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  • http://latimesblogs.latimes.com/lanow/2010/09/westside-subway-wont-relieve-much-traffic-according-to-draft-environmental-impact-report.html http://www.usatoday.com/travel/destinations/2006-02-08-la-subway_x.htm http://zev.lacounty.gov/news/transportation/westside-story-always-a-traffic-drama
  • Comparison fatality rates NYC Portland Atlanta if city rates were applied to the nation.
  • Methodology: Data on pedestrian fatalities and population for each city taken from annual summaries compiled in Traffic Safety Facts and available online at http://www-nrd.nhtsa.dot.gov/departments/nrd-30/ncsa/AvailInf.html. Rates per 100,000 were compiled for each data year and an average was taken. (Note: 2001 data was not available; 1997 rate uses 1996 population data.) Since this is not a measure of pedestrian exposure, it is not as accurate a predictor of pedestrian danger as the Pedestrian Danger Index.
  • Note: The Pedestrian Danger Index (PDI) takes the rate of pedestrian deaths per 100,000 population and weights this by the amount pedestrians walk. It is useful for comparing cities to one another and for comparing chance in pedestrian risk over time.
  • Carmaheaven
  • Tv/video games/media serve as “babysitter”; parents fear of letting their kids go outside; free-play/loitering considered “crime”/overstimulated kids with overbooked schedules leave no time for free, leisure play
  • Brain fatigue
  • Oklahoma ranked sixth worst for obesity rates
  • Relationship between BMI and risk of type 2 diabetes– corrected The risk of diabetes increases with increasing BMI values in men and women [1,2]. Moreover, the age-adjusted relative risk for diabetes begins to increase at BMI values that are considered normal for men (24 kg/m 2 ) and women (22 kg/m 2 ) based on mortality risk. The marked increase in the prevalence of obesity is an important contributor to the 25% increase in the prevalence of diabetes in the United States over the last 20 years [3]. Increases in abdominal fat mass, weight gain since young adulthood, and a sedentary lifestyle are additional obesity-related risk factors for diabetes [1,4,5]. Colditz GA, Willett WC, Rotnitzky A, Manson JE. Weight gain as a risk factor for clinical diabetes mellitus in women. Ann Intern Med 1995;122:481-486. Chan JM, Rimm EB, Colditz GA, et al. Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabetes Care 1994;17:961-969. Harris MI, Flegal KM, Cowie CC, et al. Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults. The Third National Health and Nutrition Examination Survey, 1988-1994. Diabetes Care 1998;21:518-524. Ohlson LO, Larsson B, Svardsudd K, et al. The influence of body fat distribution on the incidence of diabetes mellitus. Diabetes 1985;34:1055-1058. Helmrich SP, Ragland DR, Leung RW, Paffenbarger Jr RS. Physical activity and reduced occurrence of non-insulin-dependent diabetes mellitus. N Engl J Med 1991;325:147-152.
  • Light Rail Transit BMI PA Charlotte NC September 2010 AJPM


  • 1. Richard J Jackson MD, MPH, FAAPHonASLA, HonAIAdickjackson@ucla.eduOklahoma Must Walk to HealthApril 3,2013University of Oklahoma
  • 2. http://designinghealthycommunities.org/oram/
  • 3. USA Today 10/20/2011
  • 4. Commuting by driving is not good for yourphysical, mental, and social health.Traffic along LA freeways and Wilshire Blvd.
  • 5. We Pediatricians Fear This Most InOur Own Children…
  • 6. For every age groupfrom 3 through 34—carcrashes were the No. 1cause of death
  • 7. In 2009 in the US2,953,501million vehicle miles traveled33,808 people diedin motor vehicle traffic crashes.One in a million chance of death perevery 87 miles driven• http://www.fhwa.dot.gov/policyinformation/statistics/2009/vm1.cfm• http://www-nrd.nhtsa.dot.gov/Pubs/811363.PDF
  • 8. Automobile fatality rates by city, 1998(excluding pedestrian fatalities; deaths/100,000/year)9.8010.5211.33 13.12Source: NHTSA2.51New York3.76San Francisco6.55Portland9.80Houston10.52Phoenix11.33Dallas13.12Atlanta5.36Philadelphia
  • 9. Number of Lives Saved per yearif National Car Fatality Rate same as:• New York City 24,000• Portland 15,000• Atlanta None– 15,000 additional
  • 10. Average pedestrian fatality rates by city, 1996-2004(deaths/100,000/year)Source: FARS Analysis Reporting System, NHTSA2.29New York3.43San Francisco2.42Portland2.63Houston4.06Phoenix3.39Dallas4.91Atlanta2.36PhiladelphiaSource: Calculated from annual summary of traffic fatalities published by the National Highway TrafficSafety Administration in Traffic Safety Facts.
