly correlated with lower levels of 
physical activity; increasing tree canopy coverage from 
4% to 60% reduced daily maximum temperatures by 

approximately 3 - 5.23 degrees Celsius
(Esfehankalateh, et al., 2021)

Sleep < 7 
hours

Likely Small

The odds of insufficient sleep were lower among participants 
having higher tree canopy coverage (Astell-Burt & Feng, 

2019) - low-level vegetation was not associated with 
sufficient sleep (Astell-Burt & Feng, 2019)

Mental Health 
Status (not 
good for >=14 
days)

Likely Moderate
Higher levels of green space are associated with lower 

depressive symptoms, anxiety and stress (Park, et al., 2011)

Table 4: Summary Outcomes, Likelihood, Magnitude, and Additional Considerations in 
Implementation



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Outcome Likelihood Magnitude Additional Considerations & Details

Physical 
Health Status 
("not good" 
for >=14 days)

Likely Small

Direct impacts can be measured through increases in 
physical activity and associated reductions in cardiovascular 

disease, diabetes, and other chronic health conditions
(Wolf, et al., 2020)

Respiratory 
Risk due to 
cumulative air 
toxics

Likely Moderate

The planting location of the trees are essential; research 
suggests that trees planted close to the street may disrupt 
wind flow and subsequently trap pollutants below the tree 

canopy line (Vos et al., 2013)

Summertime 
Maximum 
Daily 
Temperature

Likely Moderate

Tree canopy coverage is associated with fewer ambulance 
calls for heat-related events (e.g. heat stroke, heat 

exhaustion) and subsequent heat-related mortality
(Graham, et al., 2016). 

Crime Rates Likely
Small to 

Moderate

Tree canopy coverage is inversely associated with crime 
rates (robbery, theft, shootings). Trees planted near the 

street were associated with decreased crime
(Troy, et al., 2012)

Table 4: Continued

Explanations:  
* Likelihood: strength of evidence in the literature (likely or unlikely); Magnitude: estimated size of the impact (effect on 
number of disease cases or adverse events)

Projected Impacts
We evaluated each of the metrics outlined 
in Table 3 and assessed the likelihood that 
increasing tree canopy coverage has on 
influencing the respective metric and the 
intensity and magnitude of the effect; these 
effects are outlined in Table 4.  In summary, 
increasing tree canopy coverage or additional 
green spaces in this community have the 
potential to reduce all reviewed health outcomes 
if the proper mitigation strategies are executed. 

Mitigation Metrics & Considerations
While the projected impacts of expanding 
the Thrive Indianapolis program to include 
increasing tree canopy coverage are 
overwhelmingly positive, it is also essential 
in the HIA process that mitigation metrics be 
developed to reduce any potential negative 

impacts. Our team would suggest tracking or 
considering the following to ensure mitigation of 
negative outcomes:

1. Planning proper tree planting location; 
literature suggests that trees planted in 
near proximity of the street can disrupt air 
flow thereby trapping air toxins (Vos et al., 
2013)

2. While increased tree canopy coverage 
is associated with reduced gun assaults 
(Wolf, et al., 2020), researchers found 
that small view-obstructing trees are 
associated with increased crime rates 
(Donovan, 2012)

3. Careful consideration must be placed 
on the tree species planted to ensure 
community members are not allergic



Impacts of Increasing Tree Canopy Coverage Kampman; Whitlock; Hosler

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4. While increased urbanization is linked to 
an increase in the incidence of vector-
borne diseases, increasing eco-habits for 
these species also provides opportunity for 
increased exposure and hospitalizations 
(Diuk-Wasser, et al., 2020)

Recommendations
Our team exhibited vigilance to not duplicate 
current efforts and measures that are being 
taken in conjunction with the Thrive Indianapolis 
program. Rather, we found limiting factors in 
the plans that would help to supplement and 
accelerate meeting currently devised metrics.

Recommendation 1: Convert Empty Vacant 
Lots into Community Gardens or Rain Gardens
Direct observation of census tract 3505 
– Crown Hill enables the research team to 
recommend the conversion of vacant lots to 
either community gardens, rain gardens, or 
green spaces. This recommendation directly 
aligns with three of the current metrics being 
reported: 1) total tons of materials recycled; 2) 
square feet of rain garden; and 3) % impervious 
area (City of Indianapolis Office of Sustainability, 
2021). Addressing these metrics would have 
further implications on select public health and 
safety metrics reported out like the percentage 
of adults who are overweight or obese (City of 
Indianapolis Office of Sustainability, 2021). 
While the 2021 report describes current 
funding and efforts to enhance violence 
prevention, the project plan does not report 
any mental-health related outcomes. Our team 
seeks to supplement the plan by encouraging 
additional violence-related health metrics 
to fully understand the effect that the built 
environment, including green areas, has in 
reducing Indianapolis-based crime. Community 
gardens are a proven way to encourage social 
connectivity in communities and enhances 
the sustainability of communities with this 
opportunity. Additionally, green areas have a 

sustainable impact on the mental well-being 
of populations near these areas (South, et al., 
2018). 

Recommendation 2: Develop Partnership with 
IndyGo
The expansion of bus routes in the Indianapolis 
area are contributing to increased diesel exhaust 
exposing members to poor air quality (EPA, 
2022). Our analysis found that census tract 
3505 – Crown Hill is wedged between multiple 
high-traffic city streets (38th Street, Meridian 
Street, Capitol Street, and Illinois Street) and 
is also adjacent to I-65. Our recommendation 
to engage leaders from IndyGo with the intent 
to evaluate bus routes to lessen the effects of 
air pollution from bus exhaust would improve 
psychological stress as well as asthma/COPD-
related hospitalizations. Careful consideration 
must be taken to resolve the increase in air 
pollution while either maintaining or reducing 
the level of transportation options available to 
this community. Our team stresses that barriers 
to transportation would increase vulnerabilities 
in this population.

