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Health Impact Assessment: Case-Study of Buford Highway Candace D. Rutt, Ph.D. Division of Nutrition and Physical Activity National Center for Chronic Disease.

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Presentation on theme: "Health Impact Assessment: Case-Study of Buford Highway Candace D. Rutt, Ph.D. Division of Nutrition and Physical Activity National Center for Chronic Disease."— Presentation transcript:

1 Health Impact Assessment: Case-Study of Buford Highway Candace D. Rutt, Ph.D. Division of Nutrition and Physical Activity National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention

2 HIA Projects Received funding from RWJF to complete 2 case studies of HIA Wanted projects that included physical activity as a health outcome Generated a long list of potential topics Used selection criteria to select final HIAs

3 Screening – Initial List of HIAs General Walkability Walk to School Trails (recreation and transportation) Active Commuting to Work Worksite Interventions Mass Transit Zoning Location Efficient Mortgage Buford Highway Beltine

4 Selection Criteria Specific enough to create quantitative estimates High quality data Not overly complicated Political interest Target at risk populations Foundation for other HIAs Generalizability

5 Buford Highway Background Most dangerous highway in DeKalb county for pedestrians Home to many recent immigrants who are transit dependent Seven lane highway which bisects both residential and commercial areas – greyfield Center for Quality Growth and Regional Development (CQGRD) created detailed conceptual plans for redevelopment

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7 Buford Highway Background CQGRDs conceptual plan –Reduce the number of lanes from 7 to 4 –Reduce speed limit –Build sidewalks and add crosswalks –Add bike lanes –Add center median –Allow shared parking and on-street parking –Increase density and land-use –Develop unused greenspace

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10 LINER: THE OREO DECK - BEFORE

11 LINER: THE OREO DECK - AFTER

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14 Scoping Creation of logic model –Specify how policy and infrastructure changes will eventually impact health outcomes –Helps in focusing the impact assessment QuantitativeQualitative

15 NE Plaza Logic Model Build sidewalks and crosswalks Safety Physical activity Obesity Mortality Lung disease CVD Cancer Diabetes Traffic Land-use People outside Depression, anxiety, stress Hypertension Osteoporosis Air and noise pollution Permit mixed-use zoning floor/area ratio dwelling units pop. density Change 60 ft. easement to 40 ft. (thin wall arcade, buildings built closer to sidewalk, Oreo deck) Social capital Parking requirements Injury I-85 traffic connectivity Bus ridership PolicyProximal Intermediate Health Impacts Impacts Outcomes parking Injuries and fatalities Pop. density

16 Risk Assessment Qualitative –Traffic –Pollution –Social capital –Crime and safety –Economic development –Gentrification Quantitative –Injury –Physical Activity

17 Determining Affected Population The individuals who live in the study area (N. Druid Hills to Clairmont) The individuals who live in the study area (N. Druid Hills to Clairmont) 5 census blocks 5 census blocks Only counted those that lived ½ mile from highway Only counted those that lived ½ mile from highway 14,000 people 14,000 people Individuals who drive through study area Individuals who drive through study area ADT (23,034) x people per car (1.63) ADT (23,034) x people per car (1.63) 37,545 people 37,545 people No demographic data available No demographic data available

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19 Demographics for Study Area Study Area Atlanta Study Area Atlanta % Male Ages: Hispanic Foreign-born Non-resident Poverty

20 Household Demographics Average family size is % of families have 2 or more workers 12% of households have no car and 48% have only 1 car 17% take transit to work and 3% walk

21 Pedestrian Data for All Crashes in DeKalb County, GA Of the 62 fatally injured pedestrians: –47% Black –36% Hispanic –17% White DeKalb Board of Health (2003)

22 Severity of Pedestrian Injuries in DeKalb on Buford Severity of Pedestrian Injuries in DeKalb on Buford Highway SeverityN % Fatalities Serious Injuries Visible Injuries Complaints No Injuries DeKalb Board of Health (2003)

23 Number of Injuries and Deaths on Buford Highway DeKalbStudy Area DeKalbStudy Area (8 miles)(2.37 miles) (8 miles)(2.37 miles) Injuries/year Deaths/year DeKalb Board of Health (2003)

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26 Estimating Changes in Injury No studies could be located to determine injury reduction based on proposed changes Hired senior traffic engineers (Hamilton & Associates) to calculate expected changes

27 Injuries and Fatalities: Study Area Current Expected After Reduction ReductionPedestrian Injuries/Year ( ) 0.4 Pedestrian Deaths/Year ( ) 0.1 Automobile Injuries/Year ( ) 46

28 Physical Activity Hard to find study that had good measures of physical activity and the built environment – we chose study with best measure of physical activity Saelens et al. (2003) found a 72.5 minute difference in total walking per week between neighborhoods in San Diego Saelens et al. (2004) found 124 minute difference in walking for transport In low- income neighborhoods in Seattle

29 Walkability Audit Results Neighborhood Score Grade San Diego High Walkable1.4A- San Diego Low Walkable2.0B Buford Before4.1D Buford After2.4B- 1=A to 6=F

30 Estimating Increases in Walking Since there were only two data points to serve as the source for the effect parameter there was uncertainty with respect to the shape of the relationship between walkability and minutes walked per week –Linear –Dichotomous –Curvilinear –No effect

31 Buford Highway Post-Project – Seattle Estimate = 200 mins/week

32 Cost Effectiveness Model Determine cost-effectiveness of redeveloping Buford Highway (street-scale urban design) compared to other physical activity interventions recommended by the Community Guide for Preventive Services

33 Cost Effectiveness Model In almost all scenarios the redevelopment of Buford Highway was a good investment of money (<$50,000 per QALY) and in most of the scenarios it was cost saving –This does not take into account QALY loss and cost of injuries just increases in QALYs due to physical activity

34 Reporting and Review Manuscripts Numerous presentation at national meetings (Smart Growth, ACSM, etc.) Presentations for local groups (ARC, FHWA, GDOT, DeKalb Board of Health)

35 Evaluation of Impact Sections of Buford Highway (Shallowford to I-285) will be redeveloped starting in the spring of 2005 –Changes will not be as extensive as those proposed by the CQGRD –Decision made before HIA was completed –Possible to get greater changes made to the southern section of Buford Highway

36 Conclusions Redeveloping greyfields could lead to an increase in physical activity and a decrease in injuries HIA is a new and evolving science, however it is a promising new approach to quantify health impacts of a wide variety of policies and projects HIA provides an outlet for health to be appropriately factored into complex decisions


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