Incorporating Health Impact Assessment into Community Design & Transportation Decisions Andrew L. Dannenberg, MD, MPH National Center for Environmental Health Centers for Disease Control and Prevention acd7@cdc.gov
Poll Question How familiar are you with the relationship between community design and health? A. Very familiar B. Familiar C. Somewhat familiar D. Not at all familiar
Community Design and Health Land use Automobile dependency Social processes Obesity, physical activity, CVD Water quantity and quality Air pollution and asthma Climate change contribution Car crashes Pedestrian injuries Mental health impact Social capital Environmental justice
Land Use
Walkable Community Designs Suburban Development Traditional Neighborhood Drawing by Duany Plater Zyberk, in ITE Journal 1989;59:17-18
Access to Parks
Walking & Cycling: International Comparisons Walking and biking trips, 1995 Pedestrian fatalities per 100 million trips, 2000 Pucher, AJPH 93:1509,2003
Increasing Bicycle Use, Portland, OR Cyclists / Day 10,000 Bridge Bicycle Traffic Bikeway Miles 7,500 5,000 78 bikeway miles 2,850 daily trips 263 bikeway miles 11,956 daily trips 2,500 0 78 83 86 103 113 144 166 183 213 222 235 252 254 260 262 263 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 Year
Obesity Trends* Among U.S. Adults 1990 1998 2007 No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% *BMI 30, or about 30 lbs. overweight for 5 4 person (Source: CDC, BRFSS)
Children Walking to School Parental reported barriers to walking/ biking to school: 55% distance 40% traffic danger Source: MMWR 2002;51(32):701-704
Safe Routes to School: Benefits for the Larger Community Half mile school buffers Minneapolis-St. Paul, MN (city population: 2,388,593) Half mile school buffers Bartow County, GA (county population: 76,019) Watson M, Dannenberg AL. Preventing Chronic Disease. July 2008; 5(3):A90
Automobile Dependency
Asthma and Air Pollution Natural experiment during 1996 Summer Olympic games in Atlanta Peak morning traffic decreased 23% and peak ozone levels decreased 28% Asthma-related emergency room visits by children decreased 42% Children s emergency visits for nonasthma causes did not change during same period Friedman et al. JAMA 2001;285:897
Water Quality Water run-off from roads and parking lots pollute water supplies with possible impact on human health Increased erosion and stream siltation causes environmental damage and may affect water treatment plants
Deaths & Injuries by Motor Vehicles Leading cause of deaths among persons 1-34 years old Annual motor vehicle crashes 42,000 deaths 3 million nonfatal injuries $230 billion in costs Sources: CDC, 2000 and NHTSA, 2002
Social Processes
Mental Health Issues Depression Stress ADHD Violent behavior (road rage) Relieved by physical activity & social interaction Relieved by shorter commutes or mass transit May be relieved by greenspace May be relieved by alternate forms of commuting
Social Capital Social networking, civic engagement, trust and reciprocity Decreased by long commutes Travel Portland
Building Social Capital Sunflower painted in Portland, OR, intersection Sidewalk conversations Photos Pause to admire Reading signs Increased to 32% of users vs. 7% in similar unimproved intersection Semenza J, AJPH 93:1439, 2003
Design Principles & Climate Change Transportation alternatives Density Mixed land use Parks and green spaces Energy efficient buildings
Poll Question How aware are you of Health Impact Assessment? A. Very aware B. Aware C. Somewhat aware D. Never heard about it
Health Impact Assessments
Health Impact Assessment (HIA) A tool to increase partnerships and communication between public health professionals and planners and other decision-makers to improve the health of the population
A Vision of Health Impact Assessment Planners request information on potential health consequences of projects and policies as part of decision-making process Health officials will have a tool to facilitate their involvement in planning and land-use decisions HIAs will lead to a better informed decisions
Steps in Conducting an HIA 1 2 3 4 5 6 Screening: Identify projects/policies for which HIA useful Scoping: Identify which health impacts to include Risk assessment: Identify how many and which people may be affected. Assess how they may be affected Recommendations: Identify changes to promote health or mitigate harm Reporting: Report results to decision-makers Evaluation: Evaluate impact of HIA on decision process
Scoping: Health Impacts to Consider Physical activity Air quality Water quality Food quality Injuries Accessibility for disabled Social capital Access to jobs, schools, parks Social equity Mental health Noise
Voluntary vs. Regulatory Approach to HIA Voluntary (tool to inform a planning agency) Regulatory (modeled on a required environmental impact statement) Simpler Less expensive Less litigious More politically acceptable More likely to be used if required More complex More expensive More litigious May be less politically acceptable Less likely to be used if not required
HIAs & Environmental Impact Assessment (EIA) Process HIA components could logically and legally fit into an EIA Incorporating HIAs into an EIA are necessarily regulatory Incorporating health issues into an EIA 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
