transportation and health - metrics and modeling cdr arthur wendel, md, mph geoff whitfield, phd,...
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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: [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 YouCDR Arthur M. Wendel, MD, MPH; [email protected]
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