Safer People, Safer Streets, and Safer Policies at USDOT
#35 Bridging Sectors: Fostering Collaboration between Health and Transportation Professionals - Hubsmith
1. Health and Transportation
Pro Walk Pro Bike, September 2012
CDR Arthur Wendel, MD, MPH
NCEH/EEHS/HCDI
dvq6@cdc.gov
www.cdc.gov/healthyplaces
National Center for Environmental Health
Division of Emergency and Environmental Health Services
2. 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
3. Case Patient – “Pete”
10 year old male is brought to his physician by his
parents because of difficulty in his classroom
4. 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/
5. Treatment Plan
Join sports team
Meet with nutritionist
Teacher fills out ADHD assessment
6. 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
7. 30 Years Later
On multiple medications for hypertension, diabetes,
cholesterol
Drives kids to school for safety concerns
8. Percent of U.S. GDP spent on Health Care
25%
20%
15%
10%
5%
0%
1960 1970 1980 1990 2001 Projected Projected
2010 2019
https://www.cms.gov/NationalHealthExpendData/25_NHE_Fact_Sheet.asp
9. 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
•Premature death •Depression
•Coronary heart disease •Colon cancer
•Stroke •Breast cancer
•Hypertension, •Unhealthy weight gain
•Type 2 diabetes
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/.
10. 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
11. 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
13. 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
14. 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
15. 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
16. Deaths per 100,000 population
0.5
1
1.5
2
2.5
3
0
Florida
Louisiana
District of Columbia
Maryland
Mississippi
South Carolina
New Mexico
Arizona
New Jersey
Delaware
New York
North Carolina
Montana
Georgia
California
Rhode Island
Texas
Alabama
Nevada
Alaska
Arkansas
Hawaii
Michigan
West Virginia
Missouri
Tennessee
Pennsylvania
Kentucky
Colorado
Virginia
by State, 2009
Washington
Oregon
Illinois
Oklahoma
Maine
Minnesota
Vermont
Indiana
Kansas
Connecticut
Ohio
Massachusetts
Iowa
Utah
2009 (ARF). Available at http://www-fars.nhtsa.dot.gov/States/StatesCrashesAndAllVictims.aspx
Wisconsin
Idaho
North Dakota
New Hampshire
Source: National Highway Traffic Safety Administration (NHTSA). Fatality Analysis Reporting System (FARS).
Nebraska
Per Capita Pedestrian Deaths from Motor Vehicles
South Dakota
Wyoming
17. 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
18. 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
19. HIA as a Pre-op Physical for
Communities
http://www.phoenix5.org/hum
or/CartoonOperation.html
20. 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
21. Next Steps
Define a metric
Develop surveillance
Look for Health Impact Assessment opportunities
Help with selection criteria
Connect with health officers
22. Health Impact Pyramid
Education
Increasing
Increasing Clinical
Interventions Individual
Population
Effort Needed
Impact
Long-lasting Protective
Interventions
Changing the Context to make
Individuals’ Default Decisions
Healthy
Socio-Economic Factors
Frieden, AJPH, 2010
23. Thank You
CDR Arthur M. Wendel, MD, MPH
dvq6@cdc.gov
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.
National Center for Environmental Health
Division of Emergency and Environmental Health Services
24. 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
25. LA County’s Approach to
Health in All Policies
LA County Dept. of Public Health
PLACE Program
Policies for Livable Active Communities and Environments
Louisa Franco, MPH
Policy Analyst
lfranco@ph.lacounty.gov
September 2012
26. LA County Strategic Goals
County: Create a physical
environment that is conducive to
good health by encouraging and
enabling residents to make
healthy choices
DPH: Address elements of the
physical environment to improve
population health and reduce
disparities.
