Transcript CONNECTING - Center for Science in the Public Interest

Driving Factors:
How Transportation Policy
Affects Health
Environmental Defense
National Alliance for Nutrition and Activity
Surface Transportation Policy Project
For more information, contact Dr. John Balbus (202) 387-3500
1
Summary
• Federal transportation policy offers great potential
for enhancing the nation’s health
• Transportation policy decisions will affect the
severity of two epidemics in the U.S., asthma and
obesity
• The many thousands of deaths each year from
transportation-related crashes demand more
effective safety measures
• Transportation and community design also affect
health through toxic air pollution, impaired water
quality, noise, and access to healthy food
2
What’s driving the asthma epidemic?
Asthma Prevalence in Children and Young Adults: 1980-94
Asthma rates up 75%
from 1980 to 19941
80
70
Number/1,000
60
• Children affected most
50
0- 4
5-14
15-34
40
30
20
– 160% increase in asthma
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prevalence for children under 4
years old between 1980 and
1995
• up from 2.3 million in 1980 to
5.5 million in 19952
– Asthma is the number one
cause of hospitalization
among children under the age
of 153
• Unequal burdens
– Rates in blacks 21% higher
than whites
•
94
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93
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92
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90
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89
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87
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86
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84
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80
0
The annual costs of asthma:
– 5500 deaths
– 1.5 million ER visits
– Estimated $12 billion dollars in 2000
• $8.1 billion direct costs
• 3 million lost adult workdays
• 10.1 million lost schooldays
3
Transportation affects asthma by
worsening air quality
Transportation sources emit over onethird of the chemicals that form ozone
VOC emissions from transportation, 1997
• Motor vehicles release 31% of
volatile organic compounds (VOCs)
•VOCs and Nitrogen oxides (NOx)
combine to form ozone in the
atmosphere
NOx emissions from transportation, 1997
•
National emissions of NOx have
increased 9 % over the past 20 years.
This increase is directly related to
increased driving
4
Medical research links asthma to
transportation
Living within 200 meters
of a major road has been
linked with asthma,cough,
and airway irritation
• Substantial research links
ozone and particulate air
pollution with worsened
symptoms and increased
hospitalization for asthma
• A recent study for the first time
documented children
exercising in high ozone areas
are at higher risk of becoming
asthmatics4
•
The lesson of Atlanta’s summer Olympics5
– A 22.5% drop in morning traffic volume due
to improved traffic management was
associated with:
• Greater than 40% reduction in acute care
visits for asthma
• A 28% drop in peak ozone
• An 11.1% reduction in pediatric ER visits for
asthma
• A 19.1% reduction in hospitalization for
asthma
5
Toxic traffic: carcinogenic effects
of air emissions
• American Cancer Society
study of mortality associated
with fine particulates (PM2.5)
• Multiple Air Toxics Exposure
Study (MATES-II)6
– Landmark urban air quality
study done by Southern
California Air Quality
Management District
– Total added risk 1.4 per
thousand
– 90% of added cancer risk from
transportation sources
– 10 mcg/m3 increase in PM2.5
associated with 8% increase
in lung cancer mortality7
• Denver study found children
living near roads with highest
traffic density had eight-fold
higher leukemia risk8
– Subsequent study in California
did not find increased risk
• 70% diesel particulates
• 20% other air toxics
6
TEA-3: opportunity to support
physical activity
75% of Americans age 18
and older get too little
physical activity11
64% of the U.S.
population is overweight9
(BMI over 25 kg/m2)
• Over 30% are obese, with
higher rates among black and
Mexican-American women10
• Obesity rates doubled between
1980 and 2000
• Obesity increases the risk of
diabetes, heart disease,
cancer and other serious
medical conditions
•
Rising obesity rates are related to
61% increase in diabetes since
199012
7
Obesity Trends* Among U.S. Adults
BRFSS, 1991, 1995 and 200013
(*BMI  30, or ~ 30 lbs overweight for 5’4” woman)
1991
1995
2000
No Data
<10%
10%-14%
15-19%
>20%
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Impacts of physical inactivity
• Health Impacts of
Physical Inactivity14
– Increased risk of obesity
– Increased risk of major
diseases
• Diabetes
• Heart disease and
stroke
• Colon cancer
– Increased symptoms of
depression, anxiety
– Poorer development and
maintenance of skeletal
and muscle tissue
Inactivity and
poor diet second
leading cause
of preventable
death in the U.S
–
Leading to one-third
of all premature
deaths
• The Costs of Physical Inactivity15
– Increasing physical activity among
inactive Americans over the age of 15
could reduce annual national medical
costs by $77 billion
– Estimated 5.5-7% of nation’s total health
costs related to obesity
– 17% of total cost of CVD attributable to
overweight and obesity
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Current transportation policy
discourages physical activity
• The built environment
directly affects whether
people walk or bike16
• Transportation policies
and design influence
choices
Less than 1% of federal
transportation funds go to
pedestrian facilities or
safety
– N. Europe: >40% of trips by
foot or bike, <40% by
private auto
– US: 86% of trips by private
auto, <5% by foot
Anyone for a stroll?
10
Fewer people are walking
• Fewer people are
walking to work:
– 1990 Census: 3.9%
– 2000 Census: 2.9%
• 75% of children don’t
bike or walk to school17
Barriers to Walking
How children get to
school
5-9 yrs
10-15
yrs
Car
53%
44%
School Bus
30%
36%
Walk
11%
12%
Source: U.S. Dept. of Transportation, 1995 Nationwide Personal
Transportation Survey
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Impacts on children
Children are walking less,
gaining weight, and suffering
related illness as a result
Among children, walking trips have
dropped by 37%18
Childhood Obesity*
18
15
percent
•
12
9
6
3
0
1963-65, 1971-74 1976-80 1988-94
196670**
6-11 year olds
19992000
12-19 year olds
95th
*Obese is defined by the
percentile of the sexspecific CDC BMI-for-age-growth charts.