  • 11. Pedestrian Danger Index, 2002-2003Source: Mean Streets 200433.4New York49.4San Francisco43.0Portland121.9Houston117.2Phoenix103.7Dallas144.4Atlanta48.3PhiladelphiaSource: Ernst, M. Mean Streets 2004: How far have we come? Surface Transportation PolicyProject, November 2004. Accessed online at http://www.transact.org/report.asp?id=235 on Oct 4,2006.
  • 12. Pedestrian Fatality Rates forCollisions at Different SpeedsZegeer et al 2002
  • 13. The Most Prevalent ChronicDisease of Childhood Is…
  • 14. Asthma Study in 12 SouthernCalifornia High Schools• 3535 children with no history of asthma in 6high and 6 low air pollution high schools• 5 years later: 265 children developed asthma.– High ozone high schools:• asthma rate was 3.3x higher in children playingthree or more sports.– Low ozone high schools:• sports had no effect on asthma rates
  • 15. 30% reduction in Driving30 % Improvement in AirQuality
  • 16. Results: Acute Care Visits for Asthma1-16 year old residents of Atlanta0123456Medicaid Claims* Kaiser HMO Pediatric ERs Hospital AdmissionsBaseline Period Olympic Period†MeanDailyNumberofEvents•p = 0.01† July 19 –August 4, 1996Source: Friedman, et al, JAMA, 2001
  • 17. Did you Hear about Carmageddon?When the 405 Freeway in LA WasClosed for a Weekend in 2011?
  • 18. Air Quality Change During CarmageddonClose to the Highway Improved 83%In West Los Angeles and Santa Monica Improved 75%For the Region Improved 25%2 day closureof 10 miles ofHighway 405in July 2011
  • 19. “I like to play indoorsbetter ’cause that’swhere all the electricaloutlets are,”-fourth grader.
  • 20. New York TimesMarch 31, 2013CDC Data20% of Teen Ageboys takingDiagnosed withHyperactivity
  • 21. • The BuiltEnvironment:DesigningCommunities toPromote PhysicalActivity inChildren• Policy StatementAmericanAcademy ofPediatrics• June 2009
  • 22. Obesity Trends* Among U.S. AdultsBRFSS, 1991(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19%
  • 23. Obesity Trends* Among U.S. AdultsBRFSS, 1997(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19% ≥20%
  • 24. Obesity Trends* Among U.S. AdultsBRFSS, 2009(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
  • 25. Obesity Trends* Among U.S. AdultsBRFSS, 2010(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
  • 26. NHANES -- MeasuredNHANES – In person interview-- self-reportedBRFSS – Telephone InterviewBody Mass Index US Females 1988-1994
  • 27. • …by 2030obesity rates willrise to 42%• The US will needto care for …32 million moreobese peoplethan in 2010.Forecast:by 2030 the prevalence of the USpopulation with a BMI over 40 (~100 poundsoverweight) will be 11%
  • 28. 0255075100Relationship Between BMI and Riskof Type 2 DiabetesChan J et al. Diabetes Care 1994;17:961.Colditz G et al. Ann Intern Med 1995;122:481.Age-AdjustedRelativeRiskBody Mass index (kg/m2)WomenWomenMenMen<22 <23 23-23.924-24.925-26.927-28.929-30.931-32.933-34.935+
  • 29. Percentage of US Adults with DiagnosedDiabetes - 1994
  • 30. Percentage of US Adults with DiagnosedDiabetes - 2007
  • 31. U.S. “Health” CareExpenditures as Percent ofGDPKeehan et al: Health AffairsMarch/April 2008 27: 145-155
  • 32. Male Life ExpectancyUS Life Expectancy is #49 Worldwide – CIA Chartbook
  • 33. “The Status ofBaby Boomers’Health in theUnited States:The HealthiestGeneration?”JAMA InternalMedicineFebruary 4, 2013
  • 34. Overall Health Status USPersons Aged 46-64NHANES 1988-1994 NHANES 2007-2010Report “excellent” health32% 13%“Functional Limitation”9% 14%Using Walking Assist (wheelchair, cane, etc)3% 7%
  • 35. “Lifestyle Factors” USPersons Aged 46-64 (NHANES)1988-1994 2007-2010Smoking28% 21%Obesity29% 39%
  • 36. “Lifestyle Factors” USPersons Aged 46-64 (NHANES)1988-1994 2007-2010Smoking28% 21%Obesity29% 39%No Regular Physical Activity17% 52%
  • 37. 100.511.52Lean ObeseRisk of DeathActiveHu et al. NEJM, December 23, 2004; 351(26):2694-2703.Nurse Study 1976-2000
  • 38. 11.900.511.52Lean ObeseRisk of DeathActiveHu et al. NEJM, December 23, 2004; 351(26):2694-2703.Nurse Study 1976-2000
  • 39. 11.61.900.511.52Lean ObeseRisk of DeathActiveInactiveHu et al. NEJM, December 23, 2004; 351(26):2694-2703.Nurse Study 1976-2000
  • 40. ObeseRisk of DeathActiveInactiveHu et al. NEJM, December 23, 2004; 351(26):2694-2703.Nurse Study 1976-2000
  • 41. Gain in Longevity for a 45-Year Old Male5.8 years8.7 years0246810Low vs Moderate Low vs HighYears of added lifeAdditional years of Life:Moving from Low to Moderate Fitness -- 5.8 yearsFrom Low to High –- 8.7 years.
