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ATS-16: Assessing and Improving the Multiple Health Impacts of Crash Safety Interventions, Joseph Marek and Steve White
- 1. Integrating a Health Impact Assessment into a Road Safety Audit: Lessons from a Case Study in Clackamas County, Oregon 2016 Oregon Active Transportation Summit Joseph F. Marek, PE, PTOE Steve White, MURP Transportation Safety Program Manager Oregon Public Health Institute Clackamas County, OR Portland, OR March 14, 2016
- 2. You are Here Clackamas County, Oregon
- 3. Clackamas County, Oregon 1839 sq. miles/385,000 people 1,400 miles of County maintained roads Over 2,200 total miles 17 cities Summit of Cascade Mountains to fertile Willamette Valley
- 4. Crashes In Clackamas County Each Year - All Roads 26 deaths average 128 serious injury crashes One death every 13 days One serious injury every 3 days
- 5. What is a Road Safety Audit (RSA)? • Formal safety performance study • Independent audit team • Discrete geographic focus • Qualitatively estimates and reports on potential safety issues • Identifies improvements for all users • VERY COMMON!
- 6. What is a Health Impact Assessment (HIA)? A structured process that uses scientific data, professional expertise, and stakeholder input to identify and evaluate public health consequences of proposals and suggests actions that could be taken to minimize adverse health impacts and optimize beneficial ones Source: “Improving Health in the United States: The Role of Health Impact Assessments” by the National Research Council, September 2011
- 7. RSA + HIA Project Overview • RSA: Examine a portion of McLoughlin Blvd. (Hwy 99E) in Jennings Lodge, OR • Focus on the safety of pedestrians and bicycles primarily related to roadway crossings • HIA: Take outputs from RSA and use them as inputs into HIA • Examine results
- 11. Wide pedestrian crossings Unsignalized crossings High transit use Intermittent street lighting
- 12. Project Rationale ISSUE #1: How can we improve safety for bicyclists and pedestrians who need to access resources along and across McLoughlin Blvd? – Road Safety Audit ISSUE #2: How might the safety improvements impact other active transportation-related health determinants? – Health Impact Assessment
- 13. HIA Project Goals • Provide DTD and ODOT staff with information about the potential health impacts of the RSA recommendations • Build capacity for HIA and other HiAP strategies in CCPH and DTD • Develop replicable model for integrating health considerations into other transportation projects
- 14. Process Road Safety Audit Health Impact Assessment Conclusions/Recomme ndations
- 15. RSA Outputs • Identified and prioritized 11 primary safety issues – Left turn crossing movements – Night time visibility – Sidewalk quality – Etc.
- 16. RSA Outputs • 46 Recommended solutions – For “Sidewalk quality”: • Fill gaps in sidewalk network. • Add reflective tape to improve visibility at nighttime. • Create delineation to prevent pedestrians from falling off sidewalk edge. • Improve sidewalk grade and increase sidewalk width.
- 17. RSA + HIA Process 1. Convene knowledgeable stakeholders: a. Transportation planners and engineers b. Public health professionals c. Community members 2. Identify potentially impacted health determinants (other than safety) 3. Determine how to assess and rate potential impacts 4. Conduct assessment 5. Findings and recommendations
- 18. Impacted Health Determinants RSA Recommendations Crash Safety Exposure to Air Pollutants Access to resources Opportunities for Physical Activity Noise Injury Asthma Cardiovascular health Diabetes Obesity Stress Cancer
- 19. How to Assess Impacts? • Physical Activity: – Does the recommendation improve access to the Trolley Trail? – Does the recommendation encourage walking, biking, or transit use? – Does the recommendation improve access to schools and parks?
- 20. How to Assess Impacts? • Exposure to Air Toxics and Noise – Does the recommendation encourage walking/biking along streets/paths parallel to McLoughlin?
- 21. How to Assess Impacts? • Access to Health Supportive Resources – Does the recommendation improve access to schools and employment opportunities?
