Health Impact Assessment Working Group Meeting #2

Health Impact Assessment Working Group Meeting #2 October 18, 2017 LYNX Central Station LYNX Board Room

Introductions and Icebreaker 2

Agenda SR 436 Transit Corridor Study Update HIA Pathway Diagram / Indicators Linking BRT and Complete Streets to Indicators Vulnerable Populations Discussion Interactive Exercise- Quality of Life survey topics Next Steps

SR 434 I-4 Study Area 23 Miles along SR 436 Regional and gateway corridor Connects 7 jurisdictions 11 LYNX routes along and 8 LYNX routes across the corridor 3 SuperStops Red Bug Lake Aloma SR 50 SR 408 Curry Ford Hoffner OIA 4

Schedule What are the issues, opportunities, & objectives? What are our alternatives? Which alternatives best meet our goals & objectives? How will the project impact the health of the corridor communities? Which alternatives do we want to move forward? How can we best fund & implement the preferred alternative? 7/17-6/18 2017 Jan Mar May Jul Sep Nov 2018 Mar May 2018 5

Tiered Alternatives Analysis Level 1 Modes Level 2 Alignments Level 3 Prep Operating scenarios Stations Multimodal access (Complete Streets) Identify Screen Select 6

Level 1 Screening Pop. and emp. density Ridership present Local bus Limited-stop bus Corridor Based BRT Fixed Guideway BRT BRT-Gold Modern Streetcar Light rail transit Commuter rail Heavy rail High speed rail Yes Yes Yes No No No No No No No No Yes Yes Yes No No No No Yes No No No MagLev Proven in North America Easy/simple accessibility Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes No No No Influence economic activity Low Low Medium High High High High Medium High High Adapt to land use changes High High High Medium Medium Low Low Low Low Low Low Permanence of infrastructure Low Low Medium High High High High High High High High ROW Needs Low Low Low High High Medium High High High High High Impact on auto access/turns Environmental/ROW impacts Low Low Low Medium High Medium High High Medium Medium Medium Low Low Medium Medium High Medium High High High High High Req s major improvements Low Low Medium High High High High High High High High Relative capital cost Low Low Low Medium Medium High High High High High High Relative operational cost Low Low Low Low Low Medium Medium High High High High 7 Potential for simple mods High High High Medium Medium Low Low Low Low Low Low

Level 1 - Modes BRT - Silver Ex: Cleveland Healthline Fixed Guideway BRT BRT - Bronze Ex: Eugene Emerald Express Corridor-Based BRT Limited-Stop Bus Ex: FastLinks Local Bus 8

Elements of Bus Rapid Transit Corridor Based BRT Operates in mixed traffic Frequent bi-directional service on weekdays Defined stations Transit Signal Priority Short headway times Fixed Guideway BRT Operates in exclusive lane on >50% of alignment during peak periods Frequent bi-directional service on weekdays and weekends Defined Stations Transit Signal Priority Short headway times *FTA BRT Categories 9

Eugene, OR Emerald Express Branded stations 10

Los Angeles, CA Metroliner Real-time info 11

Grand Rapids, MI The Rapid Level boarding 12

Cleveland, OH Healthline Light rail experience Ticket machines 13

Level 2 Alignments/Segments Extents From where to where? Facilities On which road? Runningways Shared/exclusive? Median/curb? 14

SR 434 Mall Level 2 Candidate Alternatives (Alignments/Segments) Aloma Ave OIA to SR 434 (red) OIA to Aloma Ave (blue) OIA to SR 50 (green) Aloma Ave to Altamonte Mall (orange) US 17/92 to SR 434 (purple) SR 50 OIA 15

Complete Streets Improvements 16

HIA Pathway Diagram/ Health Indicators 17

HIA Goal The goal of the HIA is to better understand the impacts of the potential SR 436 transit improvements on the overall health of the communities that would be served by this proposed transit investment. This would include potential impacts of improvements on: 1. Enhanced transit experience to support current customers, increase ridership from a wider range of potential users, and increase access to community assets 2. Safe, comfortable, and accessible walking and bicycling environments 3. Transportation investments that encourage development and redevelopment consistent with community goals 4. Reliable and safe vehicular mobility 18

Pathway Diagram Exercise Mapping exercise that connects project goals to long-term health outcomes associated with them Outcomes to consider within the scope of an HIA include: Immediate Intermediate Long-term (measured by health indicators) Data sources

Pathway Diagram Exercise Needs/Goals Immediate Outcomes Intermediate Outcomes Long-Term Outcomes (Health Indicators) Potential Data Sources Increase Access and Ridership SR 436 Premium Transit Service Safe and Comfortable Walking & Biking Encourage Development / Redevelopment Reliable & Safe Vehicular Mobility

