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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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rgia
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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
LA County’s Approach to
Health in All Policies
LA County Dept. of Public Health
PLACE Program
Policies for Livable Active Communities and Environments
Louisa Franco, MPH
Policy Analyst
September 2012
LA County Strategic Goals
County: Create a physical environment that is conducive to good health by encouraging and enabling residents to make healthy choices
DPH: Address elements of the physical environment to improve population health and reduce disparities.
PLACE: Foster policy change that supports the development of healthy, active environments
3 3
Cities/Communities with Lowest and Highest Childhood Obesity Prevalence, 2008
*Table excludes cities/communities where number of students with BMI data < 500. Source: California Physical Fitness Testing Program, California Department of Education. Includes 5th, 7th, and 9th graders enrolled in LA County public schools; 2000 Census
Top 10*
City/Community Name
Obesity
Prevalence
(%)
Rank of
Economic
Hardship
(1 - 128)
Manhattan Beach 3.4 2
Calabasas 5.0 8
Hermosa Beach 5.1 1
Agoura Hills 5.3 10
Beverly Hills 5.4 19
Malibu 5.9 4
Palos Verdes Estates 7.3 5
San Marino 7.8 15
Rolling Hills Estate 8.4 9
La Canada Flintridge 8.5 18
Average 10 lowest 6.2%
Ave Median Household Income $99,555
Bottom 10*
City/Community Name
Obesity
Prevalence
(%)
Rank of
Economic
Hardship
(1 - 128)
West Athens 30.6 94
South Gate 30.7 110
Florence-Graham 31.0 128
West Whittier-Los Nietos 31.1 81
West Carson 31.4 56
Vincent 32.2 69
East Los Angeles 32.9 117
Hawaiian Gardens 33.4 107
South El Monte 34.5 111
Walnut Park 38.7 113
Average 10 highest 32.7%
Ave Median Household Income $37,747
4
Foster Change in
Cities & Communities
The Whittier Greenway Trail
1. Comment on city,
county and
regional plans
2. Fund cities and
nonprofits
3. Partner with cities
1. Comment on City, County
and Regional Plans
• County’s General Plan
• Southern California Association of
Government (SCAG) Regional
Transportation Plan (RTP)
– Dept. of Public Health estimated cost to build
bikeable, walkable communities in SCAG
region: $37 Billion to $59 Billion
5
2. Fund Cities and Nonprofits to
Create Healthy Environments
• County funds
• Federal grant funds
– First CDC grant $16 million (2 years)
– Second CDC grant $10 million (5 years)
6
What Have We Funded?
• Bicycle and Pedestrian Master Plan
• Health Element of a General Plan
• Complete Streets Policies
• Joint-Use Policies
• Healthy Vending, Corner Store
Conversions
7
Upcoming HEAL Grants
• Funded by Community Transformation
Grant
―Part of the Affordable Care Act
• Fund up to 8 agencies to develop HEAL
strategies
―Active Transportation Plans
―Open Streets Events
• $125K per year for approx. 4 years
• Grantees announced in late 2012
8
Additional Active Living
Strategies Funded by CTG
• Promote increased transportation funding
for pedestrian and bike infrastructure
• Adopt and implement a health and
wellness element in LA City General Plan
and enact health-enabling ordinances
• Expand the Parks After Dark Program
9
3. Partner with Cities
10
11
Childhood Obesity Prevalence in Los Angeles County Cities (2008)
*Table excludes cities/communities where number of students with BMI data < 500.
Source: California Physical Fitness Testing Program, California Department of Education. Includes 5th, 7th, and 9th
graders enrolled in LA County public schools.
10 Lowest*
City Obesity
Prevalence (%)
Manhattan Beach 3.4
Calabasas 5.0
Agoura Hills 5.3
Beverly Hills 5.4
Palos Verdes Estates 7.3
Rolling Hills Estates 8.4
Arcadia 10.1
South Pasadena 10.2
Glendora 10.9
El Segundo 11.4
Average 10 lowest 7.7%
10 HPI Cities*
City Obesity
Prevalence (%)
Palmdale 23.1
Inglewood 26.8
Gardena 27.3
San Fernando 27.4
Lynwood 27.7
La Puente 27.8
Pomona 28.6
Compton 29.0
Huntington Park 30.3
South Gate 30.7
Average 27.9%
Healthy Policies Initiative
• 10 cities with high childhood obesity
rates – outreach and presentations
• 4 of these cities – free technical
assistance for policy change efforts
• PLACE staff working with City staff (and
electeds) to offer assistance to make
one policy change
12
City of Lynwood – Bike and
Pedestrian Master Plan
13
City of Pomona
Active Transportation Plan
14
Huntington Park and South Gate
Safe Routes to School Plans
15
Focus Bike and Ped Efforts in
High Need Communities
• Low-income communities with high rates
of childhood obesity need the most help
• Crime and violence (real or perceived)
• Cities have limited resources
– Matching funds
– Grant writers
• Bike and pedestrian issues are not a top
priority for residents
16
17 17
Louisa Franco
DPH PLACE Program
www.ph.lacounty.gov/place
Health and Transportation: Health and Transportation: A City Perspective A City Perspective
ProWalk ProBike ‐ September 2012
Erika Lewis‐Huntley City of Rancho Cucamonga
§ Lead by Example
§ Comprehensive Approach to Health
§ Mobilize Public‐Private Resources
§ Empower Resident Leaders
§ Advance Policies and Programs that Support Healthy & Sustainable Lifestyles
Healthy RC Strategies Healthy RC Strategies
§ Rancho Cucamonga population: ~170,000 (grown 350% since incorporation in 1977)
§ 40.2 square miles § Health indicators parallel those of San
Bernardino County – 4 th most obese – 9 th highest death rate from heart disease – 2 out of 3 residents are obese or overweight – 2 out of 4 students do not meet fitness
standards § Recognize public health is under City
purview
Commitment to Community Health Commitment to Community Health
§ City‐wide initiative to encourage healthy and sustainable lifestyles – Comprehensive and integrated approach
– Multi‐departmental effort coordinated by City Manager’s Office
§ Broad definition of health – Impacted by how we develop our
communities
The Road to Healthy RC The Road to Healthy RC
Healthy RC inspires a lifestyle that embraces a Healthy Mind, Body, and Earth, through lifelong learning and enrichment, active and healthy
living and environmental sustainability.