- 22. Scoring Impacts Scoring -2 relatively strong negative impact -1 relatively minor negative impact 0 no impact +1 relatively minor positive impact +2 relatively strong positive impact
- 23. Scoring Solutions Potential Solutions proposed by the RSA Access to the Trolley Trail Walking, biking, or transit use Access to schools and parks Walking/ biking along parallel streets/ paths Access to schools Access to jobs HIA Score Relocate bus stops closer to marked pedestrian crossings. 1 2 1 1 0.5 1 6.5
- 24. Table 2: HIA raw and average scores for each health determinant PHYSICAL ACTIVITY EXPOSURE TO AIR AND NOISE POLLUTION ACCESS TO RESOURCES AVERAGE SCORES Potential Solutions proposed by the RSA HIA Score RSA Risk score Access to the Trolle y Trail Walkin g, biking, or transit use Access to schools and parks Walking/biking along parallel streets/paths Access to school s Acces s to emplo yment Physic al Activit y Exposur e to Air and Noise Pollutio n Access to resourc es HIGH IMPACT Build sidewalks 12 2 2 2 2 2 2 2 2.0 2.0 2.0 Improve lighting 12 2 2 2 2 2 2 2 2.0 2.0 2.0 Provide additional crossing enhancements to increase visibility and attract pedestrians (e.g. warning signs, crosswalk markings, reflectors, advanced stop bars) 12 2 2 2 2 2 2 2 2.0 2.0 2.0 Flashing Beacons, RRFB, etc. 11.5 2 2 2 2 1.5 2 2 2.0 1.5 2.0 Add street lighting to remove contrast with private illuminated signs. 9.5 2 2 2 0.5 2 1 2 1.5 2.0 1.5
- 25. Findings - Most of the 42 RSA solutions would improve multiple health issues - Physical activity is the health determinant impacted by most RSA solutions - The “high impact” solutions are relatively large pedestrian infrastructure projects that both improve pedestrian mobility and encourage changes in driver behavior
- 26. Lessons Learned • The HIA helped: – Identify additional benefits for safety improvements – Prioritize investment decisions – Highlight transportation equity – Stakeholders discuss and articulate preferences and advocate for action – Staff articulate benefits of investments – Develop partnerships between county departments
- 27. Lessons Learned • Future RSAs could (and should) easily be designed to include consideration of potential impacts on multiple health determinants, especially: – Opportunities for physical activity – Access to health supportive resources – Exposure to air/noise pollution – Health equity
- 28. Moving Forward – Post HIA/RSA
- 29. County Strategic Priorities • Build public trust through good government • Grow a vibrant economy • Build a strong infrastructure • Ensure safe, healthy and secure communities • Honor, utilize, promote and invest in our natural resources Safe Roads Vibrant Economy Healthy People 29
- 30. Two Worlds Combine! Transportation Capacity Level of Service Crash rate Av. Daily Traffic Keep people safe Health Obesity Asthma rates Access to services Heart disease Keep people safe Discipline barrier
- 31. Organizational Elements • At some point – need transportation and health professionals talking to each other
- 33. Transportation System Plan • Goal 4: Promote a transportation system that maintains or improves our safety, health, and security • Had County Health Officer on project team
- 34. Community Health Assessment • Update in progress • Better understand how transportation fits in with – Community health – Sense of community
- 35. Community Health Improvement Plan Priorities • Decrease – Obesity – Youth tobacco use – Falls – older adults – Prescription drug Misuse • Increase – Breastfeeding
- 36. Organizational Integration of Health, Transportation and Safety
- 37. Most Policy Decisions Have Health Impact • County Commission decisions in 2014 – 527 policy decisions – 78% - impact to health and safety
- 38. Health and Safety in All Policies • Pilot project FY 2016/17 – Select several policy proposals – Assess health and safety consequences of options within policy development process – Promote cross-sector collaboration and policy conversations
- 41. Growing and Learning Together! • Building relationships • Opening minds • Change our lens • Creating positive impact • Always considering how we can help our customers
- 42. And … Out of the Toolbox! • A new way to help us improve our communities! • www.transportation.gov/transportation-health-tool