Pathway Diagram Exercise

Long List of Indicators Asthma / Air Quality Socioeconomic Status Physical Activity Sleep disturbance, stress, hypertension Chronic Disease (Diabetes, Obesity, Heart Disease) Range of Motion Cognition Mental Health / Depression Sense of Community / Quality of Life Bicyclist and Pedestrian Fatality Rates Crime Rates Disposable Income Health Costs Health Insurance Coverage Poverty Levels Mortality / Morbidity Rental Costs / Housing Cost Burden Economic Return on Investment Number of Jobs Crash Rates

Long List of Indicators Pathway Diagram Exercise during WG Meeting #1 Long List Indicators Strongest Relationships to Goals, Outcomes, and Public Preference Short List Indicators Data Availability Primary Indicators Final Pathway Diagram

Linking BRT & Complete Streets to HIA Indicators 24

Research Questions 1. How can the project impact: Ridership and physical activity levels? Transit travel time to work? To health care? Transportation affordability / disposable income? Economic development / redevelopment? 2. How can the project increase access to: Hospitals, clinics, and healthy food sources? Jobs and education? Social services, parks, and exercise opportunities?

Research Questions 3. How can the project affect frequency and severity of bike and pedestrian crashes? 4. How can the increased physical activity and commute benefits of the project affect obesity, respiratory disease, diabetes, and other chronic disease? 5. How can the project affect mental health, hypertension and corridor residents and workers perception of quality of life? 6. How can the project affect air quality and asthma levels? 7. Any others?

Economic Development/Return on Investment Social, Environmental, and Economic Impacts of BRT Systems EMBARQ, 2013 Travel time reductions & improvements with new transit = willingness to pay premium to be closer to stations Bus systems often do not provide sufficient service for working hours of low-skill/entrylevel, temporary, and evening/weekend shift-work jobs More Development for Your Transit Dollar Institute for Transportation and Development Policy, 2013 Economic Returns per Transit Dollar Spent $115: Cleveland Healthline $102: Kansas City MAX $4: Eugene Emerald Express Green Line

Transportation and Housing Affordability Transportation Affordability: Evaluation and Improvement Strategies Victoria Transport Policy Institute, 2017 Lower-income households spend a disproportionate share of their income on transportation Neighborhoods with > mobility options spend less on transportation than cardependent communities National Community Preference Survey National Association of Realtors, 2015 Americans are increasingly prioritizing affordable housing and alternatives to driving Losing Ground: The Struggle of Moderate- Income Households to Afford the Rising Costs of Housing and Transportation Center for Housing Policy, 2012 High housing and transportation costs leave less disposable income for food, education and health care

Transit Commute Time to Work and Health Care and Other Essentials Economic Development Impacts of Bus Rapid Transit University of Minnesota, 2016 BRT improvements shorten commutes and enhance job access Evaluating Public Transportation Health Benefits Victoria Transport Policy Institute, 2010 High quality transit (convenient, comfortable, fast rail and bus transport) can lead to increased access to medical care and healthy food Compared with those who drive, non-driving Americans aged 65 or older make 15% fewer trips to the doctor; 59% fewer shopping trips and restaurant visits; and 65% fewer trips for social, family and religious activities.

Bike and Pedestrian Crash Rates Evaluation of the Safe Routes to Transit Program in California Safe Transportation Research & Education Center, 2014 Safe, welcoming streetscapes increase walking, biking and transit ridership Lessons from the Green Lanes National Institute for Transportation and Communities, 2014 Protected bike lanes (buffered bike lanes and separated cycle tracks) increase the perceived and actual safety of cycling Safety in numbers: more walkers and bicyclists, safer walking and bicycling Injury Prevention, 2003 Increased walking and biking = increased safety Motorists pay attention and adjust behavior

Mental Health and Quality of Life The Mental Health Benefits of Walking Atkinson, 2015 Increasing physical activity decreases anxiety and depression Social Ties and Mental Health Kawachi, 2001 Physical activity has been shown to prevent mental disorders Women who did not exercise were 2x as likely to have depressive symptoms than women who reported moderate+ levels of exercise

Respiratory Disease, Obesity, Diabetes, and Other Chronic Disease Lack of Exercise Responsible for Twice as Many Early Deaths as Obesity University of Cambridge, 2015 A brisk 20 minute walk each day can reduce an individual's risk of early death by between 16-30% Does Bus Rapid Transit Promote Walking? Journal of Physical Activity and Health, 2014 Walking distances to BRT > walking distances to local bus Transit can increase walking by 20 blocks per month or 240 blocks per year Safe walking environments increase walking and health

