Transportation and Health - Metrics and Modeling CDR Arthur Wendel, MD, MPH Geoff Whitfield, PhD, Med Healthy Community Design Initiative AMPO October2014 National Center for Environmental Health Healthy Community Design Initiative

Healthy Community Design Initiative (HCDI):  Create environments that prevent disease and injury by providing people the opportunity to safely walk, bicycle, or use public transit.  Public health surveillance and translation  Education  Strategic partnerships  HIA practice support  Targeted research and evaluation

Ways to Improve Health through Transportation  Increase physical activity  Reduce injuries  Reduce air pollution exposure  Improve access  Reduce health disparities

Transportation and Public Health Surveillance  Benchmarking Report  Transportation and Health Tool  Comprehensive Planning for Public Health  Healthy Community Design Module within the National Environmental Public Health Tracking Network

Healthy Community Design Checklist  I want more options to help me get outside and be more active  I want to have healthier and more affordable food choices  I want to get around in my community more easily without a car  I want to feel safer in my community  I want to have more chances to get to know my neighbors  I want my community to be a good place for all people to live regardless of age, abilities, or income  I want to live in a clean environment

Health Impact Assessments  Health Impact Assessment (HIA)  HIA is a systematic process that uses an array of data sources and analytic methods and considers input from stakeholders to determine the potential effects of a proposed policy, plan, program, or project on the health of a population and the distribution of those effects within the population. HIA provides recommendations on monitoring and managing those effects. - National Research Council, 2011  Steps  Screening  Scoping  Risk Assessment  Recommendations  Reporting  Evaluation

Health Impact Modeling  Simple transportation health impact models  Focus on health benefit of walking and bicycling  Do not include concomitant health risks  Assumed equal effects for all age/sex groups  E.g. WHO’s Health Economic Assessment Tool (HEAT)  Can be easier to use  Future additions for modeling  Health benefits of physical activity  Health benefits of reduced air pollution  Health risks of bike/ped vs auto accidents  Age/Sex effects  E.g. Integrated Transportation and Health Impact Modelling Tool (ITHIM)

(RR=relative risk) Bicycle Lanes ↑ Parking $ New Ped Bridge New Bikeway Bicycle Racks Environment ↓ Vehicular Trips Behavior ↑ Active Transport Trips Exposure ↓ Air Pollution ↑ Physical Activity ↑ Vulnerable Time in Traffic Health Outcome ↓ Respiratory Disease ↓ Chronic Diseases (Many) ↑ Injury and Death ITHIM Model Schematic

Diseases and Exposures Physical ActivityAir PollutionCollisions Ischemic Heart DiseaseRespiratory InfectionsAuto DepressionCardiovascular DiseaseBicycle DementiaHypertensive Heart DiseasePedestrian DiabetesInflammatory Heart DiseaseBus Colon CancerLung CancerTruck Breast CancerRespiratory DiseaseHighway All-Cause MortalityStrokeArterial Local Fatal Non-Fatal Key Point: Thoroughness = Data-hunger!

Calibration  Cost of improved accuracy is calibration data Courtesy of Neil Maizlish, California Department of Public Health

Example – Physical Activity and Ischemic Heart Disease % of Pop at PA Level PA – min/dayRelative RiskBAUScenario (ref)50%5% %7.5% %12.5% %55% %20% Weighted Average “risk”: Population Attributable Fraction:0.40/0.79 = 0.49 Change in Disease Burden:0.49 * Current DALYs Courtesy of Neil Maizlish, California Department of Public Health

Running the Model  After calibration, enter scenarios for comparison  Following slides present shifts from car to bike/ped:  Conservative  Moderate  Aggressive

Lessons Learned  Data collection supports a variety of health and transportation endeavors  Modelling can help foster support for bike/ped initiatives  ITHIM is a comprehensive tool for modelling health impact of biking and walking  Data requirements as tradeoff of thoroughness

For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA Telephone, CDC-INFO ( )/TTY: Web: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Thank You CDR Arthur M. Wendel, MD, MPH; Geoff Whitfield, PhD, Med Acknowledgements Nashville MPO Leslie Meehan Michael Skipper ITHIM Developers Neil Maizlish James Woodcock National Center for Environmental Health Division of Emergency and Environmental Health Services