The Impact of Transportation on Health: Evidence, Practice and the Case for Mode Shift WE BUILD A BRIGHTER FUTURE Loel Solomon, Ph.D. Vice President, Community Health Kaiser Permanente Transportation Research Board Washington, D.C. January 27, 2011
About Kaiser Permanente Founded in 1945 America s oldest and largest private, nonprofit healthcare organization 8.6 million members 14,600 physicians representing all specialties 167,300 employees Operations in 9 states and D.C. 35 Medical Centers and 431 Clinics 2
Active Transportation: At the Heart of Our Health Mission 3
Impacts on Health: Air Quality Pollutants from autos 8,800 premature deaths a year in CA Air pollution is a known trigger for asthma attacks 4
The High Cost of Polluted Air Failing to meet federal air quality standards led to nearly 30,000 hospital admissions and emergency room visits in California over the period 2005-2007 Illnesses costing almost $200 million per year Kaiser Permanente s share: $30 million The Impact of Air Quality on Hospital Spending John A. Romley, Andrew Hackbarth, Dana P. Goldman RAND Corporation, 2010 5
Impacts on Health: Traffic Safety Leading cause of death for people ages 4 to 34 People of color are disproportionally impacted 6
Smart growth promotes safety Annual Traffic Deaths Per 100,000 Population 40 35 30 25 20 15 10 5 0 Most Sprawled Smartest Growth Source: Reid Ewing et al (2003); as reported by Todd Litman, Victoria Transportation Institute 2009 7
Impacts on Health: Access to Care and Services Transportation is access In an auto-centric society, many are left out: People of color have limited access to cars Poverty compounds the problem Elderly and disabled populations drive less 8
Impact on Health: Physical Inactivity 9
The Impact of Inactivity on Our Clinical Priority Areas Clinical Area Prevalence/Incidence Overweight and Obesity 4,400,000 Asthma 95,000 Cancer 25,000 new cases/yr Chronic Pain 250,000 Coronary Artery Disease 165,000 Depression 415,000 Diabetes 450,000 Heart Failure 80,000 10
Impacts on Health: Physical Activity Increase in obesity risk per hour in a car: 6% Walking and biking reduces obesity Public transit riders are more physically active Driving is a risk factor for obesity 30% 25% 27% % obese (BMI>30) 20% 15% 10% 10% 14% 18% 5% 0% First Quartile Second Quartile Third Quartile Fourth Quartile Vehicle Miles Traveled Source: Lopez-Zetina, Health and Place, 2006 11 11
Every trip on public transit begins and ends with a walk Data from the 2001 National Household Travel Survey (N=3,312) show that 29% of public transit users achieve the Surgeon General s recommendation of 30 minutes or more of physical activity a day while walking to and from transit. Racial/ethnic minorities reported even greater percentages of achieving the recommended level of activity. 50% Percent walked 30+minutes/day 40% 30% 20% 10% 18% 33% 41% 39% Nat l Avg. (10%) 0% White African American Asian/Pacific Islander Hispanic Public Transit Users Source: Besser L, Dannenberg A. Walking to public transit: Steps to help meet physical activity recommendations. American Journal Preventive Medicine 2005; 29(4): 273 280. 12
Active Living Research: Factors associated with active transportation Existence of physical features (e.g. sidewalks, crosswalks, traffic control devises) Perceived safety from traffic and crime Availability of services and goods (e.g. school, work, retail) nearby Accessibility/availability of public transit (i.e. transit users walk to/from transit) Access to public open space, parks, and recreation areas Existence of traffic calming and greater distance from high levels of vehicle traffic High density neighborhoods Source: Active Living Research, 2010 13
Consensus on Active Transportation as Obesity Prevention Strategy Strategy CDC Recommended Strategies IOM Recommended Action Steps Leadership for Healthy Communities Bicycling Supports Enhance infrastructure supporting bicycling Encourage walking and bicycling for transportation and recreation through improvements in the built environment Expand trails, bicycle lanes and connections; improve safety for bicyclists and pedestrians. Walking Supports Enhance infrastructure supporting walking Plan, build, and maintain a network of sidewalks and street crossings that creates a safe and comfortable walking environment and that connects to schools, parks, and other destinations. Expand trails, bicycle lanes and connections; improve safety for bicyclists and pedestrians. School Siting Support locating schools within easy walking distance of residential areas Collaborate with school districts and developers to build new schools in locations central to residential areas and away from heavily trafficked roads. Support walk-to-school and Safe Routes to School (SRTS) programs; expand trails, bicycle lanes and connections. Public Transit Improve access to public transportation. Promote increased transit use through reduced fares for children, families, and students, and improved service to schools, parks, recreation centers, and other family destinations. Promote walkable communities and enhance community access to transportation elements that prioritize the interconnection between walking, bicycling and mass transit Traffic Safety Enhance traffic safety in areas where people are or could be physically active. Implement a traffic enforcement program to improve safety for pedestrians and bicyclists. Access to Facilities Improve access to outdoor recreational facilities Build and maintain parks and playgrounds that are safe and attractive for playing, and in close proximity to residential areas. Increase access to recreation facilities and open spaces, including parks and community gardens. Sources: 1. Centers for Disease Control and Prevention, Recommended Community Strategies and Measurements to Prevent Obesity. July 2009. 2. Institute of Medicine s (IOM) Local Government Actions to Prevent Childhood Obesity. September 2009. 3. RWJF, Leadership for Healthy Communities Action Strategies Toolkit. May 2009. 14
