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

7. Buford Highway Background
CQGRD’s 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

10. LINER: THE OREO DECK - BEFORE

11. LINER: THE OREO DECK - AFTER

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

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

16. Risk Assessment Qualitative Quantitative 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)
5 census blocks
Only counted those that lived ½ mile from highway
14,000 people
Individuals who drive through study area
ADT (23,034) x people per car (1.63)
37,545 people
No demographic data available

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

20. Household Demographics
Average family size is 3.4
70% 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 Highway
Severity N %
Fatalities
Serious Injuries
Visible Injuries
Complaints
No Injuries
DeKalb Board of Health (2003)

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

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
Pedestrian
Injuries/Year ( )
Deaths/Year ( )
Automobile
Injuries/Year ( )

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 Walkable A-
Low Walkable B
Buford Before D
Buford After B-
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