1. Use of Health Impact Assessment to Improve Health Benefits of Transportation Projects and Policies Andrew L. Dannenberg, MD, MPH Affiliate Professor, University of Washington Consultant, Healthy Community Design Initiative Centers for Disease Control and Prevention acd7@cdc.gov Transportation Research Board Annual Conference Washington DC January 25, 2012

2. How Does Transportation Affect Health? Physical activity and obesity Air pollution and asthma Motor vehicle crashes and pedestrian injuries Other impacts Noise Water quality Climate change Mental health Social capital Environmental justice

3. Obesity Trends* Among U.S. Adults BRFSS, 1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

4. Obesity Trends* Among U.S. Adults BRFSS, 2010 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

5. A Vision of Health Impact Assessment Transportation planners and elected officials will request information on potential health consequences of projects and policies as part of their decision-making process Local health officials will have a tool to facilitate their involvement in transportation planning decisions that impact health Public health will be at the table

6. Definition of Transportation-Related HIA  Included: Project or policy HIAs in which a local, state, or federal transportation agency was or could have been involved  Example: HIA of walking and bicycling trails designed by a parks department, because a transportation agency could have been involved  Excluded: HIAs of development along a road corridor and transit oriented development projects unless transportation was a major component of project

7. Methods to Identify Transportation-Related HIAs  Networking among HIA investigators who have been involved in HIAs done in United States  Literature search on Medline, Google Scholar, Health Impact Project, and other databases  List of HIAs identified may be incomplete

8. NM 1 OH1 CA 7 Completed Transportation-Related HIAs in the U.S., 2004–2011 (N = 27) MN 3 GA 3 WA 5 OR 5 PA 1 MD 1

9. HIAs of Transportation Projects and Policies, U.S., 2004-2011 (N=27) 5 Corridor redevelopments 5 Road and bridge redevelopments 4 Transit-related projects 4 Transportation-related policies 4 Community transportation plans 3 Trails and greenway projects 1 Seaport redevelopment 1 Airport operations assessment

10. Seattle SR520 Bridge Replacement HIA Seattle King County Health Department HIA for bridge replacement mandated by state legislature Recommendations related to construction- associated pollution, walking and biking connectivity, landscaped lids to cover parts of highway, and design features to reduce noise City council and project mediation team supported recommendations Impacts on final design pending

11. HIA of Proposed Redirection of Mass Transit Funding in California UCLA School of Public Health 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

12. HIA of Policies to Reduce Vehicle Miles Traveled in Oregon, 2009 Mel Rader, Upstream Public Health, Portland Examined health impacts of 11 policies designed to reduce vehicle miles traveled in Oregon Findings: Optimal choice for health benefits would be a combination of policies that: –Change land use –Increase cost of driving –Increase investment in public transit Impact: Pending

13. Sacramento Safe Routes to School Program HIA, 2005 Expansion of Safe Routes to School program to more local schools in Sacramento Examined predicted changes in physical activity, pedestrian safety, violence, air pollution Predicted children active >30 minutes/day to increase from 13% to 21%, and BMI decrease of 0.09 in overweight students Predicted possible improvements in pedestrian safety and in neighborhood safety http://www.ph.ucla.edu/hs/hiaclic/archive/walk04.htm

14. Population Affected by Project or Policy in 27 Transportation-Related HIAs Local levelN = 25 Statewide N = 2 -------------------------- Primary impact on: Persons with low incomeN = 8 Children/adolescents N = 1 Whole populationN = 18

15. Impact of HIA on Subsequent Decisions  Documentable impacts were evident for some HIAs  Urban road corridor plans improved (Lowry corridor)  Health professional added to project’s decision making team (Atlanta BeltLine)  HIA recommendations submitted for incorporation into EIS process (Baltimore Red Line)  Some HIAs encouraged projects or policies that would be health-promoting as designed (Walk to school)  Most HIAs raised awareness of health issues for some audiences

16. Relationship of HIA to Environmental Impact Assessment (EIA) HIA components could logically and legally fit within an EIA process HIA incorporated into EIA is necessarily regulatory Incorporating health issues into current EIA process has been successful in some settings

17. 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

18. Minutes of Walking To and From Public Transit Per Day Besser LM, Dannenberg AL Amer J Prev Med 29:273, 2005 Data from National Household Travel Survey, 2001, USDOT N= 3312 transit users

19. Cooper River Bridge, Charleston, SC How many pedestrians and bicyclists will use a walkway on a major bridge?

20. Modeling of Health Impacts Pedestrian injury modeling Wier M, Weintraub J, Humphreys EH, Seto E, Bhatia R. An area-level model of vehicle-pedestrian injury collisions with implications for land use and transportation planning. Accid Anal Prev. 2009 Jan;41(1):137-45. Noise modeling Seto EY, Holt A, Rivard T, Bhatia R. Spatial distribution of traffic induced noise exposures in a US city: an analytic tool for assessing the health impacts of urban planning decisions. Int J Health Geogr. 2007 Jun 21;6:24.

21. Required HIAs: Massachusetts Massachusetts legislature adopted Healthy Transportation Compact in 2009 Requires state agencies to “implement health impact assessments for use by planners, transportation administrators, public health administrators and developers” Implementation details being worked out through collaboration between Department of Transportation and Department of Health

22. National policies and statements that encourage use of HIA National Research Council, Committee on Health Impact Assessment, 2011 “HIA is a particularly promising approach for integrating health implications into decision- making. International experience and the limited (but growing) experience in the United States provide important clues as to what is needed most to advance HIA.”

23. National policies and statements that encourage use of HIA CDC Recommendations for Improving Health through Transportation Policy, 2011 “Encourage states and communities to consider health impacts as part of transportation planning. Health impact assessments and safety audits may be a useful tool to identify the impact of a new policy, program or major transportation project on community and individual health.”

24. Challenges in Conducting Transportation-related HIAs Modeling – difficult to quantitate health impacts Resistance – experience of regulatory burden from EIAs Capacity - few staff trained to conduct HIAs Resources - who pays to conduct HIAs Evaluation – need to document value of HIA

25. Final comments Use of HIA for transportation projects and policies growing in US, but not widespread Some HIAs conducted within context of Environmental Impact Assessment process Ongoing demand for HIA training More work needed on modeling of health impacts New RWJF/Pew initiative expands HIA use in US New TRB health and transportation subcommittee

26. Health Impact Assessment can help guide transportation choices to promote human health www.cdc.gov/healthyplaces www.healthimpactproject.org