Focus on ALL Influencers of Health Focus on ALL Influencers of Health
Healthy RC Institutionalization Healthy RC Institutionalization § Minimize reliance on General Fund
– Integrate into existing and new programming
– Leverage resources
§ Health in ALL Policies approach: identify policy opportunities to increase healthy lifestyles – Long‐term sustainability – City is in an excellent position to
modify environments that directly affect health
§ Emphasis on areas at highest risk for obesity and least amount of resources to address the problem Employee Programs Newsletters
Facilities Community Events
Aerial 1969
Aerial 2009
Health in All Policies Health in All Policies
§ What is the General Plan? – Long‐range policy document
(“Blueprint”) for the development of the city
– Overarching goal to maintain & enhance the health of Rancho Cucamonga
§ Spirit of Rancho Cucamonga – Reflect the City’s pursuit of a Healthy
Mind, Body, & Earth
– Defines the way we want to work together to create a healthy more livable community
General Plan Chapters That Reference Healthy RC
General Plan Chapter Mind Body Earth Managing Land Use, Community Design, and Historic Resources
� � �
Housing � � �
Community Mobility � �
Economic Development � �
Community Services � � �
Resource Conservation �
Public Facilities and Infrastructure � � �
Public Health and Safety � � �
Healthy RC Overarching Theme of General Plan Healthy RC Overarching Theme of General Plan
Policies Promoting Policies Promoting Community Mobility Community Mobility
§Goal CM‐1: Provide an integrated and balanced multi‐ modal transportation network of Complete Streets to meet the needs of all users and transportation modes.
§Policy CM‐1.2: Provide an integrated network of roadways that provides for convenient automobile, transit, bicycle, and pedestrian circulation movement around the City.
Mobilizing Public/Private Resources to Mobilizing Public/Private Resources to Improve Community Mobility Improve Community Mobility
§ Optimize community resources § Healthy RC Collaborative:
‐ Residents (youth & adults) ‐ City staff ‐ Public health professionals ‐ Community organizations ‐ Faith‐based institutions ‐ Hospitals ‐ Schools ‐ Local businesses ‐ Universities
(Randall Lewis Health Policy Fellow)
Community Engagement Community Engagement
§ Community Forums for youth and adults
§ Identify barriers and challenges to healthy eating and active living in their neighborhood; i.e., lack of curbs, sidewalks, and bike lanes
§ Propose strategies to mitigate challenges, i.e., Active Transportation, SRTS
§ Formed Subcommittees made up of City staff, community organizations, and residents
§ Community‐based Participatory Approach
§ Building “Community Champions” § Recognizes that EVERYONE has
something to contribute to the process § Participate in decisions that affect their
community § Meaningful participation § Sense of ownership § Increases trust and bridges cultural
gaps § Long‐term sustainability
Empowering Community Leaders Empowering Community Leaders
Empowering Youth Leaders Empowering Youth Leaders § Modeled after “Community
Champions” § Competitive process § Branding Workshops § Youth empowerment
workshops § Activities:
– Walkability audits – Video development (PSA’s) – Park Assessments – Assessments for Nutrition &
Beverage Standards – Farmer’s market evaluation
§ Improving health, safety, & transportation
§ 13 schools § City management tool – creating safer,
more accessible settings for walking and bicycling
Programs Promoting Community Mobility
Stakeholder Workshops Safety Education Special Events
GIS Interactive Web GIS Interactive Web‐ ‐based SRTS Map based SRTS Map
Neighborhood Neighborhood Walkability Walkability Assessments Assessments
Infrastructure Project Encouraging Community Mobility Infrastructure Project Encouraging Community Mobility Sidewalk Improvements Sidewalk Improvements
Trail Accessibility Trail Accessibility
Infrastructure Project Encouraging Community Mobility Infrastructure Project Encouraging Community Mobility Upgrade maintenance access road to Class 1 bike trail
Technology Improving Community Mobility Technology Improving Community Mobility Sidewalk Inspection Program Sidewalk Inspection Program – – Mobile App Mobile App
Mobile Application
Pedestrian Safety Campaign Pedestrian Safety Campaign
§ Joint‐use Agreements
§ Community Gardens
§ Farmers’ Markets
§ Nutrition Standards
§ Healthy RC Dining Program
§ Smoke‐free Recognition Program
§ Fun on the Run Mobile Recreation Program
Other Healthy Living Initiatives Other Healthy Living Initiatives
For More Information about Healthy RC
Visit the Healthy RC Website: www.HealthyRC.info
Contact: Erika.Lewis‐[email protected]
(909) 477‐2700 ext.2008
