Transcript of "#35 Bridging Sectors: Fostering Collaboration between Health and Transportation Professionals - Hubsmith"
Health and Transportation Pro Walk Pro Bike, September 2012 CDR Arthur Wendel, MD, MPH NCEH/EEHS/HCDI firstname.lastname@example.org www.cdc.gov/healthyplacesNational Center for Environmental HealthDivision 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 colaImages:http://managetheunmanageable.blogspot.com/2011/03/students-who-are-easily-distracted.htmlhttp://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 Care25%20%15%10% 5% 0% 1960 1970 1980 1990 2001 Projected Projected 2010 2019https://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 •Premature death •Depression •Coronary heart disease •Colon cancer •Stroke •Breast cancer •Hypertension, •Unhealthy weight gain •Type 2 diabetes1. CDC National Health Interview Survey2. CDC Youth Risk Behavior Surveillance System 20093. http://www.cdc.gov/chronicdisease/resources/publications/aag/nutrition.htm4. U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. October 2008. http://www.health.gov/paguidelines/.
How do people get exercise? Leisure They walk They ride bicycles Utilitarian They walk They ride bicyclesHam, 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 changehttp://www.who.int/hia/examples/trspt_comms/hge_transport_lowresdurban_30_11_2011.pdf
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 livingwww.cdc.gov/winnablebattleswww.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 creationwww.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
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 Utah2009 (ARF). Available at http://www-fars.nhtsa.dot.gov/States/StatesCrashesAndAllVictims.aspx Wisconsin Idaho North Dakota New HampshireSource: National Highway Traffic Safety Administration (NHTSA). Fatality Analysis Reporting System (FARS). Nebraska Per Capita Pedestrian Deaths from Motor Vehicles South Dakota Wyoming
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 recommendedhttp://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 Communitieshttp://www.phoenix5.org/humor/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 IncreasingIncreasing Clinical Interventions IndividualPopulation Effort NeededImpact Long-lasting Protective Interventions Changing the Context to make Individuals’ Default Decisions Healthy Socio-Economic Factors Frieden, AJPH, 2010
Thank You CDR Arthur M. Wendel, MD, MPH email@example.comFor 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: firstname.lastname@example.org Web: www.cdc.govThe findings and conclusions in this report are those of the authors and do not necessarily represent the officialposition of the Centers for Disease Control and Prevention. 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
LA County’s Approach to Health in All Policies LA County Dept. of Public Health PLACE ProgramPolicies for Livable Active Communities and Environments Louisa Franco, MPH Policy Analyst email@example.com September 2012
LA County Strategic GoalsCounty: Create a physical environment that is conducive to good health by encouraging and enabling residents to make healthy choicesDPH: 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
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. 3Source: California Physical Fitness Testing Program, California Department of Education. Includes5th, 7th, and 9th graders enrolled in LA County public schools; 2000 Census
Foster Change in Cities & Communities1. Comment on city, county and regional plans2. Fund cities and nonprofits3. Partner with cities The Whittier Greenway Trail 4
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
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
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
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
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
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 23.1Calabasas 5.0 Inglewood 26.8Agoura Hills 5.3 Gardena 27.3Beverly Hills 5.4 San Fernando 27.4Palos Verdes Estates 7.3 Lynwood 27.7Rolling Hills Estates 8.4 La Puente 27.8Arcadia 10.1 Pomona 28.6South Pasadena 10.2 Compton 29.0Glendora 10.9 Huntington Park 30.3El Segundo 11.4 South Gate 30.7Average 10 lowest 7.7% Average 27.9%*Table excludes cities/communities where number of students with BMI data < 500. 11Source: California Physical Fitness Testing Program, California Department of Education. Includes 5th, 7th, and 9thgraders enrolled in LA County public schools.
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
City of Lynwood – Bike and Pedestrian Master Plan 13
Huntington Park and South Gate Safe Routes to School Plans 15
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
Louisa FrancoDPH PLACE Programwww.ph.lacounty.gov/place firstname.lastname@example.org 17
Health and Transportation: A City Perspective ProWalk ProBike ‐ September 2012 Erika Lewis‐Huntley City of Rancho Cucamonga
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
Commitment to Community HealthCommitment 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
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.
Focus on ALL Influencers of HealthFocus on ALL Influencers of Health
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
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
Healthy RC Overarching Theme of General PlanHealthy 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
Policies Promoting Community Mobility §Goal CM‐1: Provide an integrated and balanced multi‐ modal transportation network of Complete Streets to meet the needs of all users and transportation modes. §Policy CM‐1.2: Provide an integrated network of roadways that provides for convenient automobile, transit, bicycle, and pedestrian circulation movement around the City.
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)
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
Empowering Community LeadersEmpowering 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
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
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
GIS Interactive Web‐based SRTS MapGIS Interactive Web based SRTS Map ‐
Other Healthy Living InitiativesOther Healthy Living Initiatives § Joint‐use Agreements § Community Gardens § Farmers’ Markets § Nutrition Standards § Healthy RC Dining Program § Smoke‐free Recognition Program § Fun on the Run Mobile Recreation Program
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
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