PLACE: Foster policy change that
supports the development of
healthy, active environments
27. Cities/Communities with Lowest and Highest
Childhood Obesity Prevalence, 2008
Top 10* Bottom 10*
Rank of Rank of
Obesity Obesity
Economic Economic
City/Community Name Prevalence City/Community Name Prevalence
Hardship Hardship
(%) (%)
(1 - 128) (1 - 128)
Manhattan Beach 3.4 2 West Athens 30.6 94
Calabasas 5.0 8 South Gate 30.7 110
Hermosa Beach 5.1 1 Florence-Graham 31.0 128
Agoura Hills 5.3 10 West Whittier-Los Nietos 31.1 81
Beverly Hills 5.4 19 West Carson 31.4 56
Malibu 5.9 4 Vincent 32.2 69
Palos Verdes Estates 7.3 5 East Los Angeles 32.9 117
San Marino 7.8 15 Hawaiian Gardens 33.4 107
Rolling Hills Estate 8.4 9 South El Monte 34.5 111
La Canada Flintridge 8.5 18 Walnut Park 38.7 113
Average 10 lowest 6.2% Average 10 highest 32.7%
Ave Median Household Income $99,555 Ave Median Household Income $37,747
3
*Table excludes cities/communities where number of students with BMI data < 500. 3
Source: California Physical Fitness Testing Program, California Department of Education. Includes
5th, 7th, and 9th graders enrolled in LA County public schools; 2000 Census
28. Foster Change in
Cities & Communities
1. Comment on city,
county and
regional plans
2. Fund cities and
nonprofits
3. Partner with cities
The Whittier Greenway Trail
4
29. 1. Comment on City, County
and Regional Plans
• County’s General Plan
• Southern California Association of
Government (SCAG) Regional
Transportation Plan (RTP)
– Dept. of Public Health estimated cost to build
bikeable, walkable communities in SCAG
region: $37 Billion to $59 Billion
5
30. 2. Fund Cities and Nonprofits to
Create Healthy Environments
• County funds
• Federal grant funds
– First CDC grant $16 million (2 years)
– Second CDC grant $10 million (5 years)
6
31. What Have We Funded?
• Bicycle and Pedestrian Master Plan
• Health Element of a General Plan
• Complete Streets Policies
• Joint-Use Policies
• Healthy Vending, Corner Store
Conversions
7
32. Upcoming HEAL Grants
• Funded by Community Transformation
Grant
―Part of the Affordable Care Act
• Fund up to 8 agencies to develop HEAL
strategies
―Active Transportation Plans
―Open Streets Events
• $125K per year for approx. 4 years
• Grantees announced in late 2012
8
33. Additional Active Living
Strategies Funded by CTG
• Promote increased transportation funding
for pedestrian and bike infrastructure
• Adopt and implement a health and
wellness element in LA City General Plan
and enact health-enabling ordinances
• Expand the Parks After Dark Program
9
35. Childhood Obesity Prevalence in Los Angeles
County Cities (2008)
10 Lowest* 10 HPI Cities*
Obesity Obesity
City Prevalence City Prevalence
(%) (%)
Manhattan Beach 3.4 Palmdale 23.1
Calabasas 5.0 Inglewood 26.8
Agoura Hills 5.3 Gardena 27.3
Beverly Hills 5.4 San Fernando 27.4
Palos Verdes Estates 7.3 Lynwood 27.7
Rolling Hills Estates 8.4 La Puente 27.8
Arcadia 10.1 Pomona 28.6
South Pasadena 10.2 Compton 29.0
Glendora 10.9 Huntington Park 30.3
El Segundo 11.4 South Gate 30.7
Average 10 lowest 7.7% Average 27.9%
*Table excludes cities/communities where number of students with BMI data < 500. 11
Source: California Physical Fitness Testing Program, California Department of Education. Includes 5th, 7th, and 9th
graders enrolled in LA County public schools.
