Health Impact Assessment: Health Impact Assessment: Case-Study of Buford HighwayCase-Study of Buford Highway

Candace D. Rutt, Ph.D.Candace D. Rutt, Ph.D.Division of Nutrition and Physical ActivityDivision of Nutrition and Physical Activity

National Center for Chronic Disease Prevention National Center for Chronic Disease Prevention and Health Promotionand Health Promotion

Centers for Disease Control and PreventionCenters 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 CriteriaSelection Criteria

Specific enough to create quantitative estimatesHigh quality data Not overly complicatedPolitical interestTarget at risk populationsFoundation for other HIAsGeneralizability

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 BackgroundBuford Highway Background

CQGRD’s conceptual planCQGRD’s conceptual plan– Reduce the number of lanes from 7 to 4Reduce the number of lanes from 7 to 4– Reduce speed limitReduce speed limit– Build sidewalks and add crosswalksBuild sidewalks and add crosswalks– Add bike lanesAdd bike lanes– Add center medianAdd center median– Allow shared parking and on-street parkingAllow shared parking and on-street parking– Increase density and land-useIncrease density and land-use– Develop unused greenspaceDevelop unused greenspace

LINER: THE OREO DECK - BEFORE

LINER: THE OREO DECK - AFTER

ScopingScoping

Creation of logic modelCreation of logic model– Specify how policy and infrastructure changes Specify how policy and infrastructure changes

will eventually impact health outcomeswill eventually impact health outcomes– Helps in focusing the impact assessmentHelps in focusing the impact assessment

QuantitativeQuantitative

Qualitative Qualitative

NE Plaza Logic ModelNE Plaza Logic Model

Build sidewalks and crosswalks Safety

Physical activity Obesity

Mortality

Lung disease

CVD

Cancer

Diabetes

Traffic

Land-use

People outside

Depression, anxiety, stressHypertensionOsteoporosis

Air and noise pollution

Permit mixed-use zoning floor/area ratio dwelling units pop. density

Change 60 ft. easement to 40 ft. (thin wall arcade, buildings built closer to sidewalk, Oreo deck)

Social capitalParking requirements

Injury

I-85 traffic

connectivity

Bus ridership

Policy Proximal Intermediate HealthImpacts Impacts Outcomes

parking

Injuries and fatalities

Pop. density

Risk AssessmentRisk Assessment

QualitativeQualitative– Traffic Traffic – PollutionPollution– Social capitalSocial capital– Crime and safetyCrime and safety– Economic development Economic development – GentrificationGentrification

QuantitativeQuantitative– InjuryInjury– Physical ActivityPhysical Activity

Determining Affected PopulationDetermining Affected Population

The individuals who live in the study area (N. The individuals who live in the study area (N. Druid Hills to Clairmont) Druid Hills to Clairmont) 5 census blocks5 census blocks Only counted those that lived ½ mile from highwayOnly counted those that lived ½ mile from highway 14,000 people14,000 people

Individuals who drive through study area Individuals who drive through study area ADT (23,034) x people per car (1.63)ADT (23,034) x people per car (1.63) 37,545 people37,545 people No demographic data availableNo demographic data available

Demographics for Study AreaDemographics for Study Area

Study Area AtlantaStudy Area Atlanta% Male% Male 60.060.0 49.449.4Ages: 18-39Ages: 18-39 51.651.6 36.536.5Hispanic Hispanic 49.849.8 6.5 6.5Foreign-bornForeign-born 61.161.1 10.310.3Non-resident 1995Non-resident 1995 26.626.6 4.1 4.1PovertyPoverty 15.815.8 9.2 9.2

Household DemographicsHousehold Demographics

Average family size is 3.4 Average family size is 3.4

70% of families have 2 or more workers70% of families have 2 or more workers

12% of households have no car and 48% 12% of households have no car and 48% have only 1 carhave only 1 car

17% take transit to work and 3% walk17% take transit to work and 3% walk

Pedestrian Data for All Crashes Pedestrian Data for All Crashes in DeKalb County, GAin DeKalb County, GA

Of the 62 fatally injured pedestrians:Of the 62 fatally injured pedestrians:– 47% Black47% Black– 36% Hispanic36% Hispanic– 17% White17% White

DeKalb Board of Health (2003)DeKalb Board of Health (2003)

Severity of Pedestrian Injuries in Severity of Pedestrian Injuries in DeKalb on Buford DeKalb on Buford Highway

SeveritySeverity NN % %

FatalitiesFatalities 1212 16.216.2

Serious InjuriesSerious Injuries 1717 23.023.0

Visible InjuriesVisible Injuries 2929 39.239.2

ComplaintsComplaints 1212 16.216.2

No InjuriesNo Injuries 4 4 5.4 5.4DeKalb Board of Health (2003)DeKalb Board of Health (2003)

Number of Injuries and Deaths Number of Injuries and Deaths on Buford Highwayon Buford Highway

DeKalbDeKalb Study AreaStudy Area (8 miles)(8 miles) (2.37 miles)(2.37 miles)

