Transcript Health Impact Assessment: Case-Study of Buford Highway Candace D. Rutt, Ph.D. Division of Nutrition and Physical Activity National Center for Chronic Disease Prevention and Health.

Health Impact Assessment:
Case-Study of Buford Highway
Candace D. Rutt, Ph.D.
Division of Nutrition and Physical Activity
National Center for Chronic Disease Prevention
and Health Promotion
Centers for Disease Control and Prevention
HIA Projects
Received funding from RWJF to complete
2 case studies of HIA
Wanted projects that included physical
activity as a health outcome
Generated a long list of potential topics
Used selection criteria to select final HIAs
Screening – Initial List of HIAs
General Walkability
Walk to School
Trails (recreation and transportation)
Active Commuting to Work
Worksite Interventions
Mass Transit
Zoning
Location Efficient Mortgage
Buford Highway
Beltine
Selection Criteria
Specific enough to create quantitative
estimates
High quality data
Not overly complicated
Political interest
Target at risk populations
Foundation for other HIAs
Generalizability
Buford Highway Background
Most dangerous highway in DeKalb county for
pedestrians
Home to many recent immigrants who are transit
dependent
Seven lane highway which bisects both
residential and commercial areas – “greyfield”
Center for Quality Growth and Regional
Development (CQGRD) created detailed
“conceptual” plans for redevelopment
Buford Highway Background
CQGRD’s conceptual plan
– Reduce the number of lanes from 7 to 4
– Reduce speed limit
– Build sidewalks and add crosswalks
– Add bike lanes
– Add center median
– Allow shared parking and on-street parking
– Increase density and land-use
– Develop unused greenspace
LINER: THE OREO DECK - BEFORE
LINER: THE OREO DECK - AFTER
Scoping
Creation of logic model
– Specify how policy and infrastructure changes
will eventually impact health outcomes
– Helps in focusing the impact assessment
Quantitative
Qualitative
NE Plaza Logic Model
Policy
Build sidewalks
and crosswalks
Change 60 ft.
easement to 40
ft. (thin wall
arcade, buildings
built closer to
sidewalk, Oreo
deck)
Proximal
Impacts
Safety
Traffic
 connectivity
Parking
requirements
Land-use
Permit mixed-use
zoning
 floor/area ratio
 dwelling units
 pop. density
 parking
Intermediate
Impacts
Health
Outcomes
Air and noise
pollution
Lung disease
Physical activity
Mortality
Obesity
Social capital
CVD
Injuries and
fatalities
Cancer
Diabetes
People outside
Depression,
anxiety, stress
I-85 traffic
Hypertension
Pop. density
Osteoporosis
Bus ridership
Injury
Risk Assessment
Qualitative
– Traffic
– Pollution
– Social capital
– Crime and safety
– Economic development
– Gentrification
Quantitative
– Injury
– Physical Activity
Determining Affected Population
 The individuals who live in the study area (N.
Druid Hills to Clairmont)
 5 census blocks
 Only counted those that lived ½ mile from highway
 14,000 people
 Individuals who drive through study area
 ADT (23,034) x people per car (1.63)
 37,545 people
 No demographic data available
Demographics for Study Area
% Male
Ages: 18-39
Hispanic
Foreign-born
Non-resident 1995
Poverty
Study Area
60.0
51.6
49.8
61.1
26.6
15.8
Atlanta
49.4
36.5
6.5
10.3
4.1
9.2
Household Demographics
Average family size is 3.4
70% of families have 2 or more workers
12% of households have no car and 48%
have only 1 car
17% take transit to work and 3% walk
Pedestrian Data for All Crashes
in DeKalb County, GA
Of the 62 fatally injured pedestrians:
– 47% Black
– 36% Hispanic
– 17% White
DeKalb Board of Health (2003)
Severity of Pedestrian Injuries in
DeKalb on Buford Highway
Severity
Fatalities
Serious Injuries
Visible Injuries
Complaints
No Injuries
DeKalb Board of Health (2003)
N
12
17
29
12
4
%
16.2
23.0
39.2
16.2
5.4
Number of Injuries and Deaths
on Buford Highway
Injuries/year
Deaths/year
DeKalb
(8 miles)
18.6
3.6
DeKalb Board of Health (2003)
Study Area
(2.37 miles)
6.7
1.8
Estimating Changes in Injury
No studies could be located to determine
injury reduction based on proposed
changes
Hired senior traffic engineers (Hamilton &
Associates) to calculate expected changes
Injuries and Fatalities: Study Area
Current
Expected
Reduction
After
Pedestrian
Injuries/Year
6.7
.91 (.89- .94)
0.4
Pedestrian
Deaths/Year
1.8
.91 (.89- .94)
0.1
Automobile
Injuries/Year
120
.60 (.39 -.65)
46
Physical Activity
Hard to find study that had good measures of
physical activity and the built environment –
we chose study with best measure of
physical activity
Saelens et al. (2003) found a 72.5 minute
difference in total walking per week between
neighborhoods in San Diego
Saelens et al. (2004) found 124 minute
difference in walking for transport In lowincome neighborhoods in Seattle
Walkability Audit Results
Neighborhood
Score
Grade
San Diego
High Walkable
1.4
A-
San Diego
Low Walkable
2.0
B
Buford Before
4.1
D
Buford After
1=A to 6=F
2.4
B-
Estimating Increases in Walking
Since there were only two data points to serve
as the source for the effect parameter there was
uncertainty with respect to the shape of the
relationship between walkability and minutes
walked per week
–
–
–
–
Linear
Dichotomous
Curvilinear
No effect
Buford Highway Post-Project
– Seattle Estimate = 200
mins/week
Cost Effectiveness Model
Determine cost-effectiveness of
redeveloping Buford Highway (street-scale
urban design) compared to other physical
activity interventions recommended by the
Community Guide for Preventive Services
Cost Effectiveness Model
In almost all scenarios the redevelopment
of Buford Highway was a good investment
of money (<$50,000 per QALY) and in
most of the scenarios it was cost saving
– This does not take into account QALY loss
and cost of injuries just increases in QALYs
due to physical activity
Reporting and Review
Manuscripts
Numerous presentation at national
meetings (Smart Growth, ACSM, etc.)
Presentations for local groups (ARC,
FHWA, GDOT, DeKalb Board of Health)
Evaluation of Impact
Sections of Buford Highway (Shallowford
to I-285) will be redeveloped starting in the
spring of 2005
– Changes will not be as extensive as those
proposed by the CQGRD
– Decision made before HIA was completed
– Possible to get greater changes made to the
southern section of Buford Highway
Conclusions
Redeveloping greyfields could lead to an
increase in physical activity and a
decrease in injuries
HIA is a new and evolving science,
however it is a promising new approach to
quantify health impacts of a wide variety of
policies and projects
HIA provides an outlet for health to be
appropriately factored into complex
decisions