- 43. A Transportation and Health Tool! • A set of transportation and public health indicators to help show how an area compares based on several transportation and health metrics • A resource to help understand the links between transportation and health • A set of strategies to improve public health through transportation programs and policies
- 44. 14 Key IndicatorsTransportation 1. Commute Mode Share 2. Housing and Transportation Affordability 3. Land Use Mix 4. Person Miles Traveled by Mode 5. Proximity to Major Roadways 6. Public Transportation Trips per Capita 7.VMT Per Capita Health 8. Alcohol-Impaired Fatalities 9. Physical Activity from Transportation 10. Road Traffic Fatalities by Mode 11. Road Traffic Fatalities Exposure Rate Policy 12. Complete Streets Policies 13.Seat Belt Use 14. Use of Federal Funds for Bicycle and Pedestrian Efforts
- 45. SAFE and HEALTHY COMMUNITIES START WITH YOU! Thank You Questions? Joseph Marek JoeM@clackamas.us 503-742-4705 Philip Mason PMason@Clackamas.us 503-742-5956 www.clackamas.us
- 46. Person Roadway 22% 70% <1% <1% <1% 6% 1% Clackamas County Crash Cause Diagram >99% (Person as a cause factor) 8% (Vehicle as a cause factor) 24% (Roadway as a cause factor) Crash Cause Factor % Person >99 Roadway 24 Vehicle 8 Sole Crash Cause Factor % Person 70 Roadway <1 Vehicle <1 Combination Crash Cause Factors % Person & Roadway 22 Person & Vehicle 6 Roadway & Vehicle <1 Roadway & Vehicle & Person 1 Source: Oregon DOT crash data, 2009-2013
Editor's Notes
- JM Good afternoon Thank you for having me and Steve here today to discuss a work that we did combining a road safety audit and health impact assessment My name is Joseph Marek with Clackamas County Serve as the Transportation Safety Program Manager for the County Director of our Drive to Zero Program – focused on reducing fatalities and injuries Steve White with Oregon Public Health Institute is also here Yes – it is possible – the engineer and Public Health professional standing side-by-side!
- JM Just to get you oriented …. Clackamas County located in NW Oregon in the lush Willamette Valley We’re the County the forms the south edge of Portland Our boundaries go from the summit of Mt. Hood nearly half way to Salem
- JM We work in a big County – or, as I like to think about it – we have a very big playground! Over 1800 square miles, 385,000 people Mix of 50/50 split of urban and rural population 1400 miles of County maintained roads, 2400 intersections, 180 bridges Over 2000 total miles of roads 17 cities
- JM Data – 2010-2012 = 3 years All roads; 73 fatal; 73/3 = 24 per year; 365/26 = 1 every 15 days All Roads; 383 serious injury; 383/3 = 128 per year; 365/128 = 1 every 2.8 or 3 days County roads = 27 fatals; County Road = 132 serious injury Wow – a different way to think about crashes – Not bad considering all of the people and modes on the road … but still I don’t want to get in a crash and be injured and die and I guess you don’t either! When I review a crash – I always try and remember that these numbers represent members of are our families, our friends, our neighbors… To accept this situation and do nothing would be wrong. Professionally and personally. We have to work to change this. And we can. That’s the good news. Through our efforts, I’m absolutely convinced we can help save lives.
- JM How many of you are familiar with an RSA? How many of you have participated in an RSA? Excellent! Summarize slide
- Steve
- Joe Set out to examine a section of McLoughlin Boulevard in an area called Jennings Lodge A little trivia for you birders out there – William Finley lived for many years in Jennings Lodge and had a pet Condor Wildlife Refuge south of Corvallis named after him We had been working with a group of citizens looking at planning along McLoughlin Blvd Because of concerns about bike and ped movements, Focus on bike and ped crossings of McLoughlin Take outputs from a RSA and use them as inputs into HIA
- Joe Vicinity Map
- Joe More detailed map Dense urban Much of the area initially built up around a trolley line – now a multi use path Immature infrastructure – many sidewalk gaps, areas with no bikelanes
- Joe Example of a facility that has been very car-centric ODOT has made a number of improvements to Help transition from a highway to a transportation facility with improved modal equity Doesn’t happen overnight!
