Health and Transportation   Pro Walk Pro Bike, September 2012        CDR Arthur Wendel, MD, MPH             NCEH/EEHS/HCDI...
Healthy Community Design Initiative (HCDI):   Mission: To understand and improve the relationship    between community de...
Case Patient – “Pete”   10 year old male is brought to his physician by his    parents because of difficulty in his class...
Problem List       Teacher describes fidgeting, being        boisterous, but notes sustained        effort with tasks   ...
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...
30 Years Later   On multiple medications for hypertension, diabetes,    cholesterol   Drives kids to school for safety c...
Percent of U.S. GDP spent on Health Care25%20%15%10% 5% 0%            1960            1970           1980            1990 ...
Public Health Impacts of Physical Inactivity    36% of adults report no leisure-time physical activity and     82% do not...
How do people get exercise?    Leisure        They walk        They ride bicycles    Utilitarian        They walk    ...
Cost Effectiveness    Bonus! IPCC finds that active transportation     interventions are cost-effective measures for     ...
The 10 Essential Public Health Services
Concordant Health Strategies    CDC’s Winnable Battles       Motor vehicle injuries       Nutrition, physical activity,...
CDC’s Transportation Policy Recommendations    Make cars safer and less polluting    Support robust public transportatio...
Surveillance   Benchmarking Bicycling and Walking       http://www.peoplepoweredmovement.org/site/index.php/site/members...
Deaths per 100,000 population                                                                                             ...
Aligned Solutions    Proven Safety Countermeasures (FHWA)          Medians and Pedestrian Refuge Areas in Urban and Subu...
Health Impact Assessments   Health Impact Assessment (HIA)     HIA is a systematic process that uses an array of data so...
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 T...
Next Steps   Define a metric   Develop surveillance   Look for Health Impact Assessment opportunities   Help with sele...
Health Impact Pyramid                       Education                                              IncreasingIncreasing   ...
Thank You                                         CDR Arthur M. Wendel, MD, MPH                                           ...
Resources for more information   Online course, built in partnership with APA:    http://professional.captus.com/Planning...
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#35 Bridging Sectors: Fostering Collaboration between Health and Transportation Professionals - Wendel

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#35 Bridging Sectors: Fostering Collaboration between Health and Transportation Professionals - Wendel

  1. 1. Health and Transportation Pro Walk Pro Bike, September 2012 CDR Arthur Wendel, MD, MPH NCEH/EEHS/HCDI dvq6@cdc.gov www.cdc.gov/healthyplacesNational Center for Environmental HealthDivision of Emergency and Environmental Health Services
  2. 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. 3. Case Patient – “Pete” 10 year old male is brought to his physician by his parents because of difficulty in his classroom
  4. 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 colaImages:http://managetheunmanageable.blogspot.com/2011/03/students-who-are-easily-distracted.htmlhttp://catherinelramstetter.wordpress.com/research-on-school-recess/
  5. 5. Treatment Plan Join sports team Meet with nutritionist Teacher fills out ADHD assessment
  6. 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. 7. 30 Years Later On multiple medications for hypertension, diabetes, cholesterol Drives kids to school for safety concerns
  8. 8. 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
  9. 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 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/.
  10. 10. 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
  11. 11. 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
  12. 12. The 10 Essential Public Health Services
  13. 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 livingwww.cdc.gov/winnablebattleswww.healthcare.gov/prevention/nphpphc/strategy/report.pdf
  14. 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 creationwww.cdc.gov/transportation
  15. 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. 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 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
  17. 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 recommendedhttp://safety.fhwa.dot.gov/provencountermeasures/http://www.thecommunityguide.org/pa/environmental-policy/index.html
  18. 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. 19. HIA as a Pre-op Physical for Communitieshttp://www.phoenix5.org/humor/CartoonOperation.html
  20. 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. 21. Next Steps Define a metric Develop surveillance Look for Health Impact Assessment opportunities Help with selection criteria Connect with health officers
  22. 22. 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
  23. 23. Thank You CDR Arthur M. Wendel, MD, MPH dvq6@cdc.govFor 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: cdcinfo@cdc.gov 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
  24. 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

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