Outline. Current health challenges (a very partial list)

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1 Atlanta Regional Council Regional Leadership Institute September 21, 2006 Transportation, Land Use, and Public Health: Opportunities for Designing and Building Healthy Places Kenneth Rose, M.P.A., Associate Director National Center for Environmental Health / Agency for Toxic Substances and Disease Registry Centers for Disease Control and Prevention Outline Current and future health challenges The contribution of transportation and land use Getting to healthy places The findings and conclusions in this presentation have not been formally disseminated by CDC/ATSDR and should not be construed to represent any agency determination or policy. Current health challenges (a very partial list) Sedentary lifestyles, overweight/obesity Injury Cardiovascular disease Asthma Mental health Health disparities 1

2 Obesity Trends* Among U.S. Adults BRFSS, 1991, 1996, 2004 (*BMI 30, or about 30 lbs overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 2

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4 Disparities: Housing Non-elderly in Families That Were Unable to Pay Rent, Mortgage, or Utility Bills, 1997 (%) White Non- Hispanic Black Non- Hispanic Hispanic (All Races) Asian/ Pacific Islander Native Amer / Aleut All Races / Ethnicities Low Income Higher Income All Incomes Source: Urban Institute. Racial and Ethnic Disparities: Key findings from the National Survey of America's Families. 2/ Percentage of Students Who Were Overweight (at or above 95% for BMI) Total, 13 White, 12 Black, 16 Hispanic, 17 Total White Black Hispanic Youth Risk Behavior Survey, Consumption and Happiness At and near the poverty level, increased wealth predicts increased happiness (and improved health) Above that level, increased wealth does NOT predict increased happiness 4

5 Income and happiness in the U.S Per capita income Percentage very happy Source: Layard, 2005; data from Gallup and General Social Survey The Genuine Progress Indicator Crime & Family Breakdown Household & Volunteer Work Income Distribution Resource Depletion Pollution Long-Term Environmental Damage Changes in Leisure Time Defensive Expenditures Lifespan of Consumer Durables & Public Infrastructure Dependence on Foreign Assets Indicators of well-being Source: Redefining Progress 5

6 Future Challenges The US population will be: - More numerous - Older - More diverse Physical limits will include: - Petroleum increasingly scarce and expensive - Water increasingly scarce and expensive - Climate change advancing - Land near cities and towns finite Health care increasingly expensive To meet those challenges Room for many people Good places for old people Decrease greenhouse gas emissions Decrease petroleum dependence Promote active lifestyles Prevent injury, CVD, asthma Promote mental health and well-being Rectify health disparities The role of transportation and land use 6

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9 Paving with Good Intentions Source: Atlanta Journal-Constitution, March 10,

10 Residential Segregation 10

11 Food Access In MS, NC, MD, MN neighborhoods: 3x fewer places to consume alcoholic beverages in the wealthiest neighborhoods 4x more supermarkets in white neighborhoods Unequal access a variety of healthy food choices available to non-minority and wealthy communities. Morland K et al. Neighborhood characteristics associated with the location of food stores and food service places. Am J Prev Med 2002;22: Fast-food restaurants are more commonly located in black and low-income neighborhoods. J.P. Block, R.A. Scribner, K.B DeSalvo et al

12 Hubbard Lake Elementary School, Hubbard Lake, Michigan "Outstanding in Its Field" 12

13 What s the alternative? 13

14 Sidewalks and paths: The National Never Walk Campaign 13 Strategies Strategy #1: Don t Build Sidewalks Pedestrian infrastructure 14

15 Strategy #2: Build Repellant Sidewalks 15

16 Strategy #3: Allow Sidewalks to Disintegrate Strategy #4: Build Treacherous Sidewalks 16

17 Strategy #5: Obstruct Sidewalks 17

18 Strategy #6: Use creative design. 18

19 Strategy #7: Crosswalks should be dysfunctional, if not silly. 19

20 Strategy #8: Combine Multiple Strategies 20

21 Strategy # 9: Never place an interesting or useful destination within walking distance of where anybody lives Strategy #10: Just Say It 21

Strategy #11: Zealous Law Enforcement Woman, 82, gets ticket for slow crossing LOS ANGELES (AP) An 82-year-old woman received a $114 ticket for taking too long to cross a street.

She said the motorcycle officer who ticketed her on Feb. 15 told her she was obstructing traffic. "I think it's completely outrageous," said Coyle.

