1. ERIC AMSTER, MD MPH INTRODUCTION TO ENVIRONMENTAL AND OCCUPATIONAL HEALTH Built Environment

2. How a city is built including  Roadways  Sidewalks  Public transportation  Housing  Parks and recreation

3. Walkability More walkable a city is the healthier it is  Decreased obesity  Decreased diabetes and hypertension  Safer neighborhoods  Increased social interaction  decreased use of anti- depressants.

4. What makes a place walkable

7. Walkability Wide sidewalks, removed from vehicles Recreational spaces Stores and markets Safe Good lighting

8. Walkability: benefits Increased physical activity  Decreased weight, hypertension, diabetes Decreased air pollution Economic benefits Safer neighborhoods Improved community atmosphere.

9. Sprawl

10. Sprawl: Health Poor access to shopping Large busy roads Need to drive everywhere Distance/detached from neighbors Nutrition Road accidents/injury Increased airpollution decreased activity Decreased community support and trust

11. Cars and Roadways What’s the problem with cars and roadways?

12. Health effects of roadways Trauma: More sprawl, young drivers, nighttime, trucks and speed  road deaths Air Pollution-  Cardioresp disease, resp infections, asthma, MI’s, Angina, premature mortality and LBW. Diesel Particulates and Cancer Note: From exhausts of suburban rich to lungs of urban poor Water Pollution: Sludge and fugitive dust  ground water-  aquifer contamination Urban Sprawl and travel time: Less exercise, more stress, obesity and hypertension

13. Indirect Effects: Economic, Health and Social Impacts of Road Building and Urban Sprawl Capital/Hard Currency Outflow: Cars, Trucks, Oil Wider rich poor gap: Diversion of budgets away from mass transit, education, health. Israel: 45 billion NIS for roads in last decade Estimated costs of 10 cm of TIH-->day care; 15 cm-- >university scholarship; 20 cm for one disabled, 30 cm one teacher.

14. Predict & Provide build roads more cars increased congestion

15. Trans-Israel Highway Largest public works project Affects 202,000 population 16 connecting roads 90 km (stage I) 320 km total Major aquifers 110-120 kph +

16. Trans-Israel Highway and Urban Sprawl from Derech Eretz website

17. Vehicle Travel

18. Deaths/100 million km driven Road (total).95 Motorcycle 13.8 Foot 6.4 Cycle 5.4 Car 0.7 Bus.07 Air.035 Rail.035 Source: ETSC 2003

19. Increased Speed: Higher Emissions New Directions in Speed Management: A Review of Policy, DETR 2000 Speed km/hr PM 10 emissions [gr/km] e.g. PM 10 Emissions from Euro II diesel car

20. Air Pollution from Truck Traffic and Lung Function in Children Living near Motorways Bert Brunekreef, Nicole A. H. Janssen, Jeroen de Hartog, Hendrik Harssema, Mirjam Knape, and Patricia van Vliet “The results indicate that exposure to traffic-related air pollution, in particular diesel exhaust particles, may lead to reduced lung function in children living near major motorways.” Epidemiology 1997; 8:298-303 Environmental Justice: From diesel to kids

21. Residential Proximity to Traffic and Adverse Birth Outcomes in Los Angeles County, California, 1994-1996 Michelle Wilhelm and Beate Ritz Pregnant women living near high traffic roadways face a greater risk of adverse birth outcomes, especially if their third trimester falls during winter or autumn. Children ’ s Health | Articles Environmental Health Perspectives, Feb. 2003, 111:207 Environmental Justice

22. Deaths vs. Speed: Vehicles Nilsson G, The effect of speed limits on road accidents in Sweden. NRTSI, 1982 Percentage change in accident risk

23. Deaths vs. Speed: Pedestrians

24. Problems everywhere Speed Fatigue Cell phones Mass Alcohol/Drugs Young male drivers Vehicle-pedestrian mix Cyclists, motorcyclists, cab-cycles.

25. Road Death Trends in Countries With and Without Speed Cameras: % change from year prior to speed camera implementation * * Except for Israel and the US, where no nationwide speed camera program exists

26. World Totals: >1,200,000 deaths per year Israel: 350/y, 25% Pedestrians Currently: Ranking Cause of PYL<60 Projected Trends: second ranking cause of deaths/y by 2020 Driving Forces, Pressures, Stresses: Economic growth, Explosive growth of number of vehicles Parameters: See next slide

27. הודעה לעיתונות http://www1.cbs.gov.il/reader/newhodaot/hodaa_template.html?hodaa=2 01227095 ____________________________________________________________ __________ Recent Trends: 341 killed in 2012 (120 Pedestrians) 27,141 Injured, 60% interurban 26% of crashes were interurban 28% from Arab sector Increases in Motorcyclist deaths : In 2011: 70% of the pedestrians injured while crossing the road, were injured on crosswalks.

28. Israel and Speed Raise in speed limit: Nov 1993 Each 1 kph raise  10 deaths/yr Effects in interurban roads Effects in soldiers?