- Joe Facility functions as a transportation system Quite a bit of pedestrian and bicycle use High transit use Higher population of non-auto users Immature infrastructure – such as street lights
- Joe How can we continue to improve this corridor to create more equity between modes Make it safer for peds and bikes So people can get to resources they need along the corridor That tool is an RSA What about health How will engineering solutions affect health and affect health determinants
- Steve With our local advocates, ODOT, Tri-Met and County Engineering and Public Health Look at health impacts of RSA recommendations Secondarily, wanted to build capacity with our Public Health Division Develop a process that we could replicate across the county
- Steve
- Joe Identified a number of issues Left turning conflicts with other vehicles and pedestrians Poor night time visibility – no street lights Gaps in sidewalk system, poor surfaces Many driveways Wide cross section Signals widely spaced – good for cars – not so much for peds
- Joe The RSA had 46 recommended solutions As an example for sidewalk quality … Read slide
- Steve Now starts the fun part! Summarize slide
- Steve
- Steve
- Steve
- Steve
- Steve
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- Steve Challenge of displaying this information
- Steve What did we learn from this process Summarize slide text
- Steve Look at benefits of safety improvement differently Help demonstrate the link between transportation and health They need to be examined together in all decisions Help stakeholders see different view of safety and how their community is affected
- Steve With this project, we showed how health consideration can be incorporated into an RSA process Also, the importance of health in our transportation decision making Collective effects – opportunities for physical activity, access to health supportive resources, exposure to air and noise pollution and health equity
- Joe Where has the HIA/RSA work led us at the County Shattered my lovely engineering box – dang it!! Helped me and others understand how our county, our community is interconnected Our way of running the county should also be more interconnected
- JM County developed a new set of Strategic Priorities a about two years ago Good government Vibrant economy Good infrastructure Safe, healthy, secure communities Stewardship of natural recourses - 3 legged stool – healthy people, safe roads, vibrant economy! There are also several plans that are important to understand the foundational elements for transportation and health to be at the table together
- Joe As a result of the RSA – HIA work I saw how these two worlds, focused on keeping people safe and healthy were not talking – not intentially working together What do we have in common – our vocabularies are different, we use different acronyms But – we want people to be safe – I say – “everyone deserves to get home safely to their family each night”
- Joe it’s very important to talk just a bit about organizational elements For us to work together ….. We have to know about each other, appreciate our work, learn a little about our different worlds …
- JM Organizational structure is very important BCC = 5 Elected Commissioners + Sheriff is Elected Oversee budgets for all areas Opportunity to identify links in one department that may help or hurt another department Reflected in Strategic Priorities – but not always applied across departments – new opportunity
- JM Second Updated our TSP Included a health element County Health Officer on Policy Advisory Committee Plan adopted in December 2013 Included very strong safety language and references to TSAP Sets the state for Safety – Health –Transportation!
- Joe Community Health Assessment – led by County Public Health Look at health including transportation elements Start with our Health Rankings Looking at High school graduation rates Childhood poverty Preventable deaths – including traffic crashes Health risk behaviors – obesity, smoking Youth and adults are distressed Oral health Sexually transmitted diseases Hispanic population increases
- Joe Reduce Health Disparities and Health Risks Engage Communities Strengthen Partnerships to Support Educational Achievement Increase Access to and Coordination between Services
- Joe Started a conversation about incorporating Health and Safety in all Policies Makes sense – our County Strategic Priorities send us in this direction Actually – very exciting to think this way
- Joe What if we could think very broadly about BCC level decisions and their impact on health and safety There are many policy decisions In 2014 – 527 with nearly 80% having an affect on health Examples Location of purchases of property for low income housing Decisions to shut down, reduce hours, increase hours of health clinics, behavior health clinics Insurance changes – loss of xxx number of appointments with your health professional Transportation funding – decisions on focus of funds – vehicles, bikes, peds?
- Joe Proposed pilot project Will be part of Budget request for 16-17 budget year Work with Department of Transportation and Development and Health, Housing and Human Services
- JM The world according to me! All of these component intertie and intertwine with each other One does not thrive without the other
- JM There are a lot of puzzle pieces and So much to learn The exciting part is that doors are opened that have never been opened before And there are welcoming outspread arm on the other side!!
- JM Grand opportunity awaits to improve our communities by bringing people together! Let’s jump in and embrace this!
- Joe But wait there is more!! We have tools now Out comes the tool box – how can we make some improvements to our system – Well – let’s give the Transportation and Health Tool a little test drive!
- JM The THT has 14 key indicators as you have all heard We thought we’d dig down a little into this proximity to major roadways measure
- JM Thank you very much
- PM This diagram tells our story – arguably this tells the story of the importance of cross sector coordination when we think about traffic crashes! Examine crashes and the relationship of the human, roadway and vehicle Note – person is cause in over 99% of crashes – 99.8% to be exact And sole cause in 70%, Road <1%, Vehicle <1% You have heard – “can’t build our way out of congestion?” Well, I don’t think I can engineer my way to safety either! So, I need to reach out as a transportation professional and become part of the solution to influence what happens on the human side!