Injuries/year Injuries/year 18.6 18.6 6.76.7Deaths/yearDeaths/year 3.63.6 1.81.8

DeKalb Board of Health (2003)DeKalb Board of Health (2003)

Estimating Changes in InjuryEstimating Changes in Injury

No studies could be located to determine No studies could be located to determine injury reduction based on proposed injury reduction based on proposed changeschanges

Hired senior traffic engineers (Hamilton & Hired senior traffic engineers (Hamilton & Associates) to calculate expected changesAssociates) to calculate expected changes

Injuries and Fatalities: Study AreaInjuries and Fatalities: Study Area

CurrentCurrent Expected Expected After After

ReductionReduction

PedestrianPedestrian

Injuries/YearInjuries/Year 6.76.7 .91 (.89- .94).91 (.89- .94) 0.4 0.4

PedestrianPedestrian

Deaths/YearDeaths/Year 1.81.8 .91 (.89- .94) .91 (.89- .94) 0.1 0.1

AutomobileAutomobile

Injuries/YearInjuries/Year 120120 .60 (.39 -.65).60 (.39 -.65) 46 46

Physical ActivityPhysical Activity

Hard to find study that had good measures of Hard to find study that had good measures of physical activity and the built environment – physical activity and the built environment – we chose study with best measure of we chose study with best measure of physical activityphysical activity

Saelens et al. (2003) found a 72.5 minute Saelens et al. (2003) found a 72.5 minute difference in total walking per week between difference in total walking per week between neighborhoods in San Diegoneighborhoods in San Diego

Saelens et al. (2004) found 124 minute Saelens et al. (2004) found 124 minute difference in walking for transport In low-difference in walking for transport In low-income neighborhoods in Seattle income neighborhoods in Seattle

Walkability Audit ResultsWalkability Audit Results

NeighborhoodNeighborhood Score Score Grade Grade

San Diego San Diego High WalkableHigh Walkable 1.41.4 A-A-

San DiegoSan DiegoLow WalkableLow Walkable 2.02.0 BB

Buford BeforeBuford Before 4.14.1 DD

Buford AfterBuford After 2.42.4 B-B-1=A to 6=F1=A to 6=F

Estimating Increases in WalkingEstimating Increases in Walking

Since there were only two data points to serve Since there were only two data points to serve as the source for the effect parameter there was as the source for the effect parameter there was uncertainty with respect to the shape of the uncertainty with respect to the shape of the relationship between walkability and minutes relationship between walkability and minutes walked per weekwalked per week– Linear Linear

– Dichotomous Dichotomous

– CurvilinearCurvilinear

– No effectNo effect

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

Cost Effectiveness ModelCost Effectiveness Model

Determine cost-effectiveness of Determine cost-effectiveness of redeveloping Buford Highway (street-scale redeveloping Buford Highway (street-scale urban design) compared to other physical urban design) compared to other physical activity interventions recommended by the activity interventions recommended by the Community Guide for Preventive ServicesCommunity Guide for Preventive Services

Cost Effectiveness ModelCost Effectiveness Model

In almost all scenarios the redevelopment In almost all scenarios the redevelopment of Buford Highway was a good investment of Buford Highway was a good investment of money (<$50,000 per QALY) and in of money (<$50,000 per QALY) and in most of the scenarios it was cost savingmost of the scenarios it was cost saving– This does not take into account QALY loss This does not take into account QALY loss

and cost of injuries just increases in QALYs and cost of injuries just increases in QALYs due to physical activitydue to physical activity

Reporting and ReviewReporting and Review

Manuscripts Manuscripts

Numerous presentation at national Numerous presentation at national meetings (Smart Growth, ACSM, etc.)meetings (Smart Growth, ACSM, etc.)

Presentations for local groups (ARC, Presentations for local groups (ARC, FHWA, GDOT, DeKalb Board of Health)FHWA, GDOT, DeKalb Board of Health)

Evaluation of ImpactEvaluation of Impact

Sections of Buford Highway (Shallowford Sections of Buford Highway (Shallowford to I-285) will be redeveloped starting in the to I-285) will be redeveloped starting in the spring of 2005spring of 2005– Changes will not be as extensive as those Changes will not be as extensive as those

proposed by the CQGRDproposed by the CQGRD– Decision made before HIA was completedDecision made before HIA was completed– Possible to get greater changes made to the Possible to get greater changes made to the

southern section of Buford Highway southern section of Buford Highway

ConclusionsConclusionsRedeveloping greyfields could lead to an Redeveloping greyfields could lead to an increase in physical activity and a decrease increase in physical activity and a decrease in injuriesin injuries

HIA is a new and evolving science, however HIA is a new and evolving science, however it is a promising new approach to quantify it is a promising new approach to quantify health impacts of a wide variety of policies health impacts of a wide variety of policies and projectsand projects

HIA provides an outlet for health to be HIA provides an outlet for health to be appropriately factored into complex decisionsappropriately factored into complex decisions