Transcript Slide 1

Use of Health Impact
Assessment to Improve Health
Benefits of Transportation
Projects and Policies
Andrew L. Dannenberg, MD, MPH
Affiliate Professor, University of Washington
Consultant, Healthy Community Design Initiative
Centers for Disease Control and Prevention
[email protected]
Transportation Research Board Annual Conference
Washington DC
January 25, 2012
How Does Transportation
Affect Health?
• Physical activity and obesity
• Air pollution and asthma
• Motor vehicle crashes and
pedestrian injuries
• Other impacts
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Noise
Water quality
Climate change
Mental health
Social capital
Environmental justice
Obesity Trends* Among U.S. Adults
BRFSS, 1995
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
Obesity Trends* Among U.S. Adults
BRFSS, 2010
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
A Vision of
Health Impact Assessment
• Transportation planners and elected officials will
request information on potential health
consequences of projects and policies as part of
their decision-making process
• Local health officials will have a tool to facilitate
their involvement in transportation planning
decisions that impact health
• Public health will be at the table
Definition of
Transportation-Related HIA
 Included: Project or policy HIAs in which a local, state,
or federal transportation agency was or could have been
involved
 Example: HIA of walking and bicycling trails designed by a
parks department, because a transportation agency could have
been involved
 Excluded: HIAs of development along a road corridor
and transit oriented development projects unless
transportation was a major component of project
Methods to Identify
Transportation-Related HIAs
 Networking among HIA investigators who
have been involved in HIAs done in United
States
 Literature search on Medline, Google
Scholar, Health Impact Project, and other
databases
 List of HIAs identified may be incomplete
Completed Transportation-Related HIAs
in the U.S., 2004–2011 (N = 27)
WA 5
MN 3
OR 5
PA 1
OH1
CA 7
MD 1
NM 1
GA 3
HIAs of Transportation
Projects and Policies, U.S.,
2004-2011 (N=27)
5
5
4
4
4
3
1
1
Corridor redevelopments
Road and bridge redevelopments
Transit-related projects
Transportation-related policies
Community transportation plans
Trails and greenway projects
Seaport redevelopment
Airport operations assessment
Seattle SR520 Bridge Replacement HIA
Seattle King County Health Department
• HIA for bridge replacement mandated by state
legislature
• Recommendations related to constructionassociated pollution, walking and biking
connectivity, landscaped lids to cover parts of
highway, and design features to reduce noise
• City council and project mediation
team supported recommendations
• Impacts on final design pending
HIA of Proposed Redirection of
Mass Transit Funding in California
UCLA School of Public Health
• Examined health impacts of loss of mass transit
funds through legislative reallocation
• Findings
– Identified multiple links between transit funding and
obesity, CVD, respiratory conditions, and injuries
– Many uncertainties in quantitative estimates
– Reallocation could improve health if used for health
care for uninsured children
• Impact: Legislature approved
reallocation of funds prior to
completion of HIA
HIA of Policies to Reduce Vehicle
Miles Traveled in Oregon, 2009
Mel Rader, Upstream Public Health, Portland
• Examined health impacts of 11
policies designed to reduce
vehicle miles traveled in Oregon
• Findings: Optimal choice for
health benefits would be a
combination of policies that:
– Change land use
– Increase cost of driving
– Increase investment in public transit
• Impact: Pending
Sacramento Safe Routes to School
Program HIA, 2005
• Expansion of Safe Routes to School program to more
local schools in Sacramento
• Examined predicted changes in physical activity,
pedestrian safety, violence, air pollution
• Predicted children active >30 minutes/day to increase
from 13% to 21%, and BMI decrease of 0.09 in
overweight students
• Predicted possible improvements in pedestrian safety
and in neighborhood safety
http://www.ph.ucla.edu/hs/hiaclic/archive/walk04.htm
Population Affected by
Project or Policy in
27 Transportation-Related HIAs
Local level