Emissions and Air Quality Risk of pediatric asthma morbidity from multipollutant exposures California Air Resources Board, 2015 Minority and low-income populations live in areas with higher levels of traffic-related pollution Conserving Energy and Preserving the Environment: The Role of Public Transportation Shapiro, 2002 Transit uses less energy and produces less pollution than travel by private vehicles reducing air pollution levels can reduce the burden of disease from stroke, heart disease, lung cancer, and both chronic and acute respiratory diseases, including asthma. ~World Health Organization

Other research? 34

Short List of Indicators Economic Return on Investment (Property Value) Transportation and Housing Affordability Transit Commute Time to Work Bicyclist and Pedestrian Injury and Fatality Rates Sense of Community / Quality of Life Mental Health / Depression / Stress and Hypertension Respiratory Disease, Obesity, Diabetes, and Other Chronic Disease Transit Access to Health Asthma / Air Quality Income and Poverty Levels Transit Access to Education Transit Access to Healthy Food

Short List of Indicators Pathway Diagram Exercise during WG Meeting #1 Long List Indicators Strongest Relationships to Goals, Outcomes, and Public Preference Short List Indicators Data Availability Primary Indicators Final Pathway Diagram

Primary Indicators Economic Return on Investment (Property Value) Transportation and Housing Affordability Transit Commute Time to Work Bicyclist and Pedestrian Injury and Fatality Rates Sense of Community / Quality of Life Mental Health / Depression / Stress and Hypertension Respiratory Disease, Obesity, Diabetes, and Other Chronic Disease Transit Access to Health Asthma / Air Quality Income and Poverty Levels Transit Access to Education Transit Access to Healthy Food

Primary Indicators No. Indicator Potential Source Data Resolution Priority 1 Economic ROI (Property Value) or New Development Seminole and Orange County Tax Collectors, DOR Parcel Primary 2 Transportation and Housing Affordability Census, Center for Neighborhood Technology Census Block Groups Primary 3 Transit commute time to work along corridor Census, LYNX O-D Survey, AirSage Corridor Users Primary 4 Bike and Pedestrian Crash Rates FDOT CARS and Signal Four Analytics Location-Specific Primary 5 Social Interaction / Quality of Life / Sense of Community HIA Survey, BRFSS, Florida Hospital Community Health Needs Assessment, DOH Survey Zip Code Primary 6 Mental Health / Depression / Hypertension or Mental Health Admissions Health Council of East Central Florida, Florida Hospital, BRFSS, CDC 500 Cities, FL Health CHARTS Zip Code, Census Tract, Blocks? Primary 7 Respiratory Disease, Obesity, Diabetes, and Other Chronic Disease Health Council of East Central Florida, Florida Hospital, BRFSS, CDC 500 Cities, FL Health CHARTS Zip Code, Census Tract, Blocks? Primary 8 Transit commute time to health care along corridor (Access to health care facilities) Orange County Health Department, Seminole County Health Department, Health Council of East Central Florida, Florida Location-Specific Hospital Primary

Final Pathway Diagram (Example)

Vulnerable Populations 40

Vulnerable Populations Rates of serious conditions such as obesity, heart disease, cancer and stroke are substantially higher in the poorest parts of the county (NASEM, 2017) Racial health disparities are projected to cost health insurers $337 billion between 2009 and 2018 (NASEM, 2017) Millions of Americans, especially people with low incomes, the elderly, people with disabilities, and other transit-dependent populations, have difficulty accessing fresh, nutritious food. (Vallianatos, 2002) Pedestrian deaths by race/ethnicity relative to U.S. Population (2005-2014) White Non-White (incl. Hispanic) 34.9% 46.1% 53.1% 62.8% Percentage of Population Percentage of Pedestrian Deaths 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0%

Corridor Demographics Non-White and/or Hispanic 49% Population at or below 150% of Poverty Line 30% Limited English Proficiency 11% Non-Working Age (<18, 65+) 34% Under 18 Seniors 13% 21% Non-SOV Commuters Zero-Car Households Transit Commuters 3% 6% 16% Orlando MSA Study Area Source: ACS data 2011-2015. Note: Updated on 4/13/2017 after the meeting had been held 0% 20% 40% 60% 80% 100%