**Data for 1966-70 are for adolescents ages 12-17.
•One in three children in the US is
overweight
•Over the last two decades, rates of
overweight have doubled in children
and tripled in adolescents.
•Children’s hospital discharge rate for
diabetes has doubled19
•From 1979 to 1999, annual hospital
costs for treating obesity-related
diseases in children rose three-fold
($35 million to $127 million)19
•One-fourth of children 5 to 10 years
old have high cholesterol, high blood
pressure, or other early warning signs
of heart disease20
12
Motor vehicle related fatalities remain a
major public health problem
• Motor vehicle crashes
are the leading cause of
deaths due to injury21
• About 13 % of traffic fatalities are
pedestrians or cyclists even
though less than 6% of all trips
are made by foot or bicycle22
• Between 1990 and 1997, there
was a 14% increase in the
number of motor vehicle trafficrelated fatalities among older
adults – defined as adults 65
years and older
13
Child
pedestrians: how
well are we •
protecting them?
Pedestrian injury remains the 2nd
leading cause of injury-related death
among children ages 5-14
In 1998, children less than 15 years
old accounted for
– 30% of all nonfatal pedestrian injuries
– 11% of all pedestrian fatalities22
• 60 percent of parents and children
encounter at least one serious
hazard along their routes to school22
– Common hazards included the lack
of a sidewalk or crosswalk, wide
roads, complicated traffic conditions,
improper parking and speeding
drivers
14
Economic impact of motor
vehicle crashes
More than $230.6 billion each year spent in the United
States according to NHTSA (2000)23
•
– $61 billion in lost workplace productivity
– $20.2 billion in lost household productivity
– $59 billion in property damage
– $32.6 billion in medical costs
– $25.6 billion in travel delay costs
– Cost for average roadway fatality: $977,000
– Cost for critically injured crash survivor: $1.1 million
Overall, nearly 75 percent of the costs of roadway crashes are paid by
those not directly involved. In 2000 these costs totaled $170 billion
– This occurred as federal transportation funding reached a record level of
$33 billion in one year
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Additional health impacts of
transportation policy
• Noise
– Linked to deterioration of children’s mental health24
• Water quality and quantity
– Paving increases pollutant runoff, impeded groundwater recharge
– 4% runoff on grassland vs 15%
in suburbs25
• Mental Health
– Isolation of private motor
vehicle use
• Decline in social capital
• Road rage a growing problem
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Contradictory federal goals
•
US Dept. of Health and Human
Services’ Healthy People 201026
– Reduce proportion of adults,
adolescents and children who are
obese
– “Improve health, fitness, and quality
of life through daily physical activity.”
•
“The major barriers most people face when
trying to increase physical activity are lack of
time, lack of access to convenient facilities,
and lack of safe environments in which to be
active” (emphasis added)
– “Increase use of alternative modes of
transportation to reduce motor vehicle
emissions and improve the Nation's
air quality.”
•
US Dept. of Transportation’s
Transportation Equity Act for the
21st Century
– Provides more funds for states
that spend more on roads and
have more vehicle miles traveled
(VMTs)
– Insufficient transit funds to level
playing field with roadbuilding
– Lack of accountability for how
spending affects communities and
their health
– In the last two years, the portion of
federal spending on new roads
grew 21% while spending on other
transportation modes fell by 19%
Shouldn’t our transportation policies do a
better job of supporting our health agenda?
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Make transportation policy work for our
communities and our health
•
Sustain and expand successful
programs
– Congestion Mitigation and Air Quality
Programs (CMAQ)
– Enchancements
– Recreational Trails
•
•
•
Increase transit funding
Dedicate funding for Safe Routes to
School Programs
Require routine accommodation of
pedestrians and bicyclists
– Also benefits disabled and infirm
seniors
•
Improve accountability through
better data collection, analysis
models and use of health-based
performance standards
–
Collect better data on pedestrians and
bicyclists of all ages
•
Ensure everyone has
transportation choices
– Provide equal employee benefits
to transit riders, pedestrians,
cyclists
•
•
Require Health Impact
Evaluations as part of planning
process
Support better collection of health
data related to transportation
hazards
– $100 million to CDC to support
health tracking system
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References cited
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8.
9.
10.
Mannino, David M., et al. 1998 April 24. Surveillance for Asthma -United States, 1960-1995. CDC
MMWR. 47 (SS-1): 1-28.
U.S. Dept. of Health and Human Services and National Heart, Lung and Blood Institute. 1999. Data
Fact Sheet: Asthma Statistics. [online]. Available from:
http://www.nhlbi.nih.gov/health/prof/lung/asthma/asthstat.pdf. Accessed 2003 Feb 03
American Lung Association. 2002. Pediatric Asthma: A Growing Health Threat. [online]. Available
from: http://www.lungusa.org/asthma/merck_pediatric.html. Accessed 2003 Feb 03
McConnell, R., et al. 2002. Asthma in exercising children exposed to ozone: a cohort study. Lancet
359 (9304): 386-91.
Friedman, MS., Et al. 2001. Impact of changes in transportation and commuting behaviors during the
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Air Quality Management District. 2002. Multiple Air Toxics Exposure Study (MATES II). [online]
Available from: http://www.aqmd.gov/matesiidf/matestoc.htm. Accessed 2003 Feb 03.
Pope et al. 2002. Lung Cancer, Cardiopulmonary Mortality and Long-term Exposure to Fine
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Pearson, R.L. 2000. Distance-weighted traffic density in proximity to a home is a risk factor for leukemia
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