Active Transportation: A Key Element of the Nation s Health Reform Strategy Patient Protection and Afford Care Act (aka Health Reform) Let s Move! and the Interagency Task Force on Childhood Obesity DOT/EPA/HUD Interagency Partnership on Sustainable Communities National Prevention Strategy (Draft) SD1: Healthy physical, social and economic environments SD8: Active living SD9: Injury-free living 15
National Prevention Strategy: Active Living (SD8) Encourage the design and development of neighborhoods that combine homes, workplaces, shopping, schools, transportation and other services so that residents have opportunity to conduct everyday activities by walking, biking and other active transportation modes. Recognize model environments. Facilitate access to safe, well-lit, attractive and affordable places for physical activity including shared spaces such as parks and playgrounds, community centers, schools, fitness centers and outdoor recreation venues. Implement workplace policies and environmental changes that support all individuals, including individuals living with disabilities, to be physically active (e.g., shower facilities, bicycle racks and walking paths, attractive and easily accessible stairwells). 16
Kaiser Permanente Strategies to Support Active Transportation Community Health Initiatives Organizational practices and facility design/siting Collaboration with other funders 17
Kaiser Permanente Supports Intensive HEAL Interventions in 39 Communities Clark County, WA Portland, OR Cleveland, OH Santa Rosa Richmond Modesto Prince George s County, MD 6 HEAC Sites Community Health Initiative sites Joint initiatives with other funders Colorado (statewide) Denver, CO Commerce City, Park Hill, Lincoln Park Atlanta, GA 18
Common Active Transportation Strategies in CHI Sites General Plan amendments Complete streets Safe Routes to School Parks, trails and other active public spaces Social marketing and other programmatic interventions 19
Denver B-Cycle Program 20
Being the Benchmark: Green Guide for Health 21
Kaiser Permanente Master Planning Standards Usable open space for staff and patients to promote activity and social capital Child play areas Exercise paths / par courses Jogging / Walking pathways Bicycle pathways Community or staff gardens Picnic or farmer s market areas. Outdoor group meeting/activity spaces 22
Kaiser Permanente Building & Design Standards Site Circulation Pedestrian Provide landscaped buffers between busy roadways and pedestrian walkways. Provide at least one covered walkway for times of inclement or hot weather. Provide adequate lighting along pedestrian routes. Provide safe crosswalks. Provide non-slip and non-trip walking surfaces. Site Circulation Vehicular When bicycle pathways are required, segregate them from vehicular traffic. (Segregate bicycles and vehicles to provide a safe and pleasant path for bicycle travel. Avoid mid-block crossings that may not be anticipated by drivers.) Site Parking Provide bicycle parking at main building entrance. Building Planning and Layout Stairs Locate stairs for convenience and easy movement between floors for staff and members. Locate and design stairs to encourage use over elevators. 23
Key Enablers of Active Transit: Incentives and Amenities for our Workforce Commuter Flex Spending Account (FSA) Transit subsidies (up to $50/month) Emergency Ride Home programs Preferred carpool/vanpool parking Rideshare assistance Shuttles to transit Bike lockers and bike racks Showers 24
Every Body Walk! Championed by senior Kaiser Permanente leaders Every Body Walk! Website Scientific and medical information on walking Interactive maps with safe walking routes Links to local bike/ped groups Calendar of organized walking events Rich, interactive, shareable video content Social media promotion KP Walk! targeting employees and physicians www.everybodywalk.org 25
Convergence Partnership 26
The Transportation Prescription 27
General Recommendations Prioritize investments in public transportation Prioritize pedestrian and bicycling infrastructure Encourage equitable transit-oriented development by incentivizing integrated land use and transportation planning Create incentives and accountability measures More local flexibility to meet local needs www.convergencepartnership.org 28
General Recommendations (cont d) Prioritize investment in high need areas Make sure job opportunities are available for low-income people Support the development of cleaner bus/truck fleets and invest in freight rail infrastructure Advance safety for all travelers Support policies and programs that increase access to healthy foods Give low-income rural communities greater access to public transportation funds 29
The Road Ahead: Working in the Nexus Healthy People Healthy Environments ACTIVE TRANSPORTATION Thriving Local Economies 30
Thank You! Email: loel.solomon@kp.org 31
ADDITIONAL SLIDES 32
Walk There! Portland, OR 33
Met Branch Trail: Washington, D.C. Photo credit: District Dept of Transportation 34
Safe Routes to School 35
Bike Trails and Walking Paths 36
Denver B-Cycle Program 37