health impact assessment: case-study of buford highway candace d. rutt, ph.d. division of nutrition...
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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