Statewide
-------------------------Primary impact on:
Persons with low income
Children/adolescents
Whole population
N = 25
N= 2
N= 8
N= 1
N = 18
Impact of HIA on
Subsequent Decisions
 Documentable impacts were evident for some HIAs
 Urban road corridor plans improved (Lowry corridor)
 Health professional added to project’s decision
making team (Atlanta BeltLine)
 HIA recommendations submitted for incorporation into
EIS process (Baltimore Red Line)
 Some HIAs encouraged projects or policies that would
be health-promoting as designed (Walk to school)
 Most HIAs raised awareness of health issues for some
audiences
Relationship of HIA to
Environmental Impact
Assessment (EIA)
• HIA components could logically and
legally fit within an EIA process
• HIA incorporated into EIA is necessarily
regulatory
• Incorporating health issues into current
EIA process has been successful in
some settings
HIA Level of Complexity
• Qualitative – describe direction but not
magnitude of predicted results
– Easy to predict; hard to use in cost/benefit models
– Example: Build a sidewalk and people will walk more
• Quantitative – describe direction and
magnitude of predicted results
– Difficult to obtain data; useful for cost/benefit models
– Hypothetical example: Build a sidewalk and 300
people who live within 200 yards of location will walk
an average of 15 extra minutes per day
Minutes of Walking To and From
Public Transit Per Day
31
30
19
20
10
ile
%
75
ED
IA
N
M
ile
0
%
Data from National Household
Travel Survey, 2001, USDOT
N= 3312 transit users
Besser LM, Dannenberg AL
Amer J Prev Med 29:273, 2005
10
25
Minutes per day
40
How many pedestrians and
bicyclists will use a walkway
on a major bridge?
Cooper River Bridge, Charleston, SC
Modeling of Health Impacts
Pedestrian injury modeling
Wier M, Weintraub J, Humphreys EH, Seto E, Bhatia R.
An area-level model of vehicle-pedestrian injury
collisions with implications for land use and
transportation planning.
Accid Anal Prev. 2009 Jan;41(1):137-45.
Noise modeling
Seto EY, Holt A, Rivard T, Bhatia R.
Spatial distribution of traffic induced noise exposures
in a US city: an analytic tool for assessing the health
impacts of urban planning decisions.
Int J Health Geogr. 2007 Jun 21;6:24.
Required HIAs:
Massachusetts
• Massachusetts legislature adopted Healthy
Transportation Compact in 2009
• Requires state agencies to “implement health
impact assessments for use by planners,
transportation administrators, public health
administrators and developers”
• Implementation details being worked out
through collaboration between Department of
Transportation and Department of Health
National policies and statements
that encourage use of HIA
National Research Council, Committee on
Health Impact Assessment, 2011
“HIA is a particularly promising approach
for integrating health implications into decisionmaking. International experience and the
limited (but growing) experience in the United
States provide important clues as to what is
needed most to advance HIA.”
National policies and statements
that encourage use of HIA
CDC Recommendations for Improving Health
through Transportation Policy, 2011
“Encourage states and communities to
consider health impacts as part of
transportation planning. Health impact
assessments and safety audits may be a useful
tool to identify the impact of a new policy,
program or major transportation project on
community and individual health.”
Challenges in Conducting
Transportation-related HIAs
• Modeling – difficult to quantitate health
impacts
• Resistance – experience of regulatory
burden from EIAs
• Capacity - few staff trained to conduct HIAs
• Resources - who pays to conduct HIAs
• Evaluation – need to document value of HIA
Final comments
• Use of HIA for transportation projects and policies
growing in US, but not widespread
• Some HIAs conducted within context of
Environmental Impact Assessment process
• Ongoing demand for HIA training
• More work needed on modeling of health impacts
• New RWJF/Pew initiative expands HIA use in US
• New TRB health and transportation subcommittee
Health Impact Assessment
can help guide
transportation choices to
promote human health
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www.cdc.gov/healthyplaces
www.healthimpactproject.org