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


Published on

  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

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

  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
  25. 25. 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 lfranco@ph.lacounty.gov September 2012
  26. 26. 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
  27. 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. 3Source: California Physical Fitness Testing Program, California Department of Education. Includes5th, 7th, and 9th graders enrolled in LA County public schools; 2000 Census
  28. 28. Foster Change in Cities & Communities1. Comment on city, county and regional plans2. Fund cities and nonprofits3. Partner with cities The Whittier Greenway Trail 4
  29. 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. 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. 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. 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. 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
  34. 34. 3. Partner with Cities 10
  35. 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 23.1Calabasas 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.
  36. 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
  37. 37. City of Lynwood – Bike and Pedestrian Master Plan 13
  38. 38. City of PomonaActive Transportation Plan 14
  39. 39. Huntington Park and South Gate Safe Routes to School Plans 15
  40. 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
  41. 41. Louisa FrancoDPH PLACE Programwww.ph.lacounty.gov/place lfranco@ph.lacounty.gov 17
  42. 42. Health and Transportation:  A City Perspective  ProWalk ProBike ‐ September 2012  Erika Lewis‐Huntley  City of Rancho Cucamonga
  43. 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. 44. 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 
  45. 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.
  46. 46. Focus on ALL Influencers of HealthFocus on ALL Influencers of Health 
  47. 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 
  48. 48. Aerial 1969
  49. 49. Aerial 2009
  50. 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. 51. 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 
  52. 52. 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.
  53. 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. 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. 55. 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 
  56. 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. 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
  58. 58. GIS Interactive Web‐based SRTS MapGIS Interactive Web  based SRTS Map  ‐ 
  59. 59. Neighborhood Walkability Assessments Assessments 
  60. 60. Infrastructure Project Encouraging Community Mobility  Sidewalk Improvements Sidewalk Improvements 
  61. 61. Trail AccessibilityTrail Accessibility 
  62. 62. Infrastructure Project Encouraging Community Mobility  Upgrade maintenance access road to Class 1 bike trail
  63. 63. Technology Improving Community Mobility  Sidewalk Inspection Program – Mobile App Mobile App 
  64. 64. Mobile Application
  65. 65. Pedestrian Safety CampaignPedestrian Safety Campaign 
  66. 66. 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 
  67. 67. 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