The Institute of Transportation Engineers 2013 Technical Conference in San Diego, California, included a Roundtable discussion of Transportation in Community Health Impact Assessments. This was a first step in a dialog between public health professionals and transportation professionals in understanding how to work together to improve public health and safety.
The roundtable discussion was intended to answer the questions where do transportation professionals need more information? And, what should ITE do?
A Health Impact Assessment (HIA) is a practical approach that uses data, research, and stakeholder input to determine a proposed policy or project’s impact on the health of a population. An HIA does not look a one single health outcome or determinate of health. A typical HIA includes six steps:
1. Screening – determines the need and value of an HIA
2. Scoping – determines the health impact to evaluate, the methods for analysis, and the work plan for completing the assessment.
3. Assessment – provides a profile of existing health conditions and an evaluation of health impacts
4. Recommendations – provides strategies to manage identified adverse health impacts
5. Reporting – includes development of the HIA report and communication of findings and recommendations
6. Monitoring – Tracks impacts of the HIA on the decision-making process and the decision, as well as impacts of the decision on health determinants.
Health Impact Assessments are typically prepared or initiated by a Health Department. However, anyone can do an HIA the important thing is that they are NEVER done by one person – a multidisciplinary team together helps to scope the work. A Community Health Assessment (CHA) –which is the ongoing process of regular and systematic collection and analyses of the health needs of a community (i.e. morbidity and mortality (illness and death) – can be a part of an HIA’s Assessment phase where you document existing conditions/baseline. A Comprehensive Plan (Land Use)typically does not include a health component.
A Transportation Plan might include the following objectives related to health:
• Reduce emissions
• Reduce traffic fatalities and injuries
• Reduce traffic conflicts
• Encourage more children to walk
• Promote safe routes to school
Communication between the health community and the transportation community should be encouraged. There is no common language between the two groups and no standard forum where these sectors convene. This is something that could be bridged by sharing data and encouragement of regular discussions and interactions. Creation of an infrastructure for data collection and sharing is important.
Between these two groups there needs to be more discussion on
• Developing tools and measures
• GIS mapping capabilities and data (a strength of TI)
• Understanding of what needs to be measured and why
• Policy or benefit against cost
Transit use promotes walking because transit riders have the walking mode incorporated into their trip (an average of 18 minutes per day)
Sidewalks to destinations are a positive for health.
Data typically missing include person miles walked or biked.
Road connectivity promotes walking as a mode of travel.
Copenhagen is known for data on health benefits.
Health professionals often have maps showing disease concentrations in a community. These would be helpful to transportation professionals.
Health issues and measures of effectiveness include physical activity, obesity, air quality, social capital, obesity rates, clinical costs, and injuries.
• Identify points of contact for health input
• Include tools or measures that look at health benefits
• Develop pedestrian trip generation
• Collect data on pedestrian and bike miles of travel
TRB and the Institute of Medicine (National Academy of Science) collaborated on a 2005 report looking at the evidence base of the built environment influence on physical activity (TRB Special report 282 http://onlinepubs.trb.org/onlinepubs/sr/sr282.pdf)
A retrofit of existing transportation facilities is needed to re-engineer physical activity back into the daily lifestyle. A dialog between the health and transportation communities is needed. A champion is needed to bring the two communities together.