Walking & Public Transit Minutes of Walking to and from Public Transit Per Day Seattle Municipal Archives Photograph Collection Source: National Household Travel Survey, 2001, USDOT, N= 3312 transit users Besser LM, Dannenberg AL Amer J Prev Med 29:273, 2005
If you build a walkway on a major bridge, how many pedestrians and bicyclists will use it? Cooper River Bridge, Charleston SC C. Frank Starmer from http://ravenelbridge.net
Cooper River Bridge walkway, Charleston SC Photo courtesy of Arthur Wendel
Increases buy-in Routinely used in EIA process Community involvement in conducting an HIA Commonly used in Europe May add to time and resources Identifies social & health issues
Completed HIAs in the U.S.1999 2009 (N = 54) WA 4 OR 2 MT 1 MN 5 CA 25 CO 2 MI 1 OH 1 PA 1 MD 1 MA 2 NJ 1 GA 4 AK 3 FL 1
Impact of HIA on Decisions Documentable impacts evident Plan improvements to increase pedestrian safety Change in redevelopment plans to provide 1:1 housing replacement for affected families Noise mitigation measures required Living wage ordinance adopted Urban road corridor plans improved Awareness of health issues raised for some audiences
HIA Examples
HIAs of Projects and Policies Housing redevelopment Highway corridor redevelopment Pedestrian/bicycle trail development Highway bridge replacement Transit line Community transportation plan Local area and comprehensive plans After-school programs Living wage ordinance Paid sick leave policy Coal-fired power plant Low income home energy subsidies Oil and gas leasing policies
San Francisco Housing Redevelopment Projects Rapid assessment of health impacts in housing redevelopment projects. Qualitative review of Environmental Impact Report, community engagement, secondary data analysis. Findings: Effects on housing affordability, vehicle commutes, displacement of residents, segregation, and public infrastructure Impact: HIA analyses led to improved project with replacement housing for low income residents Conducted by Rajiv Bhatia, San Francisco Health Department
Proposed Redirection of Mass Transit Funding, California 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 Conducted by UCLA School of Public Health
Coal-Fired Power Plant Examined health impacts of proposed 800 megawatt coal-fired power plant in Florida Findings: Fine particulate matter pollution containing SO 2 will decrease life expectancy by 2 days after 16 years of plant operation Hiring low income minority workers for plant would yield health benefits Impact: Decision-makers accepted recommendations, but plant subsequently cancelled due to climate change considerations Conducted by McLeod and Simmons, Healthy Development, Inc.
Seattle SR 520 Bridge Replacement Washington DOT decides old SR 520 bridge needs to be replaced Bridge needs more capacity Legislature mandates an HIA as part of funding process
SR 520 Proposed Replacement Add one HOV lane in each direction Widen shoulders for safety Add 14 foot bicycle/pedestrian path Improve access connections Build 5 lids to add green space Build capacity for future light rail
SR520 Recommendations Construction period Reduce construction related pollution Increase traffic management Provide for construction noise control Transit, bicycling, and walking Increase and improve transit service Install connected walking & bicycling facilities Create a common wayfinding system Provide safe mobility
SR520 Recommendations Landscaped lids and green spaces Include six landscaped freeway lids Use landscaping materials throughout the SR 520 corridor, along adjacent trail and at transit stops Preserve the integrity and ability to appreciate the Washington Park Arboretum and other green spaces Design features Reduce noise Add to the adjacent communities visual character with art and design Utilize innovative storm water management practices
SR520 Bridge HIA: Subsequent Events Project mediation team recommended to Governor to fully implement recommendations Seattle City Council passed a resolution stating that DOT should fully implement recommendations HIA raised awareness about health issues DOT educating staff about health issues HIAs may be used in future projects but no requirement at this time
HIA of Policies to Reduce Vehicle Miles Traveled Examined health impacts of 11 policies to reduce vehicle miles traveled in Oregon Findings: Optimal choice for health benefits would: Change land use Increase cost of driving Increase investment in public transit Impact: Pending Conducted by Mel Rader, Upstream Public Health, Portland, Oregon 2009
HIA of the Atlanta BeltLine Proposed 22-mile urban light rail loop Accompanied by a continuous multi-use trail Connects existing parks and 40+ neighborhoods Opens 2500+ acres for mixeduse redevelopment To be built on existing abandoned or little used rail rights of way www.beltline.org
Atlanta BeltLine HIA Recommendations Encourage project to move forward more quickly than current 25 year plan because of positive health benefits for community Include public health officials in key project decision-making groups Ensure affordable housing is actually built Add more park acreage, especially in underserved southwest quadrant
Health Impact Assessments can help guide community design choices to promote human health www.ph.ucla.edu/hs/health-impact www.cdc.gov/healthyplaces