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Pro Walk Pro Bike, September 2012
CDR Arthur Wendel, MD, MPH
NCEH/EEHS/HCDI
www.cdc.gov/healthyplaces
Health and Transportation
National Center for Environmental Health
Division of Emergency and Environmental Health Services
Healthy Community Design Initiative (HCDI):
Mission: To understand and improve the relationship
between community design and public health through:
Surveillance
Health impact assessment and other mechanisms to improve
policies
Research, evaluation and best practice dissemination
Live Longer / Walk More
Case Patient – “Pete”
10 year old male is brought to his physician by his
parents because of difficulty in his classroom
Problem List
Teacher describes fidgeting, being
boisterous, but notes sustained
effort with tasks
Overweight
BP 120/81 - prehypertensive
No exercise – recess and gym cut
due to budget problems, mom
drives to school
Symptoms of depression
Daily intake of cola
Images: http://managetheunmanageable.blogspot.com/2011/03/students-who-are-easily-distracted.html http://catherinelramstetter.wordpress.com/research-on-school-recess/
Treatment Plan
Join sports team
Meet with nutritionist
Teacher fills out ADHD assessment
Three Month Follow-Up
No major improvements
Baseball team requires 40 minutes more driving. Lack
of time leads to fast food consumption
ADHD assessment reflects some problems, but not
diagnostic
Still has some symptoms of depression
30 Years Later
On multiple medications for hypertension, diabetes,
cholesterol
Drives kids to school for safety concerns
Percent of U.S. GDP spent on Health Care
0%
5%
10%
15%
20%
25%
1960 1970 1980 1990 2001 Projected2010
Projected2019
https://www.cms.gov/NationalHealthExpendData/25_NHE_Fact_Sheet.asp
Public Health Impacts of Physical Inactivity
36% of adults report no leisure-time physical activity and
82% do not meet current federal guidelines for physical
activity and muscle strengthening.1
88% of U.S. adolescents do not meet current aerobic and
muscle strengthening guidelines.2
Estimated medical cost of physical inactivity: $75 billion per
year.3
Physical activity lowers risk for4
1. CDC National Health Interview Survey
2. CDC Youth Risk Behavior Surveillance System 2009
3. http://www.cdc.gov/chronicdisease/resources/publications/aag/nutrition.htm
4. U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. October 2008. http://www.health.gov/paguidelines/.
•Premature death
•Coronary heart disease
•Stroke
•Hypertension,
•Type 2 diabetes
•Depression
•Colon cancer
•Breast cancer
•Unhealthy weight gain
How do people get exercise?
Leisure
They walk
They ride bicycles
Utilitarian
They walk
They ride bicycles
Ham, J of Physical Activity and Health, 2009.
ACS, 2007
Cost Effectiveness
Bonus! IPCC finds that active transportation
interventions are cost-effective measures for
mitigating climate change
http://www.who.int/hia/examples/trspt_comms/hge_transport_lowresdurban_30_11_2011.pdf
The 10 Essential Public Health Services
Concordant Health Strategies
CDC’s Winnable Battles
Motor vehicle injuries
Nutrition, physical activity, and obesity
National Prevention Strategy
Creating safe and healthy community environments
Active living
Healthy eating
Injury- and violence-free living
www.cdc.gov/winnablebattles
www.healthcare.gov/prevention/nphpphc/strategy/report.pdf
CDC’s Transportation Policy Recommendations
Make cars safer and less polluting
Support robust public transportation
Create infrastructure and programs to increase active
transportation
Design communities for health – e.g. Complete Streets
Protect healthy choices
Require research and surveillance
Support professional development and job creation
www.cdc.gov/transportation
Surveillance
Benchmarking Bicycling and Walking http://www.peoplepoweredmovement.org/site/index.php/site/memberservices/2012_benchmarking_report/
Community Design Module in the National
Environmental Public Health Tracking Network http://ephtracking.cdc.gov/showCommunityDesign.action
Per Capita Pedestrian Deaths from Motor Vehicles by State, 2009
0
0.5
1
1.5
2
2.5
3
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Source: National Highway Traffic Safety Administration (NHTSA). Fatality Analysis Reporting System (FARS). 2009 (ARF). Available at http://www-fars.nhtsa.dot.gov/States/StatesCrashesAndAllVictims.aspx
Aligned Solutions
Proven Safety Countermeasures (FHWA)
Medians and Pedestrian Refuge Areas in Urban and Suburban Areas
Road diets
Pedestrian hybrid beacons
Corridor access management
Physical Activity and Community Design:
Recommended Strategies from the Community Guide
Community scale urban design and land-use policies are
recommended
Street scale urban design and land-use policies are recommended
http://safety.fhwa.dot.gov/provencountermeasures/
http://www.thecommunityguide.org/pa/environmental-policy/index.html
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
HIA as a Pre-op Physical for
Communities
http://www.phoenix5.org/hum
or/CartoonOperation.html
HIA of the Tumalo Community Plan Deschutes County, OR (2010)
Examined: Health impacts of the draft Tumalo Community Plan,
which was a part of the County Comprehensive Plan Update
Findings:
Need to implement safety measures for pedestrians/bicyclists
crossing US Hwy 20 and to decrease traffic collisions
Development of trail system linking recreational areas would
decrease environmental pollution, preserve natural areas, and
increase physical activity
Impact: Revised plan was adopted by the
Board of County Commissioners; temporary
recommendations started
Notable: Worked closely with
transportation to ensure recommendations
were feasible
Next Steps
Define a metric
Develop surveillance
Look for Health Impact Assessment opportunities
Help with selection criteria
Connect with health officers
Health Impact Pyramid
Education
Clinical Interventions
Long-lasting Protective Interventions
Changing the Context to make Individuals’ Default Decisions
Healthy
Socio-Economic Factors
Increasing
Population
Impact
Increasing
Individual
Effort Needed
Frieden, AJPH, 2010
For more information please contact Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: [email protected] Web: www.cdc.gov
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
National Center for Environmental Health
Division of Emergency and Environmental Health Services
Resources for more information
Online course, built in partnership with APA: http://professional.captus.com/Planning/hia
Minimum Elements and Practice Standards for Health
Impact Assessment: (http://www.humanimpact.org/doc-
lib/finish/11/9)
National Research Council report on HIAs in the US: (http://www.nap.edu/catalog.php?record_id=13229)
http://www.healthimpactproject.org/
http://www.cdc.gov/healthyplaces/hia.htm