  • 42. Credit: Hummel Architects, Boise, ID“Old”SchoolsCredit: Manitovic Public School District
  • 43. Schools• Since World War II–Average School Size• grew fivefold, from 127 to 653 students• Number of Schools declined 70%Credit: Constance E. Beaumant, NTHP
  • 44. • Percent ofchildren whowalk or bike toschool:• 1974  66%• 2000  13%(CDC, 2000)We have changedhow much wewalk or bike
  • 45. Fitness of California ChildrenAnnual Fitnessgram ResultsConducted in Grades 5, 7, and 9Measures 6 major fitness areas(e.g. aerobic capacity, body composition, flexibility)2011 Results: Who passed all standards?Grade 5: 25%Grade 7: 32%Grade 9: 37%http://www.cde.ca.gov/nr/ne/yr11/yr11rel95.asp#tab1
  • 46. Institute of MedicineReportAccelerating Progressin Obesity PreventionMay 8, 2012
  • 47. Complete Streets Bring Equity toCommunity and Transportation• Complete Streets– social equity, aesthetics, walking, improvedlocal sales, community building
  • 48. • Sonoma county:General Plan--Policies thatAddress PublicHealth Threats
  • 49. APHA National Meeting 2002-2003Abstracts with “land use” - 02002 2003A Big Shift in Public Health’s Awareness of BuiltEnvironment as a Core Determinant of Health
  • 50. 2011 APHAAnnual Meeting“land use” 102 matches“built environment”182 matches
  • 51. Bicycle Rental Area Outside Union Station Washington, DC
  • 52. Two Police “vehicle” parked durng lunch
  • 53. ic• Average ~200 kcal/hr• Cost of Police Mountain Bike– $700-1000• Average ~ 650/kcal/hr• Segway Personal Transporter• $5000 and up
  • 54. Charlotte, NC, Light Rail OpenedNovember, 2007
  • 55. InterviewedPeople at 839Locationsyears beforeand afterCharlotteLight RailService Began
  • 56. • Significant increase in meeting theweekly Recommended PhysicalActivity• … through walking• …and through vigorous exercise
  • 57. • The use of Light Rail Transit to commute towork was associated with an averagereduction of 1.18 BMI points (p<0.05) and81% reduced odds of becoming obese overtime.• For a person who is 5’5” --equivalentto a relative weight loss of 6.45 lbs.
  • 58. The Need for Health ImpactAssessment (HIA)• Big decisions are made without examiningpotential health impacts (both positive andnegative) over the life cycle.
  • 59. Cooper River BridgeCharleston SC• If you build a walkway on a major bridge, howmany pedestrians and bicyclists will use it?
  • 60. Walkway on Cooper River Bridge,Charleston SC
  • 61. • The Chenoggye freeway ran through thecenter of Seoul ~1970-2005
  • 62. • Cheonggyecheon -- 8.4 km long downtown Seoul, South Korea.• The $900 million project initially attracted much public criticism.
  • 63. http://www.grist.org/article/2010-08-26-when-streets-tell-the-truth-about-people-riding-in-cars-bikes/
  • 64. Richard J Jackson MD MPHdickjackson@ph.ucla.eduWe Are What We Eat, and…We Are What We Build!