Pro Walk Pro Bike, September 2012

CDR Arthur Wendel, MD, MPH

NCEH/EEHS/HCDI

dvq6@cdc.gov

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

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1.5

2

2.5

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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: 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 You

CDR Arthur M. Wendel, MD, MPH

dvq6@cdc.gov

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