Transportation and Health - Metrics and Modeling

CDR Arthur Wendel, MD, MPHGeoff Whitfield, PhD, Med

Healthy Community Design Initiative

AMPOOctober2014

National Center for Environmental HealthHealthy 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

http://bikewalkalliance.org/download-the-2014-benchmarking-report, http://www.planning.org/research/publichealth/pdf/surveyreport.pdfhttp://ephtracking.cdc.gov

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

http://www.cdc.gov/healthyplaces/factsheets/Healthy_community_Checklist.pdf

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

RR

RR

RR

ITHIM Model Schematic

Diseases and ExposuresPhysical Activity Air Pollution Collisions

Ischemic Heart Disease

Respiratory Infections Auto

Depression Cardiovascular Disease Bicycle

Dementia Hypertensive Heart Disease

Pedestrian

Diabetes Inflammatory Heart Disease

Bus

Colon Cancer Lung Cancer Truck

Breast Cancer Respiratory Disease Highway

All-Cause Mortality Stroke Arterial

Local

Fatal

Non-FatalKey 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/day Relative Risk BAU Scenario

0 1.00 (ref) 50% 5%

1-9 0.67 30% 7.5%

10-19 0.56 10% 12.5%

20-39 0.33 7% 55%

40+ 0.22 3% 20%

Weighted Average “risk”: 0.79 0.40

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 Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov 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 YouCDR Arthur M. Wendel, MD, MPH; dvq6@cdc.gov

Geoff Whitfield, PhD, Med

Acknowledgements

Nashville MPOLeslie Meehan

Michael Skipper

ITHIM DevelopersNeil Maizlish

James Woodcock

National Center for Environmental Health

Division of Emergency and Environmental Health Services