Recommendation 3: Mitigation Measures
The safety and security of members in this 
community are of utmost importance. While 
evidence shows an overwhelming number of 
positive outcomes stemming from increased 
tree canopy coverage on human health, 
environmental health, and further downstream 
effects, mitigation metrics are an essential 
component to minimize any potential negative 
outcomes. We further recommend the 
mitigation measures outlined in a prior section 
of this report be reported on a regular cadence 
to governing and funding authorities.

Reporting
Results of this analysis will be presented in 
three separate formats. First, this report will 
be provided to the stakeholders for review and 



Impacts of Increasing Tree Canopy Coverage Kampman; Whitlock; Hosler

14

additional feedback. Second, our team will be 
presenting a summarized version of this report 
to stakeholders and faculty members. Third, 
we have intent to submit this report to a peer-
reviewed journal for wider dissemination of 
findings.

Monitoring & Evaluation
Project plans for the Thrive Indianapolis 
program currently provide robust evidence, 
analyses, and tracking that allow for continual 
reporting to governing and funding authorities. 
These project plans currently track metrics 
related to the built environment, energy-use, 
food and urban agriculture, transportation/
land use, and waste/recycling efforts. This HIA 
serves as a supplement to these project plans 
by providing health-related metrics showing the 
direct effect on the populations of the target 
communities. We found several metrics that 
are formally reported with varying timelines 
by the project stakeholders: most occurring 
every year or every three years. However, there 
were minimal health-based outcome measures 
developed. Our team’s recommendations 
would be to partner directly with data-collecting 
organizations such as the Indiana State 
Department of Health to obtain hospitalization 
data from mental health conditions, asthma, 
COPD, heat-related, and cardiovascular-
related events. This partnership would aid in 
regularly monitoring the downstream health 
impacts of increasing tree canopy coverage 
in census tract 3505 – Crown Hill. Publishing 
quantitative results using these data would also 
be beneficial in securing additional funding to 
continue sustainability efforts in Indianapolis 
communities. 

Conclusion
This Health Impact Assessment was conducted 
to determine the health-related benefits 
and consequences of Thrive Indianapolis, 
specifically focusing on the impact of increased 

tree canopy in the Crown Hill neighborhood 
of Marion County, Indiana. Crown Hill has 
disproportionately high rates of unemployment, 
poverty, and violent crime and thus has the 
most to gain from the benefits of increased tree 
canopy and/or green space.  

The assessment was initiated by Keep 
Indianapolis Beautiful and the Indianapolis 
Office of Sustainability and conducted by 
graduate students at the Richard M. Fairbanks 
School of Public Health at Indiana University-
Purdue University Indianapolis. Through key 
interviews, direct observation, secondary data 
analysis, and review of the existing literature, 
our team of graduate researchers assessed 
the impact of the increased tree canopy on 
morbidity and mortality, social equity, and 
mitigation against climate change.  We also 
provide recommendations for maximizing 
the positive and minimizing the negative 
effects of the program.  The major limitation 
of this assessment was time. Because of time 
constraints we were also unable to engage 
community members; additional input 
from these key stakeholders is essential to 
the success of the program and should be 
considered prior to planting.  

In addition to engaging community members in 
planning and evaluation, we make the following 
specific recommendations: 1) convert vacant 
lots into community gardens or rain gardens 
to reduce the effects of climate change; 2) 
develop a partnership with IndyGo to align 
public services to achieve the City’s climate 
change goals ; and 3) continuous monitoring 
of potential threats such as crime and vector-
borne disease to ensure that conditions in the 
Crown Hill neighborhood are not made worse by 
the program initiatives.    



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Astell-Burt, T., & Feng, X. (2019). Urban green space, tree canopy and prevention of cardiometabolic 
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Beyer, K., Kaltenbach, A., Szabo, A., Bogar, S., Nieto, F., & Malecki, K. (2014). Exposure to Neighborhood 
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CDC. (2022, April 4). PLACES: Local Data for Better Health. Retrieved from Centers for Disease Control: 
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CORRESPONDING AUTHOR
Haleigh Kampman
Indiana University Purdue University Indianapolis
1050 Wishard Blvd.
hkampman@iu.edu

CHIA Staff:

Editor-in-Chief 
Cynthia Stone, DrPH, RN, Professor, Richard M. Fairbanks School of Public Health, Indiana 
University-Purdue University Indianapolis

Journal Manager 
Angela Evertsen, BS, Richard M. Fairbanks School of Public Health, Indiana University-Purdue 
University Indianapolis 
Chronicles of Health Impact Assessment Vol. 7 Issue 1 (2022) DOI: 10.18060/26368
© 2022 Author(s): Kampman, H.; Whitlock, A.; Hosler, H.
       This work is licensed under a Creative Commons Attribution 4.0 International License

Wolf, K., Lam, S., McKeen, J., Richardson, G., van den Bosch, M., & Bardekjian, A. (2020). Urban Trees and 
Human Health: A Scoping Review. International Journal of Environmental Research and Public Health, 
17(12): 4371.

Acknowledgements
We would like to recognize several key partners who assisted in providing additional education on 
processes, project background, initiatives, and experiences that allowed our team to compile this 
report:

• Faculty members at the Indiana University Fairbanks School of Public Health
• City of Indianapolis stakeholders in the Office of Sustainability and Department of Public 

Works
• Stakeholders of the Keep Indianapolis Beautiful (KIB) organization


