Use of Health Impact Assessment to Improve Health

Benefits of Transportation Projects and Policies

Andrew L. Dannenberg, MD, MPHAffiliate Professor, University of Washington

Consultant, Healthy Community Design InitiativeCenters for Disease Control and Prevention

acd7@cdc.gov

Transportation Research Board Annual ConferenceWashington 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

• Noise• Water quality• Climate change• Mental health• Social capital• Environmental justice

Obesity Trends* Among U.S. AdultsBRFSS, 1995

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. AdultsBRFSS, 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

NM 1

OH1CA 7

Completed Transportation-Related HIAs in the U.S., 2004–2011 (N = 27)

MN 3

GA 3

WA 5

OR 5

PA 1

MD 1

HIAs of Transportation Projects and Policies, U.S.,

2004-2011 (N=27)5 Corridor redevelopments 5 Road and bridge redevelopments4 Transit-related projects 4 Transportation-related policies 4 Community transportation plans 3 Trails and greenway projects 1 Seaport redevelopment 1 Airport operations assessment

Seattle SR520 Bridge Replacement HIASeattle King County Health Department

• HIA for bridge replacement mandated by state legislature

• Recommendations related to construction-associated 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 N = 25

Statewide N = 2

--------------------------

Primary impact on:

Persons with low income N = 8

Children/adolescents N = 1

Whole population 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

10

19

31

0

10

20

30

40

Min

ute

s p

er d

ay

Besser LM, Dannenberg ALAmer J Prev Med 29:273, 2005

Data from National Household Travel Survey, 2001, USDOT

N= 3312 transit users

Cooper River Bridge, Charleston, SC

How many pedestrians and bicyclists will use a walkway

on a major bridge?

Modeling of Health ImpactsPedestrian injury modelingWier 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 modelingSeto 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 decision-making. 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 topromote human health

www.cdc.gov/healthyplaceswww.healthimpactproject.o

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