Transit Riders Annual Household Income Basic Demographics Less than $10,000 $10,000-$19,999 $20,000-$29,999 $30,000-$39,999 18% 18% 21% 22% Not White Non- Hispanic Zero-Car Households Limited English Proficiency 11% 54% 71% $40,000-$49,999 11% Non-Working Age (<18, 65+) 9% $50,000-$74,999 $75,000-$99,999 $100,000 or more 1% 2% 8% Orlando MSA SR 436 Transit Riders Seniors Under 18 6% 3% Orlando MSA SR 436 Transit Riders 0% 10% 20% 30% 0% 20% 40% 60% 80% 100% Source: LYNX Onboard Survey (2016-2017) 44

Transit Riders Annual Household Income 80% Basic Demographics Less than $10,000 $10,000-$19,999 $20,000-$29,999 $30,000-$39,999 18% 18% 21% 22% Not White Non- Hispanic Zero-Car Households Limited English Proficiency 11% 54% 71% $40,000-$49,999 11% Non-Working Age (<18, 65+) 9% $50,000-$74,999 $75,000-$99,999 $100,000 or more 1% 2% 8% Orlando MSA SR 436 Transit Riders Seniors Under 18 6% 3% Orlando MSA SR 436 Transit Riders 0% 10% 20% 30% 0% 20% 40% 60% 80% 100% Source: LYNX Onboard Survey (2016-2017) 45

2 4 4 2 Top 5 Areas Mid-density areas with low vehicle availability 1 4 1 5 1 5 3 3 3 2 5

SR 434 I-4 5 Housing & Red Bug Lake Transportation Affordability 4 Aloma Many residents burdened by the cost of housing and transportation In the MetroPlan Orlando region, the average household is also burdened (61%) Affordable H+T costs (as defined by the experts) = 45% 45% > 45% and 60% > 60% and 75% > 75% and 90% > 90% MSA Average: 61% 3 OIA SR 50 SR 408 Curry Ford Hoffner 1 2 Source: Center for Neighborhood Technology, American Community Survey 2011-2015 47

Previous Surveys Florida Hospital Altamonte PSA Survey (2016) 43% say it is not easy to walk to a transit stop from their home 40% say they cannot easily walk to stores 30% believe it is unsafe to ride a bike in their neighborhood Concerns about speed of traffic and safety of crosswalks Department of Health Orange County CHIP (2015) 83% rated available health care services as good to excellent 23% of the population does not have health insurance 11% of the population rates their mental health status as fair or worse 2002: 51% participated in moderate physical activity; 2007: 49.6% participated in moderate physical activity

SR 436 Transit Survey How do you typically get around? Why don t you take transit?

SR 436 Transit Survey Most important project objectives 1.Effective connections to popular destinations 2.Optimize transportation system through things like signal timing 3.Increase ability for pedestrian and bicyclists to cross SR 436 4.Increased transit frequency 5.Improved transit travel times

Most Desired Transit Features Arrival Time Display Level Boarding Pay Fare by Phone Pre-Board Payment Bike Racks Branded Stations 51

Interactive Exercise- Quality of Life Survey Topics What other health-related topics are we concerned about, keeping in mind the HIA Goal Areas: 1. Enhanced transit experience to support current customers, increase ridership from a wider range of potential users, and increase access to community assets 2. Safe, comfortable, and accessible walking and bicycling environments 3. Transportation investments that encourage development and redevelopment consistent with community goals 4. Reliable and safe vehicular mobility

Interactive Exercise- Quality of Life Survey Topics What other health-related topics are we concerned about? What factors contribute to quality of life / sense of community? Examples: How many community/neighborhood events have you attended in the past year? How connected do you feel to your community and neighbors? How often are you unable to get to work or health care due to public transportation issues?

Next Steps Assessment Phase Baseline Conditions Health Impact Assessment Next Working Group Meeting January 2018 Visit and share our website: www.lynxsr436.com Fill out our surveys Check out upcoming events Download and read study documents OVERVIEW SCHEDULE EXISTING CONDITIONS HIA NEXT STEPS

Community Events EVENTS Gateway Orlando Rebranding Semoran Block Party Full Sail SCA Networking Summit Casselberry EarthFest Neighborhood Leadership Council Orlando Gateway Guardian Active Living Expo Winter Park Casselberry Chamber of Commerce Business Expo Casselberry Jazz Fest Baldwin Park First Friday OktoberFest Bravo Grocery Store Outreach Future SuperStop Outreaches District 2 Fall Festival and more! 55 OVERVIEW SCHEDULE EXISTING CONDITIONS HIA NEXT STEPS

Please share our website and survey! www.lynxsr436.com/metroquest-survey/ 56 INTRO EXISTING CONDITIONS ONGOING WORK ALTERNATIVES NEXT STEPS

Questions? OVERVIEW SCHEDULE EXISTING CONDITIONS HIA NEXT STEPS