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

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

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

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

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

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

LINER: THE OREO DECK - BEFORE

LINER: THE OREO DECK - AFTER

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

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

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

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

Demographics for Study Area Study Area Atlanta % Male 60.0 49.4 Ages: 18-39 51.6 36.5 Hispanic 49.8 6.5 Foreign-born 61.1 10.3 Non-resident 1995 26.6 4.1 Poverty 15.8 9.2

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

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)

Severity of Pedestrian Injuries in DeKalb on Buford Highway Severity N % Fatalities 12 16.2 Serious Injuries 17 23.0 Visible Injuries 29 39.2 Complaints 12 16.2 No Injuries 4 5.4 DeKalb Board of Health (2003)

Number of Injuries and Deaths on Buford Highway DeKalb Study Area (8 miles) (2.37 miles) Injuries/year 18.6 6.7 Deaths/year 3.6 1.8 DeKalb Board of Health (2003)

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

Injuries and Fatalities: Study Area Current Expected After Reduction Pedestrian Injuries/Year 6.7 .91 (.89- .94) 0.4 Deaths/Year 1.8 .91 (.89- .94) 0.1 Automobile Injuries/Year 120 .60 (.39 -.65) 46

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

Walkability Audit Results Neighborhood Score Grade San Diego High Walkable 1.4 A- Low Walkable 2.0 B Buford Before 4.1 D Buford After 2.4 B- 1=A to 6=F

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

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

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

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

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

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

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