36. Healthy Policies Initiative
• 10 cities with high childhood obesity
rates – outreach and presentations
• 4 of these cities – free technical
assistance for policy change efforts
• PLACE staff working with City staff (and
electeds) to offer assistance to make
one policy change
12
40. Focus Bike and Ped Efforts in
High Need Communities
• Low-income communities with high rates
of childhood obesity need the most help
• Crime and violence (real or perceived)
• Cities have limited resources
– Matching funds
– Grant writers
• Bike and pedestrian issues are not a top
priority for residents
16
42. Health and Transportation:
A City Perspective
ProWalk ProBike ‐ September 2012
Erika Lewis‐Huntley
City of Rancho Cucamonga
43. Healthy RC Strategies
Healthy RC Strategies
§ Lead by Example
§ Comprehensive Approach to
Health
§ Mobilize Public‐Private Resources
§ Empower Resident Leaders
§ Advance Policies and Programs
that Support Healthy &
Sustainable Lifestyles
44. Commitment to Community Health
Commitment to Community Health
§ Rancho Cucamonga population: ~170,000
(grown 350% since incorporation in 1977)
§ 40.2 square miles
§ Health indicators parallel those of San
Bernardino County
– th
4 most obese
– th
9 highest death rate from heart disease
– 2 out of 3 residents are obese or overweight
– 2 out of 4 students do not meet fitness
standards
§ Recognize public health is under City
purview
45. The Road to Healthy RC
§ City‐wide initiative to encourage healthy
and sustainable lifestyles
– Comprehensive and integrated approach
– Multi‐departmental effort coordinated by
City Manager’s Office
§ Broad definition of health
– Impacted by how we develop our
communities
Healthy RC inspires a lifestyle that embraces a Healthy Mind, Body,
and Earth, through lifelong learning and enrichment, active and healthy
living and environmental sustainability.
47. Healthy RC Institutionalization
§ Minimize reliance on General Fund
– Integrate into existing and new
programming
– Leverage resources
§ Health in ALL Policies approach:
identify policy opportunities to
Community Events Facilities
increase healthy lifestyles
– Long‐term sustainability
– City is in an excellent position to
modify environments that directly
affect health
§ Emphasis on areas at highest risk
for obesity and least amount of
resources to address the problem Employee Programs Newsletters
50. Health in All Policies
§ What is the General Plan?
– Long‐range policy document
(“Blueprint”) for the development of the
city
– Overarching goal to maintain & enhance
the health of Rancho Cucamonga
§ Spirit of Rancho Cucamonga
– Reflect the City’s pursuit of a Healthy
Mind, Body, & Earth
– Defines the way we want to work
together to create a healthy more livable
community
51. Healthy RC Overarching Theme of General Plan
Healthy RC Overarching Theme of General Plan
General Plan Chapters That Reference Healthy RC
General Plan Chapter Mind Body Earth
Managing Land Use, Community Design, and
œ œ œ
Historic Resources
Housing œ œ œ
Community Mobility œ œ
Economic Development œ œ
Community Services œ œ œ
Resource Conservation œ
Public Facilities and Infrastructure œ œ œ
Public Health and Safety œ œ œ
53. Mobilizing Public/Private Resources to
Improve Community Mobility
§ Optimize community resources
§ Healthy RC Collaborative:
‐ Residents (youth & adults)
‐ City staff
‐ Public health professionals
‐ Community organizations
‐ Faith‐based institutions
‐ Hospitals
‐ Schools
‐ Local businesses
‐ Universities
(Randall Lewis Health Policy Fellow)
54. Community Engagement
§ Community Forums for youth and
adults
§ Identify barriers and challenges to
healthy eating and active living in
their neighborhood; i.e., lack of
curbs, sidewalks, and bike lanes
§ Propose strategies to mitigate
challenges, i.e., Active
Transportation, SRTS
§ Formed Subcommittees made up
of City staff, community
organizations, and residents
55. Empowering Community Leaders
Empowering Community Leaders
§ Community‐based Participatory
Approach
§ Building “Community Champions”
§ Recognizes that EVERYONE has
something to contribute to the process
§ Participate in decisions that affect their
community
§ Meaningful participation
§ Sense of ownership
§ Increases trust and bridges cultural
gaps
§ Long‐term sustainability
56. Empowering Youth Leaders
§ Modeled after “Community
Champions”
§ Competitive process
§ Branding Workshops
§ Youth empowerment
workshops
§ Activities:
– Walkability audits
– Video development (PSA’s)
– Park Assessments
– Assessments for Nutrition &
Beverage Standards
– Farmer’s market evaluation
57. Programs Promoting Community Mobility
§ Improving health, safety, & transportation
§ 13 schools
§ City management tool – creating safer,
more accessible settings for walking and
bicycling
Stakeholder Workshops Safety Education Special Events
69. For More Information about Healthy RC
Visit the Healthy RC Website:
www.HealthyRC.info
Contact:
Erika.Lewis‐Huntley@CityofRC.us
(909) 477‐2700 ext.2008