22 Strategy #11: Zealous Law Enforcement Woman, 82, gets ticket for slow crossing LOS ANGELES (AP) An 82-year-old woman received a $114 ticket for taking too long to cross a street. Mayvis Coyle said she began shuffling with her cane across Foothill Boulevard in the San Fernando Valley when the light was green, but was unable to make it to the other side before it turned red. She said the motorcycle officer who ticketed her on Feb. 15 told her she was obstructing traffic. "I think it's completely outrageous," said Coyle. "He treated me like a 6-year-old, like I don't know what I'm doing." Los Angeles police Sgt. Mike Zaboski of the Valley Traffic Division said police are cracking down on people who improperly cross streets because pedestrian accidents are above normal. "I'd rather not have angry pedestrians," Zaboski said. "But I'd rather have them be alive. Others, however, supported Coyle's contention that the light in question doesn't give people enough time to cross the busy, five-lane boulevard. On Friday, the light changed too quickly even for high school students to make it across without running. It went from green to red in 20 seconds. Monday, April 10,

23 Strategy #12: Enshrine the labor-saving device The drive-thru culture. Pharmacies 23

24 Dry Cleaners Booze Baked goods 24

25 Groceries Auto Service Fine Food 25

26 Coffee A nice touch Braille buttons for blind drivers Banking Mail Boxes 26

27 Utility Bills Tunnel of Vows Drive-Thru Wedding Chapel Las Vegas, NV Child support payments 27

28 Gardner Memorial Chapel Davidson, TN Junior Funeral Home Pensacola, FL Drive-Thru Funerals Parking Trees 28

The result April 22, 2003 Transportation, land use, and health Related to automobile dependency Related to land use Related to social processes physical activity air pollution climate change

29 The result April 22, 2003 Transportation, land use, and health Related to automobile dependency Related to land use Related to social processes physical activity air pollution climate change contribution traffic-related injuries water quantity and quality heat island effect mental health impact social capital Non-walkable environment Physical Activity Sedentary lifestyle Overweight Adverse health outcomes 29

The algebra of weight change Calories in Calories out FOOD PHYSICAL ACTIVITY Physical activity A sedentary lifestyle increases the risk of overall mortality (2 to 3-fold) cardiovascular

, JAMA 1999; Blair et al., JAMA 1996 Overweight Increasing weight associated with: risk of overall mortality (up to 2.

30 The algebra of weight change Calories in Calories out FOOD PHYSICAL ACTIVITY Physical activity A sedentary lifestyle increases the risk of overall mortality (2 to 3-fold) cardiovascular disease (3 to 5-fold) multiple other diseases The effect of low physical fitness on CVD is comparable to that of hypertension, high cholesterol, diabetes, and even smoking. Sources: Wei et al., JAMA 1999; Blair et al., JAMA 1996 Overweight Increasing weight associated with: risk of overall mortality (up to 2.5-fold at age 30-44, less at older ages) risk of cardiovascular mortality (up to 4-fold at age 30-44, less at older ages) risk of diabetes (up to 5-fold) risk of hypertension risk of some cancers risk of gall bladder disease Source: Willett et al., New Eng J Med,

31 Air Quality Air quality Car Crashes 31

Automobile fatality rates by city, 2003 (excluding pedestrian fatalities; deaths/100,000/year) New York 2.34 San Francisco 3.32 Seattle 4.22 Philadelphia 5.

32 Automobile fatality rates by city, 2003 (excluding pedestrian fatalities; deaths/100,000/year) New York 2.34 San Francisco 3.32 Seattle 4.22 Philadelphia 5.48 Portland 5.94 Houston 7.86 Washington 8.52 Phoenix Dallas Atlanta Source: NHTSA Pedestrian fatalities Source: Center for Watershed Protection 32

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34 Social capital Social networking and engagement Trust and reciprocity 34

35 Sprawl and social capital commute time social capital (Putnam) Inability to age in place Absence of third places Enforced, and reinforced, income inequality Transportation, land use, and health Related to automobile dependency Related to land use Related to social processes physical activity air pollution climate change contribution traffic-related injuries water quantity and quality heat island effect mental health impact social capital Getting to Healthy Places: How Are We Doing? 35

36 SMART GROWTH good for Obesity! Heart disease! Cancer! Depression! Diabetes! Gall bladder! Social life! Health Built environment 36

37 Environmental sustainability Public education Health Crime prevention Built environment Affordable housing Greenspace and Recreational Facilities 37

38 Arabia Mountain Trail, Georgia 38

39 Envisioning Change 39

40 Elements of Social Marketing Understanding the competition Understanding target markets Creating mutually beneficial exchanges Segmenting markets and targeting based on anticipated return Maibach E. Am J Health Promot 2003;18:

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44 California says its long anti-tobacco campaign has paid off USA Today, January From 1988 to the present: Adult smoking prevalence fell from 23% to 16% High school smoking prevalence fell from 22% to 13% Lung cancer incidence fell from 73.6 to 57.9 /100,000/year Conclusions We face many current and future health challenges in which transportation and land use play a role. We are making real progress in getting to healthy places but we aren t where we need to be Solutions: The Big Picture Transportation Land use Housing Education Recreation Energy 44

Environmental groups Hook and bullet groups Faith community

45 Potential Allies Developers/builders Architects/planners Medical/health professionals Health/environmental agencies Environmental groups Hook and bullet groups Faith community Disease advocacy groups Economic development groups The public and many others Thank you! 45

Active People, Healthy Nation Creating an Active America, Together

National Center for Chronic Disease Prevention and Health Promotion Division of Nutrition, Physical Activity, and Obesity Active People, Healthy Nation Creating an Active America, Together October 19,